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Oxygenation: Acute Exacerbated Chronic Obstructive Pulmonary Disease…
Oxygenation: Acute Exacerbated Chronic Obstructive Pulmonary Disease (AECOPD)
Pathophysiology/Etiology
Etiology: Tobacco exposure damages lung tissue and develops into COPD, unable to defend against infection
Damaged lung tissue initiates local inflammatory response with cytokine and histamine activation. Excessive mucous production, increased airway muscle thickness and fibrosis of epithelial cells.
Chronic respiratory inflammation causes remodeling of cells in the airway and alveoli, becomes less resistant to irritants and more vulnerable to infection.
Infection triggers additional immune response surrounding respiratory tissue, further impairing ventilation through narrow bronchioles and gas exchange in inflamed alveoli. Cough, sputum, and SOB worsen.
Exacerbation of symptoms causes reduced systemic oxygenation and hypercapnia. Hypoxia causes activation of sympathetic nervous system, increasing cardiac output and respiratory response. Dyspnea causes anxiety, further exacerbating the feedback loop.
Compensatory system to oxygenate and perfuse tissue in response to hypoxia fail if adequate oxygen isn't delivered and respiratory failure occurs.
Risk Factors
Tobacco exposure
Risk increases with age
Prior exacerbation
Viral infection, C. Diff
Diabetes and hyperglycemia
Labs/Diagnostics
ABGs: PaCO2 >45 mmHg, PaO2 <55 mmHg, blood pH <7.35
Serum Biomarkers: Lactate, antitrypsin deficiency, C-reactive protein
Physical examination, oxygen saturation
Chest x-ray showing chest hyperinflation
ECG showing diminished PR and ST intervals
Complications
DVT and PE
Hypercapnic respiratory failure (PaCO2 >50 mmHg, pH <7.3)
Repeat exacerbation -- further damage, higher mortality
Collaborative Treatment
Acute at Presentation
Short-acting bronchodilator (albuterol)
Systemic corticosteroid (prednisone)
Airway clearance technique -- cough, turn, deep breath
Humidify room to loosen secretions
Oxygen therapy to maintain O2 sat >94%
Noninvasive/invasive positive-pressure ventilation as indicated
Antibiotics
IV fluids
Interventions
Suction secretions
Encourage fluid intake
Semi-Fowler's
Small meals
Monitor for deterioration, prepare for intubation
Bedrest, cluster cares
Avoid another exacerbation
Identify and avoid triggers
Reduce exposure to infections
Pulmonary rehab
Assess readiness to learn and educate about chronic disease management
Symptoms
Cough w/ sputum production
Rapid worsening of baseline symptoms
Tachypnea & hypercapnia
Lethargic, altered LOC
Activity intolerance, DOE
O2 sat <94%
Shortness of breath
Cyanosis