Nclex Review on COPD - Lecture notes COPD PDF

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NCLEX Review on COPD Definition: pulmonary disease that causes chronic obstruction of airflow from the lungs Keys Point for COPD: 

Limited Airflow (due to thick and swollen bronchioles that have become deformed with excessive sputum production and this narrows the airways)

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Inability to fully exhale (due to loss of elasticity of the alveoli sacs from damage and the sacs start to develop air pockets)

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Irreversible once developed…cases vary among people from mild to severe…managed with lifestyle changes and medications.

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Happens gradually….most people start to notice signs and symptoms middle-aged and will present with dyspnea with activity they could normally tolerate, recurrent lung infections, chronic cough etc.

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COPD is a term used as a “catch all” for diseases that limit airflow and cause dyspnea, chronic cough , sputum production

Types of COPD include: 

Emphysema “pink puffers”

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Chronic bronchitis “blue bloaters”

Pathophysiology of COPD Normal breathing: Inhaled oxygen travels down through the trachea which splits at the carina into bronchial tubes starting with the primary bronchus then into smaller airways called secondary and tertiary bronchi which divide into bronchioles and the oxygen goes into the alveolar sacs where gas exchange happens. As the alveoli inflate and deflate with ease, inhaled oxygen attaches to the red blood cells and carbon dioxide enters the respiratory system to be exhaled. What happens in breathing with COPD?

In conditions such as chronic bronchitis “blue bloaters”: The name “blue bloaters” is due to cyanosis from “hypoxia” and bloating from edema AND increase in lung volume. The bloating is from the effects of the lung disease on the heart which causes right-sided heart failure. In chronic bronchitis, the bronchioles become damaged that leads them to be thick and swollen and deformed. This is accompanied by more sputum production. This limits the ability of the person being able to completely exhale the air taken in. So, when they take another breath in, it will increase the air volume even more (because they have retained air from the previous breath), and this leads to hyperinflation. Also, less oxygen is getting into the blood and more carbon dioxide is staying in the blood. This leads to low blood levels and high carbon dioxide levels. Patients will have cyanosis due to a decreased oxygen level. To compensate, the body increases RBC production and cause blood to shift elsewhere which increases pressure in the pulmonary artery leading to pulmonary hypertension. Pulmonary hypertension leads to right-sided heart failure (which is why you will start to see bloating.. edema in the abdomen and legs) In conditions such as emphysema “pink puffers”:

The name comes from hyperventilation (puffing to breathe) and pink complexion (they maintain a relatively normal oxygen level due to rapid breathing) rather than cyanosis as in chronic bronchitis. In emphysema, the alveoli sacs lose their ability to inflate and deflate due to an inflammatory response in the body. So, the sac is unable to properly deflate and inflate. Inhaled air starts to get trapped in the sacs and this causes major hyperinflation of the lungs because the patient is retaining so much volume. Hyperinflation causes the diaphragm to flatten. The diaphragm plays a huge role in helping the patient breathe effortlessly in and out. Therefore, in order to fully exhale, the patient starts to hyperventilate and use accessory muscles to get the air out now. This leads to the barrel chest look and during inspect it may be noted there is an INCREASED ANTEROPOSTERIOR DIAMETER. The damage in the sacs cause the body to keep high carbon dioxide levels and low blood oxygen levels. Inhaled oxygen will not be able to enter into the sacs for gas exchange and carbon dioxide won’t leave the cells to be exhaled. The body tries to compensate by causing hyperventilation (increasing the respiratory rate…hence puffer) and the patient will have less hypoxemia “pink complexion” than chronic bronchitis who have the cyanosis because pink puffers keep their oxygen level just where it needs to be from hyperventilation. -wheezing primary cause of emphysema

Signs & Symptoms of COPD Remember: Lung Damage Lack of energy Unable to tolerate activity (shortness of breath) Nutrition poor (weight loss) due to energy used breathing especially with emphysema Gases abnormal (high PCO2 >45 and low PO2...