ANAMBRA STATE COLLEGE OF NURSING SCIENCES,

NKPOR

PRESENTATION

ON

Chronic Obstructive Pulmonary Disease

BY

ANYAEGBU IJEAWELE WILSON

ASCONS/2020/009

CHIGBO PECULIAR CHINAECHEREM

ASCONS/2021/011

COURSE: COMMUNITY HEALTH NURSING

TUTOR: CHIEF NWOKA

FEBRUARY 2024
 GROUP MEMBERS

1. ANYEGBU IJEAWELE WILLSON

2. CHIGBO PECULIAR CHINECHEREM

 CHRONIC OBSRTUCTIVE PULMONARY DISEASES

Chronic obstructive pulmonary disease (COPD) is defined by the global initiative for chronic lung disease
(GOLD) as a preventable and treatable disease with some significant extrapulmonary effects that may
contribute to the severity in individual patients. It is progressive inflammatory lung disease
characterized by increasing difficulty in breathing. It is a disease that limits airflow from the lungs. Its
pulmonary component is characterized by airflow limitation that is not fully reversible. The airflow
limitation is usually progressive and associated with an abnormal inflammatory response of lung to
noxious particles or gases. COPD may include diseases that cause airflow obstruction such as
emphysema, chronic bronchitis or any combination of these disorders.

COPD may include diseases that cause airflow obstruction such as emphysema and chronic bronchitis or
any combination of this disorder. COPD can coesist with asthma. COPD and the other associated
conditions like chronic lower respiratory diseases are the fourth leading cause of death in United States
of America and account for death of almost 125,000 Americans each year.

Types

There are two main forms of COPD namely:

 Chronic bronchitis
 Emphysema

Causes

 Inflammation stimulus such as

 Cigarette Smoking is the main cause (account for 85-90% of all COPD)
 Second hand smoke and dust
 Long term exposure to air Pollution
  Fumes and chemicals which are often work related
 Alpha 1 Deficiency (This is caused by genetic inherited condition that affects the body's ability
to produce a protein called Alpha 1 which protects the lungs.

Risk factors

 Breathing secondhand smoke

 Passive smoking (Second hand smoke)
 Prolonged and intense exposure to occupational dust and chemicals
 Exposure to fumes from burning fuel
 Exposure to air pollution
 A genetic condition called Alpha-1 deficiency
 A history of childhood respiratory infection.
 People with Asthma

Classification

COPD is classified into four stages depending upon the severity measured by lung function and

Symptoms

1. Stage 1 (Mild): This is defined by a Forced expiratory volume 1 (FEVI) /lunced vital capacity (FVC) less
than 70% and an FEVI greater than or equal to 80% predicted. The patient may be with or without
symptoms of cough and sputum production.

2. Stage 11 (Moderate). Is defined by an FEVI and FVC less than 70%, and FEVI 50% to 80% predicted and
shortness of breath typically developing upon exertion. 3. Stage 111(Severe): Is defined as FEV1/FVC less
than 70% and FEV1 less 30% το 50% predicted. Severe COPD symptoms include increases shortness of
breath, reduced exercise capacity and repeated exacerbation. 4. Stage IV (Very severe): Is defined as
FEV1/FVC less than 70%, an FEV1 less than 30% predicted and symptoms/signs of chronic respiratory
failure

Note: Factors that determine clinical source and survival of patients with COPD include

 History of cigarette smoking

 Passive smoking exposure (second-hand smoke)
 Age
 Rate of decline of Fev
 Hypoxemia
 Pulmonary artery pressure
 Resting heart rate
 Weight loss and reversibility of airflow obstruction

Clinical Manifestations
It is a progressive disease generally characterized by three primary symptoms namely:

 Chronic cough
 Sputum production
 Dyspnons on exertion (may be severe and inters with the patients activities). It is often
progressive, worsens with exercise and is persistent. Again as COPD progresses, dyspnoea may
occur at rest.

Early symptoms include:

 Occasional shortness of breath especially after exercise

 dyspnoea may occur at rest.
 Mild but recurrent cough
 Often clearing of the throat especially first thing in the moming

Worsening symptoms Include:

 Shortness of breath
 Wheezing (higher pitched noisy breathing especially during exhalation
 Chest tightness
 Chronic cough with or without mucus Having the need to clear the ing every day
 Constant cold, flu and other respiratory infections

Later symptoms that occurs in the later stage of COPD:

 Weight loss is common because dyspnoea interferes with eating and the work of breathing is
energy depleting. These symptoms often worsen over time.
 Fatigue
 Swelling of the feet, ankles or legs.

Diagnostic Evaluation.

 Clinical manifestation
 Health History of the patients
 Lung function Test (Spirometry): Used to evaluate air flow obstruction
 Arterial gas measurement may also be used to assess baseline oxygenation and gas
 exchange and specially essential in advanced COPD
 Chest X-ray or CT scan provides a detailed look at the lungs, blood vessels and heart. Screening
for Alpha 1 antitrypain deficiency may be performed for patients younger than 45 years of age
and for those with strong family history of COPD.

Note: The primary differential diagnosis of COPD is asthma. It may be difficult to differentiate s patient
with COPD and one with chronic asthma. Other diseases to consider in the differential diagnosis include
heart failure, bronchietasis, tuberculosis etc.
Key factors in determining the diagnosis are the patient's history and the patient's responsiveness to
bronchodilators.

Medical Management

There is no cure for COPD but treatment

Bronchodilators help to relieve broncho spasm by altering smooth muscle tone and reduce airway
obstruction by allowing increased oxygen distribution in the lungs and improving alveolar ventilation Eg
Salbutamol, Aminophylline.

Corticosteroids: It is only used for long term treatment. Long term treatment with oral corticosteroid is
not recommended and can cause steroid myopathy leading to muscle disease and respiratory failure.

 Antibiotic agents
 Mucolytic agents
 Antitussive agents
 Vasodilators
 Vaccines may also be effective Eg Influenza vaccine that can reduce morbidity and mortality by
approximately 50%.
 Narcotics

Surgical Management

The following surgeries could be done

 Bullectomy:
This is a surgical option to select patients with bullous emphysema. Bullae are enlarged air
spaces that do not contribute to ventilation but occupy space in the thorax. These areas may be
surgically excised. These bullae compress areas of the lung and may impair gas exchange.
Bullectomy may reduce dyspnoeu and improve lung function. It can be performed through a
video assisted thoracoscope or a limited thorscotomy incision.
 Lung volume Reduction Resection
This is a treatment option for patient with end stage COPD (Stage (v) with a primary
emphysematous component are limited. It is a palliative surgical option in some selected
patients. These selected patients include patients with homogenous disease or disease that is
focused on one area and not wide spread throughout the lungs. The surgery involves the
removal of the portion of the diseased lung parenchyma. This reduces hyperinflation and allows
the functional tissue to expand, resulting in improved elastic recoil of the lung and improved
chest wall and diaphragmatic mechanies.

Nursing Management

 Assessment of the patient which includes obtaining information about current symptoms and
previous disease manifestations.
  Achieving airway clearance
 Improving breathing pattern Improving activity tolerance
 Teaching patients self care
 Patient education
 Nutritional therapy
 Teach patient coping measures
 Complications
 Acute respiratory insufficiency
 Pneumonia
 Chronic atelectasis
 Respiratory failure
 Pneumothorax
 Pulmonary arterial Hypertension
 Lung cancer
 Depression
 Heart problems such as heart attack.

EMPHYSEMA

Emphysema is pathologic term that describes abnormal distension of the airspaces beyond the terminal
bronchioles and destruction of the walls of the alveoli. As the walls of the alveoli are destroyed, a
processed accelerated by recurrent infection, the alveolar surface area in direct contact with pulmonary
capillaries continually decreases. This is the end stage of a process that progresses slowly for many
years. This causes an increase in dead space that is lung areas where gas exchange cannot occur and
impaired oxygen diffusion which leads to hypoxemia.

Causes

 Long term exposure to air berne irritants such as:

 Chemical fumes and dust
 Tobacco smoke Marijuana smoke
 Air pollution
 Risk factors
 Age
 Exposure to second hand smokz
 Occupational exposure to dust and fumes
 Exposure to Indoor Eg fumes from heating fuel and uut dour pollution Eg car exhaust.

Types

There are two main types of emphysema based on changes taking on in the lungs. Both of the times may
occur in the same patient. They are as follows:
Panlobular (Panacinar) emphysema: In this type, there is destruction of the respiratory beonchiole,
alveolar duct and alveolus. All the air spaces within the lobules are enlarged with little inflammatory
disease. A hyperinflated chest, marked dyspnoea on exertion and weight loss typically occur

Centrilobular Centroacinar). Pathologic changes mainly take place in the center of the secondary lobe,
preserving the peripheral portions of the acinus. There is frequent derangement of ventilation perfusion
ratios, producing chronic hypoxemia, hypercapnia, polycythemia and episodes of right sided heart
failure. The patient also develop peripherial oedema which is treated with diuretic therapy.

Clinical manifestations.

 Shortness of breath especially with physical activity

 Frequent coughing
 Cardiac enlargement
 > Wheezing (Whistling sound when one breathes)
 Tightness of the chest
 Frequent tespiratory infections
 Weight loss
 Swelling in the ankles feut and legs
 Wheezing (Whistling sound when one breathes)
 Tightness of the chest
 Frequent respiratory infections
 Weight loss
 Swelling in the ankles feet and legs

Diagnostic Evaluation

 Medical history to ascertain the symptoms

 Family history Lung function test will reveal air flow obstruction
 Chest x-ray will reveal flattened diaphragm
 CT Scan
 ECG will show abnormal waves.
 Blood head.

Medical Management

 Bronchodilators: They relax the muscles around the airways and helps to open up the airways. It
could be in oral or spray form eg Aminophylline, aaventolin, Salbutamol
 Antibiotics is necessary to treat acute respiratory infections
 Corticosteroids eg hydrocortisone or pre to reduce air way inflammation.
 Oxygen therapy.
 Vaccine for flu and pneumococcal pneumonia.
 Surgery at hat for people with severe amphysema and symptoms have not get better with
  medication. The surgeries to
 Remove damaged lung tissue
 Remove large air spaces (Bullae that can form whwn air spaces are destroyed.
 Lung transplant done when one has severe emphysema.

Nursing Management

 Assess air way patency, breathing and sputum characteristics

 Quit smoking. This is the first and most essential step Avoid secondary smoke and places where
you might breathe in other lung irritants
 Adequate eating plan so as to maintain good nutritional needs
 Encourage rest
 Keep patient free from irritants such dust and smokes
 Be aware of the physical activities to engage in since it aids in breathing and increases
 overall wellness.
 Pulmonary rehabilitation helps to the well being of the peuple. It includes An exercise program,
disease management program, nutritional counselling and psychological
 Pulmonary rehabilitation helps to the well being of the people. It includes An exercise program,
disease management program, nutritional counselling and psychological counselling.

Complication

 Pneumonia Pneumothoras
 Cor pulmonale
 Respiratory failure
 Recurrent respiratory tract infections
 Respiratory acidosis
 Hypoxia

CHRONIC BRONCHITIS

It is long term inflammation of the bronchi. It is common among smokers This is a disease of the airway
characterized by the presence of cough and sputum for at least three months in each two consecutive.
In many cases smoke or other environmental pollutants irritate the airways resulting to inflammation
and hypersecretion of macus.

Causes

 Other lung diseases such as

 Asthma
 Pulmonary emphysema
 Sinusitis
 Tuberculosis
 Upper respiratory tract infections
Clinical Manifestations

 Cough often called smokers cough

 Coughing up mucus
 Wheezing
 Chest discomfort
 Severe dypanoca
 Cynosis Fever
 Narrowing and plugging of the bronchi
 Swollen feet
 Bluish finger nails
 Heart failure
 Weakness

Diagnostic evaluation

 Pulmonary function test which helps to measure the lungs ability move air in and out the lungs.
They include:
 Spirometry: Measure how well the lungs are working and how serious the lung discase is Prak
flow monitor. Measures the fastest speed that air can be blown out of the lungs. This
measurement is very paramount in teling hw well the disease is being controlled.
 Chest x-ray pictures the internal tissues, bones and organs including the lungs
 CT scan shows detailed images of the lungs.
 Medical Management
 Bronchodilators
 Cortecosteroids
 Oxygen therapy
 Lang transplant in rare cases
 Vaccination

Nursing Management

 Avoid secondhand smoke and other irritants

 Quit smoking
 Avoid dust, chemicals and other that leads to bronchial irritation
 Humidify the air
 Pulmonary rehabilitation help to learn how to live with the breathing problem and stay active
 Adequate nutrition
 Copious fluid intake etc

Complications

 Severe shortness of breath

 COPD
 Respiratory failure
 Increased mortality rate