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COPD
Encompasses pulmonary emphysema and chronic bronchitis |
Not reversible |
PULMONARY EMPHYSEMA
Destruction of alveoli, narrowing of bronchioles, and trapping of air resulting in loss of lung elasticity |
CONTRIBUTING FACTORS
Cigarette smoking (main causative factor) |
Exposure to air pollution |
Passive smoke inhalation |
Alpha-antitrypsin deficiency (inability to break down pollutants) |
Advanced age |
Occupational dust and chemical exposure |
MANIFESTATIONS
Dyspnea w/ productive cough |
Fatigue |
Difficult exhalation, use of pursed lip breathing |
Clubbed fingernails |
Wheezing |
Weight loss |
Crackles |
Respiratory acidosis w/ hypoxia |
Barrel chest |
Shallow, rapid respirations |
CHRONIC BRONCHITIS
Inflammation and hyper secretions of mucus in the bronchi and bronchioles caused by chronic exposure to irritants |
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CONTRIBUTING FACTORS
Cigarette smoking (main causative factor)) |
Exposure to air pollution and other environmental irritants |
MANIFESTATIONS
Productive cough |
Thick, tenacious sputum |
Hypoxemia |
Respiratory acidosis w/ hypoxia |
DIAGNOSTIC PROCEDURES FOR COPD
Chest x-ray |
Pulmonary function tests: air remains trapped in lungs |
Pulse oximetry: often less than 90% |
ABGs: Chronic respiratory acidosis |
Computed tomography (CT) |
NURSING INTERVENTIONS
Monitor respiratory status |
Monitor cardiac status for signs of right-sided failure |
Position pt upright and leaning forward |
Schedule activities to allow for frequent rest periods |
Administer oxygen therapy as prescribed |
Use incentive spirometry, breathing techniques, & effective coughing |
Encourage fluids 2-3 L/day unless contraindicated |
Encourage a high calorie diet |
Provide emotional support |
Reinforce teaching about immunizations for pneumonia & influenza |
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MEDICATIONS
Bronchodilators |
Beta-adrenergic agents |
Cholinergic antagonists |
Corticosteroids |
Methylxanthine |
Anti-inflammatory agents |
Mucolytic agents |
THERAPEUTIC MEASURES
Chest physiotherapy/pulmonary drainage |
Lung reduction surgery |
CLENT EDUCATION & REFERRAL
Breathing techniques |
Oxygen therapy |
Medications |
Nutrition |
Refrain from smoking |
Infection prevention measures |
Pulmonary rehabilitation |
Activity pacing |
COMPLICATIONS OF COPD
Cor pulmonale |
Carbon Dioxide Toxicity |
Pneumonia |
Tuberculosis |
Laryngeal Cancer |
Lung Cancer |
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