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Saturday, November 24, 2012

MS: COPD Chronic Obstructive Pulmonary Diseases


Chronic Obstructive Pulmonary Disease (COPD), also known as chronic obstructive lung disease (COLD), chronic obstructive airway disease (COAD), chronic airflow limitation (CAL) and chronic obstructive respiratory disease (CORD), is the occurrence of chronic bronchitis or emphysema, a pair of commonly co-existing diseases of the lungs in which the airways narrow over time. This limits airflow to and from the lungs, causing shortness of breath (dyspnea). In clinical practice, COPD is defined by its characteristically low airflow on lung function tests. In contrast to asthma, this limitation is poorly reversible and usually gets progressively worse over time. In England, an estimated 842,100 of 50 million people have a diagnosis of COPD.




Chronic Obstructive Pulmonary Diseases

Chronic Bronchitis
(Blue Bloaters) Inflammation of the bronchi due to hypertrophy or hyperplasia of goblet mucous producing cells leading to narrowing of smaller airways
Smoking
Air pollution

ü  Consistent productive cough
ü  Dyspnea on exertion with prolonged expiratory grunt
ü  Anorexia and generalized body malaise
ü  Cyanosis
ü  Scattered rales/rhonchi

Bronchial Asthma
Reversible inflammatory lung condition caused by hypersensitivity to allergens leading to narrowing of smaller airways
Allergens
ü Cough that is productive
ü Dyspnea
ü Wheezing on expiration
ü Tachycardia, palpitations and diaphoresis
ü Mild apprehension, restlessness
ü Cyanosis

Bronchiectasis
Permanent dilation of the bronchus due to destruction of muscular and elastic tissue of the alveolar walls
Recurrent  LRTI
Congenital disease
Presence of tumor
Chest trauma

ü Consistent productive cough
ü Dyspnea
ü Presence of cyanosis
ü Rales and crackles
ü Hemoptysis
ü Anorexia and generalized body malaise
ü  
Pulmonary Emphysema
Terminal and irreversible stage of COPD characterized by :

·       Inelasticity of alveoli
·       Air trapping
·       Maldistribution of gasses
·       Overdistention of thoracic cavity (Barrel chest)

Smoking
Pollution
Hereditary
Allergy
ü Productive cough
ü Dyspnea at rest
ü Prolonged expiratory grunt
ü Resonance to hyperresonance
ü Decreased tactile fremitus
ü Decreased breath sounds
ü Barrel chest
ü Anorexia and generalized body malaise
ü Rales or crackles
ü Pursed-lip breathing


Nursing Management:
ü  Enforce CBR
ü  Low inflow O2 admin; high inflow will cause respiratory arrest
* most accurate: venturi mask
ü  Administer medications as ordered
Bronchodilators
Antimicrobials
Corticosteroids (5-10 minutes after bronchodilators)
Mucolytics/expectorants
ü  Force fluids
ü  Nebulize and suction client as needed
ü  Provide comfortable and humid environment
ü  Avoidance of smoking and allergens




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