PULMONARY DISEASE

1. PRESENTED BY,
ANGELA.V.RAI
MSC NURSING
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2.  A.GENERAL OBJECTIVES :
AT THE END OF THE SEMINAR THE GROUP WILL BE ABLE TO
IDENTIFY PATIENTS WITH COPD AND ALSO WILL BE ABLE TO APPLY
COMPREHENSIVE NURSING CARE WHENEVER APPLICABLE.
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3. B.SPECIFIC OBJECTIVES :
AT THE END OF THE SEMINAR, THE GROUP WILL BE ABLE TO :-
1.REVIEW THE ANATOMY AND PHYSIOLOGY OF THE RESPIRATORY
SYSTEM.
2.ENLIST THE DISEASE CONDITION OF RESPIRATORY SYSTEM
3. LIST THE VARIOUS INVESTIGATIONS DONE TO RULE OUT A
RESPIRATORY CONDITION.
4.DEFINE COPD.
5.LIST THE CLINICAL MANIFESTATIONS OF COPD
6. LIST THE ETIOLOGY/RISK FACTORS OF COPD
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4. 7) EXPLAIN THE PATHOPHYSIOLOGY OF COPD.
8) LIST THE DIAGNOSTIC FINDINGS SEEN IN COPD.
9) EXPLAIN THE CLASSIFICATION OF COPD.
10) EXPLAIN THE MEDICAL MANAGEMENT OF COPD.
11) EXPLAIN THE SURGICAL MANAGEMENT OF COPD.
12) EXPLAIN THE NURSING MANAGEMENT OF COPD.
13) EXPLAIN THE DIETARY MANAGEMENT OF COPD.
14) DETERMINE THE REHABILITATION AND FOLLOW UP CARE.
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5. REVIEW OF ANATOMY AND PHYSIOLOGY OF
RESPIRATORY SYSTEM:
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6. PARTS OF RESPIRATORY SYSTEM:
•NOSE AND NASAL CAVITY
•PHARYNX
•LARYNX
•TRACHEA
•BRONCHI ,BRONCHUS AND BRONCHIOLES
•ALVEOLI
•LUNGS
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7. REVIEW OF RESPIRATORYSYSTEM:
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8. MECHANISM OF BREATHING :
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9. LIST OF RESPIRATORY DISORDERS:
UPPER RESPIRATORY TRACT DISORDERS:
1. RHINITIS.
2. VIRAL RHINITIS (COMMON COLD).
3. RHINOSINUSITIS.
4. PHARYNGITIS.
5. TONSILLITIS.
6. ADENOIDITIS
7. PERITONSILLAR ABSCESS
8. LARYNGITIS.
9. EPISTAXIS (NOSEBLEED).
10. NASAL OBSTRUCTION.
11. FRACTURES OF THE NOSE.
12. LARYNGEAL OBSTRUCTION.
13. CANCER OF THE LARYNX.
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10. LOWER RESPIRATORY TRACT DISORDERS:
1. PNEUMONIA.
2. ASPIRATION.
3. SEVERE ACUTE RESPIRATORY SYNDROME.
4. PULMONARY TUBERCULOSIS.
5. LUNG ABSCESS.
6. PLEURISY.
7. EMPYEMA.
8. PULMONARY EDEMA.
9. ACUTE RESPIRATORY FAILURE.
10. ACUTE RESPIRATORY DISTRESS SYNDROME.
11. PULMONARY ARTERIAL HYPERTENSION.
12. PULMONARY HEART DISEASE (COR PULMONALE).
13. PULMONARY EMBOLISM.
14. SARCOIDOSIS.
15. LUNG CANCER (BRONCHOGENIC CARCINOMA)
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11. 16. TUMOURS OF THE MEDIASTINUM.
17. BLUNT TRAUMA.
18. PENETRATING TRAUMA (GUNSHOT, STAB WOUNDS).
19. PNEUMOTHORAX.
20. CARDIAC TAMPONADE.
21. SUBCUTANEOUS EMPHYSEMA.
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12. CHRONIC PULMONARY DISEASES:
1. CHRONIC OBSTRUCTIVE PULMONARY DISEASE.
2. BRONCHIECTASIS.
3. ASTHMA.
4. STATUS ASTHMATICUS.
5. CYSTIC FIBROSIS.
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13. ASSESSMENT OF RESPIRATORY SYSTEM
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14. ASSESSMENT OF ABNORMAL BREATH SOUNDS
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15. DIAGNOSTIC ASSESSMENT OF RESPIRATORY SYSTEM:
THE DIAGNOSTIC ASSESSMENT OF THE RESPIRATORY SYSTEM CONSISTS OF NON
INVASIVE AND INVASIVE TESTS WHICH ARE AS FOLLOWS:-
NON INVASIVE TESTS:
DIAGNOSTIC PROCEDURES FACILITATE THE ASSESSMENT AND DIAGNOSIS OF CLIENT
RESPIRATORY DISORDERS.
COMMONLY AVAILABLE DIAGNOSTIC TESTS INCLUDE:
1. PULMONARY FUNCTION TESTS.
2.SPIROMETRY
3. PULSE OXIMETRY
4. VENTILATION PERFUSSION SCAN.
5. CHEST XRAY
6. AND SPUTUM CULTURES.
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16. PULMONARY FUNCTION TEST:
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17. SPIROMETRY
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18. PULSE OXIMETRY
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19. CHEST XRAY
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20. VENTILATION PERFUSSION SCAN
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21. COMPUTED TOMOGRAPHY
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22. ( MRI) MAGNETIC RESONANCE IMAGING:
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23. INVASIVE TESTS -
THE FOLLOWING CLEARLY DESCRIBE INVASIVE DIAGNOSTIC TESTS USED TO
DETECT PULMONARY DISORDERS.
1. LARYNGOSCOPY
2. BRONCHOSCOPY
3.THORACENTESIS AND PLEURAL FLUID ANALYSIS
4.BIOPSY
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24. LARYNGOSCOPY
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25. BRONCHOSCOPY
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26. THORACENTESIS AND PLEURAL FLUID ANALYSIS
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27. BIOPSY
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28. LABORATORY TESTS :
SPUTUM CULTURE
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29. NOSE AND THROAT CULTURE
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30. ARTERIAL BLOOD GASES (ABGs)
THE ABG ANALYSIS INVOLVES THE USE OF ARTERIAL, RATHER THAN VENOUS, BLOOD TO
MEASURE PAO2, PACO2 AND PH DIRECTLY.
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31. DEFINITION 0F COPD:
THE GLOBAL INITIATIVE FOR CHRONIC OBSTRUCTIVE LUNG DISEASE (GOLD) HAS
DEFINED COPD AS “A PREVENTABLE AND TREATABLE DISEASE WITH SOME
SIGNIFICANT EXTRA PULMONARY EFFECTS THAT MAY CONTRIBUTE TO THE
SEVERITY IN INDIVIDUAL PATIENTS. ITS PULMONARY COMPONENT IS
CHARACTERIZED BY AIRFLOW LIMITATION THAT IS NOT FULLY REVERSIBLE.THE
AIRFLOW LIMITATION SI USUALLY PROGRESSIVE AND ASSOCIATED WITH AN
ABNORMAL INFLAMMATORY RESPONSE OF THE LUNG TO NOXIOUS PARTICLES
AND GASES”.
COPD MAY INCLUDE DISEASES THAT CAUSE AIRFLOW OBSTRUCTION EG.
EMPHYSEMA, CHRONIC BRONCHITIS OR ANY COMBINATION OF THESE
DISORDERS.
OTHER DISEASES SUCH AS CYSTIC FIBROSIS, BRONCHIECTASIS AND ASTHMA THAT
WERE PREVIOUSLY CLASSIFIED AS TYPES OF COPD ARE NOW CLASSIFIED AS
CHRONIC PULMONARY DISORDERS.
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32. EMPHYSEMA: IS A COMPLEX LUNG DISEASE CHARACTERISED BY DAMAGE TO THE
GAS EXCHANGING SURFACES OF THE LUNG (ALVEOLI) I.E. ABNORMAL DISTENSION
OF TERMINAL BRONCHIOLES AND DESTRUCTION OF THE WALLS OF ALVEOLI. (BY
GOLD 2008)
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33. CHRONIC BRONCHITIS: IS A CHRONIC INFLAMMATION OF THE LOWER
RESPIRATORY TRACT CHARACTERISED BY EXCESSIVE MUCUS SECRETION, COUGH
AND DYSPNEA ASSOCIATED WITH RECURRENT INFECTIONS OF THE LOWER
RESPIRATORY TRACT. (BY GOLD 2008)
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34. PATHOPHYSIOLOGY OF COPD:
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35. CLINICAL MANIFESTATIONS OF COPD:
AS PER GOLD 2008-
IT IS CHARACTERISED BY THREE PRIMARY SYMPTOMS:
1.CHRONIC INTERMITTENT COUGH (MAY BE UNPRODUCTIVE IN SOME PATIENTS)
WHICH IS THE FIRST SYMPTOM TO DEVELOP, MAY LATER BE PRESENT EVERYDAY
AS THE DISEASE PROGRESSES. THE COUGH MAY BE UNPRODUCTIVE OF MUCUS.
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36. 2.SPUTUM PRODUCTION
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37. DYSPNEA: GRADUALLY DYSPNEA INTERFERES WITH DAILY ACTIVITIES, SUCH
AS CARRYING GROCERY BAGS. THEY CANNOT WALK AS FAST AS THEIR
PARTNERS OR PEERS. (MAY INCREASE ON EXERTION LIKE STAIRS/EXERCISE
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38. OTHER SYMPTOMS ALSO INCLUDED ARE
1.WHEEZING:
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39. CHEST TIGHTNESS: WHICH OFTEN FOLLOWS ACTIVITY, MAY FEEL SIMILAR TO
MUSCLE CONTRACTION.
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40. INCREASED ANTERIOR POSTERIOR DIAMETER (BARREL CHEST)
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41. WEIGHTLOSS: EVEN WITH ADEQUATE CALORIC INTAKE, THE PATIENT STILL LOSES
WEIGHT
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42. ANOREXIA
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43. FATIGUE: FATIGUE IS A HIGHLY PREVALENT SYMPTOM THAT AFFECTS THE
PATIENT’S ACTIVITIES OF DAILY LIVING
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44. TRIPOD POSITION: PATIENT MAY SIT UPRIGHT WITH ARMS SUPPORTED ON A
FIXED SURFACE SUCH AS AN OVERBED TABLE
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45. ETIOLOGY/RISK FACTORS OF COPD:
1. GENETICS:
ALPHA1 ANTITRYPSIN DEFICIENCY(AAT).
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46. 2.CIGARETTE SMOKING
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47. 3.OCCUPATIONAL EXPOSURE
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48. 4.AIR POLLUTION
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49. 5.INFECTION
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50. 7.AGING:
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51. COMPLICATIONS
•PNEUMONIA MORE FREQUENT LUNG INFECTIONS, SUCH AS .
• OSTEOPORESIS AN INCREASED RISK OF THINNING BONES , ESPECIALLY IF
YOU USE ORAL CORTICOSTEROIDS.
• WEIGHT IF CHRONIC BRONCHITIS IS THE MAIN PART OF YOUR COPD, YOU
MAY NEED TO LOSE WEIGHT. IF EMPHYSEMA IS YOUR MAIN PROBLEM, YOU
MAY NEED TO GAIN WEIGHT AND MUSCLE MASS.
•HEART FAILURE AFFECTING THE RIGHT SIDE OF THE HEART(COR
PULMONALE).
• COLLAPSED LUNG PNEUMOTHORAX COPD CAN DAMAGE THE LUNG'S
STRUCTURE AND ALLOW AIR TO LEAK INTO THE CHEST CAVITY.
•INSOMNIA BECAUSE YOU ARE NOT GETTING ENOUGH OXYGEN INTO
YOUR LUNGS.25/10/2016 51

52. MEDICAL MANAGEMENT OF COPD
1. OXYGEN THERAPHY
2.PHARMACOLOGICAL THERAPHY
•BRONCHODILATORS:
BRONCHODILATORS RELIEVE BRONCHOSPASM BY ALTERING SMOOTH MUSCLE
TONE AND REDUCE AIRWAY OBSTRUCTION BY ALLOWING INCREASED OXYGEN
DISTRIBUTION THROUGHOUT THE LUNGS AND ALVEOLAR VENTILATION.
ALTHOUGH REGULAR USE OF BRONCHODILATORS THAT ACT PRIMARILY ON THE
AIRWAY SMOOTH MUSCLE DOES NOT MODIFY THE DECLINE OF FUNCTION OR
THE PROGNOSIS OF COPD.
THESE AGENTS CAN BE DELIVERED THROUGH:
A.INHALOR
B.NEBULIZATION
C.ORAL ROUTE
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53. SURGICAL MANAGEMENT OF COPD
1.LUNG VOLUME REDUCTION SURGERY:
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54. 2.LUNG TRANSPLANTATION:
IT MAY BE CONSIDERED FOR PEOPLE WITH ADVANCED COPD.
A LUNG TRANSPLANT IS AN EFFECTIVE TREATMENT FOR DISEASE THAT HAS
DESTROYED MOST OF THE LUNGS’ FUNCTION. FOR PEOPLE WITH SEVERE LUNG
DISEASE, A TRANSPLANT CAN BRING BACK EASIER BREATHING AND PROVIDE
YEARS OF LIFE. HOWEVER, LUNG TRANSPLANT SURGERY HAS MAJOR RISKS AND
COMPLICATIONS ARE COMMON.
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55. BULLECTOMY
BULLECTOMY IS THE SURGICAL REMOVAL OF A BULLA, WHICH IS A
DILATED AIR SPACE IN THE LUNG PARENCHYMA MEASURING MORE THAN 1
CM.
BULLA
A LARGE BLISTER CONTAINING SEROUS FLUID.
1]
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56. NURSING MANAGEMENT OF PATIENTS WITH COPD
SMOKING CESSATION IS ESSENTIAL TO REDUCE DISEASE PROGRESSION AND
IMPROVE SURVIVAL.
NURSING DIAGNOSIS
1.INEFFECTIVE BREATHING PATTERN RELATED TO CHRONIC AIRFLOW
LIMITATION AS EVIDENCED BY INCREASED RESPIRATORY RATE
2. INEFFECTIVE AIRWAY CLEARANCE RELATED TO BRONCHOCONSTRICTION,
INCREASED MUCUS PRODUCTION, INEFFECTIVE COUGH,POSSIBLE BRONCHO
PULMONARY INFECTION AS EVIDENCED BY CHRONIC COUGH.
3. IMPAIRED GAS EXCHANGE RELATED TO CHRONIC PULMONARY
OBSTRUCTION DUE TO DESTRUCTION OF ALVEOLAR CAPILLARY MEMBRANE
AS EVIDENCED BY BREATHLESSNESS.
4. ACTIVITY INTOLERENCE RELATED TO COMPROMISED PULMONARY
FUNCTION, RESULTING IN SHORTNESS OF BREATH AND FATIGUE, SKELETAL
MUSCLE DYSFUNCTION AS EVIDENCED BY DECREASED ACTIVITY.25/10/2016 56

57. NURSING DIAGNOSIS:
5. RISK FOR INFECTION RELATED TO COMPROMISED PULMONARY FUNCTION,
RETAINED SECRETIONS AND COMPROMISED DEFENSE MECHANISMS.
6.IMBALANCED NUTRITION LESS THAN BODY REQUIREMENTS RELATED TO
INCREASE WORK OF BREATHING, AIR SWALLOWING,DRUG EFFECTS WITH
RESULTING WASTING OF RESPIRATORY AND SKELETAL MUSCLE AS EVIDENCED BY
PATIENTS WEIGHT.
7 .DISTURBED SLEEP PATERN RELATED TO HYPOXEMIA AND HYPER CAPNIA,
DYSPNEA,COUGH AND WHEEZING .
8. INEFFECTIVE COPING RELATED TO STRESS OF LIVING WITH CHRONIC DISEASE,
LOSS OF INDEPENDENCE,DEPRESSION ,ANXIETY DISORDER, PANIC OF
BREATHLESSNESS.
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58. INDIAN DIET PLAN FOR COPD PATIENTS.
DAY STARTS AT :
– 7.30 AM: CUP OF TEA (WITH SOME LEAVES OF BASIL, GINGER) WITH BISCUIT ( IF
BRAN / SOY /OAT BISCUIT IS USED, THEN ADDED BENEFIT)
–8.30 AM: BANANA OR SOME OTHER FRUIT
–9.30 AM: BREAKFAST– SOME PORRIDGE OR DALIA WITH VEGETABLE/COTTAGE
CHEESE OR 2 EGG WHITE WITH A SINGLE YOLK SANDWICH/ VEGETABLE OR PANEER
SUFFED PRANTHA WITH A GLASS OF MILK.
(DALIA AT TIMES CAN BE COOKED IN SOUTH INDIAN TASTE OR CHINESE FLAVOUR,
SANDWICH CAN HAVE A DIFFERENT DRESSING OR BE WITH CHEESE SLICE WITH
TOMATO AND OREGANO)
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59. –11.30 AM: FRUIT LIKE APPLE WHICH IS GOOD IN IRON I.E HEMOGLOBIN/ ORANGE
WHICH HAS VIT-C, COMBINATION OF DIFFERENT FRUIT IS ALSO GOOD. FULL FRUIT
OR HALF DEPENDS ON THE PATIENT APPETITE/ A GLASS OF FRESH JUICE IS ALSO
GOOD IF PATIENT IS UNABLE TO CONSUME REASONABLE AMOUNT OF FRUIT I.E IF
ISSUE OF DIABETES IS NOT THERE.
–1.30 PM: LUNCH:BEGIN WITH SMALL PLATE OF PAPAYA, ONE SMALL BOWL(KATORI)
OF VEGETABLE STEW/ DAL/PANEER, ONE SMALL BOWL OF GREEN VEGETABLE
WITH 1-2 CHAPATIS, LITTLE SALAD, ONE SMALL BOWL OF CURD (CURD IS GOOD FOR
PEOPLE WITH LUNG PROBLEM, JUST MAKE SURE IT IS NOT COLD FROM FRIDGE,
SERVE IT AT ROOM TEMPERATURE OR MICROWAVE IT FOR FEW SECONDS SO THAT IT
DOESN’T FEEL COLD). END THE MEAL WITH A SMALL KATORI OF CUSTARD OR ANY
OTHER DESERT.
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60. –4.00 PM: A PROTEIN SHAKE / 1-2 PROTEIN BISCUITS/1-2 PIECES
OF SLICED PANEER/TOFU.
–5.30 PM: TEA WITH SOY NAMKEEN, SOY CHIPS, BESAN NAMKEEN
(PROTEIN BASED NAMKEEN).IF THEY LIKE SWEET BISCUIT THEN THAT
AS WELL BUT TRY AGAIN TO GIVE BRAN OR OATS BASED.
–7.O0 PM: SOME CHICKEN/ MIXED VEGETABLE/ ALMONDS/ TOMATO/
MUSHROOM SOUP WITH 1-2 BREAD STICKS. LOOKS AND FLAVOURS
CAN BE CHANGED BY CUTTING VEGETABLES DIFFERENTLY EACH
TIME OR ADDING CHINESE FAVOURING.
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61. COMPLICATIONS OF COPD
PNEUMONIA MORE FREQUENT LUNG INFECTIONS, SUCH AS .
•OSTEOPOROSIS AN INCREASED RISK OF THINNING BONES , ESPECIALLY IF YOU USE
ORAL CORTICOSTEROIDS.
•WEIGHT . IF CHRONIC BRONCHITIS IS THE MAIN PART OF YOUR COPD, YOU MAY
NEED TO LOSE WEIGHT. IF EMPHYSEMA IS YOUR MAIN PROBLEM, YOU MAY NEED TO
GAIN WEIGHT AND MUSCLE MASS.
•HEART FAILURE AFFECTING THE RIGHT SIDE OF THE HEART (COR PULMONALE).
•A COLLAPSED LUNG (PNEUMOTHORAX). COPD CAN DAMAGE THE LUNG'S
STRUCTURE AND ALLOW AIR TO LEAK INTO THE CHEST CAVITY.
•SLEEP PROBLEMS BECAUSE YOU ARE NOT GETTING ENOUGH OXYGEN INTO YOUR
LUNGS.
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62. REHABILITATION
PULMONARY REHABILITATION FOR COPD INCLUDES A PROGRAM OF
EXERCISES THAT HELPS PEOPLE BUILD THEIR PHYSICAL FITNESS.
MANY PULMONARY REHAB CENTERS ALSO TEACH PEOPLE BREATHING
TECHNIQUES AND STRATEGIES FOR LIVING BETTERWITH COPD.
THE EFFECTS OF PULMONARY REHABILITATION ON QUALITY OF LIFE
AND HEALTH CARE UTILIZATION IS REVIEWED HERE, FOCUSING ON THE
PRIMARY GOALS OF REHABILITATION — LOWER AND UPPER
EXTREMITY EXERCISE CONDITIONING, BREATHING RETRAINING,
EDUCATION, AND PSYCHOSOCIAL SUPPORT [4].
OTHER IMPORTANT THERAPEUTIC MODALITIES THAT ARE STRESSED IN
MANY REHABILITATION PROGRAMS, INCLUDING SMOKING CESSATION,
OXYGEN THERAPY, BRONCHODILATORS, ANTIBIOTICS, NUTRITIONAL
SUPPORT, AND RESPIRATORY MUSCLE TRAINING AND RESTING
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63. EVIDENCED BASED RESEARCH ON COPD
CHRONIC OBSTRUCTIVE PULMONARY DISEASE • 12: NEW TREATMENTS FOR COPD
•P J BARNES
•CORRESPONDENCE TO:
P J BARNES, NATIONAL HEART AND LUNG INSTITUTE, IMPERIAL COLLEGE SCHOOL OF
MEDICINE, LONDON SW3 6LY, UK
P.J.BARNES@IC.AC.UK
DRUGS CURRENTLY AVAILABLE OR UNDER DEVELOPMENT FOR THE TREATMENT OF
CHRONIC OBSTRUCTIVE PULMONARY DISEASE (COPD) ARE REVIEWED
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64. FEBRUARY 2009 ISSUE
NUTRITION AND COPD - DIETARY CONSIDERATIONS FOR BETTER
BREATHING
BY ILARIA ST. FLORIAN, MS, RD
TODAY’S DIETITIAN
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65. CONCLUSION
AT THE END OF THE SEMINAR THE GROUP WILL BE ABLE TO GIVE
COMPREHENSIVE NURSING CARE, IDENTIFY THE RISK FACTORS,EXPLAIN
ABOUT THE REHABILITATION CARE AT THE TIME OF DISCHARGE TO PATIENTS
SUFFERING FROM CHRONIC OBSTRUCTIVE PULMONARY DISEASE.AND
WOULD ALSO BE ABLE TO TAKE KEEN INTEREST IN UPDATING ONESELF
ABOUT THE NEW RESEARCH WORK DONE FOR THE BENEFIT AND
IMPROVEMENT OF SUCH PATIENTS.
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66. BIBLIOGRAPHY
1.LEWIS’S MEDICAL –SURGICAL NURSING,SECOND SOUTH ASIA EDITION,NEW
DELHI,REED ELSEVIER INDIA PVT LTD,PG NO587-628.
2. BRUNNER AND SUDDHARTH’S TEXTBOOK OF MEDICAL –SURGICAL
NURSING, TWELFTH EDITION, NEW DELHI, WOLTERS KLUWER INDIA PVT
LTD,PG NO 602-619.
3. LIPPINCOTT MANUAL OF NURSING PRACTICE, TENTH EDITON, GURGAON,
WOLTERS KLUWER INDIA PVT LTD,PG NO 305-316.
4. LIPPINCOTT WILLIAMS AND WILKINS PATHOPHYSIOLOGY,FOURTH
EDITION,NEW DELHI, WOLTERS KLUWER INDIA PVT LTD,PG NO 79-81
5. WWW.GOOGLE.COM
6. WWW.TODAY’SDIETICIAN.COM
7. WWW.THORAX.BMJ.COM
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