Chronic Obstructive

Pulmonary Disease

Chronic obstructive pulmonary disease (COPD)

is a lung disease characterized by chronic
obstruction of lung airflow that interferes with
normal breathing and is not fully reversible.

 CHRONIC BRONCHITIS
 EMPHYSEMA
• Is an inflammation or swelling in the linings of
the bronchial tubes (bronchi).

• Is caused by viruses, bacteria, and other

BRONCHITIS
particles that irritate the bronchial tubes.

Acute Bronchitis – is a shorter illness that commonly

follow a cold or viral infection, such as the flu. It is
usually lasts a few days or weeks (1-3 weeks).

Chronic Bronchitis – is characterized by a persistent,

mucus-producing cough on most days of the month,
three months in a year for two successive years in
absence of a secondary cause of the cough. It occurs
with emphysema & it may become COPD
 Etiology & risk
 Smoking (major cause) factors
 People who are exposed to a lot
of secondhand smoking & air
pollution
 People with weakened immune
systems
 The elderly and infants
 People with gastroesophageal
reflux disease (GERD)
 Etiologic Factors
Pathophysiology KINDLY WATCH THE
Microorganism enter into the respiratory tract by inhalation Chronic Bronchitis VIDEO for better
understanding of the
disease.
Widespread inflammation occurs
Narrowing of the airways

Thin mucus lining of the bronchi can become irritated &

swollen Ventilation decrease as a secretion thickens

Cell that makes up this lining may leak fluid in response to the Mucus within the airways produces resistance in small airways and can
inflammation cause severe ventilation perfusion imbalance

Signs & Symptoms

Coughing as a reflex that works to clear secretion from the lungs

Alveolar fluid response

Signs & Symptoms

Complications

 Secondary polycythemia vera due to

hypoxemia

 Pulmonary hypertension due to reactive

vasoconstriction from hypoxemia

 Cor pulmonale from chronic pulmonary

hypertension
HISTORY - this is to know the exact cause of
the patient’s condition.
PHYSICAL EXAMINATION – must be thoroughly
performed to check signs & symptoms
the disease.
CHEST X-RAY – in severe cases, may show
enlarged lungs & cardiomegaly.
SPUTUM – for gram stain, culture &
sensitivity test may be obtained to determine
presence of bacterial infection.
PULMONARY FUNCTION TEST - by using
spirometer – to determine peak expiratory flow
(person’s maximum speed of expiration)
ABG TEST – to check O2 saturation in the
blood & the acidity in pH of the patient’s
blood.
CBC – to check hemoglobin count.
Diagnostic &
of
Laboratory Evaluation
- It’s best to collect sputum
specimens first thing in the morning,
when you get up.
- The necessary amount of sputum
for most tests is 5 ml (about 1
teaspoon).
- Rinse mouth with water
- Take a very deep breath and hold
the air for 5 seconds. Slowly breathe
out. Take another deep breath and
cough hard until some sputum
comes up into your mouth.
SMOKING CESSATION!
Antibiotics : Azithromycin, for 7-10 days as
prescribed by the physician. Management
Bronchodilators – to dilate the bronchi
• Beta2-adrenergic agonist agents – Antipyretics – for fever
Salbutamol, Terbutaline Others – Oxygen therapy, pulmonary rehabilitation
• Anticholinergic agents – Ipratropium program, chest physiotherapy, nutritional therapy
bromide
• Methylxanthines – Theophylline Additional Behavior Remedies Include
Mucolytics – Acetylcysteine- to thin the
secretions. • Removing the source of irritants from the lungs
Corticosteroids – Dexamethasone, • Using a humidifier – loosen mucus
Methylprednisolone to relieve the • Exercise
inflammation • Breathing exercise – pursed lip breathing
Diuretics – furosemide (Lasix) – to reduce
extra fluids in the body (edema).
 Nursing diagnosis
• Ineffective airway clearance related to
thick mucus discharge as evidence by
presence of rhonchi, cough and tachypnea
• Impaired respiratory functioning related
to ineffective breathing pattern as
evidence by increased respiratory rate.
• Acute pain related to inflammation, cough
as evidence by report of discomfort and
facial expression.
Nursing
interventions
• Monitor respiratory system & educate the importance of
SMOKING CESSATION!
• Lung sound (may need suction)
• Sputum production (collect if ordered) to check for
complications like pneumonia
• Keep O2 sat at 88-93% because patient with COPD are
stimulated due to low oxygen levels, if given too much
oxygen they will stop breathing.
• Administer O2 as prescribed 1-2L/min
• Teach about pursed-lip breathing & diaphragmatic
breathing
•Place the patient laterally & recumbent to help maintain an
open airway & drain the secretion
 Is a type of chronic obstructive pulmonary
disease (COPD) that is considered long-
term, progressive disease involving
damage to the air sacs (alveoli) in the EMPHYSEMA
lungs.
 It causes dilation of air spaces by
destruction of alveolar wall, leading to
collapse of alveoli during expiration. Etiology & risk factors
 Cigarette Smoking & long term second hand or
passive smoke exposure
 Air pollution
 Alpha-1-antitrypsin deficiency
 Inherited diseases (Rare)
 Cutis laxa
 Marfan’s syndrome
 Menke’s syndrome
 Etiologic Factors Inherited a-1 anti-
trypsin deficiency Pathophysiology KINDLY WATCH THE
VIDEO for better
EMPHYSEMA
understanding of the
Inflammation of Neutrophils &
airway epithelium Macrophages disease.
release elastage Loss of elastic recoil of bronchial wall

Infiltration of A-1 anti-trypsin

Lungs become damaged
inflammatory cells & deficiency leads to
release of cytokines failure of elastage
inactivation Irreversible enlargement of the air spaces

Increased protease activity with Collapse of terminal bronchial causing airway obstruction
breakdown of elastin in connective
tissue of lungs
 Destruction of alveolar walls

Loss of fibrous & muscle Inability of alveoli recoil Pathophysiology

tone breakdown of normally after
alveolar elasticity expanding

Inability of the lungs to Bronchial collapse

supply sufficient air
supply to body

Impaired oxygen Air trapped in the lungs

diffusion causes causes over distention
hypoxemia of lungs

Signs & symptoms

 Complications
 Pneumothorax due to bullae/bleb
 Weight loss due to work breathing
Diagnostic Evaluation
• Health history & physical examination
• Spirometry & other pulmonary function
• Chest x-ray / CT of the chest
• ABG analysis
• CBC
• Pulse oximetry
• Sputum examination
• Pulmonary ventilation/perfusion scans
• Testing for alpha-1 antitrypsin deficiency
(AAT deficiency) it also causes
breakdown of elatin.
Medical Management
• Smoking cessation – the most important & effective
treatment and can stop the progression of lung
damage.
• Bronchodilators: ipratropium bromide, albuterol
• Corticosteroids
• Antibiotics
• Steroids: corticosteroids, aerosol sprays
Vaccines against flu & pneumonia are
recommended for people with emphysema
Surgical Management
Pulmonary
rehabilitation
• LUNG REDUCTION SURGERY
Removal of small wedges of damaged lung
tissue.
• Includes education, nutrition,
• BULLECTOMY counselling, learning special breathing
Removal of one or more of the large air techniques, help with quitting smoking
spaces called bullae that form when the and starting an exercise regimen.
small air sacs are destroyed.

• LUNG TRANSPLANTATION
Lung transplant surgery is another
• Encourage the patient to stop
smoking
Nursing interventions
• Assess for signs & symptoms
of hypoxia and hypercapnia
• Auscultation chest to listen to
breath sounds every hour
• Educate about deep breathing
& coughing exercises
• Chest percussion
• Breathing techniques
• Avoid air pollution including
second hand smoking
• Adequate nutritional intake
 REVIEW
QUESTION
1. The nurse expects that a client 2. Jose, a COPD patient is in danger 3. A patient with chronic bronchitis
with right sided heart failure would of respiratory arrest following the often shows signs of hypoxia. Which
demonstrate physical symptoms administration of oxygen via nasal clinical manifestation is the
associated with congestion of cannula. Oxygen saturation is PRIORITY to look out for in this
blood in the: obtained. Nurse Oliver would expect patient?
that the O2 saturation of this patient
A. kidneys is which of the following values?
B. Jugular vein A. chronic, nonproductive dry, cough
A. 87%
C. Aorta B. clubbing of fingers
B. 88%
D. Lungs C. large amounts of thick mucus
C. 95%
D. barrel chest
D. 89%
 ANSWER w/ RATIONALE
1. ANSWER: B. Jugular 2. ANSWER: C. 95%
vein distention
RATIONALE: Neck veins RATIONALE: For most COPD
become distended patients, you should be aiming
because of increased back for an SaO2 of 88-92% only
pressure of blood from because these patients breathe
the right atrium. when their oxygen levels drop
to a certain level; this is known
as the hypoxic drive. If too
much oxygen is given, the client
has little stimulus to take
another breath which may lead
to respiratory arrest.
3. ANSWER: C. large amounts of
thick mucus
RATIONALE: Chronic bronchitis
features regular coughing and
spitting up of large amounts of
thick mucus. This mucus can
partly or completely block the
airways, making breathing in of
oxygen and breathing out of
carbon dioxide difficult.