COPD

Table of Contents Introduction .................................................................................................................................... 1 Patient Overview ............................................................................................................................ 2 Pathophysiology of the Disease ..................................................................................................... 4 TREATEMENT ............................................................................................................................. 5 Nursing assessment, management and evaluation ...................................................................... 6 Pharmacology ................................................................................................................................. 6 Conclusion ...................................................................................................................................... 6

Introduction COPD was classified as chronic obstructive pulmonary disease (COPD) in 1995 by the European Respiratory Society (ERS) "the presence of decreased maximal expiratory flow and sluggish lung emptying over a period of several months; these characteristics do not change significantly over time. Airflow limitation is a progressive process that cannot be stopped or reversed once it has begun. The airflow restriction is induced by a variety of distinct combinations of airway disease and emphysema; determining the relative contribution of the two processes in vivo is difficult to determine. There is no universally accepted term for airway illness, which is mostly an inflammatory sickness. Even though obstructive bronchiolitis 2 and 3 have a number of advantages, they have not gained general acceptance. The American Thoracic Society (ATS) provided this definition of chronic obstructive pulmonary disease (COPD) in its 1995 Statement on Chronic Obstructive Pulmonary Disease (COPD), which stated that "the airflow obstruction is usually progressive, may well be accompanied by airways hyper-reactivity, but may be partially reversed." 2. When the term "chronic bronchitis," which is generally used to describe mucus hypersecretion arising mostly from larger airways, is utilised in the description of COPD, it can easily generate confusion (Lötvall, et.al, 2000). COPD was defined as such an airway limitation with only an expected expiratory volume in one second (FEV) 1/forced cardiorespiratory fitness (FVC) L of 88 percent in males and 89 percent in females, respectively, as compared to a healthy population. COPD does not include conditions such as cystic fibrosis, bronchiectasis, byssinosis, or bronchiolitis obliterans, which are not included in this classification. Nevertheless, if both positively and negatively weighted criteria are utilised in determining the parameters of a case, a difficulty develops. It is still difficult to discern between asthma and COPD (Niederman, et.al, 1997). The adoption of definitions or the translation of definitions into diverse operational criteria may result in a variety of assessments of prevalence rates or risks, which complicates the interpretation of data that appears to be inconsistent. Because of the ambiguity in the definition of COPD, many people choose to smoke. Many clinical trials do not include non-smokers, despite the fact that smoking is not a requirement in any of the COPD categories listed above, including the one described above (Martin, et.al, 2013).

Patient Past History The diagnosis of severe COPD is made based on the patient's medical history. An ultrasound scan revealed that the patient had high blood pressure and angina, as well as an abdominal aortic aneurysm, which is a triple vessel illness that is more severe than gallbladder stones. Social History He lives with his wife in a two-story house with a yard. With regards to ADLs, I am self- sufficient. He is a retired lorry driver who was exposed to asbestos, a carcinogen that can cause lung cancer in some people. He is a former smoker who now utilises vapes to quit. Furthermore, he has given up smoking since 2018. He used to smoke 20 cigarettes a day, five days a week. Anatomy of the System involve in COPD Upper airways and lower airways make up the respiratory system. Nasal or oral pharynx, epiglottis, and the larynx comprise upper airway. The lower airway below your larynx, which is made up of three major parts: the larynx (the vocal cords), the larynx (the windpipe), and the alveoli (the air sacs in your lungs). Thoracic cavity carries two lungs: one on left side by a border that fit heart, and one on right hand side with a border that fit the diaphragm. It is the diaphragm, which separates the chest and abdomen that is responsible for breathing. The internally and externally intercostal of ribs, as well as abdominal muscles, serve as auxiliary muscle that aid in opening thoracic cavity. By pulling the lungs downward, the diaphragm expands the thoracic cavity, freeing up the lungs to extend and take in air via the nose, throat, and bronchial tubes. Small blood vessels called capillaries surround alveoli in the lung and exchange oxygen molecules. Because of the reduced ability of the bronchial tubes and alveoli to extend and dilate because of mucus buildup and constriction, air is retained and gas exchange is impeded. This results in the barrel chest seen throughout patients with COPD as a result of a buildup of pressure in the lungs. Upper airways and lower airways make up the respiratory system. It comprises the nose, nasal or oral pharynx, epiglottis, the larynx, which are all located in the upper airway. You can see the alveoli at the bottom of the throat, where the trachea and the bronchial tubes split into smaller ones like a tree's branches.

Thoracic cavity houses two lungs: one on left side by such a line to fit heart, and three on a right side with such a border to fit diaphragm. The main respiratory muscle is the diaphragm, which separates the chest from the abdomen. Including I the internally and externally intercostal of ribs, as well as the abdominal muscles, serve as auxiliary muscles that aid in opening the thoracic cavity. Expansion of a thoracic cavity and subsequent expansion of lung capacity are made possible by diaphragmatic contraction, which pushes the lungs downward into the chest cavity. There are capillaries surrounding the alveoli that exchange oxygen for the carbon dioxide at alveolar levels. There is less gas exchange when the bronchial tubes and alveoli get obstructed by mucus and are less ready to broaden and dilate. This results in the barrel chest seen throughout patients with COPD as a result of a buildup of pressure in the lungs. Pathophysiology of the Disease In COPD, the lungs' airways developed into as inflamed and restricted airways, making it difficult to breathe. During a person's exhalation, mucus accumulates and causes them to collapse. A bronchial tube's airflow is reduced as a result of this. Airway blockage as a result of the condition COPD cause narrowing and inflammation of bronchial tubes. When you exhale, they can become clogged by mucus and collapse. There is less airflow thru the bronchial tubes, resulting in what is known as airway obstruction. This makes breathing more difficult (Barnes, et.al, 2009). Lung nerves become extremely sensitive as a result of bronchial tube inflammation. A cough is a quick and powerful contraction of a muscles of respiration that occurs when the body is inflamed. Helps eliminate mucus in the lungs by moving air quickly via breathing tubes. Mucus that has accumulated over the night might cause COPD sufferers to cough heavily in the morning (Rogers, et.al, 2000). The exchange of o2 and co2 It is in the lungs where blood obtains oxygen for distribution all through the body system and where waste carbon dioxide is expelled. This process is affected by COPD.

Treatment Surgical emphysema The Surgical emphysema also known as subcutaneous emphysema were done when air/gas has been located within a subcutaneous tissues (A layers present under skin) Thus typically occurs in chest, neck, face, Currently on a very low mood due to the recent passing of his step daughter. Patient prepared for news before the surgery. Before the surgery the ECS and bloods were done and pre- operative checklist was done. Covid test was done before 7 hours (Decramer, et.al, 2010). Ascending artery which lies posteriorly was dissected out and stapled. The upper lobe of the bronchus was dissected out and stapled (Green lobe) the tissue were completed and lobe removed from the chest in an endocatth bag. Nodes resected stations 4, 10 and 11 wash. Intercostal blocks (30ml) PUC under direct vision (10ml) single drain to apex lung. Two parts and accessory incision, lots intrapleural adhesions taken. Low mass palpable in upper lobe. Helium dissected and portion of SPU draining the upper lobe identified dissected and stabled First branch of the pulmonary artery to the upper lobe dissected and stapled (Decramer, et.al, 2010). Causes of the treatment Surgical Emphysema is a lung condition caused by trapped air in the lung following surgery. One of the most prevalent causes of pulmonary embolisms is a pneumothorax, which can be caused by a plugged chest tube. Surgeons refer to this condition as surgical emphysema because it occurs when the alveoli rupture spontaneously, resulting in a dramatic presentation of the sickness (Renkema, et.al, 1996).

Nursing assessment, management and evaluation According to my patient condition I have chosen two tools. Falls assessment and waterloo. A number of characteristics were taken into consideration when developing the Waterlow revised scale, including: built/weight for height BMI; assessment of skin; gender; age; continence; mobility; nutrition; medication; tissue malnutrition; neurological impairments; and substantial surgery or trauma The inclusion of such a broad range of risk indicators allows the scales to be used to assess a broader range of patients, but it also increases the potential of overestimating an individual's risk and making the scales' administration more complicated. So for this reason for the patient score we have diagnosed the weight that is 62 kg and the height that’s is 1.75cm. So the BMI we get is 20.4 kg.m 2 The falls assessment tool is a testing in which series of question has been asked about the patient health or a question of asking previous imbalance or not maintaining in balance, standing and walking. When we have taken the patient test we have seen that he requires anyone to stand or requires any assistance in handling. Further on testing the type of his skin is like a tissue paper. Hence his falls risk score is YES. Moreover his Covid report were negative. The ECG of a patient is that the right shift of the P wave axis by a P waves inferiorly and inverted P waves. Pharmacology Lactulose oral liquid, morphine sulphate liquid. Conclusion After the surgery, the Patient airways were patent, there was nil obstruction, and the patient could speak whole sentences. Self-ventilating, his RR in range and SPO2 levels are in the range targeted at room air. Moreover, the cough, SOB or respiratory distress has been diagnosed nil. Cardiovascular stability, Blood process and heart rate are in range. The patient was physically stable and balanced, alert. The Intravenous access or thoracic attachment were found normal. No internal and external pain has been complained by the patient. The patient's diet was regular, but he has been recommended to the dietitian because of losing a large amount of weight.

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