COPD

othepnea

orthopnoea is shortness of breath (dyspnea) that occurs when lying flat, causing the person to have to sleep propped up in bed or sitting in a chair.

COPD

preventable and treatable disease characterized by persistent airflow limitation that is usually progressive.

recommended diet

A diet high in calories and protein, moderate in carbohydrate, and moderate to high in fat is recommended and can be divided into five or six small meals a day. High-protein, high-calorie nutritional supplements can be offered between meals

COPD objective data

General: Debilitation, restlessness, assumption of upright position Integumentary: Cyanosis (bronchitis), pallor or ruddy color, poor skin turgor, thin skin, digital clubbing, easy bruising; peripheral edema (cor pulmonale) Respiratory: Rapid, shallow breathing; inability to speak; prolonged expiratory phase; pursed-lip breathing; wheezing; crackles, diminished or bronchial breath sounds; ↓ chest excursion and diaphragm movement; use of accessory muscles; hyperresonant or dull chest sounds on percussion Cardiovascular: Tachycardia, dysrhythmias, jugular venous distention, distant heart tones, right-sided S3 (cor pulmonale), edema (especially in feet) Gastrointestinal:Ascites, hepatomegaly (cor pulmonale) Musculoskeletal: Muscle atrophy, ↑ anteroposterior diameter (barrel chest) Possible Diagnostic Findings: Abnormal ABGs (compensated respiratory acidosis, ↓ PaO2 or SaO2, ↑ PaCO2), polycythemia, pulmonary function tests showing expiratory airflow obstruction (e.g., low FEV1, low FEV1/FVC, large RV), chest x-ray showing flattened diaphragm and hyperinflation or infiltrates

Effects of cigarette smoke on respiratory tract

The irritating effect of the smoke causes hyperplasia of cells, including goblet cells, thereby increasing the production of mucus. Hyperplasia reduces airway diameter and increases the difficulty in clearing secretions. Smoking reduces the ciliary activity and may cause actual loss of cilia. Smoking also produces abnormal dilation of the distal air space with destruction of alveolar walls. Smoking causes chronic, enhanced inflammation of various parts of the lung with structural changes and repair (called remodeling).

COPD clinical manifestations

dypnea Patients may complain of not being able to take a deep breath, heaviness in the chest, gasping, increased effort to breathe, and air hunger. with advanced COPD frequently experiences fatigue, weight loss, and anorexia. During physical examination a prolonged expiratory respiratory phase, wheezes, or decreased breath sounds are noted in all lung fields. barrel chest from chronic air trapping tripod position pursed lip breeathing, use accessory muscles in the neck to aid with inspiration Over time, hypoxemia (PaO2 less than 60 mm Hg or O2 saturation less than 88%) may develop with hypercapnia (PaCO2 over 45 mm Hg). The bluish-red color of the skin results from polycythemia and cyanosis.

diaphragmatic breathing

focuses on using the diaphragm instead of the accessory muscles of the chest to (1) achieve maximum inhalation and (2) slow the respiratory rate. may increase the work of breathing and dyspnea pts with moderate/severe COPD with marked hyperinflation may be poor candidates

cor pulmonale

hypertrophy of the right ventricle of the heart The right ventricle dilates and may eventually lead to right-sided heart failure. edema in the legs

malnutrition in COPD patients causes

including increased inflammatory mediators, increased metabolic rate due to the ventilatory effort, and lack of appetite. other factors: altered taste caused by chronic mouth breathing, excessive sputum, fatigue, anxiety, depression, increased energy needs, numerous infections, and side effects of polypharmacy.

Maximizing food intake in COPD

increase calories and protein without increasing the amount of food eaten • Eat high-calorie foods first. • Limit liquids at mealtimes. • Rest before meals. • Try more frequent meals and snacks. • Increase calories by adding margarine, butter, mayonnaise, sauces, gravies, and peanut butter to foods. • Keep favorite foods and snacks on hand. • Try cold foods, which can make you feel less full than hot foods. • Keep ready-prepared meals available for times when you have increased shortness of breath. • Eat larger meals when you are not as tired. • Avoid foods that you know cause gas (e.g., cabbage, beans, cauliflower). • Add skim milk powder (2 Tbsp) to regular milk (8 oz) to add protein and calories. • Use milk or half-and-half instead of water when making soups, cereals, instant puddings, cocoa, or canned soups. • Add grated cheese to sauces, vegetables, soups, and casseroles. • Choose dessert recipes that contain egg (e.g., sponge cake, angel food cake, egg custard, bread pudding, rice pudding).

Airway clearance techniques

loosen mucus and secretions so they can be cleared by coughing

pursed lip breathing

prolong exhalation and thereby prevent bronchiolar collapse and air trapping Patients should be taught to use "just enough" positive pressure with the pursed lips because excessive resistance may increase the work of breathing.

Emphysema

the destruction of the alveoli and is a pathologic term that explains only one of several structural abnormalities in COPD patients.

To decrease dyspnea and conserve energy while eating

the patient should rest for at least 30 minutes before eating and use a bronchodilator before meals. Teach the patient to avoid exercise and treatments for at least 1 hour before and after eating. If a patient has O2 therapy prescribed, use of supplemental O2 by nasal cannula while eating may be beneficial. assess condition of pts teeth

chronic bronchitis

the presence of cough and sputum production for at least 3 months in each of 2 consecutive years, is an independent disease that may precede or follow the development of airflow limitation

cachexia

weakness and wasting of the body due to severe chronic illness.

Oxygen administration RN

• Assess need for adjustments in O2 flow rate. • Evaluate response to O2 therapy. • Monitor patient for signs of adverse effects of O2 therapy. • In many cases, choose the optimal O2 delivery device (e.g., a nasal cannula or simple face mask). • Teach patient and caregivers about home O2 use.

oxygen administration respiratory therapist

• Assist in optimal O2 delivery device (e.g., nasal cannula or simple face mask). • Make sure equipment is clean and replaced as needed. • Check accuracy of O2 delivery and assess need for adjustments in O2 flow rate. • Evaluate response to O2 therapy.

energy conservation techniques

• Daily activities (e.g., waking up, bathing, grooming, shopping, traveling) • Consult with physical therapist and occupational therapist

Oxygen administration LPN/LVN

• For stable patients, adjust O2 flow rate depending on desired O2 saturation level.

Nursing Diagnosises

• Ineffective breathing pattern related to alveolar hypoventilation, anxiety, chest wall alterations, and hyperventilation • Ineffective airway clearance related to expiratory airflow obstruction, ineffective cough, decreased airway humidity, and tenacious secretions • Impaired gas exchange related to alveolar hypoventilation

Long-term effects of tabacco smoke on the respiratory system

• Nasopharyngeal: Cancer • Tongue: Cancer • Vocal cords: Chronic cough, cancer • Bronchus and bronchioles: Chronic bronchitis, asthma, cancer Cilia : Chronic bronchitis, cancer Mucous glands: Hyperplasia and hypertrophy of glands, chronic bronchitis Alveolar macrophages: ↑ Incidence of infection Elastin and collagen fibers: Emphysema

Acute effects of smoking on respiratory system

• Nasopharyngeal: ↓ Sense of smell • Tongue:↓ Sense of taste • Vocal cords: Hoarseness • Bronchus and bronchioles: Bronchospasm, cough Cilia: Paralysis, sputum accumulation, cough Mucous glands: ↑ Secretions, ↑ cough Alveolar macrophages: ↓ Function Elastin and collagen fibers: ↑ Destruction by proteases, ↓ Function of antiproteases (α1-antitrypsin), ↓ Synthesis and repair of elastin

breathing and airway clearance exercises

• Pursed-lip breathing • Airway clearance technique: huff cough

oxygen administration UAP

• Use pulse oximetry to measure O2 saturation. • Report O2 saturation level to RN. • Assist patient with adjustment of O2 delivery devices (e.g., nasal cannula, face mask). • Report to RN any change in patient level of consciousness or complaints of shortness of breath.