Post on 14-Jan-2017
“Everyone is responsible for his/her own looks after 40”
OBSTRUCTIVE PULMONARY DISORDERS
DICKSON AKANKWATSA {BSN 3}- BISHOP STUART UNIVERSITYcvdicksonakankwatsa@outlook.com
Divided into two:Fully reversible disorders {asthma}, and
Non fully reversible/ partially reversible{ COPD}
Causes1)Smoking2) Occupational exposures- exposure to workplace
dusts found in coal mining, gold mining, and the cotton textile industry and chemicals such as cadmium, and fumes from welding have been implicated in the development of airflow obstruction.
3) Air pollution4) sudden airway constriction in response to inhaled
irritants, 5) Bronchial hyperresponsiveness, is a characteristic
of asthma. 6) Genetics-Alpha 1-antitrypsin deficiency
COPDIn COPD, less air flows in and out of the
airways because of one or more of the following:
The airways and air sacs lose their elastic quality.
The walls between many of the air sacs are destroyed.
The walls of the airways become thick and inflamed.
The airways make more mucus than usual, which tends to clog them.
COPD-not fully reversible- includes 1) Bronchitis 2) EmphysemaBronchitis :-Bronchitis is a condition in which the
bronchial tubes become inflamed.
BRONCHITISChronic bronchitis:It is defined as the presence of cough
and sputum production for atleast 3 months.
PATHOPHYSIOLOGY Irritants irrritate the airway
Hypertrophy of the bronchial tree, and increased mucus production
Inflammation
Cause the mucus secreting glands and goblet cells to increase in number.
Ciliary function is reduced.
More mucus production
Bronchial walls become thickened and lumen narrows and mucus plug the airway
Alveoli adjacent to the bronchioles may
become damaged and fibrosed.
Alter function of alveolar macrophages.
infection
Acute signs and symptoms sore throat, fatigue (tiredness), fever, body aches, stuffy or runny nose, Vomiting & Diarrhea persistent cough cough may produce clear mucus shortness of breath
Chronic symptoms coughing, wheezing, and chest discomfort. The coughing may produce large
amounts of mucus. This type of cough often is called a smoker's cough.
Diagnostic evaluation History - medical history•Whether you've recently had a cold or
the flu•Whether you smoke or spend time
around others who smoke•Whether you've been exposed to dust,
fumes, vapors, or air pollution -
Mucus -to see whether you have a bacterial infection
chest x ray-may show consolidation lung function tests-brianstorm them CBC – significantly, may have
neutrophilia, eosinophilia, reduced Hb levels, etc
MANAGEMENT
medical managementsurgical managementnursing management
MEDICAL MANAGEMENTimprove ventillation1. broncho dilators like beta2
agonists(albuterol),anticholinergics(ipratropium bromide-atrovent).
2. methylxanthines(theophylline,aminophylline)
3. corticosteroids4. oxygen administration
SURGICAL MANAGEMENTbullectomy bullae are enlarged airspaces that do not
contribute to ventillation but occupy space in the thorax,these areas may be surgically excised
lung volume reduction surgery it involves the removal of a portion of the
diseased lung parenchyma.this allows the functional tissue to expand.
lung transplantation
NURSING MANAGEMENTassessmentphysical examinationdiagnosisintervention
Care plan impaired gad exchange related to decreased ventillation and
mucous plugs ineffective airway clearence related to excessive secretion
and ineffective coughing anxiety related to acute breathing difficulties and fear of
suffocation activity intolerence related to inadequate oxygenation and
dyspnoe imbalanced nutrition less than body requirement related to
reduced appetite,decreased energy level and dyspnoea disturbed sleep pattern related to dyspnoea and external
stimuli risk for infection related to ineffective pulmonary clearence
Empysema
Defined pathologically as
dilatation and destruction of the
lung tissue distal to the terminal
bronchiole. It is classified
according to the site of damage:
classification Centri-acinar emphysema. More common .Distension and damage of lung tissue
is concentrated around the respiratory bronchioles; more distal alveolar ducts
and
alveoli tend to be well preserve.
Pan-acinar emphysema. Less common. Distension
and destruction appear to involve the whole of the acinus, and in the
extreme form the lung becomes a mass of bullae. ■ Irregular emphysema. There is scarring and damage affecting the lung
parenchyma patchily without parti cular regard for acinar structure.
PathophysiologyCigarette smoking infections
Inactivates antitrypsin
Small airway filled with granulocytes or and neutophils
capable of releasing elastases and proteases
Imbalances in protease and antiprotease activity-
produces damage
Emphysema leads to expiratory airflow limitation and air trapping. The loss of lung elastic recoil results in an increase in TLC while the loss of alveoli results in decreased gas transfer.
Cont…VA/Q mismatch occurs partly because of
damage and mucus plugging of smaller airways from chronic inflam mation, and partly because of the rapid expiratory closure of the smaller airways owing to loss of elastic recoil from emphysema.
In summary, three mechanisms have been suggested for this limitation of airflow in small airways (< 2 mm in diameter).
Loss of elasticity and alveolar attachments of airwaysdue to emphysema. Reduces the elastic recoil andthe airways collapse during expiration.
Inflammation and scarring cause the small airways tonarrow.
Mucus secretion which blocks the airways. All cause narrowing of the small airways and
trapping of air leading to hyperinflation of the lungs and breathlessness.
SignsWheeze tachypnoea prolonged expiration Use of accessory muscles inter costal in-drawing on inspiration pursing of the lips on expiration . Chest expansion is poor lungs hyper-resonant loss of the normal cardiac and liver dullness.
.
Cont… Patients who remain responsive to CO2 are usually: breathless rarely cyanosed. Heart failure and edema in terminal events. Patients who become insensitive to CO2 are often
edematous and cyanosed but not particularly breathless.
Those with hypercapnia may have peripheral vasodilatation. Severe hypercapnia will lead to confusion and progressive drowsiness. At this stage papilledema may be present but is neither specific nor sensitive as a diag nostic feature
Diagnosis a) Historyb) PFTc) Spirometry-to find out airflow
obstruction.d) ABG analysise) CT scan of the lung.f) Screening of alpha antitrypsin
deficiencyg) X-ray radiography may aid in the
diagnosis.
MANAGEMENTmedical managementsurgical management as for bronchitis
nursing management
Complications Respiratory insufficiency Respiratory failure Pneumonia Pneumothorax Pulmonary artery hypertension.
Self management of COPD STAY AWAY FROM INFECTIONS BY MAINTAINING GOOD HYGIENE
QUIT SMOKIN
GEAT A REGULAR BALANCED DIET
• DRINK PLENTY OF PLAIN FRESH WATER ATLEAST 1.5L/DAY
QUESTIONS ????