COPD (Chronic Obstructive Pulmonary Disease), Chronic Bronchitis, Emphysema-NCLEX Part 1

hey everyone it's sarah thread sterner sorry and calm and in this video I want to be doing an in CLECs review over COPD also called chronic obstructive pulmonary disease and this video will be part one of a two-part series what I'm going to be covering is the path of COPD the signs and symptoms the different types and how it is diagnosed and in part two I'm going to be covering the medications and the nursing interventions so be sure to check out that part and as always over here on the side or down in the description below you can access the quiz and the notes that go along with this video so let's get started first let's start out talking about what is the definition of COPD what is this it is a pulmonary disease that causes chronic obstruction of airflow from the lungs so before we get into the pathophysiology and dive into this lecture let's talk about the key points that you need to remember so whenever we're talking about the path or the signs and symptoms you'll have a little basic understanding of what we're talking about okay okay so key point one with this disease there is limited airflow and why is this because the bronchioles which you can see right here and this right here is a viola sac there is inflammation which has become chronic and has led to this wrong he'll become in deformed and narrow then you have excessive mucus production so it's limiting the amount of oxygen that can get in to the bronchial to go to alveolar sac for gas exchange and it's limiting the amount of carbon dioxide that's coming from the alveolar sac to be exhaled so you're going to be getting some problems another key point is that there is the patient does not have the ability to fully exhale and this is due to the loss of elasticity in these alveolar sacs and here you can see there mutated looking in a sense their floppy your IV OS X should be nice and circular and uniformed and here it's completely lost elasticity and what you have Yolo sex do is they inflate and deflate platon deflate and if they don't have their form they fully can't do that and if they can't do that you're not going to have proper gas exchange so it's going to throw your blood Casas off and air pockets are going to develop over time so we'll talk about that especially in your emphysema patients this happens okay so COPD is irreversible there's not a cure cases vary from patient to patient some patients will have a mild case while some will have severe I've had some patients they cannot talk a complete sentence without stopping taking breaths or hyperventilating during the sentence because they have COPD so bad and then some patients I've had you wouldn't really know that they had COPD unless you sing their test results or they told her so it varies and COPD is managed with lifestyle changes and medications which will really go over in part two with the nursing interventions patient education and the medication regimen now the causes of this the most common cause of COPD tends to be environmental from harmful irritants that the person has breathed into their lungs for example smoking is a huge cause of this because they're smoking their cigarette that all those chemicals are constantly entering into the lungs exhaling and that wreaks havoc on the pulmonary system over time however this can happen in people who do not smoke for instance say they live in an area where there's really bad air pollution or their job and they're around irritants 24/7 or they're a welder maybe don't wear the protective mask they need to and they can develop this and COPD tends to happen gradually people will start to notice signs and symptoms in middle age they may start to notice that over time they became more short of breath with normal activity they can normally tolerate they notice that they have this chronic sometimes productive call constantly especially like that smokers Hoff in the morning and they're getting real current lung infections like pneumonia things like that then they go to the doctor the doctor runs on them and they have this condition now let's talk about the types of COPD COPD that term is used as a catch-all term for diseases that limit airflow so what we're going to concentrate in this lecture is the one type called chronic bronchitis and emphysema so let's talk about chronic bronchitis first okay sometimes you may hear these patients refer to as blue bloaters why are they referred to as blue bloaters because with emphysema those patients are referred to as pink puffers so with the blue bloaters with chronic bronchitis these patients tend to have cyanosis due to the hypoxemia that they're having the low oxygen which you will see blue around their lips mucous membranes skin things like that and they tend to have edema swelling in the belly the legs because depending on how severe this is it leads to right side of heart failure so let's look at the path though of what's happening with chronic bronchitis okay here on this diagram you have what a normal healthy lung looks like and then over here you have a lung that's been affected with COPD specifically we have some wrong chronic bronchitis and emphysema going on so first let's talk live the healthy lung and talk about how normally gas exchange goes through this and then we'll compare it with a lung that's experiencing chronic bronchitis so you breathe in some oxygen it goes down through your trachea which your trachea splits at the chorion up into your bronchus your rotten left bronchus and rotten lip bronchus your primary bronchus enter into the lungs at the hilum and then the bronchus even breaks and branches off into further smaller Airways like your secondary bronchi your tertiary bronchi and then eventually your bronchioles and then you're a vor sacs and yeah and you're a vor sacs are opening and closing inflating and deflating for gas exchange and what helps you to do this breathing is whenever you breathe in your diaphragm which is normally dumb sheep is going to contract and it's going to go down and this is going to create a negative pressure in your lungs to allow you to suck in that air which is going to go through gas exchange then all that pressure has built up your diagram is going to relax back into its dome-shaped position that's going from all that increased pressure in the lungs that's going to cause you to exhale and force that air out so they're constantly inflating and deflating and you keep a nice shape a small hyper-inflated now let's look at the COPD lung with chronic bronchitis so let's say that this person is a smoker and constantly smoking and over time the smoke is going through all these Airways and just really messing it up and as what's happened is that over time these little areas you see right here your bronchioles have become inflamed and they start to produce all this mucus so um whenever the person is trying to breathe in that oxygen can't get to these a viola sacs because all these narrow little airways and all this mucus in the way so oxygen doesn't get in then they're trying to exhale that air that they just breathe in well they can't exhale it fully because again of the narrowing and all that mucus so they're going to be retaining the carbon dioxide now when that patient takes another deep breath in they're going to be adding more air volume to whatever they already breathe in previously so this is going to lead to overtime hyperinflation of the lungs lungs going to like enlarged now when the lung and large is you have your diaphragm below your lung it's going to cause your diaphragm to flatten and whenever it flattens you and have issues with being able to breathe because your diaphragm does 80% of your breathing and then the patient's going to start using their accessory muscles to breathe which will really see with our emphysema patients who are called the pink puffers and that's for that reason now let's talk a little bit more about that gas exchange because said there's not enough oxygen getting in and we're retaining that carbon dioxide so that person's going to be experiencing what's called respiratory acidosis but because there's not a lot of that oxygen getting in because just so you go through gas exchange with you real fast here's a blown-up version of an a vo lie and what happens is that you have capillaries on these alveolar sacs and this capillary is delivering carbon dioxide through this capillary wall to be exhaled because that is a waste product of metabolism and once they get rid of it then these little red blood cells want to get re oxygenated because right now they're exhausted they've done their job through the heart and they need more oxygen so oxygen that you've breathed in will go through that wall and attach to those red blood cells and then go back to the heart and become through the body and do its job but here this is not happening so what's going to happen you're going to have low amounts of oxygen the patient is going to become cyanotic we're going to display that cyanosis then your body's like wow we've really got to compensate for that because if you've learned through all of our lectures every time something bad happens in the body the body tries to do something with some other system to help compensate it and try to save your life so what happens is that the body will start increasing the production of these red blood cells because it's like well if we get some more red blood cells in the system we can get the body oxygenate because we're not getting a lot of oxygen but this causes a problem it causes the blood to become too thick then the body sees well that's not really helping so let's throw some other things in so what will happen is that there will be an increased pressure in the arteries specifically your pulmonary artery because remember your pulmonary artery brings an oxygenated blood to the lungs to become oxygenated then that pulmonary vein sit back to the left side of the heart to be pumped through the body and do its job so your pulmonary arteries coming from the right side of the heart so what happens it starts shifting blood which is going to increase the pressure in that artery and you're going to get what's called pulmonary hypertension and whenever you get pulmonary hypertension and that artery what is happening is that that blood is going to start back flowing in that pulmonary artery into that right side of the heart and we really went in depth in this in a heart failure videos and that blood starts backing up you start getting a lot of problems it will affect your liver because you'll get congestion in those hepatic veins and fluid will start building up in the abdomen eventually into the legs and it can even lead to left-sided heart failure as well so that is where the patient is getting the bloating and that's where the blue bloating comes from now let's look at emphysema these patients are sometimes called pink puffers why is that patients with emphysema tend not to have the cyanosis as with the blue bloaters why you get the name pink and the puffers comes from what's going on due to compensation and because the body has low oh two levels from what's going on with these alveolar sacs the body will hyperventilate increase that respiratory rate so in a sense they will be puffing in order to breathe they're really breathing rapidly to get more oxygen in to increase the oxygen level so you'll have no sign of cyanosis and the pink complexion now let's look at what's going on up close okay so what's happened is that say for instance this patient is a smoker and they're inhaling that constant irritant to their lungs what happens is that an inflammation process starts going on because of all that smoke affecting the sac and the body actually releases a substance that causes those of Yolo sex to lose their elasticity so they're not going to be inflating and deflating properly and they become deformed and they don't work and whenever that happens it's not good because you're not going to have proper gas exchange happening where those ovular sacs are inflating and deflating which is allowing that carbon dioxide to pass through that capillary wall so you'll be keeping carbon dioxide and it's not going to allow that oxygen to attach to those red blood cells to go through the body so you're going to have low oxygen now also another thing that happens because you're those sacs are not fully deflating because they don't work good air is going to get trapped in those sacks which is going to lead to hyperinflation of the lungs and whenever the lungs enlarge remember what's below your lungs is your diaphragm and the diaphragm is going to go from that beautiful dome shape to flatten and how you the way you breathe what makes it effortlessly is your diaphragm it plays a huge role in it so to compensate because the lungs have to in a sense squeeze that air out the body is going to start using accessory muscles on your chest to help the person get that air out and they're also going to hyperventilate to get that air out and to hopefully get some more oxygen in so this will lead because they're using their accessory muscles so much to that barrel chest look that patients with a massima may have which is that increase anterior posterior diameter that you may see on inspection and the hyperventilation again is the compensation to help get that oxygen level where it needs to be so that's why you're not going to see we're not going to be blue while they'll have that pink complexion compared to patients who have chronic bronchitis now let's talk about the signs and symptoms of COPD to help you remember the typical signs and symptoms of COPD let's remember the mnemonic lung damage because that is what is going on with COPD they have lung damage to the lungs that is limiting the airflow from the lung so el they are going to have lack of energy and this is because they have a limited supply of oxygen flooding through the body in order for your organs and everything to work properly it needs oxygen so anything for them for them to do is very hard and requires a lot of effort you for unable to tolerate activity they will get a lot of short really short of breath and if they have it really severe even getting them from a chair to the back to the bed or walking to the bathroom it's a big deal and it makes them very short of breath in for nutrition it will be poor especially with your patients within fuzzy manaos link back to the path oh why would they have poor nutrition well they are spending a lot of energy breathing and they're burning more calories than normal a person with healthy lungs would burn just with their breathing so they're going to have weight loss also eating if they have it really released severe and just chewing their food and swallowing their food exhausts them so they may not be up to eating so you really have to manage that which we'll talk about nursing interventions with your patients with emphysema g4 gases abnormal those arterial gases your po2 pco2 will be greater than 45 usually that's carbon dioxide and your po2 which measures your oxygen less than 90 because remember they have low oxygen and high carbon dioxide and usually we'll have respiratory acidosis because of those lab results D for dry or productive call and the productive cough all these possible be constant and chronic patients will call it wrong card tend to have the productive cough because remember they have the increased mucus production from where those bronchioles have become flamed and they narrowed so that's why they have that a four accessory muscle usage for breathing again that was with your patients with emphysema and that was because that diaphragm has flattened those lungs are hyper-inflated so now they their diaphragms aren't there to help them exhale that air so they've got to compensate by using those accessory muscles and the other a for abnormal lung sounds it can vary they can be diminished where you don't hear much of anything especially in those lower bases coarse crackles especially in your chronic bronchitis because of that you because that's what you're going to be hearing or wheezing and I have a whole video if you're not familiar with what these lung sounds sound like a card should be popping up and you can access the video it has audio clips where you can actually hear these lung sounds in for modification of skin color from pink to cyanosis and this again was with her chronic bronchitis patients they have a tendency because of their low oxygen will have the blue around lips or mucous membranes or the skin and a four anterior-posterior diameter increase and that's that barrel chest look and that's mainly with the patients who are suffering from emphysema because the usage of those accessory muscles built up the chest and the hyperinflation of the lungs G and four gets in the tripod position to breathe a lot of times in order to help these patients breathe whenever they're having difficulty breathing they will get in the tripod position and this is where they're standing they're leaning forward and while supporting their hands on their knees or on an object and just being bent over like that helps them breathe better so you may see that sometimes and ii4 extreme disney a-- and that just goes along with everything that's going on they just get really short of breath a lot of times now let's look at the complications of COPD and how it is diagnosed and a few complications a patient could experience with COPD is heart disease like heart failure again and we talked about that with the path especially the chronic bronchitis patients it can lead to pulmonary hypertension which will cause increased pressure on that right side of that ventricle and I mean get right-sided heart failure another thing is pneumothorax where the lung just collapses spontaneously and this tends to be spontaneous and patients who have a history of COPD and it's because of the formation of those air sacs in those alveoli and especially your patients with emphysema and I have had patients who have been admitted with this so this does happen I have seen it lung infections pneumonia for instance and they have an increased risk of developing lung cancer okay so how is this diagnosed from a nursing standpoint just be familiar with what may be ordered so if you're taking care of a patient with this you know what to look for for their test results and physicians will order what's called a spirometry which is a test where patients breathe into a tube which measures the following it's going to measure how much volume the lungs can hold during inhalation and it's going to measure how much and how fast air volume is being exhaled because remember that's the whole problem with this disease process they have an issue with retaining too much so they don't exhale too much compared to how much they took in so it will measure that and what it's measuring the two things mainly is it's measuring the the fvc which is the forced vital capacity and if they get a low reading on this this represents restrictive breathing and this is the largest amount of air exhaled after breathing in deeply in one second another thing it looks at is it measures the force expert ory volume which is how much air a person can exhale within one second and a low reading will end okay how severe the disease process actually is so that is about COPD part one now be sure to check out part two and don't forget to take the in CLECs review quiz that goes along with this lecture and thank you so much for watching and please consider subscribing to this YouTube channel

Channel: RegisteredNurseRN

Views: 1,575,425

Keywords: chronic obstructive pulmonary disease, chronic obstructive pulmonary disease pathophysiology, chronic obstructive pulmonary disease copd, chronic obstructive pulmonary disease khan academy, chronic obstructive lung disease, chronic obstructive breathing, chronic obstructive pulmonary, copd, copd pathophysiology, copd nursing, copd exacerbation, chronic bronchitis, chronic bronchitis vs emphysema, emphysema, emphysema pathophysiology, chronic bronchitis nursing, emphysema nursing

Id: n6sPCc69WM8

Length: 21min 36sec (1296 seconds)

Published: Fri Nov 04 2016