00:00
Hi and welcome to another one of
our respiratory medication videos.
00:05
In this video, we're gonna discuss COPD,
that's chronic obstructive pulmonary disease
Obviously you can see why
we call it COPD for short.
00:15
Now COPD is an umbrella term for two
other type of disease processes
One is called emphysema, and the
other is chronic bronchitis.
00:26
Okay we're gonna start with
chronic bronchitis.
00:29
Now you can learn a lot about
the disease just from the name.
00:34
So chronic tells you that, hmm
this isn't just an acute episode,
this happens over and over
and over again to your patient.
00:42
Now there's four letters at the
end of bronchitis, I-T-I-S
Now from your medical terminology,
remember that that means inflammation,
it doesn't necessarily always mean
infection but it does mean inflammation.
00:57
So this tells me I have a chronic
inflammation, -itis of the bronch-
so obviously it's a chronic inflammation of the
respiratory tract, so in especially the bronchioles
These patients deal with this
really thick nasty mucus
and therefore they're short of breath
because that thick nasty mucus
is filling up their airways so it's
really hard for air to pass through that.
01:25
Now a lot of times they have the bacterial
colonization in their respiratory tracts so,
those those guys are real comfortable
and they just kinda hang out there.
01:34
So chronic bronchitis is an ongoing problem,
it's an inflammation of the bronchioles
and you've got usually bacteria
that are colonized in there,
and they end up with that
that nasty thick mucus.
01:50
Emphysema is a little bit different.
01:52
Remember COPD is an umbrella
term for these two disease processes
Bronchitis which is inflammation of the
airways, emphysema is a different one.
02:04
These airways are (puffs) blown up.
02:07
The alveoli are really damaged
and enlarged.
02:11
If you see in the picture, you can tell normally
an alveoli, well we usually kinda compare it to
a cluster of grapes - they're uniformly shaped,
they're round, they're open and they're inflated.
02:21
In emphysema, those walls had been damaged
and enlarged because they're destroyed.
02:27
So they're not those cute little round-shapes anymore
and when they're not those uniformed shapes,
they just don't exchange CO2 and O2 well
and in fact, air gets trapped in there
and that's why we're gonna end up having a
major respiratory problems with emphysema,
So before we move on, I'd like you to write in the
margin of your notes the words, "COPD" at the top
and then write a bridge to the
right, and a bridge to the left.
02:54
Under the right or left bridge you
pick, write the word "emphysema"
and on the other bridge,
write the word "bronchitis"
Now I remember it this way - bronchitis
is gunked up, emphysema is blown up.
03:14
Either way, the lungs aren't
able to function efficiently.
03:18
With bronchitis, they've got a thick mucus making it
difficult to breathe and for air to get where it needs to go
and emphysema, because those walls are damaged,
we also don't have good O2/CO2 exchange.
03:30
So let's look at the
overall symptoms for COPD.
03:33
Emphysema and chronic bronchitis
have some sad things in common.
03:38
Now you see up there, there's our friend nurse
Natalie, she's kind and warm and friendly.
03:42
I hope she's the type of preceptor you
guys get when you go to clinicals,
because look how kind she is and patient.
03:49
So with COPD you have air trapping.
03:51
That means I get air in but they get stuck down
there so it's hard for me to get new air in
because all the real estate is taken up.
03:59
Now you have damaged tissue
for CO2 and 02 exchange.
04:03
Different ways we got to damage the tissue,
but still you have damaged tissue.
04:08
So the excange of carbon dioxide for
oxygen is not as efficient as it would be
and someone who's lungs
don't suffer from COPD.
04:17
So here's the things you're gonna
see in these patients, now
I can remember as a new nursing student, the
first time I took care of COPD patient,
they seemed really kind of irritable to me
and the classic symptom when you walk in,
a COPD patient will be sitting up in bed,
they'll be leaned over in a tripod position
because it lengthens their chest wall and
makes it easier for them to breathe,
They usually have an emesis basin, you know
we have those available for patients to
brush their teeth and spit in or if they
throw up but they're usually pretty small,
with lined with Kleenex and they've
always got giant phlegm things
sitting in those Kleenex and they can
sometimes be a difficult patient to deal with
but here's what you have to remember - they
always feel air hungry and short of breath.
05:09
If they're in the hospital with you, it's
because they're having difficulty breathing
or they might be here for another diagnosis
originally but COPD makes everything worse.
05:20
Another reason why they're might
probably be more irritable
is the type of medications
that they have to take.
05:26
Sometimes their sympathetic nervous systems
are so on overdrive from all the stimulants,
it's difficult for them to remain calm.
05:34
So be very patient with them and know that when
you're dealing with a patient who is in COPD,
don't expect them to be like a
regular person out on the street.
05:43
They're really challenged with the
things that they're dealing with.
05:46
So they may request a fan and ask you to...
that sometimes helps them to feel better,
just put your best nurse Natalie face
on, remain very calm and kind to them
and you'll help them breathe more better
just by the way they deal with it.
06:00
So due to the difficulty of breathing, they
have this cough going on all the time.
06:04
Lots of times they're coughing up a lot
of the yuck stuff from their lungs,
hence the emesis basin lined
with Kleenexes.
06:13
I think phlegm is my worst, my least
favorite thing to deal with as a nurse.
06:18
There's a lot of body fluids that aren't
fun but that's are not really my favorite.
06:22
These guys live with a lower
oxygen level than you or I do.
06:26
Because they have such difficulty in their
lungs, they have poor CO2/O2 exchange.
06:31
Their normal oxygen level is gonna
be lower than somebody without COPD
and their CO2 level is going to be higher.
06:40
So keep that in mind.
06:41
Their arterial blood gas, ABGs are gonna
be way different than yours and mine
depending on how far the
disease has progressed.
06:49
So make sure you have
that point clear.
06:52
They're gonna have lower oxygen
levels and higher CO2 levels.
06:57
They retain CO2 because they have
poor exchange.
07:00
Okay now let's get fancy.
07:03
You guys are sharp enough
to figure this out with me.
07:05
If I have COPD, I'm at an increased risk for
right sided heart failure or cor pulmonale.
07:13
So before I give you the answer, I want you to
pause the video and just think about one thing.
07:19
These lungs are really really damaged.
07:22
Why would the right side of my heart get bigger or
have failure because of the lungs being damaged?
Okay welcome back, let's
talk about the answer
Well COPD or bronchitis, there's some real nasty
stuff that happens in those lungs, right?
So the pressures are getting higher in your lungs
but when the pressure is higher in your lungs,
which side of the heart is
pumping blood into your lungs?
The right side.
07:54
Remember, right atrium - right ventricle...
wait a minute,
right atrium- right ventricle,
wow!
When someone has COPD, (grunting sound) trying to
push that blood over to the right side of your heart,
it's really having a hard time.
08:11
So the right side of your heart says,
"That's it, I'm getting serious".
08:14
It buckles down and then
it gets bigger and bigger.
08:17
Well that works temporarily but then it gets so
out of hand that the right side of your heart
gets kinda floppy and mushy and
it's no longer as effective.
08:28
So COPD and other lung problems
can cause cor pulmonale.
08:34
Cor referring to the heart,
pulmonale - to the lungs.
08:38
It's right-sided heart failure because
of the increased pressure in the lungs,
that right side is having to push so hard
it gets bigger to deal with it and then
bigger and bigger and then
it's no longer effective.
08:52
So that's how lung problems cause
right-sided heart failure.
08:57
Good work! as long as you follow along
with us, you've got the concept.
09:01
Otherwise pause the tape, write it through again
just to make sure that you have those steps
because that's a really important
point in understanding what happens
when one disease causes
another problem in your body.
09:16
Okay now I love this picture,
isn't that precious?
How could you not look at something
like that and smile, it's really cool.
09:23
We're gonna talk about bronchodilators.
09:26
Now in stable COPD, we're
gonna use bronchodilators,
and we're gonna look at short acting
SABAs if they're in acute attack right?
or maybe some anticholinergics,
So we're looking at... I'm gonna take a patient who
has ongoing COPD but they're not in an acute crisis.
09:44
So we're gonna put them on short acting
beta-2s probably and some anticholinergics,
maybe both, maybe one or the other, that'll depend
on what the healthcare provider decides.
09:56
Now were in a crisis, so
what are we gonna do?
You got it, short actings, right?
Wait a minute, if you've watch our asthma video, which
medication do we use for an acute exacerbation there?
Short acting beta-2 adrenergic
agonist, so the takeaway point?
Whenever somebody's in respiratory distress,
we've got these bronchodilation issues,
we need to open up those airways.
10:21
SABAs are your answer right?
Doesn't necessarily mean, why do we get there?
that's not the most important point.
10:27
We know we need to have bronchodilation,
a SABA is always gonna be the answer
So those were the bronchodilators,
now let's look the glucocorticoids.
10:37
Remember these are never a rescue medication
for any one with a respiratory distress
but for stable COPD, we're gonna have them
routinely on probably a glucocorticoid
and possibly with a long acting
beta-2 adrenergic agonist.
10:52
Now we don't do this in monotherapy.
10:55
Mono- means one so you wouldn't
be on just steroids by itself,
any one with respiratory problems is also going
to be on a medication that does bronchodilation.
11:05
Okay, phosphodiesterase type 4 inhibitors
Now look at that name there, underline
that because that's kind of a weird one,
We haven't talked about that one before.
11:16
This is for severe COPD.
11:19
This is one of those special
medications that we use just for COPD.