COPD: progressive chronic airflow obstruction

Emphysema

Bronchitis: inflammation of the bronchi and bronchioles caused by chronic exposures to irritants. Vasodilation, congestion, mucosal edema and bronchospasms occur.

Respiratory infection with increased symptoms-> exacerbation or flair up leaving no time for lungs to heal->progressive destructive changes->airways are narrowed, resistance to airflow increased and expiration slows or becomes difficult resulting in a mismatch of ventilation and perfusion impairing gas exchange

effects the airway

inflammation causes an increase in size and number of mucous glands producing large amounts of thick mucus.

Bronchial walls thicken narrowing the airway; some smaller airways are totally blocked

recurrent infection is common because of wall changes and cilia function is impaired

Complications: V/Q mismatch, hypoxemia, hypercapnia, pulmonary hypertension

"Blue Bloater" : Color dusky to cyanotic; recurrent cough and sputum production, hypoxia, hypercapnia, acidosis, edematous, increased respirations, exertional dyspnea, increased incidence in smokers, cardiac englargment, use of accessory muscles to breathe, hemoptysis

Effects alveoli

destruction to alveolar walls resulting in enlargement of abnormal air spaces

Recoil is lost so inspiration may start before expiration has finished; lose the passive expiration

CO2 is produced faster than it can be eliminated

late stage; low PaO2 because O2 cant moved from diseased lung into blood stream

"Pink Puffer":Pink skin (not cyanotic, increased CO2 retention) pursed lip breather, ineffective cough, barrel chest, exertional dyspnea, wheezing, speaks in jerky sentences, anxious, accessory muscles, decreased breath sounds, skinny (cachetic appereance), othorpneic,

Diagnostics Expected to be ordered:

Pulmonary Function Test: evaluates the extent and progression of COPD. Total lung capacity and residual volume increase and forced vital capacity is decreased in patients with COPD

V/Q Scan: used to see if there is a ventilation perfusion mismatch

Sputum and blood cultures

ABGs, 12 lead EKG, CBC, BMP, BNP

ABGs to evaluate gas exhange

Pulse Ox: monitors O2 saturation of the blood

Capnogram: evaluated alveolar ventilation in ventilated patients

CBC with differential: shows increase in RBC and hematocrit from chronic hypoxemia stimulating RBC production; Increased WBC indicates bacterial infection

CXR; shows flattening of diaphragm due to hyperinflation and evidence of pulmonary infection

BNP used to determine heart failure

Treatments: Smoking cessation, avoidance of irritants and allergens, pulmonary hygiene (hydration, effective cough(instead of deep cough encourage HUFF, postural drainage and percussion), oral hygiene (prevent pneumonia), Regular aerobic exercise,

Oxygen Therapy: 2-4 L NC- 40% via venturi mask; ensure no open flames or smoking in room,

Interventions: assess every 2 hours, teach/encourage abdominal and purse lipped breathing, upright positioning, effective coughing, O2 therapy, surgical interventions, encouraging fluids 2-2.5 L a day to thin secretions,

Medications:beta-adrenergic agents, cholinergic antagosinist, xanthines, corticosteroids, cromones, muculytics,

Oxygen Toxicity: Dyspnea, nonproductive cough, pain beneath sternum, GI upset, crackles.