“Everyone is responsible for his/her own looks after 40”

OBSTRUCTIVE PULMONARY DISORDERS

DICKSON AKANKWATSA {BSN 3}- BISHOP STUART UNIVERSITYcvdicksonakankwatsa@outlook.com

Divided into two:Fully reversible disorders {asthma}, and

Non fully reversible/ partially reversible{ COPD}

Causes1)Smoking2) Occupational exposures- exposure to workplace

dusts found in coal mining, gold mining, and the cotton textile industry and chemicals such as cadmium, and fumes from welding have been implicated in the development of airflow obstruction.

3) Air pollution4) sudden airway constriction in response to inhaled

irritants, 5) Bronchial hyperresponsiveness, is a characteristic

of asthma. 6) Genetics-Alpha 1-antitrypsin deficiency

COPDIn COPD, less air flows in and out of the

airways because of one or more of the following:

The airways and air sacs lose their elastic quality.

The walls between many of the air sacs are destroyed.

The walls of the airways become thick and inflamed.

The airways make more mucus than usual, which tends to clog them.

COPD-not fully reversible- includes 1) Bronchitis 2) EmphysemaBronchitis :-Bronchitis is a condition in which the

bronchial tubes become inflamed.

BRONCHITISChronic bronchitis:It is defined as the presence of cough

and sputum production for atleast 3 months.

PATHOPHYSIOLOGY Irritants irrritate the airway

Hypertrophy of the bronchial tree, and increased mucus production

Inflammation

Cause the mucus secreting glands and goblet cells to increase in number.

Ciliary function is reduced.

More mucus production

Bronchial walls become thickened and lumen narrows and mucus plug the airway

Alveoli adjacent to the bronchioles may

become damaged and fibrosed.

Alter function of alveolar macrophages.

infection

Acute signs and symptoms sore throat, fatigue (tiredness), fever, body aches, stuffy or runny nose, Vomiting & Diarrhea persistent cough cough may produce clear mucus shortness of breath

Chronic symptoms coughing, wheezing, and chest discomfort. The coughing may produce large

amounts of mucus. This type of cough often is called a smoker's cough.

Diagnostic evaluation History - medical history•Whether you've recently had a cold or

the flu•Whether you smoke or spend time

around others who smoke•Whether you've been exposed to dust,

fumes, vapors, or air pollution -

Mucus -to see whether you have a bacterial infection

chest x ray-may show consolidation lung function tests-brianstorm them CBC – significantly, may have

neutrophilia, eosinophilia, reduced Hb levels, etc

MANAGEMENT

medical managementsurgical managementnursing management

MEDICAL MANAGEMENTimprove ventillation1. broncho dilators like beta2

agonists(albuterol),anticholinergics(ipratropium bromide-atrovent).

2. methylxanthines(theophylline,aminophylline)

3. corticosteroids4. oxygen administration

SURGICAL MANAGEMENTbullectomy bullae are enlarged airspaces that do not

contribute to ventillation but occupy space in the thorax,these areas may be surgically excised

lung volume reduction surgery it involves the removal of a portion of the

diseased lung parenchyma.this allows the functional tissue to expand.

lung transplantation

NURSING MANAGEMENTassessmentphysical examinationdiagnosisintervention

Care plan impaired gad exchange related to decreased ventillation and

mucous plugs ineffective airway clearence related to excessive secretion

and ineffective coughing anxiety related to acute breathing difficulties and fear of

suffocation activity intolerence related to inadequate oxygenation and

dyspnoe imbalanced nutrition less than body requirement related to

reduced appetite,decreased energy level and dyspnoea disturbed sleep pattern related to dyspnoea and external

stimuli risk for infection related to ineffective pulmonary clearence

Empysema

Defined pathologically as

dilatation and destruction of the

lung tissue distal to the terminal

bronchiole. It is classified

according to the site of damage:

classification Centri-acinar emphysema. More common .Distension and damage of lung tissue

is concentrated around the respiratory bronchioles; more distal alveolar ducts

and

alveoli tend to be well preserve.

Pan-acinar emphysema. Less common. Distension

and destruction appear to involve the whole of the acinus, and in the

extreme form the lung becomes a mass of bullae. ■ Irregular emphysema. There is scarring and damage affecting the lung

parenchyma patchily without parti cular regard for acinar structure.

 

PathophysiologyCigarette smoking infections

Inactivates antitrypsin

Small airway filled with granulocytes or and neutophils

capable of releasing elastases and proteases

Imbalances in protease and antiprotease activity-

produces damage

Emphysema leads to expiratory airflow limitation and air trapping. The loss of lung elastic recoil results in an increase in TLC while the loss of alveoli results in decreased gas transfer.

Cont…VA/Q mismatch occurs partly because of

damage and mucus plugging of smaller airways from chronic inflam mation, and partly because of the rapid expiratory closure of the smaller airways owing to loss of elastic recoil from emphysema.

In summary, three mechanisms have been suggested for this limitation of airflow in small airways (< 2 mm in diameter).

Loss of elasticity and alveolar attachments of airwaysdue to emphysema. Reduces the elastic recoil andthe airways collapse during expiration.

Inflammation and scarring cause the small airways tonarrow.

Mucus secretion which blocks the airways. All cause narrowing of the small airways and

trapping of air leading to hyperinflation of the lungs and breathlessness.

SignsWheeze tachypnoea prolonged expiration Use of accessory muscles inter costal in-drawing on inspiration pursing of the lips on expiration . Chest expansion is poor lungs hyper-resonant loss of the normal cardiac and liver dullness.

.

Cont… Patients who remain responsive to CO2 are usually: breathless rarely cyanosed. Heart failure and edema in terminal events. Patients who become insensitive to CO2 are often

edematous and cyanosed but not particularly breathless.

Those with hypercapnia may have peripheral vasodilatation. Severe hypercapnia will lead to confusion and progressive drowsiness. At this stage papilledema may be present but is neither specific nor sensitive as a diag nostic feature

Diagnosis a) Historyb) PFTc) Spirometry-to find out airflow

obstruction.d) ABG analysise) CT scan of the lung.f) Screening of alpha antitrypsin

deficiencyg) X-ray radiography may aid in the

diagnosis.

MANAGEMENTmedical managementsurgical management as for bronchitis

nursing management

Complications Respiratory insufficiency Respiratory failure Pneumonia Pneumothorax Pulmonary artery hypertension.

Self management of COPD STAY AWAY FROM INFECTIONS BY MAINTAINING GOOD HYGIENE

QUIT SMOKIN

GEAT A REGULAR BALANCED DIET

• DRINK PLENTY OF PLAIN FRESH WATER ATLEAST 1.5L/DAY

QUESTIONS ????