COPD (Chronic Obstructive Pulmonary Disease)
This is characterized by progressive airflow limitation that is not fully reversible. It includes chronic bronchitis, pulmonary emphysema and bronchial asthma. Chronic bronchitis, is a chronic inflammation of the lower respiratory tract characterized by excessive mucous secretion, cough, and dyspnea associated with recurring infections of lower respiratory tract. Pulmonary emphysema, is a complex lung disease characterized by destruction of the alveoli enlargement of distal air space, and break down of alveolar walls.
Causes
1. Cigarette smoking
2. Air pollution
3. Occupational exposure
4. Allergy
5. Autoimmunity
6. Infection
7. Genetic predisposition
8. Aging
Signs & Symptoms
Chronic bronchitis
* Productive cough
* Production of thick gelatinous sputum
* Wheezing and dyspnea
Emphysema
* Dyspnea
* Decreased exercise tolerance
* Minimal cough with mild expectoration
* Barrel chest
Investigations
* PFT – Pulmonary function Test
* ABG levels
* Chest X ray
Management
* Cessation of smoking
* Inhaled bronchodilators
* Inhaled and or oral corticosteroids
* Chest physiotherapy
* Oxygen administration
* Pulmonary rehabilitation
* Antimicrobial agents
* Lung volume reduction surgery
Nursing Management
Improving airway clearance
* Eliminate pulmonary irritants
* Smoking cessation
* Administer bronchodilators
* Assess for adverse effect of medications
* Auscultate chest before and after aerosol therapy
* Postural drainage
* Encourage increased fluid intake
* Avoid diary product.
Improving breathing pattern
* Teach and supervise breathing exercise
* Teach diaphragmatic, lower costal, abdominal breathing using relaxed breathing pattern
* Use pursed – lip breathing at intervals and during dyspnea
* Comfortable position
* Relief from anxiety
Controlling infection
* Recognize early sign of infection
* Sputum for culture and sensitivityImproving gas exchange
* Observe the patient for any disturbance
* Monitor ABG, and oxygen saturation
* Assist mechanical ventilation
Improving nutrition
* Collect nutritional history
* Encourage small and frequent feeds
* Liquid nutritional supplement
* Avoid gas producing food
* Encourage oral hygiene
* Encourage pursed lip breathing in between the meals
* Monitor body weight
