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hey everyone it's sarah thread sterner
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sorry and calm and in this video I want
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to be doing an in CLECs review over COPD
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also called chronic obstructive
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pulmonary disease and this video will be
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part one of a two-part series what I'm
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going to be covering is the path of COPD
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the signs and symptoms the different
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types and how it is diagnosed and in
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part two I'm going to be covering the
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medications and the nursing
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interventions so be sure to check out
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that part and as always over here on the
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side or down in the description below
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you can access the quiz and the notes
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that go along with this video so let's
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get started first let's start out
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talking about what is the definition of
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COPD what is this
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it is a pulmonary disease that causes
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chronic obstruction of airflow from the
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lungs so before we get into the
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pathophysiology and dive into this
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lecture let's talk about the key points
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that you need to remember so whenever
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we're talking about the path or the
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signs and symptoms you'll have a little
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basic understanding of what we're
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talking about okay okay so key point one
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with this disease there is limited
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airflow and why is this because the
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bronchioles which you can see right here
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and this right here is a viola sac there
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is inflammation which has become chronic
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and has led to this wrong he'll become
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in deformed and narrow then you have
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excessive mucus production so it's
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limiting the amount of oxygen that can
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get in to the bronchial to go to
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alveolar sac for gas exchange and it's
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limiting the amount of carbon dioxide
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that's coming from the alveolar sac to
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be exhaled so you're going to be getting
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some problems another key point is that
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there is the patient does not have the
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ability to fully exhale and this is due
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to the loss of elasticity in these
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alveolar sacs and here you can see there
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mutated looking in a sense their floppy
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your IV OS X should be nice and circular
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and uniformed and here it's completely
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lost elasticity and what you have Yolo
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sex do is they inflate and deflate
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platon deflate and if they don't have
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their form they fully can't do that and
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if they can't do that you're not going
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to have proper gas exchange so it's
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going to throw your blood Casas off and
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air pockets are going to develop over
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time so we'll talk about that especially
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in your emphysema patients this happens
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okay so COPD is irreversible there's not
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a cure cases vary from patient to
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patient some patients will have a mild
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case while some will have severe I've
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had some patients they cannot talk a
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complete sentence without stopping
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taking breaths or hyperventilating
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during the sentence because they have
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COPD so bad and then some patients I've
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had you wouldn't really know that they
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had COPD unless you sing their test
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results or they told her so it varies
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and COPD is managed with lifestyle
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changes and medications which will
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really go over in part two with the
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nursing interventions patient education
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and the medication regimen now the
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causes of this the most common cause of
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COPD tends to be environmental from
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harmful irritants that the person has
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breathed into their lungs for example
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smoking is a huge cause of this because
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they're smoking their cigarette that all
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those chemicals are constantly entering
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into the lungs exhaling and that wreaks
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havoc on the pulmonary system over time
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however this can happen in people who do
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not smoke for instance say they live in
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an area where there's really bad air
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pollution or their job and they're
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around irritants 24/7 or they're a
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welder maybe don't wear the protective
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mask they need to and they can develop
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this and COPD tends to happen gradually
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people will start to notice signs and
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symptoms in middle age they may start to
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notice that over time they became more
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short of breath with normal activity
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they can normally tolerate they notice
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that they have this chronic sometimes
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productive call constantly especially
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like that smokers Hoff in the morning
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and they're getting real current lung
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infections like pneumonia things like
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that then they go to the doctor the
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doctor runs
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on them and they have this condition now
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let's talk about the types of COPD COPD
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that term is used as a catch-all term
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for diseases that limit airflow so what
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we're going to concentrate in this
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lecture is the one type called chronic
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bronchitis and emphysema so let's talk
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about chronic bronchitis first okay
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sometimes you may hear these patients
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refer to as blue bloaters why are they
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referred to as blue bloaters because
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with emphysema those patients are
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referred to as pink puffers so with the
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blue bloaters with chronic bronchitis
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these patients tend to have cyanosis due
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to the hypoxemia that they're having the
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low oxygen which you will see blue
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around their lips mucous membranes skin
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things like that and they tend to have
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edema swelling in the belly the legs
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because depending on how severe this is
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it leads to right side of heart failure
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so let's look at the path though of
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what's happening with chronic bronchitis
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okay here on this diagram you have what
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a normal healthy lung looks like and
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then over here you have a lung that's
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been affected with COPD specifically we
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have some wrong chronic bronchitis and
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emphysema going on so first let's talk
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live the healthy lung and talk about how
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normally gas exchange goes through this
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and then we'll compare it with a lung
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that's experiencing chronic bronchitis
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so you breathe in some oxygen it goes
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down through your trachea which your
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trachea splits at the chorion up into
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your bronchus your rotten left bronchus
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and rotten lip bronchus your primary
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bronchus enter into the lungs at the
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hilum and then the bronchus even breaks
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and branches off into further smaller
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Airways like your secondary bronchi your
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tertiary bronchi and then eventually
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your bronchioles and then you're a vor
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sacs and yeah and you're a vor sacs are
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opening and closing inflating and
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deflating for gas exchange and what
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helps you to do this breathing is
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whenever you breathe in your diaphragm
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which is normally
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dumb sheep is going to contract and it's
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going to go down and this is going to
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create a negative pressure in your lungs
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to allow you to suck in that air which
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is going to go through gas exchange then
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all that pressure has built up your
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diagram is going to relax back into its
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dome-shaped position that's going from
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all that increased pressure in the lungs
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that's going to cause you to exhale and
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force that air out so they're constantly
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inflating and deflating and you keep a
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nice shape a small hyper-inflated now
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let's look at the COPD lung with chronic
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bronchitis so let's say that this person
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is a smoker and constantly smoking and
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over time the smoke is going through all
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these Airways and just really messing it
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up and as what's happened is that over
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time these little areas you see right
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here your bronchioles have become
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inflamed and they start to produce all
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this mucus so um whenever the person is
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trying to breathe in that oxygen can't
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get to these a viola sacs because all
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these narrow little airways and all this
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mucus in the way so oxygen doesn't get
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in then they're trying to exhale that
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air that they just breathe in well they
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can't exhale it fully because again of
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the narrowing and all that mucus so
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they're going to be retaining the carbon
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dioxide now when that patient takes
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another deep breath in they're going to
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be adding more air volume to whatever
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they already breathe in previously so
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this is going to lead to overtime
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hyperinflation of the lungs lungs going
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to like enlarged
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now when the lung and large is you have
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your diaphragm below your lung it's
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going to cause your diaphragm to flatten
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and whenever it flattens you and have
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issues with being able to breathe
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because your diaphragm does 80% of your
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breathing and then the patient's going
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to start using their accessory muscles
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to breathe which will really see with
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our emphysema patients who are called
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the pink puffers and that's for that
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reason now let's talk a little bit more
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about that gas exchange because
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said there's not enough oxygen getting
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in and we're retaining that carbon
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dioxide so that person's going to be
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experiencing what's called respiratory
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acidosis but because there's not a lot
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of that oxygen getting in because just
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so you go through gas exchange with you
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real fast here's a blown-up version of
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an a vo lie and what happens is that you
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have capillaries on these alveolar sacs
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and this capillary is delivering carbon
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dioxide through this capillary wall to
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be exhaled because that is a waste
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product of metabolism and once they get
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rid of it then these little red blood
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cells want to get re oxygenated because
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right now they're exhausted they've done
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their job through the heart and they
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need more oxygen so oxygen that you've
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breathed in will go through that wall
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and attach to those red blood cells and
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then go back to the heart and become
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through the body and do its job but here
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this is not happening
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so what's going to happen you're going
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to have low amounts of oxygen the
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patient is going to become cyanotic
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we're going to display that cyanosis
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then your body's like wow we've really
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got to compensate for that because if
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you've learned through all of our
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lectures every time something bad
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happens in the body the body tries to do
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something with some other system to help
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compensate it and try to save your life
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so what happens is that the body will
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start increasing the production of these
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red blood cells because it's like well
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if we get some more red blood cells in
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the system we can get the body oxygenate
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because we're not getting a lot of
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oxygen but this causes a problem it
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causes the blood to become too thick
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then the body sees well that's not
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really helping so let's throw some other
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things in so what will happen is that
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there will be an increased pressure in
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the arteries specifically your pulmonary
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artery because remember your pulmonary
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artery brings an oxygenated blood to the
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lungs to become oxygenated then that
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pulmonary vein
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sit back to the left side of the heart
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to be pumped through the body and do its
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job so your pulmonary arteries coming
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from the right side of the heart so what
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happens it starts shifting blood which
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is going to increase the pressure in
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that artery and you're going to get
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what's called pulmonary hypertension and
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whenever you get pulmonary hypertension
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and that artery what is happening is
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that that blood is going to start back
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flowing in that pulmonary artery into
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that right side of the heart and we
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really went in depth in this in a heart
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failure videos and that blood starts
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backing up you start getting a lot of
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problems it will affect your liver
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because you'll get congestion in those
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hepatic veins and fluid will start
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building up in the abdomen eventually
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into the legs and it can even lead to
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left-sided heart failure as well so that
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is where the patient is getting the
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bloating and that's where the blue
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bloating comes from now let's look at
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emphysema these patients are sometimes
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called pink puffers why is that patients
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with emphysema tend not to have the
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cyanosis as with the blue bloaters why
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you get the name pink and the puffers
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comes from what's going on
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due to compensation and because the body
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has low oh two levels from what's going
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on with these alveolar sacs the body
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will hyperventilate increase that
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respiratory rate so in a sense they will
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be puffing in order to breathe they're
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really breathing rapidly to get more
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oxygen in to increase the oxygen level
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so you'll have no sign of cyanosis and
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the pink complexion now let's look at
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what's going on up close
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okay so what's happened is that say for
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instance this patient is a smoker and
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they're inhaling that constant irritant
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to their lungs what happens is that an
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inflammation process starts going on
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because of all that smoke affecting the
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sac and the body actually releases a
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substance that causes those of Yolo sex
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to lose their elasticity so they're not
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going to be inflating and deflating
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properly and they become deformed and
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they don't work and whenever that
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happens it's not good because you're not
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going to have proper gas exchange
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happening where those ovular sacs are
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inflating and deflating which is
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allowing that carbon dioxide to pass
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through that capillary wall so you'll be
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keeping carbon dioxide and it's not
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going to allow that oxygen to attach to
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those red blood cells to go through the
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body so you're going to have low oxygen
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now also another thing that happens
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because you're those sacs are not fully
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deflating because they don't work good
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air is going to get trapped in those
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sacks which is going to lead to
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hyperinflation of the lungs and whenever
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the lungs enlarge remember what's below
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your lungs is your diaphragm and the
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diaphragm is going to go from that
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beautiful dome shape to flatten and how
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you the way you breathe what makes it
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effortlessly is your diaphragm it plays
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a huge role in it so to compensate
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because the lungs have to in a sense
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squeeze that air out the body is going
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to start using accessory muscles on your
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chest to help the person get that air
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out and they're also going to
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hyperventilate to get that air out and
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to hopefully get some more oxygen in so
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this will lead because they're using
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their accessory muscles so much to that
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barrel chest look that patients with a
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massima may have which is that increase
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anterior posterior diameter that you may
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see on inspection and the
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hyperventilation again is the
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compensation to help get that oxygen
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level where it needs to be so that's why
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you're not going to see
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we're not going to be blue while they'll
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have that pink complexion compared to
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patients who have chronic bronchitis now
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let's talk about the signs and symptoms
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of COPD to help you remember the typical
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signs and symptoms of COPD let's
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remember the mnemonic lung damage
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because that is what is going on with
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COPD they have lung damage to the lungs
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that is limiting the airflow from the
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lung so el they are going to have lack
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of energy and this is because they have
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a limited supply of oxygen flooding
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through the body in order for your
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organs and everything to work properly
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it needs oxygen so anything for them
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for them to do is very hard and requires
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a lot of effort you for unable to
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tolerate activity they will get a lot of
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short really short of breath and if they
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have it really severe even getting them
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from a chair to the back to the bed or
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walking to the bathroom it's a big deal
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and it makes them very short of breath
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in for nutrition it will be poor
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especially with your patients within
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fuzzy manaos link back to the path oh
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why would they have poor nutrition well
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they are spending a lot of energy
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breathing and they're burning more
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calories than normal a person with
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healthy lungs would burn just with their
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breathing so they're going to have
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weight loss also eating if they have it
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really released severe and just chewing
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their food and swallowing their food
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exhausts them so they may not be up to
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eating so you really have to manage that
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which we'll talk about nursing
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interventions with your patients with
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emphysema g4 gases abnormal those
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arterial gases your po2 pco2 will be
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greater than 45 usually that's carbon
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dioxide and your po2 which measures your
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oxygen less than 90 because remember
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they have low oxygen and high carbon
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dioxide and usually we'll have
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respiratory acidosis because of those
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lab results D for dry or productive call
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and the productive cough all these
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possible be constant and chronic
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patients will call it wrong card
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tend to have the productive cough
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because remember they have the increased
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mucus production from where those
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bronchioles have become flamed and they
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narrowed so that's why they have that a
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four accessory muscle usage for
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breathing again that was with your
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patients with emphysema and that was
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because that diaphragm has flattened
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those lungs are hyper-inflated so now
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they their diaphragms aren't there to
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help them exhale that air so they've got
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to compensate by using those accessory
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muscles and the other a for abnormal
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lung sounds
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it can vary they can be diminished where
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you don't hear much of anything
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especially in those lower bases coarse
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crackles especially in your chronic
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bronchitis because of that you because
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that's what you're going to be hearing
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or wheezing and I have a whole video if
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you're not familiar with what these lung
00:17:51
sounds sound like a card should be
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popping up and you can access the video
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it has audio clips where you can
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actually hear these lung sounds in for
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modification of skin color from pink to
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cyanosis and this again was with her
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chronic bronchitis patients they have a
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tendency because of their low oxygen
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will have the blue around lips or mucous
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membranes or the skin and a four
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anterior-posterior diameter increase and
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that's that barrel chest look and that's
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mainly with the patients who are
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suffering from emphysema because the
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usage of those accessory muscles built
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up the chest and the hyperinflation of
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the lungs G and four gets in the tripod
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position to breathe a lot of times in
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order to help these patients breathe
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whenever they're having difficulty
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breathing they will get in the tripod
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position and this is where they're
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standing they're leaning forward and
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while supporting their hands on their
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knees or on an object and just being
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bent over like that helps them breathe
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better so you may see that sometimes and
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ii4 extreme disney a-- and that just
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goes along with everything that's going
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on they just get really short of breath
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a lot of times now let's look at the
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complications of COPD and how it is
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diagnosed
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and a few complications a patient could
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experience with COPD is heart disease
00:19:16
like heart failure again and we talked
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about that with the path especially the
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chronic bronchitis patients it can lead
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to pulmonary hypertension which will
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cause increased pressure on that right
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side of that ventricle and I mean get
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right-sided heart failure
00:19:33
another thing is pneumothorax where the
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lung just collapses spontaneously
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and this tends to be spontaneous and
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patients who have a history of COPD and
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it's because of the formation of those
00:19:46
air sacs in those alveoli and especially
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your patients with emphysema and I have
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had patients who have been admitted with
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this so this does happen I have seen it
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lung infections pneumonia for instance
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and they have an increased risk of
00:20:01
developing lung cancer okay so how is
00:20:04
this diagnosed from a nursing standpoint
00:20:06
just be familiar with what may be
00:20:08
ordered so if you're taking care of a
00:20:10
patient with this you know what to look
00:20:12
for for their test results and
00:20:14
physicians will order what's called a
00:20:16
spirometry which is a test where
00:20:19
patients breathe into a tube which
00:20:22
measures the following it's going to
00:20:25
measure how much volume the lungs can
00:20:27
hold during inhalation and it's going to
00:20:30
measure how much and how fast air volume
00:20:33
is being exhaled because remember that's
00:20:35
the whole problem with this disease
00:20:37
process they have an issue with
00:20:39
retaining too much so they don't exhale
00:20:41
too much compared to how much they took
00:20:43
in so it will measure that and what it's
00:20:45
measuring the two things mainly is it's
00:20:49
measuring the the fvc which is the
00:20:52
forced vital capacity and if they get a
00:20:55
low reading on this this represents
00:20:57
restrictive breathing and this is the
00:20:59
largest amount of air exhaled after
00:21:02
breathing in deeply in one second
00:21:05
another thing it looks at is it measures
00:21:08
the force expert ory
00:21:10
volume which is how much air a person
00:21:13
can exhale within one second and a low
00:21:17
reading will end
00:21:19
okay how severe the disease process
00:21:21
actually is so that is about COPD part
00:21:25
one now be sure to check out part two
00:21:27
and don't forget to take the in CLECs
00:21:28
review quiz that goes along with this
00:21:31
lecture and thank you so much for
00:21:32
watching and please consider subscribing
00:21:33
to this YouTube channel
