FOR NURSING STUDENTS

1. PRESENTED BY
MONIKA DEVI
MSC.(N)
HCN , SRHU

2. COPD
COPD is a disease condition characterized by the
presence of airflow obstruction caused by chronic
Bronchitis or emphysema. The airflow
obstruction is generally progressive, may be
accompanied by airway hyperactivity, and may be
partially reversible.

3. Chronic Bronchitis
Chronic bronchitis, is defined as the presence of cough
and sputum production for at least 3 months in each
of two Consecutive years. In much case, smoke or
other environment pollutants irritates the airways,
resulting in hyper secretion of mucus and
inflammation.

5. Emphysema
In emphysema, impaired gas exchanges results from
destruction of the walls of over distended alveoli
“emphysema in a pathological form that describes an
abnormal distention of the air spaces beyond the
terminal bronchioles, with destruction of the walls of
the alveoli.

6. Pan Lobular (Panacinar)
There is destruction of the respiratory bronchiole, alveolar
duct, and alveoli. All air space within the lobule are
essentially enlarged, but there is little inflammatory
disease. The patient shows hyper inflated (hyper
expended) chest (barrel chest on physical examination),
dyspnea and weight loss.

7. Centrilobular
In this from, pathologic changes takes place mainly in
the center of the secondary lobule. In which the
respiratory bronchioles enlarge, the walls are
destroyed and the bronchioles became inflamed.

9. Causes
1)Cigarette Smoking
when cigarettes are smoked, Approximately 4000 chemicals
and gases are inhaled into the lungs.
2) Infection
3) Occupational exposure
4) Air pollution
5) Heredity
6) Aging

11. Clinical Manifestation
COPD is characterized by three primary symptoms
1. Cough
2. Sputum production
3. Dyspnea on exertion
4. Weight loss
5. Hypoxemia during exercise
6. Cyanosis

12. Complications OF
COPD

13. Cor Pulmonale

14. Pneumothorax

16. STAGES
STAGE CHARACTERISITICS
O Normal Spirometry,
Chronic symptoms of
. . . .. cough, sputum production
I (Mild COPD) FEV1/ FVC <70%
May or may not have
chronic symptoms of
. . cough, sputum production.

17. Cont..
II (Moderate COPD) FEV1/ FVC <70%
May or may not have
chronic symptoms of cough
and sputum production.
III (Severe COPD) FEV1/FVC <70%
FEV1 30% predicted plus .
. respiratory failure or clinical
signs of right heart failure.
[FEV1 = volume of air that the patient can forcibly exhale in 1 second
to forced vital capacity (FVC).

18. Diagnostic Finding
1. Extensive history collection
 Exposure to risk factors
 Past medical history
 Family history of COPD
 Pattern of symptoms development
 History of previous hospitalizations
 Current medical treatments
 Potential for reducing risk factors

19. Cont..
 Physical examination
 Spirometry: - to evaluate airflow obstruction.
 ABG analysis
 Chest X-Ray
 Bronchodilator reversibility Test
 Alpha1, antitrypsin deficiency screening
 Pulmonary function Test
 ECG
 Echo – cardiogram

20. Management
MEDICAL MANAGEMENT
1.Risk Reduction
Smoking cessation is the single most effective
intervention to prevent COPD.

21. 2.pharmacological therapy
1.Broncho Dilators
A) Beta-adrenergic Agonist Agents
1. Albuterol
2. Terbutaline
B) Anticholinergic Agents
1. Ipratropium Bromide
2. Oxitropium Bromide
C) Methylxanthines
1. Aminophylline
2. Theophylline

22. Cont..
2. Corticosteroids
 beclomethasone
 Budesonide
 Flunisolide
3. Alpha1antitrypsin augmentation therapy
4.Antibiotic agents
5. Anti tussive agents
6. Oxygen therapy

23. Surgical Management
bullactomy

24. Cont…
2. Lung Volume Reduction Surgery
3. Lung Transplantation

25. Dietary Management
 Liquid, blenderized diet may be given
 Foods that require a great deal of chewing should be avoided
 Avoid exercise before and after eating
 Avoid gas-forming foods
 High protein and calorie diet given
 Avoid high CHO diet
 Avoid sodium if there is heart failure.

26. Pulmonary Rehabilitation
1. Education
2. Exercise

27. Pulmonary Rehabilitation
Education
1. Diagnosis
2. Smoking Cessation
3. Pharmacology
4. Respiratory Therapy
5. Physical Therapy
6. Occupational Therapy
7. Therapeutic Recreation
8. Nutrition
9. Psychosocial

28. Pulmonary Rehabilitation
Exercise
1. Physical Therapy
2. Occupational Therapy
3. Respiratory Therapy

29. Pulmonary Rehabilitation
Inpatient
ADVANTAGES
1. 24 hour nursing care
2. Sicker patients
3. No transportation problems
4. Family participation
5. Best for ventilator, tracheostomy
patients
DISADVANTAGES
1. Cost and insurance
difficulties
2. Not suitable for less
severe patients
3. Family transportation
problems

30. Pulmonary Rehabilitation
OUTPATIENT
ADVANTAGES
1. Widely available
2. Less costly
3. Least intrusive to family
4. Efficient use of staff
DISADVANTAGES
1. Potential transportation
problems
2. Cannot observe home
activities

31. Pulmonary Rehabilitation
HOME - BASED
ADVANTAGES
1. Convenience to patient
2. Transportation no issue
3. Exercise in familiar
environment may lead to better
adherence long term
DISADVANTAGES
1. Cost/insurance issues
2. Lack of group support
3. Lack of full spectrum of
multidisciplinary
personnel

32. Pulmonary Rehabilitation
Adverse Effects
1. Musculoskeletal injury
2. Exercise-induced bronchospasm
3. Cardiovascular event (increased risk
among COPD patients)

33. Pulmonary Rehabilitation
Benefits in COPD
1. Improves exercise capacity
2. Improves perceived breathlessness
3. Improves quality of life
4. Reduces hospitalizations
5. Reduces anxiety and depression
6. Improves survival

34. Nursing Management
 The nurses play a key role to manage the client condition.
 Assess the general and respiratory condition of the patient.
 Collect the important health information
 Assess the functional health patterns
 Physical examination.

35. Nursing Diagnosis
1. Impaired gas exchange and airway clearance due to
chronic inhalation of toxin.
INTERVENTION
Evaluates current smoking status, educate regarding smoking
cessation
Provide comfortable position
Administer and teach appropriate use of bronchodilators
Administer O2 to increase O2 saturation.

36. Cont..
1. Impaired gas exchange related to ventilation – perfusion
inadequately.
INTERVENTION
Administer bronco dilators
Evaluate effectiveness of nebulizer
Instruct and encourage patient in diaphragmatic breathing and
effective coughing.
Administered O2
Instruct the patient to avoid smoking
Provide comfortable portion.

37. Cont..
3.Ineffective airway clearances related to bronco
constriction, increased mucus production.
INTERVENTION
Adequately hydrate the patient
Teach and encourage the use of diaphragmatic breathing and
coughing techniques.
Assist in nebulizer.
Avoid the smoking
Administer antibiotic

38. Cont..
4.Ineffective breathing pattern related to shortness of breath,
mucus and airway irritants.
INTERVENTION
Facilitate deep breathing by elevating head
Provide semi fowler position
Encourage alternating activity with rest period

39. Cont…
5. Imbalance nutrition: less than body requirement related
to poor appetite.
INTERVENTION
Monitor calorie intake, weight.
Provide menu suggestion for high protein & calorie foods
Give high protein and calorie diet.
Provide liquid and frequent diet.
Plan periods of rest after food intake.

40. Cont..
6.Self care deficits related to fateful secondary to increased
work of breathing.
INTERVENTION
Teach patient to coordinate diaphragmatic breathing with
activity.
Encourage patient to begin to bathe self, walk
Teach about postural drainage.

41. Cont..
7.Activity intolerance due to fatigue, hypoxemia.
INTERVENTION
Support the patient in establishing a regular regimen of
exercise.
Provide adequate ventilation

42. Cont..
8. Sleep pattern disturbance related to anxiety, dyspnea, and
hypoxemia.
INTERVENTION
Assess the sleeping habit, identify cause and reduce them
Encourage exercise & activity during day time
Avoid day time sleeping
Instruct patient in maintaining an environment conductive to
rest.
Teach avoidance of alcoholic beverages, caffeine products
before bedtime.

43. Cont..
10.Deficient knowledge about self-management to be
performed at home.
INTERVENTION
Teach the patient about self-care.
Give strong message to stop smoking
Advise the patient to take regular treatment
Teach about exercise.

45. Summary

46. References
BOOK :-
 Lewis’s medical –surgical nursing , assessment and management of
clinical problems. Second edition. Page no . 610-625.
1164,630,635,1722-1723.
 Brunner and suddarth’s textbook of medical –surgical nursing
twelfth edition page no. 602-619.
NET :-
 COPD, www.mpedia.com
 Copd medlineplus.Gov/copd