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COPD (Chronic obstructive pulmonary disease) (Management (surgery…
COPD (Chronic obstructive pulmonary disease)
an abnormal inflammatory response -> chronic inflammation lead to narrowing of airway (airflow limitation) due to
increase in no. pf goblet cells & enlarged submucosal glands -> hypersecretion of mucus
thickening of airway wall + fibrosis & exudate in the airway -> overall narrowing of the airway
emphysema
abnormal distention of airspace beyond the terminal bronchioles & destruction of the walls of alveoli
2 types
panlobular (panacinar)
lower half of lung
centrilobular (centriacinar)
upper lobe & upper part of lower lobe
chronic bronchitis
presence of persistent cough & sputum for >3 mths in 2 consecutive yrs
Risk factor
cigarette smoking, passive smoking, chemicals, pollutions, genetic abnormalities
alpha1-antitrypsin deficiency
s/s
chronic cough
sputum
dyspnea
barrel chest (anterior & posterior ratio: 1:2 to 5:7)
due to hyperinflated lung
use of accessory muscle for breathing
Diagnostic test
CXR
history taking (smoking history, exposure to risk factors)
Pulmonary function test (difficulties in exhaling, reducing forced expiratory volume in 1 sec, FEV1)
ABG (arterial blood gas)
Management
promote smoking cessation
med: bronchodilator, corticosteroid, mucolytic, antibiotics
oxygen therapy (due to chronic co2 retention, co2 is used to be the most powerful stimulant -> constant high pco2 -> body switch to respond to o2 (hypoxic drive)
2-4L O2 is the most suitable
managing co2 exacerbation
surgery
bullectomy - removal of the enlarged airspace
lung volume reduction surgery - removal of a portion of lung tissue to reduce hyperinflation -> allow functional tissue to expand
lung transplantation
pulmonary rehabilitation services
assessment, education, smoking cessation, nutritional conseling
nursing management
promoting airway clearance (coughing/ chest physiotherapy)
pulse oximetry, assess needs for oxygenation
training of diaphragmatic breathing, pursed lip breathing
improve activity intolerance -> exercise training to strengthen limb muscle
education - med, aware of copd risk factor