Chronic Obstructive Pulmonary Disease, or COPD is an umbrella term used to describe a combination of lung diseases. COPD (in the US) most commonly includes two main diseases, Emphysema and Chronic Bronchitis. COPD is a progressive disease that becomes worse over time. There is no known cure for COPD, but treatments are available to maintain quality of life. Chronic Obstructive Pulmonary Disease causes coughing fits that produce large amounts of phlegm as the bronchioles become plugged up with mucus. “COPD is not simply a "smoker's cough" but an under-diagnosed, life-threatening lung disease.” (As stated by the WHO, World Health Organization). Chronic Obstructive Pulmonary Disease affects more than 60 million people worldwide. In 2005 alone, more than 3 million people died from COPD. (2005, WHO) Those most at risk are smokers, women, especially where biomass fuel is used in the home, miners, those with a history of asthma and individuals who are unemployed, lower income, divorced, separated or widowed. Two of the elements most widely interchanged with the term COPD are, Emphysema and chronic bronchitis. These are entirely different diseases with their own diagnosis. Though most health organizations categorize them as COPD or COPD related, some institutions do not.
Chronic Bronchitis is the inflammation and irritation of the lining of the airways (bronchial tubes and bronchioles). Irritation caused by Chronic Bronchitis results in overproduction of mucus, producing obstructions within the bronchi and bronchioles. Coughing up thick mucus is a common occurrence in individuals with chronic bronchitis. The phlegm produced will often be discolored, yellow or brownish, green or even clear, and usually be darker and thicker in the m...
... middle of paper ...
...telephone booth (body plethysmograph) while breathing in and out into a mouthpiece. Changes in pressure inside the box help determine the lung volume.
Lung volume can also be measured when you breathe nitrogen or helium gas through a tube for a certain period of time. The concentration of the gas in a chamber attached to the tube is measured to estimate the lung volume.
To measure diffusion capacity, you breathe a harmless gas, called a tracer gas, for a very short time, often for only one breath. The concentration of the gas in the air you breathe out is measured. The difference in the amount of gas inhaled and exhaled measures how effectively gas travels from the lungs into the blood. This test allows the doctor to estimate how well the lungs move oxygen from the air into the bloodstream.
http://www.goldcopd.org/uploads/users/files/GOLD_Report_2011_Feb21.pdf
Additionally, some of the general diagnostic and pulmonary function tests are distinct in emphysema in comparison to chronic bronchitis. In the case of R.S. the arterial blood gas (ABG) values are the following: pH=7.32, PaCO2= 60mm Hg, PaO2= 50 mm Hg, HCO3- = 80mEq/L. R.S.’s laboratory findings are indicative of chronic bronchitis, where the pH and PaO2 are decreased, whereas PaCO2 and HCO3- are increased, when compare to normal indices. Based on the arterial blood gas evaluation, the physician can deduce that the increased carbon dioxide is due to the airway obstruction displayed by the hypoventilation. Furthermore the excessive mucus production in chronic bronchitis hinders proper oxygenation leading to the hypoxia. On the other hand, in emphysema the arterial blood gas values would include a low to normal PaCO2 and only a slight decrease in PaO2 which tend to occur in the later disease stages.
Bronchospasm is an abnormal contraction of the smooth muscle of the bronchi, narrowing and obstructing the respiratory airway, resulting in coughs, wheezing or difficulty in breathing. The chief cause of this condition is asthma, although it may also be caused by respiratory infection, chronic lung disease or an allergic reaction to chemicals. The mucosa lining of the trachea may become irritated and inflamed, which secretes mucus, causing it to be caught in the bronchi and triggers coughing.
A Peak flow meter is a medical device that measures how well your lungs are able to expel air [2.1]. By blowing rough a mouthpiece a peak expiatory flow (PEF) reading can be found. This reading is measured in litres per minute and can be read directly from the device. When the person’s airways are more closed the lower the rate in which air can be blown out. The peak flow meters are used as a simple and efficient way of monitoring how well your lungs are and see if there functioning properly.
Ascertaining the adequacy of gaseous exchange is the major purpose of the respiratory assessment. The components of respiratory assessment comprises of rate, rhythm, quality of breathing, degree of effort, cough, skin colour, deformities and mental status (Moore, 2007). RR is a primary indicator among other components that assists health professionals to record the baseline findings of current ventilatory functions and to identify physiological respiratory deterioration. For instance, increased RR (tachypnoea) and tidal volume indicate the body’s attempt to correct hypoxaemia and hypercapnia (Cretikos, Bellomo, Hillman, Chen, Finfer, & Flabouris, 2008). The inclusive use of a respiratory assessment on a patient could lead to numerous potential benefits. Firstly, initial findings of respiratory assessment reveals baseline data of patient’s respiratory functions. Secondly, if the patient is on respiratory medication such as salbutamol and ipratropium bromide, the respiratory assessment enables nurses to measure the effectiveness of medications and patient’s compliance towards those medications (Cretikos, Bellomo, Hillman, Chen, Finfer, & Flabouris, 2008). Thirdly, it facilitates early identification of respiratory complications and it has the potential to reduce the risk of significant clinical
Mrs. Jones has a history of COPD. She was already taking albuterol for her illness and it was ineffective when she took it that day. Mrs. Jones had been a smoker but had quit several years ago. According to Chojnowski (2003), smoking is a major causative factor in the development of COPD. Mrs. Jones's primary provider stated that she had a mixed type of COPD. The Global Initiative for Chronic Obstructive Lung Disease (GOLD) was established to address the growing problem of COPD. The GOLD standards identify three conditions that contribute to the structural changes found in COPD: Chronic bronchiolitis, emphysema, and chronic bronchitis. A mixed diagnosis means that the patient has a combination of these conditions (D., Chojnowski, 2003). Mrs. Jones chronically displayed the characteristic symptoms of COPD. "The characteristic symptoms are cough, sputum production, dyspnea on exertion, and decreased exercise tolerance." (D., Chojnowski, 2003, p. 27).
Chronic bronchitis differs from emphysema in that it affects the bronchioles. There are two forms of bronchitis: chronic and acute. We are going to focus on chronic bronchitis. In this disease, the bronchioles become thick and inflamed. The affected person might cough up thick mucus which can also block the bronchioles.
Chronic obstructive pulmonary disease or COPD is a group of progressive lung diseases that block airflow and make it hard to breathe. Emphysema and chronic bronchitis are the most common types of COPD (Ignatavicius & Workman, 2016, p 557). Primary symptoms include coughing, mucus, chest pain, shortness of breath, and wheezing (Ignatavicius & Workman, 2016, p.557). COPD develops slowly and worsens over time if not treated during early stages. The disease has no cure, but medication and disease management can slow its progress and make one feel better (NIH, 2013)
The purpose of this essay is to explore nursing care priorities for a patient with a common health condition. A common health condition is a disease or condition which occurs most often within a population. The author has chosen scenario 3 for this essay and will describe the nursing assessment and care planning provided to a patient with Chronic Obstructive Pulmonary Disease (COPD). The WHO definition of COPD is a lung disease which has a chronic obstruction of the airways that impedes normal breathing and is not fully reversible (). According to), there are estimated to be over 3 million people in the UK with COPD. It is common in later life and there are approximately 25,000 deaths each year, with 15% of COPD being work related (The identity of the patient will remain anonymous in adherence with the Nursing and Midwifery Council, Code of Conduct on patient confidentiality (). However, the patient will be referred to as Mr B in this essay. The author has chosen the priority of eating and drinking for Mr B. Patients with COPD are at increased risk of malnutrition and nurses must make certain they screen patients and offer advice or refer as necessary (). If this priority is managed well it will have a positive effect on the other priorities (, 2012). In accordance with NICE Guideline 101 (), the treatment and care provided should consider each persons’ individual requirements and preference. Care and treatment should take into account people’s individual needs and choices. To allow people to reach informed decisions there must be good communication, supported by evidence-based practice (). This essay will provide an evidence based discussion on how care will be implemented in relation to Mr B and his eating and drin...
Haas, D. F. (1990). The Chronic Bronchitis And EMPHYSEMA. New York,NY: John Wiley and Sons, Inc.
A diagnosis is the first step in coming terms with effective asthma treatments. One way to test for asthma is a physical exam, which is where health professionals ask questions about signs and symptoms, and other possible health issues. Lung function tests can determine the amount of air that moves in and out as you breathe. (Mayo Clinic) Spirometry is another process that estimates the narrowing of bronchial tubes by checking how much air an individual can exhale after a deep breath and how fast the patient breathes out. Peak flow meters are a common test procedure for asthma.1 The peak flow meter is a device that measures how hard you breathe out or exhale. Lower readings on the meter shows a diminished lung capacity resulting in less effective breathing. It is generally a strong signal that an individual's asthma may be getting worse.2 These measurements are taken again after the use of bronchodilators such as Albuterol to open your airways. If the inhaler impr...
When you breathe in, air containing carbon dioxide (CO2) and oxygen (O2) it moves down your trachea; a tunnel containing cartilage and smooth tissue. Air then travels through two hollow tubes called bronchi; narrow branches lined with smooth muscle, mucosal and ringed cartilage to support the structure. The bronchi divide out into smaller tunnels called bronchioles; are small branches 0.5-1mm, lined with muscular walls to help dilate and constrict the airway. At the end of the bronchioles are little air sacs called alveoli; which assist in gas exchange of O2 and CO2. (Eldridge, 2016) Towards the end of alveoli are small blood vessel capillaries. O2 is moved through the blood stream through theses small blood vessels (capillaries) at the end of the alveoli and the CO2 is then exhaled. (RolandMedically,
Chronic obstructive pulmonary disease (COPD) is preventable disease that has a detrimental effects on both the airway and lung parenchyma (Nazir & Erbland, 2009). COPD categorises emphysema and chronic bronchitis, both of which are characterised by a reduced maximum expiratory flow and slow but forced emptying of the lungs (Jeffery 1998). The disease has the one of the highest number of fatalities in the developed world due to the ever increasing amount of tobacco smokers and is associated with significant morbidity and mortality (Marx, Hockberger & Walls, 2014). Signs and symptoms that indicate the presence of the disease include a productive cough, wheezing, dyspnoea and predisposing risk factors (Edelman et al., 1992). The diagnosis of COPD is predominantly based on the results of a lung function assessment (Larsson, 2007). Chronic bronchitis is differentiated from emphysema by it's presentation of a productive cough present for a minimum of three months in two consecutive years that cannot be attributed to other pulmonary or cardiac causes (Marx, Hockberger & Walls, 2014) (Viegi et al., 2007). Whereas emphysema is defined pathologically as as the irreversible destruction without obvious fibrosis of the lung alveoli (Marx, Hockberger & Walls, 2014) (Veigi et al., 2007).It is common for emphysema and chronic bronchitis to be diagnosed concurrently owing to the similarities between the diseases (Marx, Hockberger & Walls, 2014).
Chronic bronchitis is a disorder that causes inflammation to the airway, mainly the bronchial tubules. It produces a chronic cough that lasts three consecutive months for more than two successive years (Vijayan,2013). Chronic Bronchitis is a member of the COPD family and is prominently seen in cigarette smokers. Other factors such as air pollutants, Asbestos, and working in coal mines contributes to inflammation. Once the irritant comes in contact with the mucosa of the bronchi it alters the composition causing hyperplasia of the glands and producing excessive sputum (Viayan,2013). Goblet cells also enlarge to contribute to the excessive secretion of sputum. This effects the cilia that carry out the mechanism of trapping foreign bodies to allow it to be expelled in the sputum, which are now damaged by the irritant making it impossible for the person to clear their airway. Since the mechanism of airway clearance is ineffective, the secretion builds up a thickened wall of the bronchioles causing constriction and increasing the work of breathing. The excessive build up of mucous could set up pneumonia. The alveoli are also damaged enabling the macrophages to eliminate bacteria putting the patient at risk for acquiring an infection.
There are 2 types of breathing, costal and diaphragmatic breathing (Berman, 2015). Costal refers to the intercostal and accessory muscles while diaphragmatic refers to breathing using your diaphragm (Berman, 2015).It is important to understand the two different types of breathing because it is vital in the assessment of the patient. For example, if a patient is suing their accessory muscles to aid in breathing then we can safely assume that they are having breathing problems and use a focused assessment of their respiration. Assessing respiration is fairly straightforward. The patient’s respiration rate can be affected by anxiety so a useful to avoid this is to check pulse first and after you have finished that, while still holding their pulse point, check their respiration rate. Inconspicuous assessment avoids the patient changing their breathing because they know they are being assessed which patients can sometimes do subconsciously. Through textbooks and practical classes I have learned what to be aware of while assessing a patient’s respiratory rate. For example; their normal breathing pattern, if and how their health problems are affecting their breathing, any medications that could affect their respiratory rate and also the rate, depth, rhythm and quality of their breathing (Berman, 2015). The only problem I found while assessing respiration rate was I thought it seemed a bit invasive looking at the