 Nursing 110
 Beverlyn M. Jackson RN MSN CCRN

COPD
Asthma
A chronic hyperactive disorder of the airways.
Chronic Bronchitis
 Chronic productive cough for 3 months during each of 2 consecutive years.
Emphysema
 Abnormal permanent enlargement of the air spaces distal to the terminal bronchioles, accompanied by destruction of their walls.


 Intrinsic
 Non-allergic or atopic
 Cause non-specific; seen in adults; worsens over life.
 Extrinsic
 Allergic or atopic


Increase bronchoconstriction and
Bronchospasms

Pathophysiology of Emphysema

STRESSORS FOR COPD
 CIGARETTE SMOKING IS
THE MOST IMPORTANT
STRESSOR FOR COPD
 SECONDHAND SMOKE
CAN ALSO LEAD TO
RESPIRATORY
PROBLEMS
 ALPHA
1
-ANTITRYPSIN
DEFICIENCY (AAT)
 AIR POLLUTION

ASSESSMENT


 SHORTNESS OF BREATH
 Activities that cause SOB
 Cough
 Sputum

•INTAKE
SUMMARY/DEMOGRAPHIC
DATA
AGE, SEX & ETHNIC
ORIGIN
•PERSONAL AND FAMILY
HISTORY
MAJOR ILLNESSES
SMOKING
DIET
•SOCIOECONOMIC STATUS
MARITAL STATUS
OCCUPATION


 Age
 Race
 Gender

ASSESSMENT
 PERSONAL AND
FAMILY HISTORY
 History of Major Illness
 Medication History
 Nutritional Status
 SMOKING HISTORY
 Family history

ASSESSMENT
 Socioeconomic
History
 Occupation

PHYSICAL ASSESSMENT
 Appearance
 Forward bending posture
 Barrel chest
 Use of accessory muscles
 Color


Bronchitis (cyanosis –
Blue Bloater)
Emphysema) Pink Puffer

PHYSICAL ASSESSMENT
 Respiratory Rate


 Dyspnea
Use of accessory muscles
Abnormal breath sounds

Wheezing
 No Breath Sounds

Pneumothorax

PHYSICAL ASSESSMENT
 Cardiac Assessment
 Rate and Rhythm
 Cor Pulmonale
 Edema

 Isolation
 Change in economic status
 Anxiety

 Arterial Blood Gas (ABG)
 Hypoxemia -decreased PaO
2
< 80mmHG
 Hypercarbia -increased Pa CO
2
> 45mmHG
 Respiratory acidosis, with metabolic alkalosis compensation
 Pulse Oximetry
 Less than the normal range of 95% -100%
 AAT

 H&H
 Polycythemia
 Sputum
 C&S
 WBC

 Chest xray
 Hyperinflation
 Blebs
 Bullae

PFT ASSESSMENT
 Diagnosis of COPD
 Obstructive versus
Restrictive lung disease
 FEV1/FVC used primarily to diagnose COPD.
Forced Expiratory
Volume (FEV) compared to Forced Vital Capacity
(FVC) expressed as ratio used to determine severity

 Impaired Gas Exchange R/T altered oxygen supply caused by obstruction of airways by secretions, bronchospasm/reduced airway size, alveoli destruction;
 AEB- dyspnea, weak cough, changes in VS, cyanosis, altered ABG, anxiety.
 Expected Outcome: Respiratory rate of 20-26, able to cough up secretions without difficulty, VS within patient’s normal range, no cyanosis, baseline ABG, normal mental status.

 Ineffective Breathing Pattern R/T Airway obstruction, diaphragm flattening, fatigue, and decreased energy.
 AEB: Increased respiratory rate, limited diaphragmatic movement, excessive use of accessory muscles
 Expected outcomes: Normal respiratory rate, synchronous thoracoabdominal movement, normal use of accessory muscles

 Ineffective Airway Clearance R/T Bronchospasm, thick retained secretions, fatigue
AEB: dyspnea, use of accessory muscle, wheezing, persistent cough
 Expected Outcomes: Maintain patent airway with clear breath sounds, effective cough and expectoration of secretions

NURSING INTERVENTIONS
 Primary Interventions
 Assess VS and respiratory rate q2 hours
 Elevated HOB and position patient to ease the work of breathing
 Assess color
 Assess level of anxiety
 Assess for confusion
 Monitor pulse ox and ABG’s
 NO SMOKING

NURSING INTERVENTIONS
 Primary Interventions
 Assess the breathing pattern
 Secondary
Interventions
 Breathing Techniques


Diaphragmatic breathing or belly breathing
Pursed lip Breathing

NURSING INTERVENTIONS
 Secondary Interventions
 Encourage patient to cough
 Suction as needed
 Administer O 2 therapy
 USE CAUTION

NURSING INTERVENTIONS
 Secondary Interventions
 AM Coughing
 Chest physiotherapy
 Suction as needed
 Hydration
 Tertiary Interventions
 Teach and review coughing techniques and hydration

NURSING INTERVENTIONS
 Secondary Interventions
 Drug Therapy
 Bronchodilators


Cholinergic Antagonist

Atrovent
Short and Long Acting Beta
2
Agonist


Albuterol
Serevent

NURSING INTERVENTIONS
 Secondary Interventions
 Drug Therapy


NSAIDS

Tilade
Mucolytic Agents

Mucomyst

Guaifenisin

NURSING INTERVENTIONS
 Secondary Interventions
 Drug Therapy


Methylxanthines

Theophylline
Anti-inflammatories

Corticosteroids

Flovent

Prednisone

NURSING INTERVENTIONS
 Secondary Interventions
 Positioning
 Energy Conservation
 Tertiary Interventions
 Teach and review the breathing techniques, positioning and energy conservation

 Complications of COPD
 Infection
 Pulmonary HTN
 Secondary
Polycythemia
 Hypoxemia and
Acidosis


 Bronchiectasis
 Cystic Fibrosis

THE END!!!
 Reference:
 Iggy pg. 548-566 (8 th ed.)