MDC 3 week5

CHRONIC OBSTRUCTIVE PULMONARY DISEASE

WHAT IS CHRONIC OBSTRUCTIVE PULMONARY DISEASE? Chronic obstructive pulmonary disease (COPD) is an irreversible disease encompassing emphysema and chronic bronchitis (2). Emphysema is the loss of lung elasticity and hyperinflation of lung tissue caused by the destruction of alveoli (2). This then leads to decreased surface area for gas exchange, carbon dioxide retention, and respiratory acidosis (2). Chronic bronchitis is the inflammation of the bronchi and bronchioles due to long term exposure to irritants. This can result in increased mucous production and a chronic cough (2).

RISK FACTORS OF COPD

Advanced age: Adults over 65 years old have decreased lung capacity due to age-related changes (2) Cigarette smoking: Primary risk factor for developing COPD (2) Genetic Factor: Alpha-1-antitrypsin (AAT) is a recessive gene that increases likelihood of COPD at a young age as it results in AAT deficiency (2) Exposure to environmental factors such as air pollution (2)

Risk factors of COPD include:

PRIORITY TREATMENTS One priority treatment is to ensure adequate gas exchange by utilizing breathing techniques such as using abdominal breathing and breathing through pursed lips (2). The client should also be instructed on proper use of oxygen therapy such as adhering to prescribed dose and avoiding flames while on oxygen including smoking (2). A second priority treatment is ensuring adequate nutrition to prevent excessive weight loss. This can be achieved by eating small frequent meals, eating meals high in calories and protein, resting before meal times, and decreasing fluid intake with meals (2). A third priority treatment is to ensure adequate endurance for daily activities. A short-acting bronchodilator can be used prior to exerting oneself, utilizing frequent rest periods to increase activity tolerance, performing activities while sitting down, and utilizing positions to enhance breathing such as sitting in a tripod position (2).

INTERPROFESSIONAL CARE TEAM MEMBERS Treatment for COPD patients requires a multidimensional approach involving professionals from different fields working collaboratively. Respiratory therapists will provide services for inhalers, breathing treatments, and suctioning for airway management (2). Dietitians will provide nutritional services to ensure the patient is receiving adequate nutrition and not gaining or losing weight related to medications or diagnosis (2). Occupational therapists will assist the patient in accomplishing daily tasks that are more difficult due to the characteristics of COPD (2). Physical therapists will help the client gain strength and stamina that has been lost related to COPD (2). Home services are also critical to the care team as they ensure a safe environment and necessary services such as oxygen therapy to the patient when he or she returns home (2). A social worker is can assist with financial needs as respiratory treatments can be costly (2). A case manager is also encouraged to facilitate unified care (2).

A L O W E R R E S P I R A T O R Y D I S E A S E

NURSING CARE STRATEGIES One nursing care strategy includes administering medications such as short-acting bronchodilators, long-acting bronchodilators, and glucocorticoids to open the clients airways through bronchodilation and reduction of inflammation (2). Proper medication administration can decrease signs and symptoms of COPD leading to a better prognosis (2). A second nursing care strategy includes teaching proper oxygen therapy use (2). Individuals with COPD use carbon dioxide levels to trigger their body's respiratory system, unlike individuals without COPD that use oxygen as a trigger (2). Increasing a prescribed dose of oxygen therapy and decrease the person's drive to breath (2). A third nursing care strategy is to teach the client breathing exercises and proper body positioning to increase oxygenation not increasing oxygen therapy (2). For example, individuals should take slow deep breaths, abdominal breathing, and breath through pursed lips (2). Individuals with COPD should also utilize the tripod position which is sitting leaning forward with hands on knees to open the chest cavity (2).

NATIONAL ORGANIZATIONS The COPD Foundation was established to advocate for more effective and affordable treatments for those with COPD (1). It also seeks to expand services and improve the well- being of those with COPD (1). Individuals with COPD can join the COPD Foundation for community support, resources, and education at https://www.copdfoundation.org/.

C O N T A C T A L O C A L P H Y S I C I A N W I T H Q U E S T I O N S O R C O N C E R N S R E G A R D I N G C O P D .

R E F E R E N C E S

COPD Foundation. (2020). Take action today. Breathe better tomorrow Retrieved from https://www.copdfoundation.org/ Rebar, C. R., Ignatavicius, D. D., & Workman, M. L. (2018). Medical-Surgical Nursing: Concepts for interprofessional collaborative care (9th ed.). St. Louis: Elsevier.

1.

2.