Nursing - patient with copd and vascular dementia scenario Essay

Nursing - patient with copd and vascular dementia scenario - Essay Example Chronic Obstructive Pulmonary disease (COPD) COPD generally refers to a condition wherein the airways are destroyed, narrowing the airways and eventually obstructing the air flow, impairing gas exchange. This condition is a combination of chronic bronchitis, emphysema and asthma. It is an irreversible, incurable, progressive but a preventable condition (Black & Hawks, 2005; British Lung Foundation, 2007). It is estimated that 3.7 million people in the United Kingdom are suffering form COPD, while only 900,000 are currently diagnosed, leaving the remaining 2.8 million unaware of their disease (British Lung Foundation, 2007), while 25 million in the United States (National Heart, Lung, and Blood Institute, 2009). Among those who are greater than or equal to 65 years old, the occurrence is estimated to be 34 out of 1000 (Torres & Moayedi, 2007). These values tend to increase over time due to increased tobacco consumption worldwide. COPD ranks from fourth to sixth as the leading cause of sickness and death worldwide (Mathers & Loncar, 2006; Viegi et al, 2007). According to Berry and Wise (2010), mortality can be predicted by the values of forced expiratory volume in one second, ratio of inspiratory and total lung capacities, and the BODE index (body mass index, obstruction, dyspnea and exercise capacity). Despite the severity of this condition, it is frequently under-diagnosed and under-treated (Viegi et al, 2007). Almost all cases of COPD developed symptoms, more than half manifests productive cough and half of the cases passed the Global Initiative for Chronic Obstructive Lung Disease criteria for emphysema (Lundback et al, 2003). Age, gender, race, smoking history, blood type, alpha1-antitrypsin variation, socioeconomic status, occupation, pollution exposure and infections are the known risk factors for developing COPD (Cohen et al, 1977). Race is also a factor in developing COPD, wherein whites has an odds ratio of 3.1 in dying from this condition (Meyer et al, 2002) though African Americans appear to be more susceptible to the effects of COPD than whites (Chatila et al, 2004). Among those risk factors, smoking is the most prominent cause of COPD. According to the World Health Organization (WHO), 40% to 74% who die from COPD are smokers (Mannino & Buist, 2007). Meyer et al (2002) reveals more than 80% of deaths from those who experienced smoking before and during COPD morbidity, while the odds ratio of those who currently smokes versus those who stopped smoking are 6.5 and 3.7 respectively. Aside from irritants from smoking, occupational-related vapours, gas, dust and fumes exposure is also a risk in developing COPD (Blanc et al, 2009). The numerous irritants, either from cigarette smoke or from environmental pollution, stimulate inflammatory response along the bronchi and the alveoli. The COPD-related effects of this response are increased mucus production and the release of protease and elastase, enzymes that can damage the lung’ s connective tissues. Without adequate alpha1-antitrypsin to counteract the effects of these enzymes, tissue destruction will be progressive. This destruction collapses the alveoli, allowing air pockets to form between the alveolar spaces. The elasticity of the alveolar walls is also altered, making expiration more difficult. These air pockets increase the lung area that cannot facilitate gas and blood exchange, thus this is where the manifestations of emphysema set in. As the gas