COLLEGE OF CENTRAL FLORIDA
HEALTH SCIENCES DIVISION
Student:_________________________________
Clinical Group:________________
Diagnosis: Chronic obstructive pulmonary disease
Pathophysiology:
 Changes related with chronic bronchitis include hypertrophy and hyperplasia of the bronchial mucous glands, increased
goblet cells, ciliary damage, squamous metaplasia of the columnar epithelium, and chronic leukocytic and lymphocytic
infiltration of bronchial walls.
o Extensive inflammation occurs, causing the airway to narrow and mucus inside the airways—all creating
resistance in the small airways and, therefore, a severe ventilation-perfusion imbalance.
 Changes associated with emphysema include repeated inflammation associated with the release of proteolytic enzymes
from lung cells that causes abnormal, irreversible enlargement of the air spaces distal to the terminal bronchioles.
o The amount of alveolar surface area available for gas exchange decreases.
o This enlargement leads to the destruction of alveolar walls in the distal or terminal airways, which results in a
breakdown of elasticity. Elastic recoil is reduced, limiting airflow.
o Supporting alveolar structures are lost, leading to narrowing of the airway, which further limits airflow.
o The airways and lung parenchyma are involved.
o These changes result in weakened carbon dioxide and oxygen exchange.
Risk Factors:
 Secondhand smoke, mainly in adults whose parents smoked
 factors that affects lung growth during pregnancy and childhood
 Aging (age 40 when symptoms begin most commonly)
 Airway hyperactivity
 Alcohol use
Incidence:
 COPD is the third-leading source of death in the United States.
 Emphysema is the most common cause of death from respiratory disease in the United States.
 An projected 16 million people have COPD in the United States.
 COPD affects 1% -20% of adults, most being over age 40.
 Occurs in men more frequently than women.
Textbook Signs & Symptoms:
Client Signs & Symptoms:
 hyperinflation of the lungs
 decreased breath sounds
 wheezes
 Crackles at the lung bases
 distant heart sounds
 decreased diaphragmatic excursion
 increased anteroposterior diameter of the chest.
End-Stage Disease

Tripod position needed to assist in breathing

Tachypnea after simple activity(fast-shallow
breathing)

Accessory respiratory muscles of the neck and
shoulders are in full use

Barrel chest

Pursed-lips exhaling (prolonged expiration)

Hoover sign (paradoxical retraction of the lower
interspaces during inspiration)

Cyanosis (blue)

Asterixis (tremor in hands) due to severe
hypercapnia

Enlarged, tender liver due to right-sided heart
failure

Peripheral edema

Neck vein distention (while exhaling)
Recommended Treatments:
Current Client Treatments:
 Smoking cessation
 Avoidance of air pollutants and secondary smoke
COLLEGE OF CENTRAL FLORIDA
HEALTH SCIENCES DIVISION
Student:_________________________________
Clinical Group:________________



Chest physiotherapy
Ultrasonic or mechanical nebulizer treatments
Venous thromboembolism (VTE) prophylaxis if
hospitalized
 Adequate fluid intake
 High-calorie, protein-rich diet
 As tolerated with frequent rest periods
 Outpatient pulmonary rehabilitation a consideration
for patients with moderate COPD
 Influenza vaccine yearly; pneumococcal vaccine at
diagnosis and again in 5 years if first vaccine at <
age 65
 Pneumococcal conjugate vaccine
 Long-term oxygen therapy for patients with an
SaO2 saturation of 88% at rest or less or arterial
oxygen partial pressure (SpO2) of 55 mm Hg or less
 For patients with coexisting pulmonary
hypertension, heart failure , or polycythemia
(increased red cell mass) Extended oxygen therapy
with a resting SaO2 of 88% to 93% or less or an
SpO2 of 55 mm Hg to 60 mm Hg or less
 Lung transplantation for choice patients with very
severe COPD (1-year survival rate is approximately
85%, while 5-year survival rate exceeds 50%)
Teaching:

disorder, diagnostic testing, cause, and treatment, including respiratory care measures and medications
prescribed medications, including dosages, routes, schedules of administration, expected results, and possible adverse
reactions (such as restlessness and tremors with short-acting bronchodilators)
 signs and symptoms of continual problems or problems and when to call the provider
 signs and symptoms of infection
 respiratory hygiene measures, including proper disposal of secretions
 infection control practices, including the need for hand washing
 energy-conservation measures and clustering of activities with frequent rest periods
 oxygen therapy at home, if mandatory, with safety actions in the home
 appropriate technique for inhaler use
 chest physiotherapy including postural drainage and percussion technique
 Coughing and diaphragmatic breathing exercises; pursed-lip breathing
 avoidance of air pollutants and people with known upper-respiratory tract infections
 immunizations, such as annual influenza and pneumococcal vaccines
 importance of a balanced, high-protein diet with adequate fluid intake to maintain nutrition and hydration
 possible irritants and ways to avoid exposure to them
 methods to prevent bronchospasm.
Reference: Chronic obstructive pulmonary disease. Revised: July 12, 2019. In Lippincott advisor for education. Retrieved from
https://advisor-edu.lww.com/lna/document.do?bid=4&did=791316&searchTerm=COPD&hits=copd
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