Post-Conference Clinical Teaching


Violet Figiel

Primary Diagnosis/Pathophysiology

Chronic Obstructive Pulmonary Disease (COPD): refers to a group of lung diseases that block airflow and make breathing difficult. Two most common types are emphysema and bronchitis. o Air travels down your trachea and into your lungs through the bronchi. Inside your lungs, the bronchi divide many times into bronchioles that end in clusters of alveoli. The air sacs have very thin walls full of tiny capillaries. The oxygen in the air you inhale passes into the capillaries and enters your bloodstream. At the same time, carbon dioxide is exhaled. o Your lungs rely on the natural elasticity of the bronchial tubes and alveoli to force air out of your body. COPD causes them to lose their elasticity and partially collapse, which leaves some air trapped in your lungs when you exhale.

Predisposing Factors

Tobacco smoke: 120 pack-year

Having asthma and smoking

Occupational exposure to dusts and chemicals

Age : develops slowly over the years, so people are usually at least 35-40 years old

Genetics: alpha-1 antitrypsin deficiency is the source of some cases of COPD, but some other genetic disorders also make a person more susceptible to the disease

Coronary Artery Disease:

Peripheral Vascular Disease:

Chronic Heart Failure:

COPD is a risk factor for this poor circulation; led to bilateral AKA

COPD is a risk factor for this

Diagnostic/Lab Tests

Pulmonary function tests

Chest X-ray

CT scan

Arterial blood gas analysis


SMOKING CESSATION: she won’t quit

Bronchodilators: brovana, xopenex

Inhaled steroids: budesonide

Oral steroids: prednisone

Antibiotics: Zosyn

Oxygen therapy: 2L O2 and BIPAP at NOC

Nursing Priorities/Interventions

Impaired gas exchange: 2L O2 by NC, HOB up 30 °, coughing and deep breathing, incentive spirometry

Risk for & impaired skin integrity: Mepilex on coccyx, acrylic tegaderms on upper extremities are clean, dry and intact

Risk for falls: call light in reach, hourly rounding, low bed, fall mats, bed alarm on

Evidence from Literature

COPD is an irreversible lung disease. While many medications are available to treat COPD, no drug has demonstrated effectiveness in halting the progression of the disease. Rather, the goal of drug therapy at this time is to maintain control of symptoms and prevent COPD exacerbation. o Number 1 way to prevent or slow the progression of the disease: smoking cessation is the most essential and yet most commonly overlooked aspect of COPD treatment



Cough and Deep Breathing Exercise


) o A good controlled cough is especially helpful when you first get up in the morning and about an hour before bedtime. Have a cup of coffee or tea first (or other drink recommended by your physician) and relax. o 1. Sit up straight, relax. o 2. Take in 2-3 breaths through your nose and exhale slowly through pursed lips. o 3. Take in a moderately deep breath, hold breath, and expel air while saying “H” or “K” once. o 4. When you feel comfortable with this exercise, try and say the “H” or

“K” 3-4 times while exhaling.