Chronic Obstructive Pulmonary Disease - Essay Example

Chronic Obstructive Pulmonary Disease Introduction COPD (Chronic Obstructive Pulmonary Disease) is the 4th leading cause of death in the USA. Although there has been continuous public education about the relationship of COPD and smoking, about 20% of the American adult population has COPD (Dodd, 2010). A recent survey revealed that exacerbation to the disorder due to acute bronchitis and other conditions accounts for about 14 million of the clinical visits annually. COPD is said to be one of the most disabling condition in the middle aged and the elderly. In the USA, exacerbation of COPD accounts for 10% of the hospital admission and about 30,000 of deaths per year (Nicholas, 2006). Situation Cognition refers the high order neural processes that determine the handling of information. Cognitive impairment has been demonstrated in 77% of patients with COPD (Dodd, 2010). In COPD, there is an accumulation of oxygen radicals, which is associated with neural damage and inhibition of production of the neurotransmitter. Cognitive impairment is a prognostic feature on the progression and disability of the disease. Symptoms of cognitive impairment are deduced from their behavior in terms of psychological, emotional and neurological factors. The patient presents with impaired memory, inability to relate information, unconscious, disorientated and in severe cases reports of hallucination (Dodd, 2010). The patient may not understand their condition leading to neglect and noncompliance to treatment. They are anxious, unaware of their surrounding accompanied with coughing and difficulty in breathing. Acute exacerbation of COPD is characterized by an increase in symptoms, deterioration of the lung function and health status. It is mainly results from bacterial and viral infection. Acute episodes are treated using oxygen, inhaled bronchodilators, antibiotics and systemic corticosteroids. Bronchodilators include beta₂ agonist, anticholinergics and methylxanthines (Nicholas, 2006). Assessment In assessing the client’s cognitive function, a mini-mental state examination is performed. This test is made up of questions that test the arithmetic, reasoning and orientation functions. The patient is scored out of 30 points. A score of 25 and above indicates normal cognitive function. A patient who scores less than 9 points has severe cognitive dysfunction (Nicholas, 2006). The diagnosis of COPD requires the demonstration of airway obstruction by spirometry. This is established when the post-bronchodilator Forced Expiratory Volume in one second (FEV₁) is less than 80% (Nicholas, 2006). Measurements of the lung volumes also provide an assessment of hyperinflation. Other tests include a chest x-ray and a full blood count to rule out complications associated with COPD. Motivation During treatment, it is the duty of the attending nurse to ensure that the patient or their care giver understands the disease. It is vital to assess the patient’s and caregiver’s level of education. Before giving advice on the disease, the nurse should assess what the patient already knows about their disease. It is also imperative to determine how the patient perceives the illness. Information about the living conditions of the patient and their care giver is also vital. The nurse is then obligated to educate the patient on the disease. Definition of Client’s Disease COPD is defined by the presence of airway obstruction which does not change markedly over time and is irreversible. It is a heterogamous disease that encompasses several pathological processes including chronic bronchiolitis, emphysema and chronic bronchitis. It is characterized by continuous destruction and degeneration of the airways, supporting tissue and lungs. Emphysema begins with the small airway and alveolar destruction. It then progresses to narrowing of the bronchioles, bronchi and mucous gland hyperplasia (Nicholas, 2006). Smoke and other inhaled allergen elicit an inflammatory process in the epithelium lining the airway cavity. There is continuous recruitment of neutrophils, eosinophils and at the end stage, macrophages and lymphocytes. This results in edema, excess mucus production and cellular infiltration in the epithelium. It is accompanied with cilia destruction and thus the mucus secretions accumulate in the airway cavity (Dodd, 2010). The airway responds by narrowing and hyperactivity of the airway. The patient develops a chronic cough, dyspnea and wheezing. Accumulation of the secretion in the airway cavity predisposes the patient to bacterial infection. Causes of COPD The causes of COPD are divided into environmental exposures and host causes. Among the environmental factors, smoking remains the most significant cause. In the UK, about 95% of cases of COPD were attributed to smoking (Nicholas, 2006). Susceptibility to cigarette smoke varies but both the dose and duration of smoking play a vital role. Other environmental exposures include outdoor and occupational pollution, for example, miners, biomass solid fuel fires and recurrent lung infections. Persistent adenovirus infection in the lung tissue may modify local inflammatory response precipitating in lung damage. The host causes include genetic causes, for example, deficiency of α₁-antiproteinase, airway hyperactivity and persistent lung insults. Lung insults results from fetal and childhood insults that affect the growth and development of the lungs. Infections by Streptococcus pneumonia, Haemophilus influenza and Mycoplasma pneumonia, are known to cause exacerbation to pre-existing COPD. Infections by Pseudomonas species, viruses and other gram negative enteric bacilli are known to cause severe exacerbation in COPD (Dodd, 2010). Symptoms COPD should be sought in any patient over 40 years presenting with a persistent cough, sputum production and breathlessness (Nicholas, 2006). The cough is the first symptom, and it is accompanied by production of mucoid sputum. Chronic bronchitis is defined as the presence of persistent cough and sputum for most days for at least three consecutive months for the last two years. The patient may also complain of coughing blood accompanied with chest pain. Other symptoms include weight loss, impaired nutrition and diminished muscular function. The patient also presents with peripheral edema due to impaired salt and water excretion in the kidneys. There is increased osteoporosis, which predisposes the patient to fractures of the long bones. It is vital to rule out chronic asthma, tuberculosis and bronchiectasis as they have similar symptoms. Management This is focused on improving the health status of the patients, decreasing the disease frequency and severity of exacerbations episodes and improving the airway capacity. Treatment is based on reducing the allergen and on use of drugs. Reducing the environmental exposure and smoking plays a vital role in the progress of the disease. Currently the mainstay of treatment involves the use of bronchodilator, systemic corticosteroids, antibiotics and oxygen therapy (Dodd, 2010). Bronchodilators include the use of inhaled beta₂ agonist, inhaled anticholinergics and methylxanthines. Oral beta₂ agonists are associated with more side effects and, thus, are not used. However, these drugs are associated with vasodilatation and may precipitate orthostatic hypotension. They are also not used in pregnancy as they may precipitate preterm labor. Inhaled corticosteroids are used for patients with severe disease who report having at least two episodes of exacerbations requiring antibiotics or oral steroid twice and year. They are usually combined with long acting beta agonist. Although useful, they are attributed to osteoporosis and impaired skeletal function. The use of antibiotics plays a vital role in reducing the frequency and severity of exacerbation. They are crucial in preventing frequent infections by the micro-organisms. Tetracycline, penicillin, flouroquinolone, macrolide and third generation cephalosporin are used in management of COPD depending on the patients’ age and the disease progression. However, the surfacing of antibiotic resistant bacteria has limited the use of antibiotics. Furthermore, aggressive use of antibiotics may cause pseudomembranous colitis, which is difficult to treat. Long Term Domiciliary Oxygen Therapy (LTDOT) improves survival, prevents progression of disease and improves the neuropsychological health of the patient. The oxygen is delivered to the patient using nasal prongs, and the patient is asked to use it for 15 hours a day. Aggressive use of high concentration oxygen results in respiratory depression and worsens acidosis. In severe COPD, lung transplant and lung volume reduction procedures may be used. However, this poses the challenge of tissue rejection by the host. It is also crucial to judge on the cost and preoperative mortality before carrying out these procedures. Evaluation This includes stabilization of the patient and reduction of the symptoms. It involves relieving of the dyspnea, cough and associated bacterial infections. Exercise tolerance tests can be used to determine the response to bronchodilator therapy or rehabilitation programs. They also serve as indicators on the prognosis of the disease. Reduction of the frequency and severity of the acute attack episodes is also an indicator of successful therapy. Other tests include a chest X-ray that rules out development of complication (Nicholas, 2006). Recommendation The aim of the treatment plan is to improve the quality of life of the client, slow the progression of the disease as well as minimize severity and frequency of the attacks. This is achieved by focused treatment of the symptoms, in addition to patient’s disease education. It is also achieved by encouraging the patient on methods of improving their lives. Discharge from the hospital is contemplated once the patient is stable on their usual medication. It is also vital to provide the client with other hospital equipments, for example, nebulizers, which the patient may use at home. References Dodd, J. (2010). Cognitive function in COPD. European Respiratory Journal, 35(4), 913-921. Nicholas, A. (2006). Davidson’s practice and principles of medicine. 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