Chronic Obstructive Pulmonary
Diseases (COPD)
Chronic Airflow Limitation (CAL)
Emphysema
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Loss of lung elasticity
Hyperinflation of the lung
Formation of Bullae
Small airway collapse and air trapping
Classifying Emphysema
• Panlobular
• Centrolobular
Clinical Manifestations
• Progressive dyspnea on exertion
• Prolonged expiratory phase &
tachypnea
• Increased work of breathing
• Anorexia, weight loss
• Barrel Chest
• Flattened diaphragm
Clinical Manifestations (cont)
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Formation of blebs and bullae
Hyperresonance
Polycythemia (pink puffer)
Chronic hypoxia
Pneumothorax
Hypercapnic to hypoxic drive
Chronic respiratory acidosis (end stage)
Pulmonary Function Tests
• Increased
– residual volume
– total lung capacity
• Decreased
– Forced vital capacity
– FEV1
Clubbing of Fingers
Chronic Bronchitis
• Excessive production of mucus in the
bronchi
• Productive cough
– Persists 3 months of the year for 2
consecutive years
Pathologic Changes
• Chronic inflammation
• Hypertrophy and hyperplasia of the
mucus glands
• Increased susceptibility to infection
• V/Q changes
Presentation
• May have same symptoms as
emphysema
• Frequent respiratory infections
• Cyanosis
• Cor pulmonale
• Polycythemia
Asthma
• Not always listed as one of the diseases
of COPD/CAL
• Asthma is usually a reversible process
• Involves periodic episodes
Asthma Classifications
• Extrinsic (Allergic)
– Antigen/antibody response
– Childhood
• Intrinsic (Endogenous)
– History recurrent RTI
– adulthood
Pathologic Changes
• Hypersensitivity response
• Bronchoconstriction
• May become chronic with irreversible
changes
Presentation
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Bronchospasm
Increased mucus secretion
Dyspnea
Wheezing
Cough
Consequences of CAL
• ABG’s
– Initially normal ABG followed by decreased
PaO2 and O2 saturation
– Increased PaCO2 with an increase in HCO3
to compensate
• Compensated Respiratory Acidosis and
Hypoxemia
Polycythemia
• Related to decreased PaO2
• What is the mechanism?
Pulmonary Function Tests
• What do you expect?
TLC increased
FEV1 decreased
Cor Pulmonale
COPD/CAL
Pulmonary Vascular Bed
Pulm Hypertension
RV Failure
Hypoxemia
Polycythemia LV Failure
Collaborative Management of CAL
• Medical management
– Maximize oxygenation, ventilation and
perfusion
• Surgical management
– Bullectomy
– Lung volume reduction surgery
Drug Therapy
• Bronchodilators
– Sympathomimetics
– Methylxanthines
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Anticholinergics
Steroids
Mast Cell Stabilizers
Leukotriene Antagonists
Expectorants
Antibiotics
Nursing Diagnoses
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Impaired gas exchange
Ineffective airway clearance
Activity intolerance
Anxiety
Altered nutrition: less than body
requirements
Nursing Interventions
• Maintain a patent airway
• Safely administer oxygen
• Use oxygen delivery systems
appropriately
• Accurately assess the patient’s
breathing
• Use positioning to improve oxygenation
Teach the Patient:
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Abdominal & Pursed lip breathing
Controlled coughing
Conservation of energy
Prevent secondary infection
Insure hydration
Nutrition
Therapeutic communication/relaxation
Metered Dose Inhaler (MDI)
Peak Flow Meter