AFAMS Master Lesson Plan (MLP)
Nursing Program
Chronic Obstructive Pulmonary Disease
Instructor
Serial/Semester
Location
Start/Finish Time
Date
LESSON OBJECTIVE
Performance: To gain an understanding of chronic obstructive pulmonary disease.
Conditions:
The student will be presented a powerpoint presentation by the instructor and will have
all necessary references made available to him/her.
Standard:
1.
Given the five elements of the nursing care process and a patient with chronic
obstructive pulmonary disease by correctly responding to written, oral, and
experiential assessment measures
TEACHING POINTS
1. Describe the etiology/pathophysiology,
clinical manifestations, assessment, diagnosis,
medical management and nursing
interventions of emphysema.
2. Describe the etiology/pathophysiology,
clinical manifestations, assessment, diagnosis,
and medical and nursing management of
chronic bronchitis.
3. Compare and contrast extrinsic and intrinsic
causes of asthma.
4. Describe the etiology/pathophysiology,
clinical manifestations, assessment, diagnosis,
medical management and nursing
interventions of a patient with asthma.
5. Explain the medical and nursing management
of a patient with bronchiectasis.
6.
7.
8
9.
10.
INSTRUCTIONAL STRATEGY
Interactive Lecture
Method:
Instructor
Media:
Classroom
Environment:
OTHER LESSON SPECIFICATIONS
Knowledge Lesson
Type of Lesson:
1/50
Ratio:
Resources:
.
End of Lesson Test: None
Minutes
Instructional Time: 159
Reference(s):
ISBN 0-323-01728-2
Adult Health Nursing, 4th Edition
01 Jan 2003
ISBN 0-7817-3696-X
Introductory Clinical Pharmacology, 7th Ed.
01 Jan 2004
AFAMS Master Lesson Plan (MLP)
Nursing Program
Chronic Obstructive Pulmonary Disease
LESSON PLAN APPROVAL
Signature of Standards Officer
1
Date
AFAMS Master Lesson Plan (MLP)
Nursing Program
Chronic Obstructive Pulmonary Disease
INTRODUCTION
Allocated Time:
Review:
5 Minutes
You have had previous anatomy and physiology lectures in your combat medic
training, this lecture will build upon prior instruction.
Objective:
To discuss/describe topics related to the nursing process.
Importance:
Nurses work in various health care settings so it is important to gain an
understanding of this subject as it will apply to your clinical practice.
Fit:
While caring for a patient with a respiratory disorder, the licensed vocational
nurse must apply knowledge of pulmonary anatomy and physiology, as well as
principles to support the emotional anxiety that accompanies respiratory
distress. Chronic obstructive pulmonary disease is a progressive and
irreversible condition that is characterized by decreased inspiratory and
expiratory capacity of the lungs, which includes emphysema, chronic
bronchitis and asthma. Patients with chronic respiratory disease are a
challenge because the goal is symptomatic control rather than prevention.
Approach:
You will be presented the subject in lecture format and will be tested using a
written exam at a later date.
Control Statement:
If you have any questions during the lesson please feel free to ask.
BODY
1. Teaching Point: Describe the etiology/pathophysiology, clinical manifestations, assessment,
diagnosis, medical management and nursing interventions of emphysema.
Minutes
Allocated Time:
Introduction:
Learner Participation:
Knowledge Lesson Please follow along with your hand outs and take notes.
Skill Lesson
Powerpoint presentation with associated handouts.
Learning Support:
a. Etiology/Pathophysiology
(1) Symptoms develop when a patient is in their 40s progressing to disability in the 50s and 60s
(2) Characterized by changes in alveolar walls and capillaries (See p. 395 Figure 9-14, C)
(3) Pathophysiology
(a) Lung elastin, the component of lung connective tissue that provides the elasticity, is destroyed by
an enzyme
(b) Results in decreased pulmonary surface area available for gas exchange
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AFAMS Master Lesson Plan (MLP)
Nursing Program
Chronic Obstructive Pulmonary Disease
(c) Bronchi, bronchioles and alveoli become inflamed due to chronic irritation causing bronchiolar
narrowing
(d) Results in trapping of air in the alveoli during expiration, causing alveolar distention
(e) The alveoli rupture and scar, losing their elasticity
(f) Alveoli walls break down and form enlarged air sacs (called blebs)
(g) Capillary beds are replaced with fibrous scarring
(h) Gas exchange is compromised resulting in hypoxia and hpercarbia (increased CO2)
(4) Causes
(a) Primarily cigarette smoking - usually about 30 to 35 years between onset of smoking and
development of symptoms
(b) Air pollution
(c) Age
(5) May lead to cor pulmonale
(a) Right sided heart failure due to fibrotic changes in the lung and resultant pulmonary hypertension
(b) Results in lower extremity, sacral and perineal edema, distended neck veins and ascites
b. Clinical Manifestation
(1) Exertional dyspnea is the primary symptom of emphysema. .
(2) Sputum - minimal at the onset of the disease, but copious in later stages
(3) Use of accessory muscles.
(4) Spontaneous pursed-lip breathing
(5) Development of barrel chest –an increase in anteroposterior diameter caused by over inflation (See
figure 9-16, page 396 for illustration)
(6) Wheezing (due to air movement through narrowed bronchioles)
(7) Chronic weight loss with emaciation
c. Assessment
(1) Subjective
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AFAMS Master Lesson Plan (MLP)
Nursing Program
Chronic Obstructive Pulmonary Disease
(a) History of onset of symptoms to include intensity of dyspnea, cough and sputum production
(b) Identification of history of smoking or exposure to inhalational irritants
(c) Note family history of respiratory disease
(2) Objective
(a) Tachycardia
(b) Tachypnea
(c) Peripheral cyanosis
(d) Clubbing of fingers
(e) Lung examination will include auscultation, listening for expiratory wheezing, percussion will
reveal tympanal
d. Diagnostic test the goal of the diagnostic examination is to determine the severity of the disease and its
impact on the patient’s quality of life
(1) Pulmonary function test (PFT)
(a) Performed to measure
1) Total lung capacity- decreased
2) Residual volume (RV)- increased. (volume remaining in lungs at end expiration)
3) Compliance- increased (distensibility of lung)
4) Airway resistance- increased (due to narrowing of bronchioles)
(2) Arterial blood gas
(a) Decreased PaO2
(b) Increased PaCO2
(c) Normal pH, as a result of compensation (will reveal an elevated HCO3)
(3) Chest x-ray
(a) Reveals hyperinflation of lungs, widened intercostal spaces, and flattened diaphragm
(b) Increased anterior-posterior (AP) diameter (barrel chest)
(4) Labs
4
AFAMS Master Lesson Plan (MLP)
Nursing Program
Chronic Obstructive Pulmonary Disease
(a) Alpha1-antitrypsin assay to determine enzyme deficiency (familial deficiency which causes
emphysema, even in nonsmokers)
(b) Complete blood count
1) Reveals elevated erythrocytes, hemoglobin, and hematocrit
2) Indicates secondary polycythemia (a compensatory mechanism due to chronic hypoxia)
e. Medical Management-the plan will include long-term management with home oxygen therapy and
chest physiotherapy. In acute exacerbations, mechanical ventilation may be required
(1) Medications
(a) Bronchodilators
1) Enlarges bronchioles for greater oxygenation and ease of secretion clearance
2) Include terbutaline, isoproterenol, and albuterol inhalers
3) Patients may also receive PO theophylline
(2) Antibiotics are frequently ordered to reduce the risk of pulmonary infection during exacerbations
(3) Corticosteroids
(a) Usually prescribed only during acute exacerbation because of the long-term side affects
associated with systemic steroids
(b) Used to decrease pulmonary inflammation and obstruction
(4) Diuretics may be used for fluid removal
(5) Oxygen therapy to increase oxygenation
(6) Anti-anxiety agents
(a) Patients with chronic respiratory disease can experience considerable anxiety, restlessness and
irritability during exacerbations
(b) Patients must be carefully monitored to evaluate for respiratory depression with these agents
f. Nursing interventions
(1) Directed at attempting to decrease patient’s anxiety and promote optimal air exchange
(2) Oxygenation
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AFAMS Master Lesson Plan (MLP)
Nursing Program
Chronic Obstructive Pulmonary Disease
(a) Elevate the head of the bed
(b) Low flow oxygen 1-2 liters by nasal cannula
- Important for the COPD patient, as respiratory drive can be depressed with high flow oxygen
(normal drive to breath is CO2 levels; this changes with COPD when the respiratory drive is O2 levels)
NURSING DIAGNOSIS
Airway clearance, ineffective,
related to narrowed
bronchioles
OUTCOME
Patient will maintain patent
airway
Activity intolerance, related
to imbalance between oxygen
demand, secondary to
inefficient work of breathing
Patient will perform ADLs
NURSING INTERVENTIONS
1) Assist with chest
physiotherapy and postural
drainage
2) Encourage fluids 2-3 L/day
to liquefy secretions
3) Assist with respiratory
treatments
4) Auscultate lungs frequently
and notify physician of changes
5) Administer medications as
ordered
1) Organize care so patient can
have periods of uninterrupted
rest
2) Advise patient to rest 30
minutes before meals
3) Assist patient with ADLs and
exercises to increase stamina
4) Asses patient’s respiratory
response to activity
(3) Patient teaching will focus on optimizing nutrition and smoking cessation
(a) Nutrition
1) Patient with emphysema has an increased protein and caloric requirement
2) Adequate protein and calories should be divided in five or six small meals per day
3) Instruct patient to drink fluids between meals, rather than with meals to reduce gastric distention
on the diaphragm
(b) Smoking cessation
1) Probably the most significant factor in slowing disease progression
2) Nicotine replacement helpful in minimizing nicotine craving
3) Encourage participation in support groups for behavior modification
(c) Infection control
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AFAMS Master Lesson Plan (MLP)
Nursing Program
Chronic Obstructive Pulmonary Disease
1) Patient should receive flu vaccine each year and pneumovax every 5 years
2) Teach patient to avoid contact with those with an active respiratory infection
3) Teach/assess understanding of reasons to contact physician
(d) Relaxation techniques- critical for the patient and family members to prevent complications of
the disease process
g. Prognosis
(1) COPD is usually irreversible and is the fourth leading cause of death in the US
Knowledge Lesson:
Question:
Answer:
Check on Learning
In a knowledge lesson, pose questions to the class.
What is the respiratory drive for patients with COPD?
Low O2 levels
Skill Lesson:
In a skill lesson, provide practice and watch students perform a skill.
2. Teaching Point: Describe the etiology/pathophysiology, clinical manifestations, assessment,
diagnosis, and medical and nursing management of chronic bronchitis.
Minutes
Allocated Time:
Introduction:
Learner Participation:
Knowledge Lesson Please follow along with your hand outs and take notes.
Skill Lesson
Powerpoint presentation with associated handouts.
Learning Support:
a. Etiology/pathophysiology
(1) Chronic bronchitis is characterized by a recurrent chronic productive cough for a minimum of three
months for at least two years. One of the respiratory diseases that make up COPD
(2) Caused by physical or chemical irritants or bacterial or viral infection
(3) Smoking is the most common cause of bronchitis
(4) Pathophysiology
(a) The cilia are impaired and can no longer move secretions- mucous gland hypertrophy causes
hypersecretion of mucous causing the ciliary dysfunction
(b) Results in an increased susceptibility to infection
(c) Chronic infection leads to scarring which causes obstruction
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AFAMS Master Lesson Plan (MLP)
Nursing Program
Chronic Obstructive Pulmonary Disease
(d) Obstruction leads to increased airway resistance and bronchospasm
(e) Results in hypoxia and hypercapnia
b. Clinical Manifestations
(1) Primary sign is productive cough which is most pronounced in the morning
(2) Dyspnea and use of accessory muscles
(3) Later signs include cyanosis and right ventricle failure (cor pulmonale)
(4) Many patients exhibit characteristic reddish-blue skin resulting from polycythemia, cyanosis and
dependent edema (from right heart failure)
c. Assessment
(1) Subjective
(a) Focused on detailed smoking history exposure to irritants
(b) Identify family history of respiratory disease
(c) Determine patient's disease progression and current treatment regimen
(2) Objective
(a) Assess cough, including characteristics and amount of sputum
(b) Assess severity of dyspnea
(c) Auscultation for presence of wheezing
(d) Asses patient’s anxiety/restlessness level
(e) Vital signs observing for tachypnea, tachycardia, and hyperthermia
d. Diagnostic tests
(1) CBC reveals polycythemia and elevated WBCs
(2) ABG may reveal respiratory acidosis (although may be normal due to compensation), hypoxia, and
hypercapnia
(3) Pulse oximetry to continuously monitor saturation levels due to potential for hypoxia
(4) PFT reveals decreased flow on expiration and increased airway resistance and residual volumes
(5) Patients often experience electrolyte abnormalities
8
AFAMS Master Lesson Plan (MLP)
Nursing Program
Chronic Obstructive Pulmonary Disease
e. Medical management
(1) Aimed at minimizing disease progression and facilitating optimal air exchange
(2) Medications
(a) Bronchodilators (same agents as with emphysema)
(b) Mucolytics
(c) Antibiotics
f. Nursing interventions
(1) Secretion management
(a) Provide adequate hydration
(b) Suction as needed
(2) Oxygenation
(a) Maintain on low-flow oxygen
(b) Provide frequent oral hygiene
(c) Provide frequent rest periods
(3) Nutrition- patients require high calorie, high protein diet (similar to the requirements for the patient
with emphysema)
(4) See home health consideration box on page 399 for patient teaching on home oxygen therapy
NURSING DIAGNOSIS
Breathing pattern, ineffective,
related to retained pulmonary
secretions
OUTCOME
Patient will maintain effective
breathing pattern and patent
airway
Fatigue, related to increased
respiratory effort
Patient will deny fatigue and
achieve adequate rest
g. Prognosis
9
NURSING INTERVENTIONS
1) Assess degree of dyspnea
2) Teach/assess understanding
of effective breathing
techniques
3) Suction as needed
1) Assess degree of fatigue
2) Provide treatments in a calm,
unhurried manner
3) Encourage adequate periods
of rest
4) Identify support systems and
support if needed
AFAMS Master Lesson Plan (MLP)
Nursing Program
Chronic Obstructive Pulmonary Disease
(1) Irreversible, and with emphysema is the fourth leading cause of death in the US
Knowledge Lesson:
Question:
Answer:
Check on Learning
In a knowledge lesson, pose questions to the class.
What is hypercapnia?
Greater than normal amounts of carbon dioxide in the blood.
Skill Lesson:
In a skill lesson, provide practice and watch students perform a skill.
3. Teaching Point: Compare and contrast extrinsic and intrinsic causes of asthma.
Minutes
Allocated Time:
Introduction:
Learner Participation:
Knowledge Lesson Please follow along with your hand outs and take notes.
Skill Lesson
Powerpoint presentation with associated handouts.
Learning Support:
a. Extrinsic asthma – is caused by external factors and occurs in response to allergens, such as pollens,
dust spores, feathers, or animal dander, food etc.
b. Intrinsic asthma –is from internal causes. Not fully understood but often triggered by upper
respiratory infection and emotional upsets
c. Re-occurrence of attacks is influenced by mental or physical fatigue
Knowledge Lesson:
Question:
Answer:
Check on Learning
In a knowledge lesson, pose questions to the class.
Identify three common environmental allergens that cause asthma
Pollens, dust spores, feathers, or animal dander, food etc.
Skill Lesson:
In a skill lesson, provide practice and watch students perform a skill.
4. Teaching Point: Describe the etiology/pathophysiology, clinical manifestations, assessment,
diagnosis, medical management and nursing interventions of a patient with asthma.
Minutes
Allocated Time:
Introduction:
Learner Participation:
Knowledge Lesson Please follow along with your hand outs and take notes.
Skill Lesson
Powerpoint presentation with associated handouts.
Learning Support:
a. Etiology/pathophysiology
(1) Episodic increased tracheal/bronchial responsiveness to various stimuli
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AFAMS Master Lesson Plan (MLP)
Nursing Program
Chronic Obstructive Pulmonary Disease
(2) Results in widespread narrowing of the airways which resolves spontaneously or in response to
treatment
(3) Classified as intrinsic or extrinsic
(4) Results from an altered immune response or increased airway resistance and altered air exchange
(5) Acute attacks are caused by the antigen-antibody reaction in which histamine (causes
inflammation) is released (See figure 9-14, B, page 395 for an illustration)
(6) There are three primary mechanism involved in producing allergy symptoms
(a) Recurrent, reversible obstruction of the airway in the bronchioles and the terminal airway
secondary to bronchospasm- the muscles of the airways constrict and narrow the air passages
(b) Increased capillary permeability results in edema of mucous membranes- produces increased
mucous production and narrowing of the airways
(c) Acute inflammatory response in the mast cells of the lungs initiated by an asthma trigger- mast
cells release histamine and other inflammatory producing substances that cause circulating inflammatory
cells to migrate to the lungs
b. Clinical manifestations
(1) Mild asthma is manifested by dyspnea on exertion and wheezing. Symptoms can be easily
controlled with medications
(2) An acute asthma attack is most likely to occur at night and includes tachypnea, tachycardia,
diaphoresis, expiratory wheezing, accessory muscle use, and nasal flaring
(a) The musical wheezes often audible without a stethoscope are caused by air forcing its way out of
narrowed airways
(b) The patient experiences anxiety
(3) Status asthmaticus
(a) Severe, unrelenting form of asthma in which airway obstruction is unresponsive to drug therapy
(b) Symptoms of an acute attack are present and the trapped air and increased work of breathing
leads to exhaustion and respiratory failure
c. Assessment
(1) Subjective
(a) Gather information related to quality of life, medications, asthma triggers and anxiety
(2) Objective data
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AFAMS Master Lesson Plan (MLP)
Nursing Program
Chronic Obstructive Pulmonary Disease
(a) Identify signs and symptoms suggesting severity of respiratory distress and impending respiratory
failure
1) Presence of cyanosis
2) Amount of respiratory effort
3) Frequent vital signs
4) Auscultate for wheezing and decreased air movement
5) Check for patient assuming the tripod or hunched position in an effort to move more air
d. Diagnostic tests
(1) ABG- reveals hypoxia and hypercarbia
(2) PFTs- used to test airway reversibility during and after an attack (reveals volumes consistent with
air trapping)
(a) Not particularly helpful during an acute asthma attack, as the patient cannot complete the test
(b) Ask patient to perform peak flow (peak expiratory flow rate)
(3) Chest x-ray reveals airway trapping and hyperinflation of the airways
(4) Sputum culture to rule out secondary infection
(5) CBC will reveal increased eosinophil count in the differential, which indicates allergic response
(6) Theophylline level must be drawn on patient's taking this medication to ensure drug level is
therapeutic
e. Medical management- placed in two categories maintenance and rescue (acute) therapy
(1) Maintenance therapy- used to prevent or minimize symptoms. Medications are taken long-term
and on a daily basis
(a) Bronchodilators- Salmeterol (Serevent)- long acting beta 2 agonist used for prophylaxis and not
rescue.
(b) Inhaled corticosteroids- Fluticasone (flovent)- decrease the inflammatory process in the airways.
(c) Leukotriene inhibitors
1) New medications used to treat chronic asthma ranging from mild to more severe symptoms by
antagonizing leukotrienes or inhibiting the synthesis of leukotrienes
2) Control both symptoms of asthma: bronchoconstriction and inflammation
12
AFAMS Master Lesson Plan (MLP)
Nursing Program
Chronic Obstructive Pulmonary Disease
a) Leukotriene receptor antagonists-zafirlukast (Accolate)and montelukast (Singulair)
b) Leukotriene synthesis inhibitors zileuton (Zyflo)
3) Not to be used as only therapy for patients with persistent asthma
4) Not indicated for use in acute asthma attacks
(2) Acute or rescue therapy works immediately to relieve symptoms of an acute attack.
(a) Bronchodilators- short acting beta 2-agonist- albuterol which work quickly to relax airway
muscles
(b) Corticosteroids
1) A recent study shows inhaled corticosteroids (Flovent) given with inhaled beta2s may work
faster than IV steroids
2) Intravenous methylprednisolone (Solu-medrol) may be used in an acute attack to decrease
inflammation
(c) Epinephrine
1) Used as a bronchodilator when beta2 agonists have not worked
2) May be administered SQ or IM
(d) IV Aminophylline should only be considered in emergencies when all other medications have not
relieved symptoms
(3) Oxygen should be started immediately in an acute attack and should be monitored with pulse
oximetry or serial ABG’s
(4) A peak flow meter is a helpful tool to assist patient in monitor severity of symptoms
(a) The peak flow meter measures peak expiratory flow rate (PEFR) a good indicator of lung
function
(b) Peak flow can help detect early signs of asthma attacks before they occur
(c) Normal peak flow is between 80%-100% of expected expiratory function and is based on
patient’s weight, age, and sex
(d) Severe, persistent asthma is less the 60%
(e) Severe life-threatening asthma is less than 50%
13
AFAMS Master Lesson Plan (MLP)
Nursing Program
Chronic Obstructive Pulmonary Disease
(4) Identification of triggers and education to prevent exposure to these triggers, or medical
management of the response
f. Nursing interventions nursing diagnosis most pertinent to asthma are:
NURSING DIAGNOSIS
Breathing pattern, ineffective,
related to narrow airway
OUTCOME
Patient will maintain effective
breathing pattern
Health maintenance,
ineffective, related to possible
allergens in the home
Patient will minimize allergen
exposure in environment
NURSING INTERVENTIONS
1) Assess ventilation and
respiratory effort
2) Monitor closely for
signs/symptoms of increasing
dyspnea
3) Maintain position to
facilitate optimal ventilation
4) Administer prescribed
medications and monitor effects
5) Assist with respiratory
treatments
6) Provide care in calm manner
7) Attempt to minimize
exposure to triggers
8) Maintain adequate hydration
1) Assist patient and family
identify allergens and asthma
triggers
2) Facilitate allergy testing if
necessary
3) Teach/assess understanding
of the importance of allergy
avoidance
4) Teach/assess proper use of
medications ie Hold your breath
for several seconds then exhale
slowly after inhaling the
medication
5) Teach/assess understanding
of use of peak flow meter and
goals for individual patient
6) Teach/assess understanding
of reasons to call physician
g. Prognosis
(1) Death rate for asthma has increased by 50% over the past 10 years- disheartening as this disease
can be controlled with medications and trigger avoidance
(2) Status asthmaticus is fatal if not reversed
14
AFAMS Master Lesson Plan (MLP)
Nursing Program
Chronic Obstructive Pulmonary Disease
Knowledge Lesson:
Question:
Answer:
Check on Learning
In a knowledge lesson, pose questions to the class.
Why would the expiratory phase be prolonged in an asthma attack?
In an effort to move trapped air within the alveoli
Skill Lesson:
In a skill lesson, provide practice and watch students perform a skill.
5. Teaching Point: Explain the medical and nursing management of a patient with bronchiectasis.
Minutes
Allocated Time:
Introduction:
Learner Participation:
Knowledge Lesson Please follow along with your hand outs and take notes.
Skill Lesson
Powerpoint presentation with associated handouts.
Learning Support:
a. A gradual irreversible process of chronic dilation of the bronchi that eventually destroys the elastic and
muscular properties of the lung
b. Follows repeated lung infections in adults and children
c. Usually secondary to failure of normal lung tissue defenses, as with cystic fibrosis, foreign body, or
tumor
d.. A complication of many episodes of inflammation that gradually alters the pulmonary structures
e. Assessment
(1) Subjective- note the patient's complaint of dyspnea, weight loss and fever
(2) Objective
(a) Signs and symptoms of dyspnea, cyanosis and clubbing of fingers
(b) Paroxysmal coughing episodes when lying down and arising in the morning
(c) Copious amounts of foul-smelling sputum
(d) Fatigue, weakness and anorexia
(e) Crackles and wheezing in the lower lobes on auscultation
(f) Prolonged expiratory phase
(g) Hemoptysis seen in 50% of patients
(h) Increased hematocrit
f. Medical Management
15
AFAMS Master Lesson Plan (MLP)
Nursing Program
Chronic Obstructive Pulmonary Disease
(1) Low-flow oxygen
(2) Chest physiotherapy
(3) Adequate hydration
(4) Medications
(a) Mucolytic agents-Mucomyst
(5) Bronchodilators- theophylline or aminophylline
(6) Antibiotics
(7) If conservative measure fails, a lobectomy may be necessary to remove damaged portion of lungs
g. Nursing intervention
NURSING DIAGNOSIS
Airway clearance, ineffective,
related to retained pulmonary
secretions
OUTCOME
Patient will maintain patent
airway
Physical mobility, impaired,
related to decreased exercise
tolerance
Patient will verbalize normal
exercise tolerance
NURSING INTERVENTIONS
1) Assess patient’s ability to
mobilize secretions
2) Encourage postural drainage,
cough, and suction as needed
3) Encourage frequent position
changes
4) Maintain adequate hydration
5) Administer medications as
prescribed and monitor effects
1) Asses patient’s activity
tolerance and promote adequate
rest periods
2) Promote gradual increase of
activity
3) Problem solve with patient
and family on energy
conserving techniques
Knowledge Lesson:
Question:
Answer:
Check on Learning
In a knowledge lesson, pose questions to the class.
Bronchiectasis destroys which properties of lung tissue?
Elastic and muscular
Skill Lesson:
In a skill lesson, provide practice and watch students perform a skill.
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AFAMS Master Lesson Plan (MLP)
Nursing Program
Chronic Obstructive Pulmonary Disease
END OF LESSON TEST
Allocated Time:
Instructions:
Test Questions or
Performance
Expected:
Test Key:
0 Minutes
You will be tested on this subject at a later date.
You will be expected to review and study the material taught in this session in
order to pass the associated written test. If you have difficulty with the material
please see me so we can review together.
None.
CONCLUSION
Allocated Time:
Summary:
5 Minutes
Review and re-emphasize the difficult Teaching Points below.
1.
2.
3.
4.
5.
Describe the etiology/pathophysiology, clinical manifestations,
assessment, diagnosis, medical management and nursing interventions
of emphysema.
Describe the etiology/pathophysiology, clinical manifestations,
assessment, diagnosis, and medical and nursing management of
chronic bronchitis.
Compare and contrast extrinsic and intrinsic causes of asthma.
Describe the etiology/pathophysiology, clinical manifestations,
assessment, diagnosis, medical management and nursing interventions
of a patient with asthma.
Explain the medical and nursing management of a patient with
bronchiectasis.
6.
7.
8
9.
10.
Closing Statement:
Nurses work in various health care settings so it is important to gain an
understanding of this subject as it will apply to your clinical practice.
Re-motivating
Statement:
While caring for a patient with a respiratory disorder, the licensed vocational
nurse must apply knowledge of pulmonary anatomy and physiology, as well as
principles to support the emotional anxiety that accompanies respiratory
distress. Chronic obstructive pulmonary disease is a progressive and
irreversible condition that is characterized by decreased inspiratory and
expiratory capacity of the lungs, which includes emphysema, chronic
bronchitis and asthma. Patients with chronic respiratory disease are a
challenge because the goal is symptomatic control rather than prevention.
17