Is a term that to group of conditions characterized by continued increased resistance to expiratory airflow. C.O.P.D includes chronic Bronchitis & pulmonary emphysema.

Is a chronic inflammation of lower respiration tract characterized by :

Excessive mucous secretion.Cough.Dyspnea associated with recurring infection of the lower respiratory tract.

Is a complex lung disease characterized by:

Destruction of the alveoli.Enlargement of distal airspace.

Breakdown of alveolar wall.

Excessive secretion of muocus and chronic infection within the airway “ infection, bronchitis, irritation, hypersensitivity”

Lead to

Local hyperemia

Hypertrophy of muocus gland

Increase in sizn and number of mucous producing elements in bronchi

“ mucous glands & goblet cells”

Inflammation and edema

Narrowing and obstruction of air

Increase in size of airspace distal to the terminal bronchioles

Loss of alveolar wall “ elastic recoil of the lung”

Emphysema

Cigarette smoking.Air pollution, occupational exposure

Allergy, Autoimmunity InfectionGenetic predisposition & aging

A- chronic bronchitis:Usually insidious developing over a period of years.

productive cough lasting at least 3 months a year for 2 successive years.

Production of thick, gelatinous sputum which increased during superimposed

Wheezing and dyspnea as disease progressive

B- Emphysema “ pulmonary emphysema”

gradual onset and steadily progressive

Dyspnea decrease exercise tolerance Cough may be minimal except with respiratory infection

Sputum expectoration mildIncreased anterio-posterior diameter of chest “barrel chest”

1. Respiration force technique “RFT” demonstrate airflow obstruction

Reduce Force Expiration Volume “FEV” to

Force Vital capacity “FVC”2. ABGs show : decreased PaO2, PH, and Increased PaCO23. Chest x-ray : hyperinflation, flattened diaphragm increased retrosternal space 4. Alpha antitrypsin “Genetically” deficiency in Genetic pulmonary

emphysema.

Goal: Reverse airflow obstruction1. Stopped of smoking2. Bronchodilators drug3. Antibiotics for respiratory infection4. Corticosteroid used in acute exacerbation

for anti-inflammatory effect5. Chest physical therapy “ postural drainage,

breathing retraining6. Low flow oxygen therapy for patient with

sever hypoxemic 7. Pulmonary rehabilitation to reduce

symptoms that limit activity

When pt with COPD need Mechanical Ventilation:

Pt with COPD may need mechanical ventilation if he / she have of sign & symptoms:

1. Restlessness 2. Aggressiveness3. Anxiety 4. Irritability5. Confusion6. Disoriented7. Central cyanosis8. Shortness of breathing at rest All of these sign & symptoms may

signal for respiratory failure

Decrease PaO2 more than 55%

Decrease PH more than 7.2

Increase PaCo2 more than 50%

pneumoniaRespiratory failure Right heart failure, dysrrhythaias

DepressionMechanical ventilation depenancy

Nursing assessment Smoking Exposure history to drug, occupational or air

pollution. Note amount, color & consistency of sputum. Inspect for use of accessory muscle. chest muscle, neck muscle, abdominal

muscle, “abdominal muscle used during expiration.

Note barrel chest. Auscultation for decreased/ absent of breathing. Decreased heart function. Ask for heart disease.

1- Improve airway clearance a) Removing all pulmonary irritant “stop

smoking, pt’s room free from dust”.b) Administer bronchodilator.c) Use postural drainage.d) Keep secretion liquid by: - highly of fluid intake - inhalation of nebuliger intake - avoid irritant drug if these it

increase sputum secretione) Good suctioning with sterile technique it pt

on mechanical ventilation.

2- improve breathing patterna) Teach pt to make breathing retaining exercise to

stregth diaphragm and muscle expiration.b) Teach pt to use: low costal, diaphragmatic muscle ,

abdominal breathing in slow way. “slow in relaxed breathing to reduce respiratory rate & decrease energy cost of breathing”.

c) Teach pt for relaxation exercise to reduce stress, tension, & anxiety.

d) Teach pt to make comfortable position to decrease dyspnea.

e) Monitor ABG & CO2 level to manipulate Mechanical ventilation as needed if pt intubated.

3- Control infectiona) Recognized early manifestation of

respiratory infection “ increased dyspnea, fatigue, change in color, amount & character of sputum, fever”.

b) Obtain sputum culture and antibiotic as culture.

c) To prevent secondary infection in bronchial tree.

d) Good & sterile suctioning if pt incubation.

4- Improve Gas exchangea) report restlessness, aggressive,

anxiety, confusion, shortness of breathing a rest, central cyanosis which indicate to acute respiratory insufficiency & may signal respiratory failure.

b) Review ABGs.c) Give low flow oxygen as prescribed.d) If CO2 retention occur seek for

incubation Mechanical ventilation.

5- Improving nutritiona) Ask about nutritional history & weight.b) Encourage to frequent small meals if pt is

dyspnea, because heavy meal increase abdominal contents may press in diaphragm and impede breathing.

c) Offer liquid nutritional supplements to improve caloric intake & counteract weight loss.

d) Avoid foods producing abdominal discomfort.e) Encourage pursed-lip breathing between bites

if pt is dyspnicf) Give oxygen supplemental.

6- Increase activity intolerancea) Arrange for exercise regimen & physical

condition programs.b) Enhance delivery of oxygen to tissue.c) Allows a higher level of functioning with

greater comfort.7- Improving sleep pattern a) Maintain a balanced schedule of activity

and rest.b) Use oxygen therapy.c) Avoid the use of sedatives that may cause

respiratory depression.

8- Enhancing copinga) Understand that the shortness of breathing &

fatigue make pt irritable, anxious, depress & feeling with helpless / hopelessness

b) Demonstrate a positive and interested approach to pt.

- Be good listener & show that you care.

- Be sensitive to pt fears, anxiety, depression.

c) Strength the pt self imaged) Allow to the pt to express feeling.e) Support the family members.

A. General education : - Explain of disease for pt & family “

expect, treat & live” - Review with pt the goal of treatment. - Work with pt to set Goals.B. Avoid exposure to respiratory irritant.C. Prevent & treat respiratory infection - Avoid to exposure to person with

respiratory infection. - Avoid crowds with poor ventilation. - Advise pt how to recognize & report

evidence of respiratory infection “ amount, color, consistency of sputum”.

D) Reduce bronchial secretions: - Maintain an adequate fluid

intake. - Use bronchodilators - Teach about postural

drainage exercise every position from 5 to 15 min.