Chronic obstructive
pulmonary disease
(COPD)
Definition
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COPD (chronic obstructive
pulmonary disease), is a progressive
disease that makes it hard to breathe.
"Progressive" means the disease gets
worse over time.
Key points
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COPD encompasses two diseases: emphysema and
chronic bronchitis.
Most clients who have emphysema also have chronic
bronchitis.
Emphysema is characterized by the loss of lung
elasticity and hyperinflation of lung tissue
(destruction of the alveoli) , causing impaired gas
exchange, and respiratory acidosis.
Chronic bronchitis is an inflammation of the bronchi
and bronchioles due to chronic exposure to irritants.
COPD typically affects middle age to older adult
Risk Factors
Cigarette smoking is the primary risk
factor for the development of COPD.
 Alpha1-antitrypsin (AAT) deficiency
 Exposure to air pollution
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Diagnostic and Therapeutic Procedures and
Nursing Interventions
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Pulmonary Function Tests
Chest X-ray;
◦ Reveals hyperinflation and flattened diaphragm in late stages of
emphysema.
◦ Often not useful for diagnosis of early or moderate disease.
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Arterial Blood Gases (ABGs)
◦ Serial ABGs are monitored to evaluate respiratory status.
◦ Increased PaCO2 and decreased PaO2
◦ Respiratory acidosis, metabolic alkalosis (compensation)
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Pulse Oximetry
◦ Monitor oxygen saturation levels.
◦ Less than normal (normal = 94 to 98%) oxygen saturation
levels
Diagnostic and Therapeutic Procedures and
Nursing Interventions
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Peak Expiratory Flow Meters
◦ Used to monitor treatment effectiveness.
◦ Decreased with obstruction; increased with relief of
obstruction
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AAT levels are used to assess for AAT
deficiency.
Monitor Hgb & Hct to recognize polycythemia
(compensation to chronic hypoxia).
Evaluate sputum cultures and WBCs for
diagnosis of acute respiratory infections.
Chest physiotherapy uses percussion and
vibration to mobilize secretions, and positioning
Assessments
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Signs and symptoms:
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Chronic dyspnea
Chronic cough
Hypoxemia
Hypercarbia (hyprcapnia)
Respiratory acidosis and compensatory
metabolic alkalosis
◦ Crackles
◦ Rapid and shallow respirations
Assessments
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Use of accessory muscles
Barrel chest or increased chest diameter
Hyper-resonance on percussion (emphysema)
Asynchronous breathing
Thin extremities and enlarged neck muscles
Dependent edema secondary to right-sided
heart failure
Pallor and cyanosis of nail beds and mucous
membranes (late stages of the disease)
Assess/Monitor
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Client’s history (occupational history, smoking
history)
Respiratory rate, symmetry, and effort
Breath sounds
Activity tolerance level and dyspnea
Nutrition and weight loss
General appearance
Vital signs
Heart rhythm
Pallor and cyanosis
ABGs, SaO2, CBC, WBC, and chest x-ray results
NANDA Nursing Diagnoses
Impaired gas exchange
 Ineffective breathing pattern
 Ineffective airway clearance
 Imbalanced nutrition
 Anxiety
 Activity intolerance
 Fatigue
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Nursing Interventions
Position the client to maximize ventilation
(high-Fowler’s).
 Encourage effective coughing, or suction to
remove secretions.
 Encourage deep breathing and use of
incentive spirometer.
 Administer breathing treatments and
medications as prescribed (like asthma)
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Nursing Interventions
Administer heated and humidified oxygen
therapy as prescribed; Monitor for skin
breakdown from the oxygen device.
 Clients with COPD may need 2 to 4 L/min
per nasal cannula or up to 40% per Venturi
mask. Why?
 Instruct clients to practice breathing
techniques to control dyspnic episodes.
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Nursing Interventions
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Determine the client’s physical limitations and
structure activity to include periods of rest.
Promote adequate nutrition.
Increased work of breathing increases caloric
demands.
Proper nutrition aids in the prevention of
secondary respiratory infections.
Provide support to the client and family.
Encourage verbalization of feelings.
Encourage smoking cessation if applicable.
Complications and Nursing Implications
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Respiratory Infection
◦ Results from increased mucus production and poor
oxygenation.
◦ Administer oxygen therapy.
◦ Monitor oxygenation.
◦ Administer AB and other medications as prescribed.
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Right-sided Heart Failure (cor pulmonale)
◦ Air trapping, airway collapse, and stiff alveoli lead to
increased pulmonary pressures.
◦ Blood flow through lung tissue is difficult. This
increased work load leads to enlargement and
thickening of the right atrium and ventricle.
Manifestations include
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Hypoxia, hypoxemia.
Cyanotic lips.
Enlarged and tender liver.
Distended neck veins.
Dependent edema.
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Nursing Interventions
◦ Monitor respiratory status and administer oxygen
therapy.
◦ Monitor heart rate and rhythm.
◦ Administer positive inotropic and contractility
medications as prescribed, like what?
◦ Administer IV fluids and diuretics to maintain fluid
balance.