COPD/PNARN Strong

Jen Denno RN, BSN, CEN

Epidemiology

COPDEmphysemaChronic Bronchitis

Treatments•Mild COPD is usually treated with short-acting

bronchodilators, which are used as needed for dyspnea.•Moderate COPD requires regular treatments with

bronchodilators, sometimes with the addition of inhaled corticosteroids. At this stage, patients are often enrolled in a pulmonary rehabilitation program.

•Severe COPD typically requires two or more bronchodilators regularly. Inhaled corticosteroids are added to the regimen to prevent repeated acute exacerbations.

•Very severe COPD usually needs the addition of long-term oxygen therapy. Surgical treatments can be appropriate at this stage.

Pulmonary Rehab

Patient teaching

ComplicationsChronic inflammation initiates a generalized

prothrombotic condition in the circulation. This makes blood clots more likely to form, and patients with COPD are at increased risk for developing myocardial infarctions, strokes, deep-vein thromboses, and pulmonary emboli.

In addition, people with COPD have a high incidence of clinical depression. The depression is not only a psychological reaction to their increasingly restricted lifestyles. The metabolic and inflammatory changes of COPD make depression more likely biochemically.

Reference:http://www.nursingceu.com/courses/297/

index_nceu.html

Complications:Pulmonary hypertension Destroys lung capillaries Thickens the walls of small pulmonary blood vessels Constricts lung arteries due to chronic hypoxia and acidemia Constricts lung arteries due to the physical pressure of hyperinflated lungs

These changes increase the arterial resistance inside the lungs. More force is needed to push blood through the lungs, and the person develops pulmonary hypertension. In a normal adult lung, the mean pulmonary artery pressure is <16 mm Hg. In a lung with pulmonary hypertension, the mean pulmonary artery pressure is >20 mm Hg.

Pulmonary hypertension is especially hard on the right ventricle of the heart, which hypertrophies in response. As the strain on the right ventricle persists, the heart can fail. Heart failure secondary to lung problems is called cor pulmonale, and COPD is the leading cause of cor pulmonale (Weitzenblum & Chaouat, 2009).

http://www.ispub.com/journal/the-internet-journal-of-pulmonary-medicine/volume-7-number-2/utility-of-total-face-mask-in-a-copd-patient.article-g02.fs.jpg

Updates

Breathing training

Dynamic images collected using a sliding window radial sequence; the time interval between displayed images is 0.5s. Top row: healthy normal subject, from the first part of an inhalation of 300 ml of He3 polarized to 40%. Bottom row: COPD patient showing regions of ventilation obstruction in both lungs, particularly in the upper lobes, and a delayed emptying/depolarization of gas in the lower left lobe which could be indicative of air trapping.