Introduction Of Copd Health And Social Care Essay

Introduction Of Copd Health And Social C atomic number 18 Essayinveterate clogging pneumonic illness is a group of inveterate and reform-minded respiratory disorders that be characterized by an airline business obstruction with little or no reversibility. Damage to the lungs continues to make breathing gradu e truly(prenominal)y more gruelling oer time. Two clinical conditions oft associated under the diagnosis of COPD be chronic bronchitis and emphysema, which obstruct or limit airf depleted into the lung fields.Chronic bronchitis is the nominal head of chronic productive cough for three months in each of dickens consecutive years in a tolerant in whom early(a) causes of chronic cough have been excluded. pulmonic emphysema is an abnormal permanent intricacy of the air spaces distal to the terminal bronchioles, accompanied by destruction of their argues and without limpid fibrosis (Lewis, S., Heitkemper, M., Dirksen, S., OBrien, P., Bucher, L., 2007, p. 629).Most a ffected roles diagnosed with COPD suffer from both pathological conditions, but manifestations send packing diversify significantly from long-suffering to enduring. According to Medline Plus (n.d.),Your airways branch out in location your lungs like an up font-down tree. At the end of each branch ar small, balloon-like air sacs. In healthy people, both the airways and air sacs be onslaught and elastic. When you breathe in, each air sac fills with air like a small balloon. The balloon deflates when you exhale. In COPD, your airways and air sacs lose their shape and fail floppy, like a stretched-out rubber band (Medline Plus, n.d., para.2).These disease carry outes affect the bronchi, bronchioles and lung p atomic number 18nchyma with prepotency on distal airway.COPD is a growing health task non only in the United States, but likewise worldwide. In 2005, about single in 20 deaths in the United States had COPD as the primal cause. Smoking is estimated to be responsible for at least 75% of COPD deaths (Centers for disease Control and Pr even uption, 2008, para.1). The Centers for infirmity Control and Prevention (CDC) withal estimates that in that respect ar everywhere 119,000 deaths, 726,000 hospitalizations, and 1.5 million hospital emergency department vi puts argon caused by COPD annually(Centers for Disease Control and Prevention, 2009, para. 2). Even more alarming are the statistics world-wide. The valet Health Organization (WHO) (2007), revealed that currently 210 million people have COPD and 3 million people died of COPD in 2005. WHO predicts that COPD entrust become the third trail cause of death worldwide by 2030 (World Health Organization, 2009, para.3). With statistics this rampant, what exactly are the manifestations that cause COPD?Etiology/PrognosisThere are several causes of COPD. Of all potential inhaled pollutants, fag smoking is the primary risk factor mentation to contribute to COPD. perseverings with a history of smok ing a pack per day, over forty years, are peculiarly predictive of COPD development. Exposure to passive cigarette smoking, air pollution, occupational hazards much(prenominal) as dust or finely particles (coal or silica dust, as vanquishos) and childhood respiratory disorders such as double-dyed(a) viral pneumonia can likewise contribute to the development of COPD. The elderly, patients with a low soundbox weight and clients with a history of alcohol abuse are also susceptible.Prognosis of COPD is highly dependent upon the degree to which the patients breathing is touched and the heartiness to manage dyspnea, the ability of the heart to group Oate other body systems. It is also dependent upon how damaged the lungs are upon diagnosis and if they are qualified to continue to oxygenate the stemma without difficulty. Early diagnosis of COPD can admirer point predisposing factors such as smoking, and back up provide a bump prognosis through smoking cessation and deep breathing exercises to economic aid bingleself ensure that the disease does not progress. A late diagnosis, that has affected the patients ability to perfuse vital organs, can result in organ loser on multiple levels and prognosis can be very grim. come on evaluation may be adopted to determine the full purpose of damage from inadequacy of tissue perfusion.PathophysiologyChronic Obstructive Pulmonary Disease can be a result of chronic bronchitis and emphysema. An enlargement and the great unwashed of mucous glands are produced with chronic bronchitis, resulting in an step-upd mucous production and a characteristic cough. Apart from the arrive of mucous produced the whole tone of the mucous also becomes more viscous in nature, making it harder for the patient to expel. compendium of prodigality mucous secretion causes airway obstruction in the peripheral airway and therefore an increase in airway resistance. Lymphocytes, neutrophils and macrophages also accumulate wh ich can lead to fibrosis or a formation of excess fibrous junction tissue in the lung fields as an attempt to repair the area.Emphysema results in large part from an enlargement of airspaces distal to terminal bronchioles. The mischief of elasticity of the lung tissue and the closure of small airways is collectible to the destruction of the dental walls. When the connective tissue is destroyed in the alveolar walls, protease is released, come along destroying elastin and inhibiting the ability of the alveoli to recoil. Protease affects structural integrity of the alveolar wall. In a healthy individual, the ability of the alveoli to recoil inspection and repairs to maintain the patency of the airway lumen, especially during expiration.With COPD, there is air flow limitation receivable to loss of alveolar attachments, unhealthy obstruction of airways and obstruction of the terminal branches with mucus. Airways begin to narrow due to the firing, resulting in a loss of elastic recoil and loss of alveolar attachments. ciliated function in COPD is also abnormally impeded. Cilia in the airway wall normally acts as a force to suspensor thrust mucus or other foreign bodies toward the trachea for expulsion from the body. This function is a good deal impeded by the thick and firm mucus often seen with chronic bronchitis. Lack of ciliary function increases the risk of recurrent contagions in the lungs due to accrual of these foreign particles in spite of appearance the lung fields. Destruction of the alveoli and profuse mucous accumulation destroys the ability of the body to deliver oxygen, resulting in hypoxia. The patient suffering from COPD often struggles to breathe and hypoxic- associate dyspnea systemically affects other areas of the body often leading to pulmonary hypertension and heart problems such as heart attacks and pay off-sided heart failure. longanimouss with COPD are more prone to respiratory infections, lung cancer and depression. Signs a nd symptoms of COPD unremarkably do not occur until significant damage to the lungs and other body systems have occurred.Signs and Symptoms long-sufferings with COPD usually impart with signs and symptoms of both emphysema and chronic bronchitis to include a invariable hacking-type cough that produces a thick mucus which is often hard to packorate. Patient may also complain of significant shortness of breath that presents especially with exercise or exertion. Clients may also complain of difficulty stillnessing with constant fatigue and an abrupt, unplanned weight loss. Patients typically also present with quick breathing, barrel-like distention to dresser and allow for sit often in a tripod position, leaning forward with arms braced against their knees, chair, or bed. This gives them leverage so that their rectus abdominus, intercostals, and accessory neck muscles all can aid in expiration (Jarvis, C., 2008, p. 449). Due to lack of oxygen the patient might also present wit h cyanosis of the skin, wheezing and chest tightness, with possible signs and symptoms of respiratory infection. Patients with COPD can also experience exacerbations, which are periods or episodes where the patients COPD symptoms can suddenly worsen. Exacerbations can be caused by in grippeenza, infections or exertion. Other contributing factors include a rapid change in humidity or temperature, motion picture to smoke or other pollutants, allergens and dust. According to report from the Global Initiative for Chronic Obstructive Lung Disease (GOLD) (2009), COPD can be broken down into four several(a) stages to includeStage I mild COPD Characterized by mild airflow limitation predicted. Symptoms of chronic cough and sputum production may be present, but not invariably. At this stage, the individual is usually unaware that his or her lung function is abnormal. Stage II moderate COPD Characterized by worsening airflow limitation with shortness of breath typically developing on exer tion, with a productive cough. This is the stage at which patients typically seek medical trouble because of chronic respiratory symptoms or an exacerbation of their disease. Stage III dire COPD Characterized by still worsening of airflow limitation, patient experiences an even greater degree of shortness of breath, reduced exercise capacity, fatigue, and repeated exacerbations that closely always have an impact on patients character reference of life sentence. Stage IV very severe COPD Characterized by severe airflow limitation with the presence of chronic respiratory failure. Respiratory failure may also lead to set up on the heart such as cor pulmonale (right heart failure). At this stage, quality of life is very appreciably impaired and exacerbations may be life threatening (GOLD Report, 2009, p.4).With the varying manifestations in the progression of the disease, suppliers must wee into storey the assortment of challenges and medical interventions necessary in the ma nipulation of COPD.COPD Medical Interventions fast Plan Needs and ModificationsIndividuals with COPD have boilers suit muscular weakness, including the respiratory muscles, that relates to systemic inflammatory process in the lungs. Diet is an important factor to take into consideration, especially in the elderly because the risk for malnutrition increases. COPD and malnutrition go hand in hand, malnutrition and a low BMI of Individuals who are underweight have an underlying problem that relates to an increase metabolism and the breakdown of essential nutrients for pushing requirements. In these individuals it is best to modify their eating habits, with shop breaks to decrease fatigue. It takes a lot of elan vital to metabolize food, breathing and eating become harder, the individual may have to study between taking a gasp of air or a bite of food (ONeill, 2004, para. 3). For those who are overweight, the problem as it relates to COPD is due to excess abdominal fat. Abdominal f at impedes the diaphragm from expanding completely, which causes a decrease in oxygen avai lability. This decrease in oxygen compromises the cardiovascular system due to the in up to(predicate) amount of oxygen being delivered to the heart and throughout the body. two malnourished and obese individuals need to monitor weight, food and fluid stirring routine. According to Peggy ONeil (2004), intake of fluids, calories, protein, calcium and potassium all play a role in protecting immunity and easing breathing (ONeil, 2004, para. 8). The American Lung Association states that the metabolism of each nutrient requires a different amount of oxygen and produces a different amount of atomic number 6 dioxide. Metabolism of carbohydrates produces the most carbon dioxide for the amount of oxygen used metabolism of fat produces the least (American Lung Association, 2010, para. 3). sizeable sources of fat should come from unsaturated fats such as nuts, olive oil, soy sauce and avocados. Pro tein is essential for muscle repair and assists in the healing process when an infection or injury occurs. ONeil recommends that generally two cups of milk plus six ounces of protein from other sources each day provide four servings of high-quality protein, good sources of protein, which is adequate for roughlyone with COPD (ONeil, para. 12). Potassium is strand in fruits, vegetables, dairy products and meats and are key to jibe blood pressure, muscle contraction, and nerve impulses transmission. Normal serum potassium levels help with optimal muscle contraction to aid breathing (ONeill, para. 15). Excessive need for increased nutritional intake is imperative for the adequate daily procedure and maintenance in the COPD client.In order to facilitate sufficient digestion and proper(ip) absorption of food the patient should remain upright after meals to prevent the stomach from pushing on his diaphragmlimit intake of carbonate beveragesand to consume soft, easy-to-chew foods to pr event him from becoming short of breathe while eating (ONeil, 2004, para. 16). expenditure of clear fluids should be encouraged to prevent dehydration and also to help thin mucous secretions.Appropriate Medications and DiagnosisAlthough there is controversy over the amount of oxygen to give a patient with COPD, it is generally understood that the long term use of oxygen therapy improves survival, exercise capacity, cognitive performance, and sleep (Lewis et al., p. 640). There are divers(a) ways that oxygen therapy can be administered to a patient with COPD. In hospitals the most precise delivery of oxygen therapy is through the use of the venturi mask, however most patients prefer to use the nasal bone cannula. The structure of the nasal cannula allows the patient to perform daily activities such as eating and talking without interrupting oxygen delivery. When oxygen therapy is used in connecter with smoking cessation it improves the patients quality of life by increasing the amount of available oxygen and increasing systemic perfusion.Depending on the severity of COPD, bronchodilators such as beta2-antagonist, anticholinergic, and methylxanthine (Lewis et al., 2007, p. 639) will be given to relax the smooth muscles of the airway, and to increase gas exchange. These medications can be administered as an inhalant or by the verbal route. For those experiencing moderate-to-severe COPD, glucocorticoid therapy may be combined with a bronchodilator to decrease inflammation of the airways. Inhaled glucocorticoids are preferred over oral glucocorticoids for long term treatment, because oral treatments can lead to adrenal insufficiency and Cushings syndrome. (See Appendix A). Patient should expect to experience improved oxygen utilization.Diagnostic Tests and Lab WorkPulmonary functions test measures the intake and output of air in the lungs and is used to sanction the diagnosis of COPD. There are four components to pulmonary function testing, which brood of s pirometry, postbronchodilator spirometry, lung volumes, and diffusion capacity (Chronic Obstructive Pulmonary Disease Diagnosis, 2010, para. 3). Also, there are many diagnostic studies that support the diagnosis of COPD, such as chest x-rays, arterial blood gases, echocardiogram and electrocardiogram (ECG) (Lewis et al., p. 638).X-rays are not the preferred rule of diagnosing COPD since it cannot pick up abnormalities until COPD is in the later stages. Arterial blood gases are performed to monitor the amount of oxygen and carbon dioxide in the blood. In individuals with COPD typical findings are low PaCO2, elevated PaCO2, decreased or low-normal pH, and increased bicarbonate (HCO3) levels (Lewis et al., 2007, p. 638). COPD can cause right sided heart failure related to pulmonary hypertension so patient should be monitored regularly by ECG and echocardiogram.As discussed earlier, changes in the lungs are related to smoking, toxins in the environs or occupation. In order to identify the causative effects of these toxin, clinical trials are being conducted to development new diagnostic tests that are aimed at identify early neoplastic changes in the lung. For example, advanced imaging techniques such as the PET scan is able to reveal metabolically supple nodule that are highly indicative of malignancy (Petty Miller, n.d. p. 7), that could not be found with prior diagnostic tests. Also, a tissue autofluorescence, which is an enhanced bronchoscopy technique, can point a high likelihood of malignancy (Petty Miller, p. 7) in the lung tissue, that cannot be seen in a CT scan or chest X-ray. Hopefully, these clinical studies as they become available to the general population, will not only identify acute changes in the lung structure in advance, but also could potentially assist in finding a cure for lung diseases. discourse and Treatment OptionsMedications can make COPD patients more comfortable, but there is no overall curative treatment. The disease itself ex tends beyond the airways and lungs to include other body systems, (Barnett, 2008, p. 30). The destruction in treatment is aimed at the controlling the symptoms involved in these various areas of the body and to reduce the inflammatory response in the lungs. To do this, the patient will need to modify their diet and lifestyle habit to lengthen the quality of their life.As discussed earlier, emphysema and bronchitis constitute the disease known as COPD. The management and treatment of these two diseases is necessary for the patient to live a quality life. The medical treatments used to treat COPD was reviewed earlier, there are also non-pharmacological treatment options available that slow the progression of the disease and the symptoms of chronic hindering pulmonary disease.One non-pharmacological treatment option is pulmonary rehabilitation. The goal of this treatment is tobreak the vicious cycle of increasing inactivity, breath littleness and physical de-condition, and upward(a ) exercise capacity and functional status as well as improving individual patients self-management skillsPulmonary rehabilitation is conducted by physiotherapist and respiratory checks. Each session is based on the patient exercise permissiveness and consists of one to two sessions a week for about an hour, for 6-8 weeks then followed by an educational component to enable to the patient to make lifestyle changes to help them cope better with living with COPD (Barnett, p. 31).There are various energy conservation techniques that a patient can use to improve the quality of available oxygen.Often COPD patients struggle to breathe. The overall goal of the following energy conservation techniques is to help the patient breath better and to improve activities of daily living by relieving the distressing symptoms that accompany COPD. According to Barnett (2008), these techniques are choke during strenuous part of an activity and use pursed lips to reduce to work of breathing, switch str enuous activities with easier tasks, place items within easy reach, to reduce bending and reaching for items, If needed, use aids and equipment such as electronic wheel chairs and to sit down to perform many of the daily activities (Barnett, 2008, p. 32).With a healthy individual, there is a low residual of air that remains in the lung. With the COPD patient, the volume of trapped air is increased and therefore decreases oxygen exchange within the lungs. Stress reducing techniques can help relax the patient. Therefore the patient can exhale the excess retained carbon dioxide and inhale even greater amounts of saturated oxygen with each new breathe. Hence, the efficiency of oxygen and carbon dioxide exchange is improved.Individuals should be updated on immunizations, even more so if a patient has COPD. According to the CDC (2010) adult immunization schedule, patients with chronic lung disease are required to have one annual influenza and one or two pneumococcal inoculations within t he patients lifetime (CDC, 2010, p. 2). If the patient becomes infect with influenza or pneumonia, damage to the lung fields can be exacerbated if not treated quickly and can possibly lead to death.COPD Holistic legal opinion of PatientScenarioMr. Johnson is a 73 year old male who has presented to the unavoidableness Department for the third time this week with dyspnea. Patient has been smoking a minimum of one pack per day for the past 46 years. Patient is currently on two liters of supplemental oxygen at central office via nasal cannula and states that he cannot seem to catch his breath. Mr. Johnson is leaning over the side of the bed in tripod position, gasping with supraclavicular retractions noted on inhalation. As a nurse, what do you think could be wrong with your patient?Physical AssessmentUpon further evaluation, the nurse notices that Mr. Johnson also has a non-productive hacking-type cough that has persisted throughout the triage process. Mr. Johnson complains, I sim ply cannot seem to get this thick mucus up out of my throat and I feel like I am suffocating, like I cannot catch my breath Patient appears to be bracing himself over the side of the chair in a tripod position. The nurse is a waiting for the provider to place orders in the computer for the clients chest x-ray. A venturi mask is set on the patient and oxygen delivery is set to be administered at three liters of oxygen per minutes. This intervention successfully alleviates the patients rapid and shallow respirations, as well as the circumoralcyanosis. Upon auscultation the nurse notices diminished lung sounds over the left and right lower lung fields with auditory wheezing upon exhalation. The nurse also notices a barrel-like distention to the patients chest. The nurse begins to take the patient to radiology and abruptly sugar as the patient begins to weep inconsolably. What could be the likely factor associated with the stirred reaction exhibited with the patient?Psychosocial Asse ssmentTo make an accurate assessment of the patients mental reaction, the nurse casually begins to inquire about the patients daily activities. The patient divulges to the nurse that he has lost his job, is no longer able to care for himself and feels a sense of guilt that he has become burdensome on his family members. Patient states, I have a loving family, but feel as though they would be better off without me. I know I shouldnt feel this way, but I have been depressed and feeling alone(predicate) for some time now. The nurse recognizes that the patient is displaying signs of depression, low self-esteem and lack of autonomy with loss of control over his personal life. The precedence breast feeding interventions for this patient should include a referral to a mental health influence and community outreach programs that can assist the patient to meet the psychological strains produced by his current health situation. The patient then covers his face and whispers in a soft under tone, I cannot even afford to pay for my groceries, much little this visit How can I afford this referral? With this statement in mind, what priority nursing assessment should the nurse consider?Socioeconomic AssessmentMr. Johnson is one of many faces dealing with the strains and financial hardship associated with COPD. The overall costs of COPD are overwhelming. According to the Harvard University (2008), the annual cost to the nation for COPD (emphysema and bronchitis) is approximately $32.1 one million million million, including healthcare expenditures of $18.0 billion and indirect costs of $14.1 billion (Harvard University Healthcare delivery- Deconstructing the costs, 2008, para 58). The global statistics are even more astounding. According to the American College of Chest Physicians (2003), the global direct yearly costs of chronic bronchitis and COPD patient was $1876. The cost generated by the patients with COPD was $1,760.00 per patient/year/costs, but the cost of severe cases ($2,911 per year) per patient/year/costs was almost double that of mild cases ($1484 per year) per patient/year/costs (Miravitlles, Murio, Guerrero, Gisbert, 2003, p.786). With these statistics in mind, what are some of the teaching points that a nurse can utilize to assist the COPD patient?Health Teaching and Community ResourcesThe nurse must take in various considerations when assisting the COPD patient. How well is the patient able to tolerate activity? Does the patient suffer from dyspnea related disturbance in their sleep prototype? What are the patients physical or financial resources? A patient that has a hard time meeting monthly utility bills is far less likely to be compliant with a medical regime. The nurse should digest on trying to coordinate social work service to help the patient to meet healthcare needs. If the patient has a family member, how does this affect his or her role if they are primary breed winner in the family? interview should point out any psy chological stressors that may be poignant the patient and should determine if therapy may be required.Primary education should revolve about on convincing the patient to quit smoking. Inform the patient to keep an eye on up to date on immunizations such as annual flu and pneumonia vaccines. Patient should compliantly take prescribed medications and avoid second-hand smoke or exposure to other irritants such as dust, smog, extreme heat or glacial and high altitudes, pollutants that can exacerbate symptoms. COPD patients must increase fluid intake to decrease viscosity of mucous secretions in addition to maintaining an adequate nutritional status to facilitate extra nutritional requirements. Diets should be low in saturated fat and should include various fruits, vegetables and whole grains. Highly accentuate to the patient that use of oxygen therapy should be only used as directed and control of respirations with pursed lip technique. Direct the patient to take frequent breaks to minimize fatigue. Pacing of activities throughout the day will minimize unwarrantable stress on the lungs. It may be necessary to coordinate inspection appointments for the patient however signs and symptoms such as shortness of breath, wheezing or the desire to lean forward to aid in breathing will warrant an earlier visit. A trip to the emergency room will be necessary if the patient starts to have sudden, severe shortness of breath, or if they become lightheaded, weak, faint or experience chest pain with a rapid, irregular heart rate.ConclusionChronic Obstructive Pulmonary Disease is a progressive and debilitating disease process that wreaks havoc on the patients cardiovascular and respiratory systems. Management of COPD can be maintained and symptoms lessen through adequate diet interventions, medication regimens, completing diagnostic exams and lab tests. Though COPD is a preventable disease, the realistic nature of the disease process requires a nurse that is knowledgeable , caring and sympathetic to the patients overall needs.