Pathophysiology - COPD is characterized by airflow limitation that is poorly

reversible. Cumulative, chronic exposure to cigarette smoking is the number one

cause of the disease, but repeated exposure to secondhand smoke, air pollution
and occupational exposure (to coal, cotton, grain) are also important risk factors.
Chronic inflammation plays a major role in COPD pathophysiology. Smoking and
other airway irritants cause neutrophils, T-lymphocytes, and other inflammatory
cells to accumulate in the airways. Once activated, they trigger an inflammatory
response in which an influx of molecules, known as inflammatory mediators,
navigate to the site in an attempt to destroy and remove inhaled foreign debris
progressively worse.

Medications
Furosemide 80mg/8ml IVP
Albuterol/Ipratropium (Duoneb)
Budesonide/formoterol 2puffs
Carvedilol 6.25 MG
Gabapentin 600mg
Levothyroxine 0.025mg
Hydrocodone/Acetaminophen 10/
325mg
Isosorbide Mononitrate 30mg

Labs
NO active labs at this time

Medical Diagnosis - Chronic

obstructive pulmonary disease, also
known as chronic obstructive lung
disease and chronic obstructive airway
disease, among others, is a type of
obstructive lung disease characterized
by chronically poor airflow. It
typically worsens over time. The main
symptoms include shortness of breath,
cough, and sputum production. Most
people with chronic bronchitis have
COPD.

Nursing Diagnosis
1. Impaired Gas Exchange R/T decreased lung compliance
and altered level of conscious AEB dyspnea on exertion
2. Imbalanced Nutrition R/T Fatigue AEB Reported altered
taste sensation; aversion to eating, lack of interest in food
3. Knowledge Deficit R/T Lack of information/unfamiliarity
with information resources AEB Statement of
concerns/misconception

Nursing Intervention and

Rationale
1.Elevate head of bed, assist
patient to assume position to ease
work of breathing. Include periods
of time in prone position as
tolerated. Encourage deep-slow or
pursed-lip breathing as
individually needed or tolerated.

Oxygen delivery may be improved

by upright position and breathing
exercises to decrease airway
collapse, dyspnea, and work of
breathing. Note: Recent research
supports use of prone position to
increase Pao2.

2.Encourage a rest period of 1 hr

before and after meals. Provide
frequent small feedings.

Helps reduce fatigue during

mealtime, and provides opportunity
to increase total caloric intake.

3.Provide information about activity

limitations and alternating activities with
rest periods to prevent fatigue; ways to
conserve energy during activities
(pulling instead of pushing, sitting
instead of standing while performing
tasks); use of pursed-lip breathing, sidelying position, and possible need for
supplemental oxygen during sexual
activity.

Having this knowledge can

enable patient to make
informed choices or
decisions to reduce dyspnea,
maximize activity level,
perform most desired
activities, and prevent
complications.

Patient Education
1.Explain the type of oxygen therapy being used and why
its being used and why its maintenance is important. Issues
related to home oxygen use, storage, or precautions need
to be addressed.
2. Foods high in calories and protein that will promote
weight gain & nitrogen balance(e.g. small frequent meals
high in calories & proteins)
3. Refer patient to support groups as needed. These allow
patients to interact with others who have similar problems
or learning needs, include significant others & family
members to encourage ongoing support for patient.

Subjective
I sleep a lot
I dont wear CPAP at night because its too loud
I dont eat much, just dont have an appetite
I smoke half pack of cigarettes a day
I dont know much about my condition

A
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E
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M
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Goals/Outcomes
Objective
RS 69 yrs.old, FC, WT 147.3lb
T96.8, P97, R20, B/P118/79, o2/91% NC,
P-0/10
Pt exhibits dyspnea on ambulation
Crackles heard over lower lobes
Pulses present
Bowel sounds all 4quads
Alert & Aware

1. Patient will participate in treatment regimen within level of

ability/situation by the end of the day
2. Patient will demonstrate behaviors/lifestyle changes to regain
and/or maintain appropriate weight by discharge
3. Patient will verbalize understanding of condition/disease
process and treatment by discharge.