Chronic obstructive pulmonary disease

Transcription

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2 Chronic obstructive pulmonary disease By: Dr. Fatima Makee AL-Hakak () University of kerbala College of nursing

3 Out lines What is the? Overview Causes of Symptoms of What's the difference between and asthma? Diagnostic tests needed for Medical management of Preventive measures Nursing intervention Outlook and Prognosis

4 What is? A set of lung diseases that limit air flow and is not fully reversible. patients report they are hungry for air Usually progressive and is associated with inflammation of the lungs as they respond to noxious particles or gases Potentially preventable with proper precautions and avoidance of precipitating factors Symptomatic treatment is available

5 Two Major Causes of Chronic Bronchitis is characterized by Chronic inflammation and excess mucus production Presence of chronic productive cough Emphysema is characterized by Damage to the small, sac-like units of the lung that deliver oxygen into the lung and remove the carbon dioxide Chronic cough

6 Primary Symptoms Chronic Bronchitis Chronic cough Shortness of breath Increased mucus Frequent clearing of throat Emphysema Chronic cough Shortness of breath Limited activity level

7 Overview

8 Normal versus Diseased Bronchi

9 Emphysema

10 Overview In, less air flows in and out of the airways because of one or more of the following: The airways and air sacs lose their elastic quality. The walls between many of the air sacs are destroyed. The walls of the airways become thick and inflamed. The airways make more mucus than usual, which tends to clog them.

11 Causes Smoking Air pollution genetic (hereditary) risk

12 Symptoms Productive cough Breathlessness Chest infection Other symptoms of can be more vague, weight loss, tiredness and ankle swelling.

13 Difference between and Asthma In there is permanent damage to the airways. The narrowed airways are fixed, and so symptoms are chronic (persistent). Treatment to open up the airways, is therefore limited. In asthma there is inflammation in the airways which makes the muscles in the airways constrict. This causes the airways to narrow. The symptoms tend to come and go, and vary in severity from time to time. Treatment to reduce inflammation and to open up the airways usually works well. is more likely than asthma to cause a chronic (ongoing) cough with sputum.

14 Difference between and asthma (cont ) Night time waking with breathlessness or wheeze is common in asthma and uncommon in. is rare before the age of 35 whilst asthma is common in under-35.

15 Symptoms Diagnostic tests Physical examination Sample of sputum Chest x-ray High-resolution CT (HRCT scan) Pulmonary function test (spirometery) Arterial blood gases test Pulse oximeter

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17 Medical management Give antibiotics to treat infection Give bronchodilators to relieve bronchospasm, reduce airway obstruction, mucosal edema and liquefy secretions. Chest physiotherapy and postural drainage to improve pulmonary ventilation. Proper hydration helps to cough up secretions or tracheal suctioning when the patient is unable to cough. Steroid therapy if the patient fails to respond to more conservative treatment.

18 Medical management (cont ) Stop smoking Oxygenation with low concentration during the acute episodes In asthma adrenaline ( epinephrine) if the bronchospasm not relieved. Aminophylins IV if the above treatment does not help. IV corticosteroids for patients with chronic asthma or frequent attack. Sedative or tranquilizers to calm the patient. Increase fluids intake to correct loss of diaphoresis and inaccessible loss of hyperventilation. Intubations and mechanical ventilation if there is respiratory failure.

19 Preventive measures To prevent irritation and infection of the airways, instruct the patient to: Avoid exposure to cigarette, pipe, and cigar smoke as well as to dusts and powders. Avoid use of aerosol sprays. Stay indoors when the pollen count is high. Stay indoors when temperature and humidity are both high

20 Preventive measures (cont ) Use air conditioning to help decrease pollutants and control temperature Avoid exposure to persons known to have colds or other respiratory tract infection Avoid enclosed, crowded areas during cold and flu season. Obtain immunization against influenza and streptococcal pneumonia.

21 Preventive measures (cont ) Call the physician if ordered antibiotics do not relieve symptoms within 24 hours. To ensure prompt, effective treatment of a developing respiratory infection, instruct the patient to do the following:- Report any change in sputum color character, increased tightness of the chest, increased dyspnea, or fatigue.

22 Assessment History Nursing intervention Patient's environment Work history, exercise pattern, smoking habits The onset & development of symptoms Sleeping positions

23 Nursing intervention (cont ) Physical examination Signs of heavy smokers Observe for clubbing Distended neck vein on expiration The presence of barrel chest Observe for abdominal breathing The use of pursed lips breathing and chest movement Auscultate the chest& listen for musical wheezes characteristics of chronic bronchitis

24 Nursing intervention (cont ) review the results of diagnostic procedure: Arterial blood gases Pulmonary function tests X-ray films Nursing diagnosis Ineffective breathing pattern related to increase need of O2 Ineffective airway clearance related to excessive accumulation of secretions Impaired gas exchange related to impaired expiration &co2 retention

25 Nursing intervention (cont ) Activity intolerance related to inadequate oxygenation High risk for ineffective individual coping related to chronic disease, its effects& its treatment High risk for altered health maintenance related to insufficient knowledge of prevention, identification and treatment of respiratory complication of

26 Question The differential diagnosis of should be considered in patients who present with which of the following symptoms? A. Chronic cough B. Any sputum production C. Dyspnea D. Increased sputum production E. All of the above

27 Question Which of the following is the most appropriate to use to confirm the diagnosis of? A. Chest X-ray B. Arterial blood gas C. Spirometry D. High resolution CT scan of chest E. Clinical examination

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