airway obstruction resulting from chronic bronchitis OR emphysema. Obstruction is generally progressive, may be partially reversible & is accompanied by airway hyperreactivity
Cigarette smoking & irritating effects on cells
causes hyperplasia →↑ mucus production & ↓ airway diameter & ↑ difficulty in clearing secretions
How do resipratory tract infections contribute to COPD?
impairs normal defense mechs., makes bronchioles & alveoli more susceptible to injury. Retained secretions provide a medium for their proliferation.
Other contributing factors to COPD
Urban air pollution; occupational pollutants; genetic deficiency in a1-antitrypsin (AAT); smoking greatly exacerbates disease process; aging (decreased elasticity of lungs, thoracic cage & respiratory muscles)
What is a1-antitrypsin (AAT)
normally, it inhibits breakdown of lung tissues by proteolytic enzymes from neutrophils & lymphocytes. If deficient, result allows for destruction of lung tissue.
hyperinflation of alveoli, destruction of alveolar walls, destruction of alveolar capillary walls, narrowed, small airways and loss of lung elasticity
2 types of emphysema
centrilobular (primary area of destruction is in central part of lobule) & panlobular (whole lobule is destroyed)
How does the destruction of alveoli walls ↓ O2 in circulation?
less SA = less O2 diffusion into blood
Chronic bronchitis description
excessive prod. of mucus in bronchi accompanied by a recurrent cough for 3m of the year for 2 consecutive years
Pathologic changes in lung d/t chronic bronchitis
hyperplasia of mucous-secreting glands in trachea and bronchi, increase in goblet cells, disappearance of cilia, chronic inflamm. changes, narrowing of small airways & altered function of alveolar macrophages leading to ↑ bronchial infections
How do the airways frequently get colonized with microorganisms in a patient with chronic bronchitis?
excessive amounts of mucus harbor microorganisms can lead to infections
Biggest difference b/t emphysema and bronchitis in relation to alveoli?
Bronchitis = scarring of alveolar walls Emphysema = destruction of alveolar walls
Clinical Manis emphysema
early sign is dyspnea; underweight
chronic bronchitis clinical manis
freq., prod. cough during winter months (early sign); freq. resp. infections; dyspnea on exertion develops later; bluish-red color of skin; normal weight or heavyset with a ruddy appearance
Polycythemia is a mani of bronchitis; what is it and why does it develop?
↑ Hgb concentration in blood; as a result of ↑ production of RBCs secondary to body's attempt to compensate for lack of O2
Cor pulmonale d/t pulmonary HTN
Causes of pulmonary HTN
constriction of pulmonary vessels in response to alveolar hypoxia
Manis of cor pulmonale
jugular vein distention, hepatomegaly w RUQ tenderness, ascites, epigastric distress, peripheral edema & wt. gain
Management of Cor Pulmonale
continous low-flow O2. Long term O2 therapy can slow progression of PHTN in COPD
Diuretics are usually used, why with caution?
tendency to deplete K & Cl & reduce intravascular volume & CO
Most common event leading to acute respiratory failure in COPD
Acute resp. tract infection (usually viral) or acute bronchitis
What GI disease is increased with COPD?
peptic-ucler disease, cause is unknown (perhaps LT use of bronchodilator or corticosteroid drugs or to stressful nature of disease)
COPD pt. has purulent sputum, what complication could this be?
pneumonia; could also have systemic manis of pneumonia fever, chills, leukocytosis may NOT be present.
decreases bronchospasm and airway obstruction CI: Tagamet can cause death
normal breath sounds, effective coughing, return of PaO2 to normal range for pt, improved mental status, normal body wt., normal serum PRO levels, feeling of being rested, improvement of sleep pattern,behaviors minimizing RF infection, NO INFECTIONS!!!
postural drainage: use bronchodilator b4, work to cough & loosen up secretions, remain in postural position for 5 min (DO NOT schedule around meals)
helps with expiratory phase/stress; inhale slowly through nose
What is never a solution for COPD stress?
lay on back, put book on upper abdomen, get muscles to contract (push up on diaphragm)