Reading material on COPD (CHRONIC OBSTRUCTIVE PULMONARY DISEASE) for Nursing students and teachers. It tells pathophysiology, clinical manifestations, diagnostic evaluations, medical and nursing management of COPD.
2. S.K. Singhal Faculty GCON Jaipur
INTRODUCTION
COPD is the progressive and partially reversible disease of the airway.
Comprises primarily of two related disease chronic bronchitis and Emphysema.
Chronic obstruction of the flow of air through the airway and out of the lungs permanent and
progressive obstruction over time.
INCIDENCE
COPD is the 5th leading cause of death in the United States for all ages and both genders; fifth for
men and fourth for women
Men were found to have a prevalence of 11.8% and women 8.5%. The numbers vary in different
regions of the world
more than 12,000 persons died of COPD. The middle adult years, and the incidence of COPD
increases with age
CHRONIC BRONCHITIS
Chronic bronchitis is defined clinically as a daily cough with production of sputum at least 3 month
per year for 2 or more consecutive year.
It involves inflammation and swelling of the lining of the air way that leads to narrowing and
obstruction of the air way.
The inflammation also stimulates production of mucus which can cause further obstruction of the
airway.
EMPHYSEMA
It is permanent enlargement of the alveoli due to destruction of the wall between alveoli which
leads to reduce the elasticity of the lungs over all.
Loss of elasticity leads to collapse of the bronchioles, obstructing air flow out of the alveoli. Air
become trapped to the alveoli and reduce the ability of the lungs to shrink during exhalation.
Reduce the expansion of the lungs during the next breath reduce the amount of air that is inhaled
As a result, less air for the exchange of gasses gets in to the lungs.
This trapped air also can compress adjacent less damage lung tissue.
ETIOLOGY AND RISK FACTORS
The specific causes of COPD are not clearly understood. Some risk factors are tissue.
1.Cigarette smoking: The primary cause is exposure to tobacco smoke. cigarette smoking will
develop COPD in 15%. Overall, tobacco smoking accounts for as much as 90% of the risk of COPD.
Second-hand smoke (passive smoking)
second hand smoke, or environmental tobacco smoke, increases the risk of respiratory infections.
2.Air Pollution
3. S.K. Singhal Faculty GCON Jaipur
outdoor air pollution contributes to the development of COPD.
most common cause is indoor stoves for cooking
Some occupational pollutants such as cadmium and silica-
3.Alpha-1 Antitrypsin (AAT) deficiency-
AAT enzyme is produced by liver and present in normal lungs. Normal1.5-3.5 g/l. Block the
damaging effects of elastase on elastin.
4. Chronic Respiratory Infections
5. Alcohol Ingestion
PATHOPHYSIOLOGY
Chronic inflammation Allergic reaction
Increase number of goblet cell IgE stimulation
and mucus secretion
IgE attached to the mast cell
Increase size and number of sub mucus
gland in bronchi and mucus production Mast cell release histamine and
prostaglandin
Decrease ciliary function reduce mucus
clearance (deposit) mucus Mucus secretion and bronchospasm
Bronchi constriction Obstructive air way
SIGN AND SYMPTOMS
Cough, with or without mucus
Chronic cough and sputum production (in chronic bronchitis
Shortness of breath (dyspnea) that gets worse with mild activity
Trouble catching one's breath
Fatigue
Wheezing
Rhonchi, decreased intensity of breath sounds, and prolonged expiration on physical examination
4. S.K. Singhal Faculty GCON Jaipur
chest tightness and tiredness
People with advanced COPD sometimes develop respiratory failure
Common signs are:
Tachypnea a rapid breathing rate
Wheezing sounds or crackles in the lungs heard through a stethoscope
Breathing out taking a longer time than breathing in
Enlargement of the chest, particularly the front to-back distance (hyperaeration)
breathing through pursed lips
Increased anteroposterior to lateral ratio of the chest (i.e. barrel chest)
Warning Signs
• Increased wheezing
• Decreased pulse oximetry
• Fever (>101 *F)
• Increased pulse (>100)
• Decreased pulse (<60)
• Increased respiratory rate
INVESTIGATION
Medical History
Physical examination finds enlarged chest cavity and wheezing. Blood Test
A hematocrit value of more than 52% in males and more than 47% in female indicates disease.
Measure the alpha1-antitrypsin (AAT), the AAT level is low
Sputum for culture and microscopic examination mucoid sputum .
The pathogens Streptococcus pneumoniae and Haemophilus influenzae
Chest X-ray-
Hyper inflated lung
Flat diaphragm
Tubular heart
Increase broncho vascular markings
6. S.K. Singhal Faculty GCON Jaipur
High Resolution CT scanning (HRCT): is highly specific for diagnosing emphysema, and the
outlined bullae are not always visible on a radiograph.
CT scan (COPD)
Two-dimensional echocardiography may be helpful as a screening tool to estimate pulmonary
arterial systolic pressure and right ventricular systolic function.
Pulmonary Function Test
Forced expiratory volume in 1 second (FEV1 ) is a reproducible test and is the most commonly
used index of airflow obstruction.
Mild= FEV1 >80% predicted
Moderate= FEV1 80-50% predicted
Sever= FEV1 50-30% predicted
Very sever = FEV1 < 40mm of Hg). Oxygen (1-3L) by nasal canula may be required to raise the
pao2 to no less than 60mm of Hg. (normal 80-100 mm of Hg)
Postural drainage and chest physiotherapy they can be help expelled secretion.
Control complications: Edema and corpulmonale are treated with diuretics and digitalis.
Phlebotomy also reduces cardiac workload.
Antibiotic- Treat with antibiotic therapy for recurrent bacterial infection.
Promote exercise-
Aerobic exercise: Exercise does not improve lung function more effectively but strengthen the
respiratory muscles even the lungs are diseased.
Progressively increased walking is the most common form of exercise.
Encourage diaphragmatic breathing and pursed-lip breathing.
Improve general health- The most effective way to slow disease progression is for the client
to stop smoking
avoid exposure to known allergens
avoid high altitudes
Use supplemental Oxygen for air travel.
Adequate nutrition is essential to maintain respiratory muscle strength.
Regular Oxygen therapy should be maintained.
8. S.K. Singhal Faculty GCON Jaipur
NURSING MANAGEMENT
Assessment:
history of smoking, family history, occupational history
ABG analysis
respiratory rate, depth and characteristics
sputum amount and type
anxiety level of the patient.
1. Nursing Diagnosis: Impaired gas exchange related to dyspnoea, mucus plug and decreased
ventilation
Goal: Client will be demonstrated improved ventilation and adequate oxygenation.
Nursing intervention
Assess respiratory rate, depth, note use of accessory muscles, pursed lip breathing, inability to
speak.
Elevate head of bed, assist patient to assume position to ease work of breathing.
Encourage deep slow or pursed lip breathing as individually tolerated.
Administer low- flow oxygen therapy (1-2lit/min) as needed via nasal prongs.
Administer bronchodilators if ordered
Regularly monitor the client's respiratory rate and pattern, pulse oximetry, ABG results.
2.Nursing Diagnosis: Activity intolerance related to inadequate oxygenation and dyspnea
Nursing Goals: The client will have improved activity tolerance within hospitalization period
Nursing Intervention
Monitor the severity of dyspnea and oxygen saturation with and following activity Keep the
patient in semi- flower position.
Maintain supplemental oxygen therapy (2lit/min)
Assist the client in scheduling a gradual increase in daily activity and exercise.
Advise the client to avoid conditions that increase oxygen demand such as temperature extremes,
excess weight and stress.
Instruct the client energy conservation techniques such as pacing activities throughout day.
Teach the client to use pursed-lip and diaphragmatic breathing techniques
3.Nursing Diagnosis: Ineffective airway clearance related to excessive production of secretions,
retained secretions and ineffective coughing
Goal: The client will be maintaining patent airway with breath sounds clear within hospitalization
Nursing Intervention
9. S.K. Singhal Faculty GCON Jaipur
Monitor respiratory rate and auscultate breath sounds e.g. wheeze, crackles, rhonchi
Assist the patient to assume position of comfort e.g. elevate head of bed, sitting on edge of bed.
Keep environmental pollution to minimum e.g. dust, smoke and feather pillows according to
individual situation
Encourage/ assist with abdominal or pursed lip breathing exercises
Administer medications as indicated such as bronchodilators
Perform chest physiotherapy.
4.Nursing Diagnosis: Anxiety related to disease prognosis
Nursing goal: Patient will not have any more anxiety after nursing intervention
Nursing Intervention
Provide care in a calm and quiet environment.
Encourage the use of breathing retraining and relaxation techniques.
Explain the patient about disease including cause, signs and symptoms, medication, procedures,
prevention and follow up care
Given the opportunity to talk the patient with similar problem who admitted in the same ward and
almost in recovery phase.
5.Nursing Diagnosis: Risk for infection related to ineffective pulmonary clearance Goal: Client will
have a decreased risk of infection related to ineffective pulmonary clearance after intervention
Nursing Intervention
Teach the client to wash his or her hands after contact with potentially infectious material.
Teach the client and family how to care for and clean respiratory equipment used at home.
Assess vital signs including temperature and sputum colour, odour and character.
Teach the client and family the manifestations of pulmonary infections like change in colour or
volume of sputum, fever, chills, malaise, productive cough, confusion, increased dyspnea etc
Discuss need for adequate nutritional intake
Explain client about the importance of self-care
Notify the physician if any sign of infections occurs.
Complications of COPS:
• Core pulmonale (abnormal enlargement of the right side of the heart as a result of disease
of the lungs or the pulmonary blood vessels).
• Exacerbations of COPD
• Acute Respiratory Failure
• Overwhelming disability
• Death
10. S.K. Singhal Faculty GCON Jaipur
CONCLUSION:
This above reading material just give an important debriefing of COPD. As it includes an introduction,
small definition, sign and symptoms, Diagnostic evaluations, pathophysiology, warning signs,
treatment algorithm and also nursing management of COPD. And I had a chance of referring current
information from the Net reference and Journals. Students must be very thankful to our honourable
Principal Dr. Jogendra Sharma for circulating out this study material even in the time of present
crisis. So that studies should not be sacrificed.
You can also refer:
• Brunner &Suddarth B, 2009,’ Test book of Medical Surgical Nursing,’ Eleventh Edition, Joyce
young johnson, Lippincott, Williams &wilkinspp 607.
• Joyce M.Black,’Medical – Surgical Nursing,’ Fifth Edition ,W.B.Saunders Company, pp 1022-
1050
• Net Reference:
Respiratory system, Wikipedia, free encyclopaedia.
Assignment for students
Deadline for Submission: 4 May 2020 Email ID: Santoshsinghal72@gmail.com
LONG ANSWER:
Q.1. Mr. Parker 62-year-old is admitted in the hospital with the diagnosis of COPD.
Define COPD, Etiology, Pathophysiology, medical and nursing management in detail.
Q.2. Write Short note on:
a) Diagnostic evaluation of COPD.
b) Warning signs of COPD.
c) Complications of COPD.
d) Emphysema
