Chronic Obstructive Pulmonary Diseases (COPD) Chronic Airflow Limitation

(CAL)

Emphysema

• Loss of lung elasticity• Hyperinflation of the lung• Formation of Bullae• Small airway collapse and air

trapping

Classifying Emphysema

• Panlobular

• Centrolobular

Clinical Manifestations

• Progressive dyspnea on exertion• Prolonged expiratory phase &

tachypnea• Increased work of breathing• Anorexia, weight loss• Barrel Chest• Flattened diaphragm

Clinical Manifestations (cont)

• Formation of blebs and bullae• Hyperresonance• Polycythemia (pink puffer)• Chronic hypoxia• Pneumothorax• Hypercapnic to hypoxic drive• Chronic respiratory acidosis (end

stage)

Pulmonary Function Tests

• Increased– residual volume– total lung capacity

• Decreased– Forced vital capacity

– FEV1

Clubbing of Fingers

Chronic Bronchitis

• Excessive production of mucus in the bronchi

• Productive cough– Persists 3 months of the year for 2

consecutive years

Pathologic Changes

• Chronic inflammation• Hypertrophy and hyperplasia of

the mucus glands• Increased susceptibility to infection• V/Q changes

Presentation

• May have same symptoms as emphysema

• Frequent respiratory infections• Cyanosis• Cor pulmonale• Polycythemia

Asthma

• Not always listed as one of the diseases of COPD/CAL

• Asthma is usually a reversible process

• Involves periodic episodes

Asthma Classifications

• Extrinsic (Allergic)– Antigen/antibody response– Childhood

• Intrinsic (Endogenous)– History recurrent RTI– adulthood

Pathologic Changes

• Hypersensitivity response• Bronchoconstriction• May become chronic with

irreversible changes

Presentation

• Bronchospasm• Increased mucus secretion• Dyspnea• Wheezing• Cough

Consequences of CAL

• ABG’s– Initially normal ABG followed by

decreased PaO2 and O2 saturation

– Increased PaCO2 with an increase in HCO3 to compensate

• Compensated Respiratory Acidosis and Hypoxemia

Polycythemia

• Related to decreased PaO2• What is the mechanism?

Pulmonary Function Tests

• What do you expect?

TLC increasedFEV1 decreased

Cor Pulmonale

COPD/CAL

Pulmonary Vascular Bed

Pulm Hypertension Hypoxemia

RV Failure PolycythemiaLV Failure

Collaborative Management of CAL

• Medical management– Maximize oxygenation, ventilation

and perfusion

• Surgical management– Bullectomy– Lung volume reduction surgery

Drug Therapy• Bronchodilators

– Sympathomimetics– Methylxanthines

• Anticholinergics• Steroids• Mast Cell Stabilizers• Leukotriene Antagonists• Expectorants• Antibiotics

Nursing Diagnoses

• Impaired gas exchange• Ineffective airway clearance• Activity intolerance• Anxiety• Altered nutrition: less than body

requirements

Nursing Interventions

• Maintain a patent airway• Safely administer oxygen• Use oxygen delivery systems

appropriately• Accurately assess the patient’s

breathing• Use positioning to improve

oxygenation

Teach the Patient:

• Abdominal & Pursed lip breathing• Controlled coughing• Conservation of energy• Prevent secondary infection• Insure hydration• Nutrition• Therapeutic

communication/relaxation

Metered Dose Inhaler (MDI)

Peak Flow Meter