CHRONIC OBSTRUCTIVE

PULMONARY DISEASE

Nursing instructor
Nauman peter
BSN,RN
 objectives
At the end of this presentation the students will be
able to
 Define chronic obstructive disease
 Pathophysiology
 Clinical manifestations
 Medical management and nursing management
 DEFINITION
Chronic obstructive pulmonary disease, or COPD,
refers to a group of diseases that cause airflow
blockage and breathing-related problems.
It includes:

 Emphysema
 Chronic bronchitis.
 EMPHYSEMA
 It is a pathologic term that describes an abnormal
distention of the airspaces beyond the terminal
bronchioles and destruction of the walls of the
alveoli.
Conti...
 Conti...
Pathophysiology:
The walls of alveoli are destroyed (the process
accelerated by recurrent infections) ,the
Alveolar surface area indirect contact with the
pulmonary capillaries continually decreases. This
causes an increase in dead space(lung area where
no gas exchange can occur) and impaired oxygen
diffusion which can leads to hypoxemia.
 Conti...
 There are two main types of emphysema, based
on the changes taking place in the lung
 Pan lobular (panacinar) type of emphysema
 Centrilobular emphysema (CLE)
 Chronic Bronchitis
Chronic bronchitis, a disease of the airways is defined
as the presence of cough and sputum production for at
least 3 months in each of 2 consecutive years.
 Conti...
In many cases smoke or other environmental
pollutants irritate the airways, resulting in
inflammation and hyper secretion of mucus.
Constant irritation cause the mucus-secreting glands
and goblet cells to increase in number leading to
increased mucus production. Mucus plugging of
airway reduces ciliary function.
 Conti...
Bronchial walls also become thickened, further
narrowing the bronchial lumen alveoli adjacent to the
broncioles may become damaged and fibrosed,
resuling in altered function of the alveoler
macrophages. This is significant because of the
macrophages play an important role in destroying
foreign particles, including bacteria. As a result,the
patient become more susceptible to respiratory
infection.
Conti...
 Clinical Manifestations
Disease characterized by three primary symptoms:
 Chronic cough
 Sputum production
 Dyspnoea on exertion
 Weight loss is common
 Accessory muscles are recruited in an effort to
breathe
 Patients with COPD are at risk for respiratory
insufficiency and respiratory infections
 Conti...
In patients with COPD that has a primary
emphysematous component chronic hyperinflation
leads to the “barrel chest” thorax configuration.
Retraction of the supraclavicular fossa occurs on
inspiration, causing the shoulders to heave upward
 Wheezing
 Chest tightness
 Blueness of the lips or fingernail beds(cyanosis)
 Frequent respiratory infections
 Lack of energy
 Clubbing of the fingers
 Risk Factors

 Smoking or second hand smoke

 Lung irritants like chemical fumes
 Family history, with the AATD gene being linked to
COPD
 History of respiratory infections as a child
 Emphysema vs chronic bronchitis
Pink puffers Blue bloaters
 No bronchitic  Bronchitis productive
component cough, mucus
 Barrel chest  No barrel chest
 Dyspnea early  Dyspnea late
 Hunched over  No air hunger
 Hyperventilation  Cyanosis
 Adequate oxygenation  Obese
 Weight loss
 Assessment and Diagnostic Findings
 Thorough health history
 Spirometry is used to evaluate airflow obstruction,
which is determined by the ratio of FEV1 to forced
vital capacity
 Arterial blood gases
 A chest x-ray may be obtained to exclude alternative
diagnose
 Screening for alpha1-antitrypsin deficiency may be
performed for patients younger than 45 years
 Stages of COPD
COPD is classified into four stages depending upon the
severity (measured by pulmonary function tests) and
symptoms.
 Stages 1 (mild): It is defined by an FEV1/FVC less than
70% and an FEV1 greater than or equal to 80% predicted
and the patient may be with or without symptoms of
cough and sputum production.
 Stage 2 (moderate): It is defined by an FEV1/FVC less
than 70% an FEV1 50% to 80% predicted and shortness
of breath typically developing upon exertion.
 Conti...

 Stage 3 (severe): is defined as an FEV1/FVC less

than 70% and an FEV1 less than 30% to 50%
predicted. Severe COPD symptoms include
increased shortness of breath, reduced exercise
capacity and repeated exacerbations.
 Stage 4 (very severe): is defined as an FEV1/FVC
less than 70% an FEV1 less than 30% to 50%
predicted and symptoms/signs of chronic
respiratory failure.
Conti...
 NANDA nursing diagnosis
 Ineffective Airway Clearance.
 Impaired Gas Exchange.
 Ineffective Breathing Pattern.
 Imbalanced Nutrition: Less Than Body Requirements.
 Risk for Infection.
 Deficient Knowledge.
 Activity Intolerance.
 Medical Management
 Riskreduction:
Smoking cessation
Avoid modifiable factors
 Pharmacologic therapy:
Bronchodilators
Corticosteroids
0ther medications
influenza vaccine
antibiotics
 Conti...
 Management of exacerbations:
Identify and treat cause of exacerbation i.e air pollution
 Oxygen therapy:
Not more than 2L to be administered
 Surgical management:
Bullectomy
Lung Volume Reduction Surgery
Lung Transplantation
 Conti...
Pulmonary rehabilitation:
Breathing exercise: pursed lips breathing
Activity pacing
 Nursing Management
 Assessing the patient: Obtain information about
current symptoms as well as previous disease
manifestations. In addition to the history nurses
review the results of available diagnostic tests.
 Improving breathing patterns: Pursed lip
breathing helps slow expiration, prevent collapse
of small airways and control the rate and depth of
respiration it also promotes relaxation .
 Conti...
Achieving airway clearance:
 If bronchodilators or corticosteroids are prescribed
administer the medication properly and be alert for
potential side effects
 Encourage patient to eliminate or reduce all pulmonary
irritants, particularly cigarette smoking
 Chest physiotherapy with postural drainge, intermittent
positive pressure breathing, increased fluid intake may
be useful in some patients with COPD
 Instruct patient in direct or controlled coughing
 Complications

 Respiratory infections
 Heart problems
 Lung cancer
 Pulmonary hypertension
 Depression
 References

Smeltzer, S. C., Bare, B. G., Hinkle, J. L., & Cheever, K. H.

(2010).
Brunner and Suddarth’s textbook of medical-surgical
nursing (12th ed.).
Philadelphia: Lippincott Williams & Wilkins.