Pathophysiology of Chronic Obstructive Pulmonary Disease

This article delves into the pathophysiology of chronic obstructive pulmonary disease (COPD), its clinical features, respiratory compensation, risk for respiratory infection, pulmonary embolism, and musculoskeletal conditions. It also discusses how hip fracture and replacement influence respiratory function and urinary volume. Additionally, it provides insights on Audrey's blood test and the complications she might develop.

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PATHOPHYSIOLOGY OF CHRONIC OBSTRUCTIVE
PULMONARY DISEASE
Name:
Institutional affiliation:

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DAY ONE
Audrey is diagnosed with chronic obstructive disease. According to (National Health
Institute,2014) the guidelines provided indicate Audrey is most likely to have chronic bronchitis
or emphysema. Audrey might be suffering from chronic bronchitis since she has severe dyspnea,
coughs a lot and excess mucus production. Audrey might also be suffering from emphysema
which is characterized by barrel chest due to the hyperinflation of the lungs, dyspnea and a high
respiratory rate.
PATHOPHYSIOLOGY LINKS WITH CLINICAL FEATURES
Pathophysiology of chronic bronchitis majorly involves inflammation of the airway due to
irritants, excess mucus production which further worsens the airway flow. According to
(Hogg,2014) chronic bronchitis results due to inflammation of the airway due to irritation mostly
by the chemicals in cigarettes. This leads to an increase in goblet cells which secrete mucus and a
decrease in ciliary action hence stasis of mucus. The bronchial walls are filled with mucus
further decreasing the airway flow. The alveoli in the bronchioles have undergone fibrosis and
the macrophages which play a role in phagocytosis of foreign material are unable to function.
This increases the chance of infection as defense mechanism are compromised. Audrey has a
history of smoking. Smoking is a risk factor in chronic bronchitis. The excess mucus production
is due to the inflammation of the airway. The coughing is a reflex to get rid of the secretions
while the high respiratory rate is a compensatory mechanism of excreting accumulating carbon
(IV)oxide.
Pathophysiology of emphysema involves hyperinflation and damage to the alveoli. According to
(Hinkle and Cheever,2013) emphysema is as a result of alveolar hyperinflation hence the alveoli

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are damaged mostly due to smoking. This causes decreased air exchange as there is less surface
area in contact with pulmonary capillaries. The accumulation of carbon (IV)oxide leads to
respiratory acidosis. The expiration is forceful, the rib joints are fixed and chest is rigid hence
barrel chest. Audrey presents with a barrel chest, high respiratory rate due to hypercapnia,
labored breathing due to low levels of oxygen saturation and constant fatigue.
RESPIRATORY COMPENSATION
Audrey attempts to compensate for the imbalance in physiological state by hyperventilation and
hyperinflation. (Stephen, Mauricio and Atul,2013) states that in chronic obstructive disease
hyperinflation is necessary in maintaining perfusion severe airflow limitation hence the
formation of barrel chest in Audrey’s case. Also, tachypnea demonstrated by respiratory rate of
32 breaths per minute increases lung elasticity. The compensatory mechanism is due to the rising
levels of retained carbon (IV)oxide which changes plasma Ph then triggers the respiratory center
in the medulla to increase the respiratory rate. The rate is increased to eliminate the carbon
(IV)oxide and increase the oxygen levels in the blood.
RISK FOR RESPIRATORY INFECTION
Audrey is at a high risk of suffering from respiratory infection because her primary defense
mechanisms have been altered in the disease process. (Sethi,2013, p.1210) states that patients
with chronic obstructive pulmonary disease have increased frequency of acquiring lower
respiratory tract infections both viral and bacterial. Audrey being a heavy smoker, the
tracheobronchial tree is disrupted as there is slowed ciliary activity, increased mucus secretions,
therefore, microbial agents are able to attack. Macrophages which phagocytose foreign agents
are decreased hence a higher risk of infections. Smokers are at a greater risk of infections

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compared to nonsmokers (Einarsson et al.,2016). The immune defense mechanisms in
nonsmokers such as increased ciliary activity is efficient compared to that of smokers hence
Audrey is at a high risk of contracting a respiratory infection.
PULMONARY EMBOLISM
Audrey is constantly tired and has labored breathing which means she is unable to conduct
activities of daily living hence immobile. Long states of immobility increase the chances of
pulmonary embolism. Audrey is overweight at 110 kilograms which increases risk of pulmonary
embolism. (Akpinar et al.,2014, p.44) states that patients with chronic obstructive pulmonary
disease who are immobile and obese were more likely to have pulmonary embolism. This is
attributed to poor blood circulation hence stasis leading to clot formation. Proper management
includes fitting Audrey with deep venous thrombosis stockings since most clots form from the
lower extremities. Audrey’s medication includes anticoagulants which counter any clots that may
have formed. Audrey should be taught how to perform leg exercises to encourage blood
circulation.
DAY TWO
MUSCULOSKELETAL CONDITIONS
Audrey has a body mass index of 40.4 which is obesity grade three according to (Australian
Heart Foundation,2018). (Cielen, Maes and Gayan-Ramirez,2014) states that osteoporosis is a
comorbidity in patients suffering from chronic obstructive pulmonary disease. This is majorly
because of decreased bone mineral density which causes pathological fractures such as in
Audrey’s case. Osteoporosis progresses to fractures, therefore, increasing the stay of

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hospitalization and causes increased mortality. (Inoue, Watanabe and Okazaki,2016) describes
that increased bone metabolism causes osteoporosis in chronic obstructive pulmonary disease
and smoking highly contributes to osteoporosis.
(Cielen et al.,2014) suggests decreased skeletal muscle strength in patients with chronic
obstructive pulmonary disease. This causes easy fatigability and risks accidental injuries.
Weakness in skeletal muscles is attributed to reduced physical activity, smoking and increased
oxidative stress due to inflammation processes.
According to (Pfeger&Woolf,2013, p.648) chronic pain is a major complaint that has to be dealt
with after hip fracture due to osteoporosis. This limits activities the client can perform and may
need nursing care for probably the rest of their lives. Audrey is at risk of developing chronic pain
related to hip replacement surgery.
Just like any other invasive procedure, there is a likelihood of invasion by microorganisms.
(Namba, Inacio and Paxton,2012, p.1337) states that among the high-risk factors of acquiring an
infection post hip replacement surgery is high body mass index. Audrey’s body mass index is at
40.4 thus there is need to practice aseptic technique while managing her.
(Phillips et al.,2013, p.24) retaliates that pulmonary embolism should be monitored six months
after hip replacement surgery. The patient is at risk of deep venous thrombosis related to
immobility which may progress to the lung causing an embolus dislodgement. Audrey is at risk
of pulmonary embolism after the fracture.
FACTORS CONTRIBUTING TO FRACTURES
Audrey is 66 years and her age might be contributing factor to having a fracture. (Greenspan,
Myers, Maitland, Resnick & Hayers, 2014, p.130) clarifies that there is increased risk for hip

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fractures among people above the age of fifty. Audrey has been rendered immobile by chronic
obstructive pulmonary disease due to dyspnea and labored breathing. Immobility is a risk factor
which may contribute to fractures. (Hoffman&Kelsey,2013) states that prolonged immobility
predisposes an individual to a hip fracture.
Audrey has a diagnosis of chronic obstructive pulmonary disease which causes osteoporosis.
Osteoporosis renders bones brittle hence fractures. According to (Jørgensen et al,2014, p.180)
there is need for screening patients with chronic obstructive pulmonary disease to investigate risk
for fractures and initiate prophylactic treatment.
Audrey is a smoker which is a risk factor in development of hip fractures. In combination with
all other factors smoking further increases Audrey’s risk of fractures. (Kanis et al,2013, p.160)
states that history of smoking was strongly associated with increased frequency of fractures
compared to individuals who don’t smoke.
INTERPRETATION OF HOW HIP FRACTURE AND REPLACEMENT INFLUENCES
RESPIRATORY FUNCTION
Audrey having undergone hip replacement surgery remains immobile for the next postoperative
days. Immobility contributes to stasis of secretions in the respiratory system. There is increased
risk of Audrey acquiring pneumonia. This is further facilitated by preexisting chronic obstructive
pulmonary disease where she presents with mucous secretions. There is need to assess breath
sounds and performing incentive spirometry to determine lung capacity. A rise in temperature is
an early indicator of respiratory infection. Audrey should be taught on deep breathing and
coughing exercises. If there is risk for respiratory failure Audrey should be on mechanical
ventilation.

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Hip replacement surgery renders Audrey immobile. Her weight and immobility contribute to
poor blood circulation to the surgery site and the lower extremities. There is likelihood of deep
vein thrombosis occurring. The clots may dislodge and travel to the lungs causing pulmonary
embolism. This may manifest as sudden dyspnea, chest pain and increased respiratory rate. It is
important to assess for calf pain, swelling, tenderness, warmth, and a positive Homan’s sign.
Prophylactic anticoagulants should be administered.
During a fracture, fat may dislodge from the bone marrow and enter into the bloodstream finding
its way to the lungs. This causes a pulmonary fat embolus which manifests as difficulty in
breathing, tachypnea, and low oxygen saturation levels. This requires nursing in the intensive
care unit to control signs and symptoms including mechanical ventilation (Intensive care New
South Wale Australia,2018). Audrey should be monitored carefully since her respiratory system
is quite compromised.
DAY THREE
URINARY VOLUME
Audrey is likely to have urinary volume above five hundred milliliters. This is referred to as
postoperative urinary retention especially in orthopedic patients (Zelmanovich and
Fromer,2018). Postoperative urinary retention is caused by anesthesia, prior trauma to the
bladder. It causes bladder distention and severe discomfort to the patient. If unresolved it may
cause damage to the detrusor muscles of the bladder and cause an atonic bladder. Risk factors
leading to postoperative urinary retention are grouped into modifiable and nonmodifiable.
(Kehlet,2013) states that modifiable factors include anesthesia, fluid therapy, and intrathecal
opioids while nonmodifiable include age and type of surgery.

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Since Audrey is not comfortable there has to be several steps taken. According to
(Hälleberg,2012) hip surgery is associated with pain hence patient is unable to get out of bed, the
patient should have an indwelling catheter or intermittent catheterization. While inserting the
catheter aseptic technique should be observed to decrease chances of urinary tract infection.
AUDREY’S BLOOD TEST
Audrey’s glycated hemoglobin at 12% exceeds the normal range which is 6.5% according to
(Michael,2014). (Diabetes Australia,2015) states that normal blood glucose levels are between
4.0 to 7.8 mmol/ liter while Audrey’s blood glucose levels are 13.5mmol/ liter. The blood results
indicate Audrey is diabetic. Diabetes type two is associated with late onset of adults above forty-
five years although children and adolescents of Hispanic and Latino descent have also been
diagnosed with type two diabetes (Centers for Disease Control and Prevention CDC,2011).
Audrey has a body mass index of 40.4 which is grade three obesity. Obesity has been linked to
development of diabetes type two. (CDC,2011) stated that increased physical activity and weight
loss decreases the chances of acquiring diabetes type two by 58%.
REFLECTION ON COMPLICATIONS AUDREY MIGHT DEVELOP
Audrey is at risk of acquiring respiratory infection since the chronic obstructive pulmonary
disease process compromises immune defense mechanisms. This is worsened by her immobility
due to the surgery and low immunity after surgery. To prevent respiratory infection, all
equipment coming into contact with Audrey should be sterilized. This include oxygen masks and
ventilation equipment. The healthcare workers should also ensure prompt handwashing before
and after interacting with Audrey. Audrey should be nursed in reverse barrier nursing in her own

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room. The nurse should monitor any signs of infection such as fever and change in sputum color.
Audrey should be taught coughing exercises and the importance of hydration.
Audrey is at risk of developing pulmonary embolism. Her weight and prolonged immobility
cause poor blood circulation which leads to venous blood stasis. This may lead to clot formation
which may dislodge and clog the pulmonary arteries. Smoking may also contribute to formation
of clots since the vessels harden and become weak forming clots. Audrey should be on
anticoagulants which are monitored by clotting tests. The nurse should perform Homan's sign,
evaluate calf swelling and tenderness. Audrey should wear compression stockings to prevent
formation of deep vein thrombosis.
Audrey is at risk of infection at infection at hip joint replacement after surgery. This is majorly
contributed to by diabetes and obesity. Diabetes lowers the immunity system and just like any
other surgery, there is risk for bacterial contamination. Audrey should be on prophylactic
antibiotics since she is at high risk of infection. Dressings applied to the surgical site should be
sterile and done in an aseptic technique.
Slow wound healing is a major risk and hence Audrey should be closely monitored. Diabetes
decreases blood flow to the extremities and in severe cases may cause gangrene. Slow wound
healing may prolong hospitalization. Obesity contributes to slow wound healing as there may be
wound dehiscence and poor blood circulation. Audrey should be on high nutrition foods that
promote healing. The nurse should debride any necrotizing tissue during dressing. The dressing
should be clean and changed if soaked.
Audrey is at risk of metabolic crisis due to diabetes. High blood glucose levels may cause
dehydration and altered state of consciousness. Also, if diabetes is vigorously treated it may lead

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to hypoglycemia which results into coma. There is need to monitor Audrey blood glucose levels.
This may indicate either extremities and save Audrey’s life. Audrey should be on metformin to
control the blood sugar levels. There is need to engage a nutritionist who recommends Audrey’s
diet in light of her diabetic condition.

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