Chronic obstructive pulmonary

Learning Guide Chronic obstructive pulmonary disease (COPD) 28550 Support a person with chronic obstructive pulmonary disease in a health or wellbeing setting Level 3 3 credits Name: Workplace: Chronic obstructive pulmonary disease (COPD) (US 28550) Learning Guide Careerforce Issue 1.0 July 2015

Contents Introduction... 1 Normal Breathing... 2 What is COPD?... 3 Emphysema... 3 Chronic asthma... 4 Chronic bronchitis... 4 What causes COPD?... 5 Signs, symptoms and complications... 5 How might COPD affect a person?... 6 Health and functional status... 6 Weight loss... 9 The impact of COPD... 10 Supporting a person with COPD... 11 Eating and meals... 11 Sleep and rest... 12 Dealing with exacerbations... 12 What to look out for:... 13 Reporting and monitoring... 14 Glossary... 15 Copyright 2017 Careerforce All rights reserved. Careerforce (Community Support Services ITO Ltd) is the owner of the copyright of this publication. Other than as permitted by the Copyright Act 1994, no part of this publication may be reproduced, copied or transmitted in any other form or by any means, without prior written permission of Careerforce, PO Box 25 255, Christchurch, 8144, New Zealand. Chronic obstructive pulmonary disease (COPD) (US 28550) Learning Guide Careerforce Issue 1.0 July 2015

Chronic obstructive pulmonary disease (COPD) (US 28550) Learning Guide Careerforce Issue 1.0 July 2015

Introduction This learning guide is about supporting people who have chronic obstructive pulmonary disease (COPD). How to use your learning guide This guide supports your learning and prepares you for the unit standard assessment. The activities and scenarios should be used as a general guide for learning. This guide relates to the following unit standard: Support a person with chronic obstructive pulmonary disease (COPD) in a health or wellbeing setting (level 3, 3 credits). This guide is yours to keep. Make it your own by writing notes that help you remember things, or where you need to find more information. Follow the tips in the notes column. You may use highlight pens to show important information and ideas, and think about how this information applies to your work. You might find it helpful to talk to colleagues or your supervisor. Finish this learning guide before you start on the assessment. What you will learn This topic will help you to: understand what COPD is and what causes it understand how COPD may impact a person s life support a person who has COPD know what changes and observations you must report. More info If you have a trainer, they should give you all the forms that you need for this topic. Chronic obstructive pulmonary disease (COPD) (US 28550) Learning Guide Careerforce Issue 1.0 July 2015 1

Normal Breathing Chronic obstructive pulmonary disease (COPD) is a disease that affects the lungs and the way a person breathes. It is important to understand normal breathing in healthy lungs in order to appreciate how it affects people with COPD. People usually breathe without thinking about it. When you breathe in, air goes in via your nose or mouth, down the back of your throat, down the windpipe (trachea), splits into the two large airways (bronchi), into the smaller airways to the air sacs (alveoli) where oxygen in the air is passed into the bloodstream. The diaphragm and various other muscles assist our lungs to inflate and deflate. As you can see from the diagram below, our rib muscles are involved as well as the muscles in our shoulders, chest and back. When we are more active, these muscles have to work harder to help the breathing process. Chronic obstructive pulmonary disease (COPD) (US 28550) Learning Guide Careerforce Issue 1.0 July 2015 2

What is COPD? Chronic obstructive pulmonary disease (COPD) is an umbrella term for the diseases emphysema, chronic bronchitis and chronic asthma. All of these are lung diseases where the airways are damaged or partially blocked. This makes it difficult for the person to breathe. In New Zealand, COPD affects an estimated 200,000 people or 15% of the adult population over the age of 45 years. Stopping smoking is the most important step a person can take to treat COPD. COPD is a common cause of hospitalisation, especially in winter. COPD is the 4th most common cause of death in NZ after cancer, heart disease, and stroke. To diagnose COPD, a range of lung function tests (spirometry), imaging tests (x-rays, scans etc) and blood tests are used. It is then classified at Stages 1, 2, 3 or 4, depending on the results of the tests. Emphysema The air sacs (alveoli) in the lungs are where oxygen you breathe in is swapped with the carbon dioxide that you don t need. Emphysema is when these alveoli are gradually destroyed, making it more difficult to absorb oxygen. The walls of the individual air sacs break down and they join up together. This forms one large space rather than the normal bunch of grapes appearance. Less surface area results in low levels of oxygen in the blood (hypoxaemia) and the tissues of the body (hypoxia). More info Pulmonary is the medical term for lungs. More info A spirometry test is when a person blows air into a machine. The machine measures how well their lungs are working. Chronic obstructive pulmonary disease (COPD) (US 28550) Learning Guide Careerforce Issue 1.0 July 2015 3

Chronic asthma When a person has asthma, inflammation causes the walls of the airways to thicken. This reduces the flow of air. In normal asthma, this can be reversed with medication. In chronic asthma, this inflammation can lead to scarring and the airways are not able to return to normal. Chronic bronchitis With chronic bronchitis the large and medium sized airways (bronchi) are inflamed and produce a lot of mucous. This leads to coughing and difficulty getting air in and out of the lungs. Chronic obstructive pulmonary disease (COPD) (US 28550) Learning Guide Careerforce Issue 1.0 July 2015 4

What causes COPD? The main cause of COPD is long-term exposure to substances that irritate and damage the lungs. Nearly all COPD in New Zealand is smoking-related. Other causes include cannabis use, air pollution, recurrent chest infections and inherited factors. Exposure to workplace hazards such as dusts, chemicals and gases can also increase the risk of COPD. In low-income countries exposure to indoor air pollution are major factors; namely, from open fires for cooking and heating. More info Inherited factors are physical traits passed on through parents and grandparents. Signs, symptoms and complications COPD often starts with a productive cough. As the disease gets worse, the following become common symptoms: chest tightness. becoming short of breath doing normal activities. productive cough with lot of mucous (sputum/phlegm) wheezing, which is a whistling or rattling breathing sound. frequent colds that often turn into infections or take longer to clear up. At times, COPD can suddenly get worse due to infections, air pollution or unknown reasons. This is called an exacerbation. If not managed well, it can result in a hospital stay. Signs of exacerbation include: more breathlessness. more mucus (thicker and perhaps green/yellow). more wheezing. swollen ankles (sometimes). Chronic obstructive pulmonary disease (COPD) (US 28550) Learning Guide Careerforce Issue 1.0 July 2015 5

How might COPD affect a person? Health and functional status Health is a measured by how well a person is described in terms of physical, emotional and social aspects of life. Functional status is a measure of how well a person is able to perform normal activities in daily living. Living with COPD can have a serious impact on a person s health and functional status. The following are some of the effects and considerations. Breathing Normal lung COPD lung Do it Try breathing in and out through a straw. This is how it feels for a person with COPD. Normally the spongy tissue of the lung, which is made up of tiny air sacs, holds small airways open. In COPD, the air sacs are much larger and weaker. As a result small airways tend to collapse. Due to the physical changes to the lungs with COPD, the way breathing works can change quite dramatically. Obstruction and inflammation causes more resistance to the movement of air in and out of the lungs. The muscles and diaphragm involved with breathing have to work a lot harder. Over-inflation (hyperinflation) is another major cause of breathlessness. Air becomes trapped in the lungs (not expelled fully with each breath out). When a person is unable to breathe out fully, it makes it much harder to take in the next breath. This means that breathing is no longer a passive process, it becomes a physically tiring exercise. Muscles in the ribs, shoulders, chest and back have to work harder and they use much more energy than usual. Chronic obstructive pulmonary disease (COPD) (US 28550) Learning Guide Careerforce Issue 1.0 July 2015 6

You may see a person using their shoulders more when they breathe in, or purse their lips to breathe out. Mucous in the lungs also makes breathing harder and coughing uses even more energy. All of this leaves the person feeling tired and breathless. General fitness As people with COPD tend to use more energy just to breathe, it can mean that other previously simple tasks can become extremely difficult. They can then begin to start avoiding doing exercise or heavy tasks because the feeling of breathlessness is unpleasant or frightening. This then leads to a reduction in fitness and further breathlessness on exertion. Smoking Those with COPD are strongly advised to stop smoking. For a person who has smoked all of their life, this can be a considerable challenge. Chronic obstructive pulmonary disease (COPD) (US 28550) Learning Guide Careerforce Issue 1.0 July 2015 7

Medication Most people with COPD will be using at least one inhaler. Oral medications are also available but for various reasons, inhalers are preferred. Often inhalers are used with spacers, especially at home. Spacers make inhalers easier to use and not so reliant on good technique. They provide almost as good drug delivery as nebulisers and are more portable. More info A nebuliser is a machine that converts liquid medication into a fine mist that can then be inhaled. Nebulisers are sometimes used for administering some medications, such as normal saline and antibiotics, used in the case of infection. Oxygen may be needed either at times of exacerbation or sometimes all the time at home. With patients with COPD oxygen is usually given via nasal prongs. Make sure that you check the nose for redness and discomfort. Properly positioned nasal cannula with prongs curving downward If you are supporting someone at home or in a rest home the oxygen will usually be delivered by a machine called an oxygen concentrator. Make sure you have been taught by the RN about using it correctly and safely. Chronic obstructive pulmonary disease (COPD) (US 28550) Learning Guide Careerforce Issue 1.0 July 2015 8

Weight loss A person with COPD can lose weight as a result of an inability to eat rather than a lack of appetite. Reasons for not eating might include: difficulty swallowing or chewing due to breathlessness. chronic mouth breathing, which can alter the taste of food. chronic mucous production. coughing. fatigue. morning headache or confusion due to high carbon dioxide levels (hypercapnia). lack of appetite / lack of interest in eating. depression. side effects of medications, such as a dry mouth. Lack of nutrition can lead to a person being more at risk of infections. Loss of weight and muscle wasting can mean even more effort is required to breathe. More info Any sign of hypercapnia must be immediately reported to the RN. Bone density and mobility People with COPD are also at risk of decreased bone density due to use of steroids (as part of their medication) and smoking (past or present). Decreased mobility is also risk factors. To prevent osteoporosis and bone fractures a calcium and vitamin D rich diet is extremely important. Vitamin D is absorbed by exposure to sunlight. Anxiety Anxiety brought on by breathlessness can lead to more anxiety, leading to increased breathlessness and on it goes in an increasing circle. Continence There are many different causes of incontinence. For example, side effects of medications, constipation, and weak muscle structure made worse by coughing are the most common. Chronic obstructive pulmonary disease (COPD) (US 28550) Learning Guide Careerforce Issue 1.0 July 2015 9

The impact of COPD As you have read, COPD can have a number of impacts on a person s health and functional status. When describing these impacts we can group them into: Physical impacts, such as: weight loss. bone density. side effects of medication. incontinence. sleep interference. Talk Talk to someone you know with COPD (or someone who has a friend/family member with COPD). Ask how it has affected their life? Emotional impacts, such as: depression. fear or uncertainty over what the future holds. financial stress (change in employment or medical costs). anxiety. Psychosocial impacts, such as: withdrawal from social contact due to continence issues or inability to take part. fear of exacerbation. having to change plans when having a bad day. Cognitive impacts, such as: headaches or confusion due to high carbon dioxide levels. Environmental impacts, such as: the need for a home that has enough ventilation and is warm and dry. Psychological impacts, such as: learning to adapt to limitations Chronic obstructive pulmonary disease (COPD) (US 28550) Learning Guide Careerforce Issue 1.0 July 2015 10

Supporting a person with COPD Most people with COPD receive support and treatment to help them manage the disease themselves. They know what they need to do to stay as healthy as possible. However, as with many diseases, keeping to a strict programme of diet, exercise and medication can be difficult. If the person is feeling in a low mood or depressed, it can be even harder. They will often need your encouragement to keep to their routine and to feel confident taking part in social and physical activities. When assisting in the person s home, you can help by keeping the home clean and well aired - free of damp and mould. Eating and meals The following tips may help when encouraging a person to eat: meals are best eaten when energy levels are at their highest, which is usually in the morning. pre-prepare foods that are easy to access when the person is having a bad day. encourage the person to eat slowly and chew foods thoroughly to avoid swallowing air while eating. provide foods that are easy to chew as chewing can be tiring. cream or skimmed milk powder is a good way to add calories to soups. limit salt as too much salt can cause the body to retain water, making breathing more difficult. provide calcium-rich and vitamin D-rich foods to support bone health (milk, yoghurt, cheese, leafy greens). prepare meals that look good. aim for small, regular meals as large meals can be tiring. avoid foods that cause gas or bloating (sugar free treats, broccoli, cabbage, fizzy drinks). ensure breathing is as comfortable as possible prior to eating. Inhalers may need to be given prior to a meal to assist this; if the person is breathless before they start eating, they will not manage to eat the meal. meals should be eaten sitting up to ease lung pressure. You should encourage the person to sit at the table. discourage liquids before the meal as this can make the person feel full. encourage the person to rest before and after meals. Chronic obstructive pulmonary disease (COPD) (US 28550) Learning Guide Careerforce Issue 1.0 July 2015 11

Breathless moments If a person is feeling breathless, the following things can help: positioning is very important. Encourage the person to sit upright, well supported, with a pillow on a table in front to rest arms. This helps open up the available space in the chest for easier breathing. sometimes a breeze across the face when there is no breeze to be had can be very soothing. A mini-fan can be good for this. if the person is prone to overheating, keep a pair of cotton socks in the fridge (in a sealed bag). microfiber towels/dressing gowns can reduce the effort required when drying after a shower or bath. other aids, such as a seat in the shower, can enable the person to sit and conserve energy while washing. Sleep and rest Breathlessness is often worse when a person lies down. They may need to be positioned sitting up to sleep. Many people with COPD prefer to sleep in an armchair or lazy boy as it is easier to breathe. Hospital beds usually have back rests to help with this and some people may need a hospital type bed at home. However, we need to be aware that this increases the potential for sacral pressure injury as the person is reluctant to move off their bottom and lie on their side because of difficulty breathing. Dealing with exacerbations Almost every person with COPD will experience exacerbations. They are often seen as the curse of people with COPD lives. Exacerbations can be caused by infection or changes in air quality / air pollution. They can also be caused by a person not taking their medication correctly or suffering from stress and anxiety. Prompt treatment of the exacerbation is vital; therefore, in a hospital setting you will need to notify the RN immediately. If you are working in the community, there will be a plan in place for how you should respond in this situation. Make sure that you understand the symptoms and the plan so that you can do the right thing at the right time. Treatment will often include: antibiotics (if caused by an infection). steroids to reduce the inflammation in the airways. physiotherapy to treat the excessive mucous. additional oxygen treat the hypoxia (low oxygen levels). More info A lazy boy is a comfortable reclining armchair. The effects can be minimised if the signs are recognised early on. Chronic obstructive pulmonary disease (COPD) (US 28550) Learning Guide Careerforce Issue 1.0 July 2015 12

What to look out for: An important part of your role is to observe the person for any changes that may indicate problems. These changes might include: Signs of exacerbation More breathlessness More wheezing More mucous or phlegm Swollen ankles Not able to talk in full sentences Increase in cough Signs of depression* Appetite or weight changes Sleep changes Loss of concentration Loss of interest in daily activities Reckless behaviour e.g. substance abuse Low mood *These symptoms do not always mean depression is present; however, if you have concerns, report these to your RN. Chronic obstructive pulmonary disease (COPD) (US 28550) Learning Guide Careerforce Issue 1.0 July 2015 13

Reporting and monitoring As a support worker, you may be required to monitor a person s intake of food and fluids. You may also be asked to monitor their use of medication and level of exercise. Skin condition is also important. Steroids, a type of medication, often make the skin very fragile and papery. This means the person is more prone to skin tears and pressure injuries. Any increase in symptoms must also be reported. Refer to the signs of exacerbation on the previous page. The Registered Nurse will provide you with special forms for monitoring purposes and will explain how to use these. Any changes that you notice must be reported to the Registered Nurse. The Service Plan will provide information on what to do to address most signs and symptoms. This may vary from making a record in the person s notes to phoning an ambulance immediately. Write More info Record of care may include patient notes, daily diary, shift notes etc. You have noticed that John has not been using his inhalers as he should. When you asked him why, he said what s the point, I m never going to get better. What might you write in his record of care or report to the RN? Chronic obstructive pulmonary disease (COPD) (US 28550) Learning Guide Careerforce Issue 1.0 July 2015 14

Glossary The meanings below describe how the word is used in this workbook. The word may have other means when used in other ways. Absorb Airways Alveoli Bone density Bronchi Chronic Complications Constipation Diaphragm Dramatically Emphysema Exacerbation Exposure Functional status Hypercapnia Hyperinflation Hypoxaemia Hypoxia Imaging tests Incontinence Inflammation Inherited factors Microfiber Mucous Nebuliser Obstruction Palliative care Passive Phlegm to take something in (such as a liquid) in a natural or gradual way the tubes that air moves through when we breathe in and out air sacs in the lungs describes the strength of bones large and medium sized airways of long duration or frequent recurrence the negative effects of having a long term illness difficulty in having a bowel movement a body part separating the chest and abdominal cavities an important part of breathing severely when the air sacs in the lungs are gradually destroyed when the symptoms of COPD suddenly get worse being subject to something harmful a measure of how well a person is able to perform the activities of daily living high carbon dioxide levels in the blood where the air becomes trapped in the lungs (breathing out does not get all of the air out) not enough oxygen in the blood not enough oxygen reaching the tissues of the body scans, ultrasounds and x-rays inability to control the body s evacuation of urine and/or stool redness, heat or swelling physical traits passed on through parents and grandparents a very lightweight fabric that dries quickly a slippery fluid/substance produced by the lungs a medical device that sends a fine spray of medication to assist it in reaching the lungs something that gets in the way comfort care during end-of-life done without thinking or effort a large amount of mucous Chronic obstructive pulmonary disease (COPD) (US 28550) Learning Guide Careerforce Issue 1.0 July 2015 15

Pulmonary Recurrent Reduction Resistance Saline Spirometry Sputum Steroids Symptoms Trachea Ventilation Wheezing of the lungs occurs repeatedly lower levels something that works against the natural process of breathing fluid containing salt a medical test to measure airflow mostly mucous but can also contain pus, blood etc a form of medicine that provides additional hormones signs that may indicate an illness windpipe circulation of air a whistling or rattling breathing sound Chronic obstructive pulmonary disease (COPD) (US 28550) Learning Guide Careerforce Issue 1.0 July 2015 16