Decrease aveoli
elasticity in
connective tissue
of lungs
Airway instability
Increase lung compliance
Chronic Bronchitis "Blue Bloaters"
Bronchial
inflammation +
edema
Mucus hypersecretion
Bronchospasms
Airway obstruction, Air
trapping
Hypoxia
Polycythemia
Increased thickness of blood
Pulmonary vasoconstriction
increase pulmonary vasculature
resistance
Pulmonary hypertension
Hypertrophy of right ventricle
Cor
pulmonale
Right sided heart failure
Hypercapnia
Respiratory acidosis
Hypoxemia
Cyanosis
CLINICAL OBSERVATIONS
Etiology
Heredity
Smoking
Chemical + Air
pollutants
Infection
Age
Symptoms
Anorexia
Difficulty eating
Decrease levels of ADLs
Dyspnea
Orthopnea
Productive cough
Fatigue
Headaches
Wheezing
Bloating
Swelling of
feet
DIAGNOSIS
ABG
findings
Low PaO2; ↑ PaCO2 (> 45 mmHg) ;↓
pH (< 7.35); ↑Bicarbonate level
found in late stages of COPD (> 26
mmHg)
Pulmonary tests
Chest X-ray
Spirometry
Oximetry
Dyspnea Scale
Walk test determines oxygen
desaturation in blood
Patient health
hx.
Family history of COPD
AAT
deficiency
Body is unable to make
enough proteins to protect
the lungs and liver from
damage; may lead to
emphysema and/or liver
disease
Hx./frequency of respiratory infections; hx. of resp. and cardiac problems
ECG
findings
ST depression + T inversion;
RHF
TREATMENTS
Drug therapy
Corticosteroid
Prescribed for
moderate to severe
forms of COPD
Inhaler
Pills
Combination
medicines
Inhalers that
combine a
bronchodilator and a
corticosteroid help
to treat and prevent
COPD exacerbations
fluticasone +
salmeterol
fluticasone furoate + vilanterol trifenatate
budesonide + formoterol fumarate
Bronchodilators
Aids by opening the
airways in the lungs,
thus making it easier
to breath
Rapid-onset bronchodilators:
relieves SOB in few minutes
Slow-onset bronchodilators:
take longer to act (i.e., 4-6 hrs,
and some lasting 24 hrs)
Beta-2
agonists
Anticholinergics
Oxygen
therapy
Effective for those with low
blood-oxygen levels (hypoxemia)
and/or those with lung damage due
to infections (i.e., pneumonia)
Reduces workload on
the heart and work of
breathing
Surgical
therapy
Lung transplantation
Usually a single
lung
transplantation;
aids in
improving
quality of life
Lung volume reduction surgery
Removal of the
damaged lung
to improve
respiratory
function
Bullectomy
Surgical removal
of a bulla to
improve
symptoms and
respiratory
function for those
with emphysema
Nutritional therapy
Breathing requires a lot of energy for
those with COPD as muscles use 10x
more calories than those without
COPD
Having a high calorie & high protein diet
Eat small meals (~ 5-6 meals) to avoid bloating
Calorie increasing desserts such as ice cream can aid supplementary intake
Avoid foods that require a lot of chewing
Exercise & treatment 1 hr before and after eating
Gas-forming foods
AVOID!
Nursing Management
Assessment
Obtain patients complete health history +
physical assessment; collecting subjective +
objective data
Planning
Formulate patient goals:
improve QoL, prevent
disease progression, assess
patient knowledge and
ability to perform long-term
goals, relieve symptoms
Evaluation
Expected Outcomes:
improved sleep cycle,
maintaining body weight,
effective coughing,
normal breath sounds
Implementation
Health Promotion:
smoking cessation,
family hx. of COPD &
AAT deficiency
Acute intervention:
due to secondary
causes (i.e.,
pneumonia, acute
resp. failure, cor
pulmonale)
Ambulatory care & Home Care:
perform exercises (i..e, walk 15-20
mins/day for at least 3x a week),
instruct pt. to wait 5 mins after
finishing the exercise before using
bronchodilators and instead
allocate for slow pursed-lip
breathing
COMPLICATIONS
Infection + air pollution
Changes in dyspnea/cough/sputum
Exacerbations of COPD
Discontinuation of corticosteroid and/or bronchodilators
overuse of sedatives /benzodiazapenes/opiods
Depression/anxiety
Surgery or severe painful illness involving chest or abdomen
Peptic ulcer disease
Acute respiratory failure
an irreversible, slow,
progressive obstruction of
airflow into and/or out of
the lungs mainly due to an
abnormal inflammatory
response from the lungs