Chronic Obstructive Pulmonary Disease
Chronic Obstructive Pulmonary Disease
Chronic Obstructive Pulmonary Disease (COPD) is an irreversible debilitating disease of the airway that is currently the fourth leading cause of death in the United States and is rising. Chronic obstructive pulmonary disease is treatable but currently there is no known cure and it is a major cause of morbidity and mortality. COPD causes reduction in airflow during the ventilation cycle due to the loss of air way elasticity, narrowing of the airways, chronic airways inflammation and over active mucous production (Frace, 2008). Known risk factors for development of COPD include tobacco use (including second hand smoke), air pollution, dust and exposure to chemicals used in the production of coal, cotton and grain. There are many complications of COPD, the most common are pneumonia, pneumothorax, cor pulmonale, atelectasis, and in severe cases there maybe respiratory insufficiency and failure (Bare, Cheever, Hinkle, & Smeltzer, 2010). Nursing management for a patient with chronic obstructive pulmonary disease begins with assessment; gathering information from the patient including detailed medical history, present symptoms and evaluate findings of diagnostic tests. Symptoms vary with each patient, but may include chronic cough, clubbing of the fingers, chest tightness, weight loss, cyanosis, difficulty breathing with a higher rate of respirations and difficulty sleeping (Weber, 2008). It is common for patients suffering from difficulty breathing to use their accessory muscles to promote more efficient breathing which in turn causes weakness and fatigue. Patients further along in the disease process often are barrel-chested with kyphosis due to over inflation of the lungs caused by the inability to fully exhale (Bare, Cheever, Hinkle, & Smeltzer, 2010). In diagnosing a patient with chronic obstructive pulmonary disease many different test are available, including pulmonary function tests, arterial blood gas measurements, chest x-ray, high-resolution computed tomography (CT) chest scan and screening for alpha1-antitrypsin deficiency (Frace, 2008). Spirometry is an example of a pulmonary function test and is used to help confirm the diagnosis of chronic obstructive pulmonary disease, determine the severity of the disease and to monitor the progression of the disease. Arterial blood gas measurements are used to monitor oxygenation levels in the lungs and gas exchange because hypoxia may result from pulmonary secretions and respiratory fatigue. Chest x-rays are typically used to rule out any other conditions that may mimic similar symptoms of chronic obstructive pulmonary disease, particularly asthma which was previously classified as a form of COPD. Alpha1-antitrypsin protects the lungs from neutrophil elastase enzymes which can disrupt the connective tissue in the lungs, any deficiency in Alpha1-antitrypsin is a known cause of COPD (Bare, Cheever, Hinkle, & Smeltzer, 2010). Common nursing diagnosis for a COPD patient include ineffective airway clearance due to thick mucus secretions, decreased ciliary function, lack of energy, bronchospasms, damage to the alveolar wall and impaired exhalation evidenced by unrelenting cough, wheezing, difficulty breathing with activity and abnormal vital signs. Impaired gas exchange due to increased upper and lower airway resistance, over production of secretions, bronchoconstrictions, increased residual volume and loss of elasticity in lung tissue evidenced by difficulty breathing, abnormal arterial blood gas values, restlessness and confusion. Risk for infection related to decreased ciliary function, poor nutrition, over active secretions and a impaired pulmonary defense system evidenced by elevated white blood cell count, fever, chills, increased cough and changes in sputum color and odor. Imbalanced nutrition: less than body requirements possibly related to the poor...
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Frace, M. (2008, July). Understanding Chronic Obstructive Pulmonary Disease. Med - Surg Matters, 17(4), 8-10. Retrieved April 2, 2010, from ProQuest Nursing & Allied Health Source. (Document ID: 1629171571).
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