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Chronic Obstructive Pulmonary Disease Emphysema (Diagnostic Findings…
Chronic Obstructive Pulmonary Disease
Emphysema
Definition
Pulmonary Emphysema is a pathologic term that describes an abnormal distention of airspaces beyond the terminal bronchioles and destruction of the walls of the alveoli , there is impaired carbon dioxide and oxygen exchange and the exchange results from the destruction of the walls of over distended alveoli.
Causes
Smoking
Occupational exposure
Genetic abnormalities
Pathophysiology
The blood remains relatively well oxygenated because both ventilation and perfusion are reduced, loss of elastin fibres reduces structural support for alveoli and small airways which makes them prone to collapse on expiration leading to air trapping.
Clinical Manifestations
Chronic cough
Sputum production
Dyspnea on exertion
Dyspnea at rest
Weight loss
Barrel chest
Diagnostic Findings
Spirometry
ABG
Chest x-ray
CT scan
Screening for alpha1-antitrypsin deficiency
Pulmonary function tests
Arterial blood gases (ABGs)
Lung scan
Pharmacologic Therapy
Bronchodilators
Corticosteroids
Other pharmacologic treatments that may be used in COPD include alpha1-antitrypsin augmentation therapy, antibiotic agents, mucolytic agents, antitussive agents, vasodilators, and narcotics.
Management
Optimization of bronchodilator medications is first-line therapy and involves identifying the best medications
Hospitalization
Oxygen therapy. Upon arrival of the patient in the emergency room, supplemental oxygen therapy is administered
Antibiotics
Nursing Assessment
Registered nurse should assess patient’s exposure to risk factors.
The nurse should assess the patient’s past and present medical history.
Signs and symptoms of COPD should be assessed and monitored
Assess the patient’s knowledge of the disease.
The nurse should assess the patient’s vital signs.
Assess breath sounds and pattern.
Nursing Intervention
The nurse must appropriately administer bronchodilators and corticosteroids and become alert for potential side effect.
Inspiratory muscle training , helps to improve the breathing pattern.
Diaphragmatic breathing reduces respiratory rate, increases alveolar ventilation.
Exercise training can help strengthen muscles of the upper and lower extremities and improve exercise tolerance and endurance.
The nurse should monitor for cognitive changes such as personality and behavior changes and memory impairment.
The nurse should monitor the pulse of the patient and administer supplemental oxygen as prescribed
The nurse should encourage the patient to be immunized against influenza and S. pneumonia because the patient is prone to respiratory infection
Evaluation
Patient identifies the hazards of cigarette smoking.
Enrolls in smoking cessation program.
Patient eliminates exposures.
Verbalizes the need for fluids.
Patient Is free of infection.
Practices breathing techniques.
Performs activities with less shortness of breath.