Professional Documents
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NCM 106
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August 26,2018
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Table of Contents
I. Definiton 3-5
VII. References 24
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I. Definition
breathlessness. COPD is a progressive and (currently) incurable disease, but with the
right diagnosis and treatment, there are many things you can do to manage
your COPD and breathe better. People can live for many years with COPD and enjoy
life.
In Emphysema the tiny, delicate air sacs (alveoli) in your lungs are damaged.
The walls of the damaged air sacs become stretched out and your lungs actually get
bigger, making it harder to move your air in and out. Old air gets trapped inside the
alveoli so there is little or no room for new air to go. In emphysema it is harder to get
oxygen in and carbon dioxide (the waste product of your breathing) out. Chronic
lungs. Tiny hair-like structures (cilia) line your airways and sweep mucus up, keeping
your airways clean. When cilia are damaged, they can’t do this, and it becomes harder
for you to cough up mucus. This can make your airways swollen and clogged. These
changes limit airflow in and out of your lungs, making it hard to breathe. Refractory
(non-reversible) asthma is a type of asthma that does not respond to usual asthma
can usually reverse this, opening up the airways and returning them to how they were
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before the asthma attack. In refractory asthma, medications cannot reverse the
Most cases of COPD are caused by inhaling pollutants; that includes tobacco
smoking (cigarettes, pipes, cigars, etc.), and second-hand smoke. Fumes, chemicals
and dust found in many work environments are contributing factors for many individuals
who develop COPD. Genetics can also play a role in an individual’s development
of COPD even if the person has never smoked or has ever been exposed to strong lung
irritants in the workplace. COPD most often occurs in people 40 years of age and older
who have a history of smoking. These may be individuals who are current or former
smokers. While not everybody who smokes gets COPD, most of the individuals who
have COPD (about 90% of them) have smoked. However, only one in five smokers will
get significant COPD. Researchers are trying to find out why some smokers
get COPD and others don’t. (learn more about the COPD PPRN research study.) It is
very important to quit smoking if you haven’t! Quitting smoking helps slow the disease. It
makes treatment more effective. COPD can also occur in those who have had long term
exposure and contact with harmful pollutants in the workplace. Some of these harmful
lung irritants include certain chemicals, dust, or fumes. Heavy or long-term contact with
secondhand smoke or other lung irritants in the home, such as organic cooking fuel,
may also cause COPD. Individuals who have worked for many years around these
extended period of time, they can still develop COPD. Alpha-1 Antitrypsin Deficiency
(AATD) is the most commonly known genetic risk factor for emphysema2. Alpha-1
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Antitrypsin related COPD is caused by a deficiency of the Alpha-1 Antitrypsin protein in
the bloodstream. Without the Alpha-1 Antitrypsin protein, white blood cells begin to
harm the lungs and lung deterioration occurs. The World Health Organization and the
American Thoracic Society recommends that every individual diagnosed with COPD be
tested for Alpha-1. For more information about AATD and how to get tested, visit
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II. Signs and Symptoms
At first, COPD may cause no symptoms or only mild symptoms. As the disease gets
worse, symptoms usually become more severe. Common signs and symptoms of
COPD include:
An ongoing cough or a cough that produces a lot of mucus; this is often called
smoker's cough.
Chest tightness
If you have COPD, you also may often have colds or other respiratory infections such
Not everyone who has the symptoms described above has COPD. Likewise, not
everyone who has COPD has these symptoms. Some of the symptoms of COPD are
similar to the symptoms of other diseases and conditions. Your doctor can determine if
If your symptoms are mild, you may not notice them, or you may adjust your lifestyle to
make breathing easier. For example, you may take the elevator instead of the stairs.
Over time, symptoms may become severe enough to cause you to see a doctor. For
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The severity of your symptoms will depend on how much lung damage you have. If you
keep smoking, the damage will occur faster than if you stop smoking.
Severe COPD can cause other symptoms, such as swelling in your ankles, feet, or legs;
Some severe symptoms may require treatment in a hospital. You—or, if you are unable,
family members or friends—should seek emergency care if you are experiencing the
following:
Your lips or fingernails turn blue or gray, a sign of a low oxygen level in your
blood.
People around you notice that you are not mentally alert.
The recommended treatment for symptoms that are getting worse is not working.
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III. Laboratory tests and Diagnostic Tests
A spirometry test measures how well your lungs are working. It’s a simple and
A person may have Chronic Obstructive Pulmonary Disease (COPD) but not notice
symptoms until it is in the moderate stage. This is why it’s important to ask your doctor
about taking a spirometry test if you are a current or former smoker, have been exposed
to harmful lung irritants for a long period of time, or have a history of COPD in your
Spirometry is a simple, non-invasive test that is used to diagnose COPD. When you
take the test, you will be asked to blow all the air out of your lungs into a mouthpiece
The machine will calculate two numbers: the amount of air you blow out in the first
second, and the amount of air you blow out in 6 seconds or more.
These numbers are represented as FEV1 and FVC (sometimes FEV6 is used). FEV1
stands for the Forced Expiratory Volume in the first second—the amount of air you
exhaled in the first second of blowing. FVC stands for Forced Vital Capacity—the
A spirometry test can also show your doctor how severe your COPD may or may not
be. There are several stages of COPD. The extent of your COPD is classified into 4
different stages that are defined by your symptoms and the results of your Spirometry
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Test. The stages do not determine how long you can expect to live, or in many cases
how drastically your symptoms are affecting your quality of life. The stages are
determine what stage you are in, your pulmonologist, based on your symptoms, may
People with COPD have an FEV1/FEV6 (FVC) ratio less than 70%. The
FEV1 percentage predicted indicates how severe the airways are obstructed (blocked or
narrowed).
Less than 80% of predicted is considered moderate COPD, and less than 50% of
predicted is severe. People with asthma will have a low FEV1/FEV6 ratio when they are
having an attack, and then will return to normal or almost normal after using fast-acting
medications.
Your doctor may order additional tests to see if your symptoms are caused by lung
determines if your lung function improves significantly with medication.Your doctor may
also order a chest x-ray or a chest CT (high resolution computed tomography), which
shows your lungs in much greater detail, to see if your symptoms are brought on by
If you have any of these symptoms, you are at risk for developing COPD.
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Has a history of smoking
smoke)1
Has wheezing
undertreated may cause them to worsen faster than if they were treated with proper
medication and therapy. Many adults are incorrectly diagnosed with asthma. Providing a
proper diagnosis means individuals will receive the right treatments and follow up
monitoring. There’s no cure yet for COPD but treatments are available to help
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IV. Pathophysiology
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Emphysema Chronic Bronchitis
the alveolar walls and the septae. A that the major site of
mucus
airways.
12
Pathophysiology Parenchymal destruction: Recurrent Small airway
along with the capillary bed have the airway lumen. Despite
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these patients the characteristic oxygenation/deoxygenation
acidosis ensues).
Pulmonary hypertension
vasoconstriction in the
ventricular pressures
eventually causing RV
as cor pulmonale.
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Clinical “Pink puffer” – type A “Blue bloater” – type B
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inadequate oral intake as well as obstruction. Compared to
wasting. mucus/hypertrophy in
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V. Medical Management
COPD has no cure yet. However, lifestyle changes and treatments can help you feel
better, stay more active, and slow the progress of the disease.
To assist with your treatment, your family doctor may advise you to see a
Medicines
Bronchodilators relax the muscles around your airways. This helps open your
airways and makes breathing easier. Depending on the severity of your COPD, your
bronchodilators last about 4–6 hours and should be used only when needed. Long-
acting bronchodilators last about 12 hours or more and are used every day. Most
bronchodilators are taken using a device called an inhaler. This device allows the
medicine to go straight to your lungs. Not all inhalers are used the same way. Ask your
health care providers to show you the correct way to use your inhaler. If your COPD is
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mild, your doctor may only prescribe a short-acting inhaled bronchodilator. In this case,
you may use the medicine only when symptoms occur. If your COPD is moderate or
severe, your doctor may prescribe regular treatment with short- and long-acting
bronchodilators.
(STEROIDS)
In general, using inhaled steroids alone is not a preferred treatment. If your COPD is
more severe, or if your symptoms flare up often, your doctor may prescribe a
help reduce airway inflammation. Your doctor may ask you to try inhaled steroids with
the bronchodilator for a trial period of 6 weeks to 3 months to see whether the addition
If you have severe COPD and low levels of oxygen in your blood, oxygen therapy can
help you breathe better. For this treatment, oxygen is delivered through nasal prongs or
a mask.
You may need extra oxygen all the time or only at certain times. For some people who
have severe COPD, using extra oxygen for most of the day can help them: Do tasks or
activities while experiencing fewer symptoms, Protect their hearts and other organs
from damage, Sleep more during the night and improve alertness during the day, and
Live longer.
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DRUG STUDY (EXAMPLE OF A BRONCHODILATOR)
of diskus.
Monitor use
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of more than
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VI. Nursing Management
Subjective:
Objective:
Increased RR – 29
With crackles
Nursing Diagnosis
Planning
Short Term:
Long Term:
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After 1 day Pt will demonstrate improvement inventilation and adequate
distress.
regimen.
Nursing Interventions
Independent:
Elevate the headof the bed 45○ (semi-fowler’s) position. It maximize lung
expansion
Dependent:
Evaluation
Short Term:
Long Term:
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Patient was able to verbalize in understanding of the disease and its course of
treatment
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VII. References:
http://www.pathophys.org/copd/#Pathogenesis_pathophysiology_and_clinical_features
https://www.nhlbi.nih.gov/health-topics/copd
http://www.who.int/news-room/fact-sheets/detail/chronic-obstructive-pulmonary-disease-
(copd)
https://www.bmj.com/content/332/7551/1202
https://medlineplus.gov/copd.html
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