Nursing care COPD BASIC CONCEPT OF DISEASE DEFINITIONS Chronic Obstructive Pulmonary Disease (COPD is a term o!

ten use" !or a grou# o! lung "iseases that lasts longer an" is characteri$e" by an increase" resistance to air !lo% as the main #atho#hysiological overvie%& These three "iseases are 'no%n to !orm a unity %ith COPD are( chronic bronchitis) #ulmonary em#hysema an" asthma bronchiale (S *elt$er) +,,-( ./. ETI0O1I Cigarette 2 bronchial mucus glan" hy#er#lasia 2 s3uamous meta#lasia o! res#iratory e#ithelium 2 Inhibition o! the activity o! the hair cells vibrate) alveolar macro#hages) sur!actant In!ection) the bacterium 4aemo#hilus in!luen$a an" most are stre#tococcus #neumonia Pollution) chemicals) among others( N+O) hy"rocarbons) al"ehy"es age socio5economic circumstances&

C0ASSIFICATION -& Chronic Bronchitis Bronchitis is a clinical "e!inition o! cough almost every "ay %ith e6#ectoration) at the lac' o! 7 months in a year an" occurre" at least + years in a ro%& +& Pulmonary Em#hysema Pulmonary Em#hysema is an anatomic "e!inition) namely a change o! anatomic lung characteri$e" by abnormal %i"ening o! the "istal #art o! the bronchial air%ays terminal) %hich is accom#anie" by "estruction o! alveolar %alls - Centriolobular Em#hysema is a ty#e that o!ten arise) resulting in "amage to bronchioles) usually in the u##er lung region& In!lammation "evelo#s in the bronchioles but usually remain resi"ual alveolar sacs + Em#hysema #anlobular (#anacinar Damage to the air s#ace aroun" the acini an" usually inclu"e" at the bottom o! the lungs& This !orm is calle" centriacinar %ith em#hysema) arise very o!ten in a smo'er&

7 Em#hysema Parase#tal Destructive lo%er lobe alveoli resulting in the isolation o! #eri#heral #ulmonary blebs along& Parase#tal em#hysema is believe" to be the cause o! s#ontaneous #neumothora6& Panacinar arise in the el"erly an" clients %ith the en$yme al#ha5antitry#sin "e!iciency& In the a"vance" state) an increase in "ys#nea an" #ulmonary in!ection) o!ten arising Cor Pulmonary (C4F to# right arise& 7& Asthma Asthma is a "isease characteri$e" by hy#ersensitivity tracheobronchial branches to various ty#es o! stimuli& This con"ition mani!ests as air%ay constriction channels "ue to #erio"ic an" reversible bronchos#asm&

Patho#hysiology 8is' !actors such as smo'ing) #ollution) age) %ill bring bronchial in!lammatory #rocess an" also cause "amage to the bronchial %all terminal& As a result o! the "amage %ill occur obstruction o! small bronchi (bronchioles terminalis ) %hich e6#erience" early closure or obstruction o! the e6#iratory #hase& Easy entry o! air into the alveoli "uring ins#iration) the e6#iratory many tra##e" in the alveoli an" there %as a buil"u# o! air (air tra##ing & This is %hat causes the shortness o! breath %ith all its conse3uences& E6#iratory obstruction in early e6#iration %ill cause trouble an" cause elongation o! the e6#iratory #hase& Pulmonary !unctions( ventilation) gas "istribution) gas "i!!usion) an" #er!usion %ill be im#aire" (Brannon) et al) -//7 & C0INICA0 -& Chronic Bronchitis 5 Cough5cough almost every "ay %ith e6#ectoration) the lac' o! a minimum o! 7 months in a year an" ta'e #lace !or at least + years in a ro%& 5 Increasing the si$e an" number o! mucous glan"s 5 *ore viscous mucus 5 Damage to the ciliary !unction +& For em#hysema) asthma 2 9ea'ness bo"y 2 Cough 2 Shortness o! breath 2 Shortness o! breath on e6ertion an" breath soun"s

2 9hee$ing or %hee$e 2 #rolonge" e6#iratory 2 Form barrel chest (Barrel Chest in a"vance" "isease& 2 The use o! accessory muscles 2 :oice "ecrease" breath 2 Sometimes !oun" #ara"o6ical breathing 2 leg e"ema) ascites an" clubbing& F& *ANA1E*ENT The #ur#ose o! the management o! COPD are( -& Touch u#s mengatasiu ability o! #atients sym#toms not only in the acute #hase) but also the chronic #hase& +& Im#rove the ability o! #atients to carry out "aily activities& 7& 8e"uce the rate o! #rogression o! the "isease i! the "isease can be "etecte" early& *e"ical management -& Prevention( Preventing smo'ing) in!ections) an" air #ollution +& Thera#y in acute e6acerbations "o %ith( -& Antibiotics) usually accom#anie" by acute e6acerbations "ue to in!ection The in!ection is usually cause" by 4& In!luen$a an" S& Pneumonia) the use o! am#icillin or erythromycin ; 6 ,&+.5,&.<=hari ;6,&.<=hari Augmentin (amo6icillin an" clavulanic aci" can be given i! the germs that cause the in!ection is 4& In!luen$a an" B& Cacarhalis5#ro"ucing B& Pemberiam lactamase antibiotics such as 'otrima'sasol) amo6icillin) or "o6ycycline in #atients %ith acute e6acerbations sho%n to accelerate healing an" hel# accelerate the increase in #ea' !lo% rate& But only in >5-, "ays "uring the #erio" o! e6acerbation& I! there is a secon"ary in!ection or signs o! #neumonia) it is recommen"e" that a strong antibiotic& +& O6ygen thera#y is given i! ter"a#ata hy#erca#nia an" res#iratory !ailure "ue to re"uce" sensitivity to CO+ 7& Physiothera#y hel#s #atients to #ro#erly #ut out s#utum& ;& Broncho"ilators) to overcome air%ay obstruction) inclu"ing the class o! a"renergic an" anti5cholinergic b& In #atients can be given salbutamol . mg an" +., mg or i#rato#ium bromi"e a"ministere" every < hours %ith a nebuli$er or amino#hylline ,&+. to ,&.< I: slo%ly& 7& 0ong5term thera#y is "one( -& Antibiotics !or long5term #reventive chemothera#y) am#icillin ;6, ,&+.5,) .="ay can "ecrease the inci"ence o! acute e6acerbations& b& Broncho"ilators) "e#en"ing on the "egree o! reversibility o! air%ay obstruction each #atient #rior to a"ministration o! this "rug then ta'es an ob?ective e6amination o! the !unction o! #ulmonary !unction& c& Physiothera#y +& Physical e6ercise to im#rove #hysical activity tolerance 7& *ucolytic an" e6#ectorant ;& 0ong5term o6ygen thera#y !or #atients %ho have ty#e II res#iratory !ailure %ith PaO+ (>&7 Pa (.. mm4g .& 8ehabilitation) #atients are li'ely to !in" it "i!!icult to %or') !eeling alone an"

isolate") it is necessary !or sociali$ation to avoi" "e#ression& 8ehabilitation !or COPD #atients is( o 2 Physiothera#y o 2 8ehabilitation #sychic o 2 8ehabilitation ?obs (*ans?oer +,,-( ;@-5;@+ A 1& CO*P0ICATIONS -& 4i#o6emia 4i#o6emia "e!ine" as a "ecrease in PaO + values less than .. mm4g) %ith a value o! o6ygen saturation B@.C& At !irst the client %ill e6#erience changes in moo") "ecrease" concentration an" !orget!ulness& In a"vance" stages arise cyanosis& +& 8es#iratory aci"osis Arise as a result o! the increase in the value o! PaCO+ (hy#erca#nia & Signs that arise inclu"e( hea"ache) !atigue) lethargi) "i$$ines) tachi#nea& 7& 8es#iratory In!ections Acute res#iratory in!ections cause" by increase" mucus #ro"uction) increase" bronchial smooth muscle stimulation an" mucosal e"ema& 0ac' o! air !lo% %ill increase the %or' o! breath an" the onset o! "ys#nea& ;& 4eart !ailure Es#ecially cor5#ulmonale (right heart !ailure "ue to #ulmonary "isease ) shoul" be observe" es#ecially in clients %ith severe "ys#nea& These com#lications o!ten associate" %ith chronic bronchitis) but clients %ith severe em#hysema can also e6#erience this #roblem& .& Car"iac "ysrhythmias Arising !rom hi#o6emia) other heart "isease) "rug e!!ects or res#iratory aci"osis& <& Status asthmaticus Is a ma?or com#lication associate" %ith bronchial asthma& This "isease is very severe) #otentially li!e5threatening an" o!ten "o not res#on" to usual thera#y given& The use o! a res#irator muscles an" "isten"e" nec' veins are o!ten visible& BASIC CONCEPTS OF ND8SIN1 CA8E A& ASSESS*ENT 2 IDENTITE PatientFs name) age) gen"er) marital status) number o! chil"ren) religion) citi$ens) e"ucation) occu#ation) a""ress& 2 4EA0T4 4ISTO8E v The main com#laint v Past me"ical history v !amily me"ical history Data health history o! the "isease #rocessG -& 4o% long has the #atient ha" "i!!iculty breathingH +& Do they im#rove "ys#neaH 7& 4o% much limits the #atientFs activity toleranceH ;& 9hen #atients com#lain most tire" an" short o! breathH .& Is eating an" slee#ing habits a!!ecte"H <& 4istory o! smo'ingH

>& The "rugs use" every "ayH @& The "rugs use" in the acute attac'H /& 9hat is 'no%n about the #atientFs con"ition an" "iseaseH A""itional "ata %ere collecte" through observation an" e6amination as !ollo%s( -& The #atientFs #ulse rate an" breathingH +& Do the same %ith no res#iratory e!!ortH 7& Is there a contraction o! the ab"ominal muscles "uring ins#irationH ;& Is there any use o! accessory res#iratory muscles "uring breathingH .& Barrel chestH <& Does it seem cyanosisH >& Is there a coughH @& Are there #eri#heral e"emaH /& Is the nec' veins a##ear enlarge"H -,& 9hat color) amount an" consistency o! s#utum o! #atientsH --& 9hat is the status o! #atients sensoriumH -+& Is there an increase in stu#orH An6iety -7& 8esults o! "iagnostic tests such as( -& Chest I58ay( may in"icate lung hi#erin!lation) !lattene" "ia#hragm) increase" retrosternal air s#ace) "ecrease vascular signs = bullae (em#hysema ) an increase in the !orm o! bronchovas'ular (bronchitis ) normally !oun" "uring #erio"s o! remission (asthma +& 0ung Function E6amination( #er!orme" to "etermine the cause o! "ys#nea) "etermine %hether the !unction abnormalities "ue to obstruction or restriction) estimating the level o! "ys!unction an" to evaluate the e!!ects o! thera#y) eg broncho"ilator& 7& T0C( increase" in severe bronchitis an" usually on asthma) "ecrease" in em#hysema& ;& Ca#acity Ins#iration( "ecrease" in em#hysema .& FE:-=F:C( #ressure ratio e6#iratory volume (FE: against the #ressure o! vital ca#acity (F:C "ecrease" in bronchitis an" asthma& <& AB1s( sho%e" a chronic "isease #rocess) o!ten PaO + "ecrease" an" PaCO+ normal or increase" (chronic bronchitis an" em#hysema but o!ten "ecrease" in asthma) the normal #4 or aci"osis) res#iratory al'alosis secon"ary to hy#erventilation light (mo"erate em#hysema or asthma & >& Bronchogram( sho%e" "ilatation o! the bronchi can be ins#iration) 'olla#s bronchial e6#iratory #ressure (em#hysema ) enlargement o! mucous glan"s (bronchitis @& Com#lete bloo"( increase in hemoglobin (severe em#hysema ) an increase in eosino#hils (asthma & /& Bloo" Chemistry( al#ha -5antitry#sin is ma"e to the #ossibility o! less on #rimary em#hysema& -,& S#utum culture(

to "etermine the #resence o! in!ection) i"enti!y the #athogen) cytologic e6amination to "etermine malignancy or allergic "isease& --& EC1( 8ight a6is "eviation) P %ave height (%eight asthma ) atrial "ysrhythmias (bronchitis ) gel& P in 0ea"s II) III) A:F length) height (bronchitis) em#hysema ) J8S a6is vertical (em#hysema -+& E6ercise EC1) Stress Test( hel# assess the "egree o! res#iratory "ys!unction) evaluate the e!!ectiveness o! broncho"ilator "rugs) #lan = #rogram evaluation& Pal#ation( -& 8e"uction in the "evelo#ment o! breast #al#ationH +& Is there "ecrease" tactile !remitusH Percussion( -& Is there hi#eresonansi on #ercussionH +& The "ia#hragm moves ?ust a little bitH Auscultation( -& Is there a lou" %hee$ing soun"H +& Is there ron'hi soun"H 7& Nomal or "ecrease" vocal !remitusH A& Nursing Diagnosis -& Ine!!ective air%ay clearance relate" to bron'o'ontri'si) increase" s#utum #ro"uction) ine!!ective cough) !atigue = energy re"uction an" broncho#ulmonary in!ections& Ob?ective( Achievement o! client air%ay clearance Nursing interventions( -& 1ive #atients < to @ glasses o! !lui" = "ay unless there is a cor #ulmonale& +& Teach an" encourage the use o! "ia#hragmatic breathing an" coughing techni3ues& 7& Assist in the #rovision o! action nebuli$er) metere" "ose inhaler) or IPPB ;& Per!orm #ostural "rainage %ith #ercussion an" vibration in the morning an" evening suit is re3uire"& .& Instruct the #atient to avoi" irritants such as cigarette smo'e) aerosols) tem#erature e6tremes) an" smo'e& <& Teach about the early signs o! in!ection shoul" be re#orte" to your "octor imme"iately( increase" s#utum) change in color o! s#utum) s#utum viscosity) increase" shortness o! breath) chest tightness) !atigue& >& Beria'n antibiotics as re3uire"& @& Encourage #atients to immuni$e against in!luen$ae an" Stre#tococcus #neumoniae& +& Im#aire" gas e6change relate" to ventilation #er!usion ine3uality Ob?ectives( Im#rovements in gas e6change Nursing interventions( -& Detection o! bronchos#asm auscultation& +& *onitor the clientFs "ys#nea an" hy#o6ia&

<

7& Beria'n bron'o"ialtor "rugs an" corticosteroi"s a##ro#riately an" alert the #ossibility o! si"e e!!ects& ;& 1ive aerosol thera#y be!ore meals) to hel# thin secretions so the im#rove" lung ventilation& .& *onitor the a"ministration o! o6ygen& <& 1ive #en'es o! thera#y given& 7& Activity intolerance relate" to imbalance bet%een o6ygen su##ly nee"s& Pur#ose( Sho%s the #rogress at a higher level o! activity #ossible& Nursing interventions( -& Assess the in"ivi"ualFs res#onse to the activityG #ulse) bloo" #ressure) breathing& +& *easure vital signs imme"iately a!ter the activity) client rest !or 7 minutes an" then measuring vital signs again& 7& Assess the #atientFs level o! !unction o! the latter an" "evelo# training #lans base" on the status o! the basic !unctions& ;& 8ecommen" consulting %ith a #hysical thera#ist to "etermine the e6ercise #rogram s#eci!ic to the #atientFs ability& .& Provi"e o6ygen as necessary be!ore an" "uring running activity ?ust in case& <& Increase activity gra"uallyG client being #rolonge" be" rest or start "oing range o! motion at least + times a "ay& >& Increase tolerance to the activity by encouraging clients slo%er activity) or a shorter time) %ith more rest or %ith a lot o! hel#& ;& 8is' o! changes in nutrition less than bo"y re3uirements relate" to "ys#nea) %ea'ness) me"ication si"e e!!ects) s#utum #ro"uction an" anore6ia) nausea an" vomiting& Ob?ective( Nutritional nee"s o! clients are met& Nursing interventions( -& Assess "ietary habits) !oo" inta'e at this time& Note the "egree o! "i!!iculty eating& Evaluation o! bo"y %eight an" bo"y si$e& +& Auscultation o! bo%el soun"s 7& Provi"e !re3uent oral care) remove secretions& ;& Push the !irst hour rest #erio" be!ore an" a!ter meals& .& Or"er so!t "iet) small #ortions !re3uently) "o not nee" to be che%e" longer& <& Avoi" !oo"s that are e6#ecte" to #ro"uce gas& >& 9eigh %eight #er "ay as in"icate"& .& Disru#tion o! slee# #atterns associate" %ith "iscom!ort) setting #osition& Ob?ective( Slee# nee"s are met Nursing interventions( -& 4el# clients rela6ation e6ercises in be"& +& Per!orm #engusa#an bac' %hile he %as slee#ing an" encourage !amilies to ta'e these actions& 7& Set a com!ortable #osition be!ore be") usually high Fo%lerFs #osition& ;& Per!orm sche"uling be"time habits to suit the #atient& .& Provi"e snac's be!ore be" i! the client is %illing& <& 0ac' o! sel!5care associate" %ith !atigue secon"ary to an increase in res#iratory

>

e!!ort an" ventilation an" o6ygenation insu!!iciency& Ob?ective( In"e#en"ence in sel!5care activities Intervention( -& *onitor #atient hygiene +& Encourage clients to sho%er) get "resse") an" %al' in close 3uarters) resting as nee"e" to avoi" e6cessive !atigue an" "ys#nea& 7& Assist #atients in sel!5care ;& 1ive #en'es about the im#ortance o! sel!5care& >& An6iety relate" to the threat to sel!5conce#t) the threat o! "eath) the #ur#ose o! %hich is not being met& Ob?ective( The client "oes not ha##en an6iety Nursing interventions( -& 4el# the client to tell the an6iety an" !ear o! nurses& +& Do not leave the #atient alone !or e6#eriencing shortness& 7& E6#lain to !amilies the im#ortance o! assisting clients %hen e6#eriencing shortness& ;& 1ive s#iritual cleansing