Review and Medications for COPD: Chronic Bronchitis and Emphysema (Nursing)

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.