CHRONIC OBSTRUCTIVE PULMONARY DISEASE

Author:
Emanel, Roen Mar
Lope, Christine Joy

INTRODUCTION:

COPD or Chronic Obstructive Pulmonary disease

- chronic lung conditions that obstruct the airways in your lungs
- refers to obstruction caused by CHRONIC BRONCHITIS and EMPHYSEMA
- theres a blockage within the tubes and air sacs that make up the lungs which hinders the ability to
exhale and even breath

TYPES

Related Anatomy:

In humans it is the two main bronchi that enter the roots of the lungs. The bronchi continue to divide
within the lung, and after multiple divisions give rise to bronchioles . The bronchial tree continues
branching until it reaches the level of terminal bronchioles , which lead to alveolar sacks. Alveolar sacs are
made up of clusters of alveoli, like individual grapes within a unch. The individual alveoli are tightly
wrapped in blood vessels, and it is here that gas exchange actually occurs. Deoxygenated blood lungs ,
where oxygen in the hempglobin of the erythrocytes. The oxygen-rich blood returns to the heart via
pulmonary veins to be pumped back into systemic circulation.

Human lungs are located in two cavities on either side of the heart. Though similar in appearance, the tow
are not identical. Both are separated into lobes on the right and two on the left. The lobes are further
divided into lobules hexagonal divisons of the lungs that are the smallest subdivision visible to the naked
eye. The connective tissue that divides tobules is often blackened in smokers and city dwellers.

The medial border of the right lung is nearly vertical , while theleft lung contains a cardiac notch. The
cardia notch is a concave impression molded to accommodate the shape of the heart. Lungs are to a certain
extent overbuilt and have a tremendous reserve volume as compared to the oxygen exchange requirements
when at rest. This is the reason that individuals can smoke for years without having a noticeable decreased
in lung function while still or moving slowly ; in situations like these onlya small portion of the lungs are
actually perfursed with blood for gas exchange. As oxygen requirements increased incrased due to
exercise , a greater volume if the lung is perfused allowing the body to match its CO2/o2 exchange
requirements

The environment of the lung is very moist which makes it hospitable for bacteria. Many respiratory
illnesses are the result of bacterial or viral infection of the lungs.

PATHOPHYSIOLOGY

Chronic bronchitis is defined in clinical terms as a cough wih sputum production on most days for 3
months of a year, for 2 consecutive years. Chronic Bronchitis is hallmarked by hyperplasia (increased in
number) and hypertrophy (increased in size) of goblet cells (mucous gland) of the airway, resulting in an
increase in secretion of mucous which contributes to the airway obstruction. Microscopically there is
infiltration of the airway walls with inflammatory cells, particularly neutrophils . Inflamation is followed
by scarring and remodeling that thickens the walls resulting in narrowing of the small airway. Further
progression leads to metaplasia abnormal change in the tissue) and fibrosis (further thickening and
scarring) of the lower airway. The consequences of these changes is a limitation of airflow.

Emphysema

Emphysema is defined histologically as the enlargement of the air spaces distal to the terminal bronchioles ,
with distructionof their walls. The enlarged air sacs (alveoli) of the lungs reduces the surface area available
for the movement of the gases during respiration. This ultimately leads to dyspnea in severe cases. The
exact mechanism for the development of emphysema is not understood although it is known to be linked
with smoking and age.

TYPES OF EMPHYSEMA
Paniobular (or panacinar) Emphysema
This y\type of emphysema is characteristic of a weakening and inflammation of alveoli at the end of the
bronchioles. When destruction is very severe the affected acinus disappears and the lungs appear “spider
web-like” in xrays. A mild version of this type of emphysema occurs as aging progresses. In younger
people, this panlobular emphysemais caused by the bodysinability to produce sufficient amounts of alpha-1
antitypsin

Centrilobular (or centriacinar) Emphysema

This type of emphysema affects single alveoli entering directly into the walls of terminal and respiratory
bronchioles.

Asthma:
Underlying problem is the inflammation as a result of complex interactions among the inflammatory cells,
mediators and the tissues in the airwas. Stimuli activate the release of inflammatory mediators from the
mast cells, macrophages, eosinophils and other cells in the airways. The mediators signal other
inflammatory cells to migrate to the airways where they are activated. This causes injury of the epithelium.
Prolonged contraction of smooth muscle an secretion of mucus, as well as swelling in the involuntary
contriol of the airway.

Inflamed airways become more narrow and obstructed. Inflammation also causes hyper-responsiveness of
the airway, which also results in excessive narrowing of the airways when a stimulus is introduced . Stimuli
can include viral respiratory infections, such as colds, which trigger most attacks, other stimuli are allergens
such as pollen or mold; irritants such as tobacco smoke , cold air or exercise “ Trigger” is another term for a
stimulus that triggers.

Airways obstruction can develop suddenly or gradually and causes the symptoms associated with astma ,
wheezing, coughing, shortness of breath, chest tightness and decreased endurance.
RISK FACTORS:
Smoking
Exposure to occupational and environmental pollutants
Genetic factors
Allergies and Asthma
Nutrition
Periodontal Disease
Low Birth Weight
Age, Gender, Ethnic Background

Signs and Symptoms:

Cough
Dyspnea
Wheezing
Chestpain
Hemoptysis
Cyanosis
Swelling
Respiratory failure

DIAGNOSTIC TEST
Spirometer
Forced Vitl Capacity (FVC)
Residue Volume (RV)
Diffusing Capacity Lung Test
Chest X-ray
CT Scan (computerized Tomography)
Mucous Culture

TREATMENT;

Bronchodilators
Inhaled Glucocorticosteroids (steroids)
Flu Shots
Pneumococcal Vaccine
Pulmonaryt Rehabilitation

SURGICAL:
Bullectomy
Lung volume Reduction Surgery (LVRS)
Lung Transplant

NURSING CARE:

- Eliminate or minimize exposure to all pulmonary irritant

- Clear airways with postural drainage, clapping or vibrating and suctioning as appropriate
- Administer oxygen at the prescribed percentage
- Encourage rest
- Assess for drug allergies especially to antibiotics before administering
- Also prescribed , administer bronchodilators mucolytic agents and corticosteroid
- Provide client and family teaching , covering disease process and treatments, breathing restraining
exercises, energy conservation, use of inhalers and nebulizers medication administration and the
importance of compl;iance , prevention of complications and infections by receiving influenza and
medications prescribed

SPECIAL INSTRUCTIONS:

- Demonstrate the use of bronchodilator nebulizers

- Teach and demonstrate to the patients and caregiver and adaptive breathing techniques : deep
breathing exercise, coughing and techniques , pursed lip breathing, abdominal breathing and
position for postural drainage
- Explain the need to avoid persons with infection like flu
- Explain the importance of taking vaccines for influenza
- Instruct the patient and caregiver on cleaning of home respiratory equipments
- Explain the need to avoid persons with infection like flu
- Explain the importance of taking vaccines for influenza
- Instruct the patient and caregiver on cleaningof akk home respiratory equipments
- Esplain the need to avoid going out in cold temperatures which may cause bronchospasms
 - Stress the importance of not smoking and avoiding second hand smoke
- Suggest avoiding clothing that restricts chest or abdominal expansion

For Activity:

- Advise the patient to exercise to tolerance and to avoid fatigue by planning rest periods during the
day
- Instruct the patient to breath deeply and slowly during the periods of a activity
- Discuss energy convertion techniques
- Instruct patients to avoid emotiona stress

Diet:

- Explain the need to maintain high-calorie diet as indicated

- Encourage fluid intake at 2000-3000 mL/day to keep secretions clean
- Suggest small, frequent meals to avoid abdominal distention
- Avoid gas-producing foods

Home Care Referral:

- Give both the patient and the caregiver verbal and written instructions
- Review the signs and symptoms to be reported by the patient to the physician or nurse; elevated
temperature , sore throat, increased sputum form clear white to yellow green , increases diffuculty
in breathing decreased activity intolerance, decreased appetite).