CHRONIC OBSTRUCTIVE PULMONARY

DISEASE


Bola Kwentua
 Definition

 Chronic obstructive pulmonary disease

(COPD) is a lung disease in which your lungs
become inflamed or damaged, preventing air
from flowing in and out normally.
 It results from constantly inflamed and irritated
airways in your lungs
 Two forms of COPD
 Chronic bronchitis: a disease of the airways
defined by the presence of cough and sputum
production for at least 3 months in each of two
consecutive years.
 Forms of COPD contd

Emphysema :the walls between many of the air sacs are damaged, causing
them to lose their shape and become floppy. This damage also can destroy the
walls of the air sacs, leading to fewer and larger air sacs instead of many tiny
ones.
 STAGES OF COPD
Stage 1:
Mild COPD: Mildly reduced airflow; sometimes, a chronic cough
and sputum production

Stage 2:
Moderate COPD: Worsening airflow; shortness of breath typically
brought on by exertion

Stage 3:
Severe COPD: Further worsening of airflow; greater shortness of
breath, reduced quality of life

Stage 4:
Very Severe COPD: Severe reduction in airflow; chronic respiratory
failure; greatly reduced quality of life
Clinical Manifestations/ Symptoms

 Dyspnea
 Chronic cough
 Increased sputum
 wheezing
 Fatigue
 Respiratory Infections
 Risk Factors Associated with COPD
 Smoking
 Occupational exposures
 Air pollution
 Heredity
 Second hand smoking
 Aging
 Treatments
 Bronchodilators
 Corticosteroids
 Anticholinergics
 Long term oxygen therapy (LTOT)
 Good Nutrition
 Lung Transplant
 Pulmonary Rehabilitation
 Physical Assessment & History
 General: JP is a 68 year old African American woman presented to the ED
for dyspnea (shortness of breath).
 Temp: 97.3; BP 124/58; HR: 83; RESP: 20; PULSE: 98
 Smoker for 15years.
 Dyspnea (shortness of breath)-: Dyspnea (shortness of breath) is a
symptom of many pulmonary and cardiac disorders, particularly when there
is decreased lung compliance and or increased airway resistance. The right
ventricle of the heart is affected ultimately by lung disease because it must
pump blood through the lungs against greater resistance. This patient has a
history of severe chronic obstructive pulmonary disease (COPD) and
dyspnea is a symptom of it
 HX : bilateral pulmonary congestion, hypertension, respiratory failure,
obstructive sleep apnea, pneumonia, asthma.
 Nursing Diagnosis #1
 Activity intolerance related to imbalance between oxygen supply and
demand as evidenced by exertion dyspnea and verbal reports of fatigue.
INTERVENTION
 Observe pt tolerance to activity
 Use supplemental oxygen
 Assist in controlled breathing exercise to help reduce end expiratory

volume and breathlessness.

GOAL
 Patient will adhere to prescribed physical activity by ambulating with

the physical therapist on the hospital floor during this shift

OUTCOME
 Partially met. Pt ambulated from bed to room door, but complained of

fatigue and exhaustion.

 Nursing Diagnosis #2
 Impaired gas exchange related to ventilation-perfusion
inequality as evidenced by abnormal arterial blood gases and
arterial pH.
INTERVENTION
 Position pt in semi-fowler’s position

 Monitor respiratory rate, depth and effort with use of accessory muscles, nasal
flaring and abnormal breathing pattern.

 Observe for cyanosis of the skin

GOALS
 Pt will demonstrate improved ventilation and adequate oxygenation with blood gas
level within normal parameters for pt
 Nursing diagnosis #3
 Ineffective airway clearance related to bronchospasm,
increased mucus, ineffective cough, infection as evidenced by
ineffective cough , presence of abnormal breath sounds

Interventions
 Assist patient to semi-fowler position
 Encourage with pursed-lip breathing exercises
 Administer medication as prescribed.

Outcome
 Pt will demonstrate behaviors to improve airway clearance
 Epidemics/ Statistics
 According to CDC….
 COPD is the fourth leading cause of death, illness, and
disability in the United States.

 In 2000, 119,000 deaths, 726,000 hospitalizations, and 1.5

million hospital emergency departments visits were
caused by COPD.

(http://www.cdc.gov/copd/facts.htm)
 References
 Ackley, Betty. (2008). Nursing Diagnosis
Handbook. An Evidence-Based Guide to
planning Care. Missouri, MO: Elsevier
 Center for Disease Control. (2010). Heart
Disease Facts. Retrieved May1,2010 from
http://www.cdc.gov/copd/facts.htm
 Porth, Carol. (2007). Essentials of
Pathophysiology. Philadelphia, PA: Lippincott &
Wilkins