Chronic Obstructive

Pulmonary Disease
(C.O.P.D)
Chronic Obstructive Lung Disease
Chronic Airway Limitation

Description
A group of diseases that include:
Chronic Bronchitis- chronic
inflammation of bronchi
unrelieved in 3 consecutive
months and in 2 consecutive
years
Chronic Asthma (Status
Astmaticus)- S/sx of allergic
attack unrelieved within 24
hours of adequate therapy

Bronchiectasis- dilation of
bronchioles r/t chronic
airway obstruction
Pulmonary Emphysemaoverdilatation of alveoli
(compliance) and resulting
in Recoil
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Basis
Chronic

airway blockage
Airway resistance
Progressive airflow limitations both
ways
Irreversible alveolar distention air
trapping alveolar damage ABG
imbalances: Low pO2, High pCO2

Possible Complications

Pulmonary hypertension
Respiratory insufficiency or
Respiratory failure
Cor Pulmonale
CO2 Narcosis
Alveolar Rupture
Atelectasis
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Bronchial Asthma

Description
Also

called RAD (Reactive Airway

Disease) and ROAD (Reversible
Obstructive Airway Disease)
A complex inflammatory process
that results to increased airway
resistance and later, alveolar
damage
Airway inflammation r/t
hyperresponsiveness
(hypersensitivity) to allergens

Etiology

Extrinsic Allergens

Inhalants
Ingestants
Contactants
Temperature changes

Intrinsic allergens
Fatigue
Stress / anxiety
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Types of Asthma

Immunologic asthma
Occurs in childhood r/t
allergens; Allergic asthma
or atopic asthma; heredity;
high lgE

Non-Immunologic
Occurs in adulthood, usu.
Associated with URTI or LRTI
Non-allergic asthma or nonatopic asthma;
onset usually > 35 years

Mixed Asthma
Any age; any allergen; nonspecific stimuli

10

Pathophysiology
Allergens

Release of IgE by B-lymphocytes

IgE + mast cells (respiratory

tract)

Damage to mast cells

11

Release of chemical mediators

(Histamine, bradykinin, serotonin,
prostaglandin)

Capillary
Permebility

Vasodilation
Hypotension

Shock

Blood
congestion
(Hyperemia)

Escape of
Colloids

Edema

BV
12

 Other

signs and symptoms

DOB
Wheezing (classic)

13

Nursing Interventions

Administer medications, as
ordered
Administer nebulizer as
ordered
Provide patient teaching
about preventing attacks
and proper use of
medications
14

Pharmacotherapy:
Bronchodilators to relieve bronchospasm
Beta-Adrenergic agents: rapid onset of
actions when administered by aerosol
Theophylline check pulse and blood pressure

Corticosteroids to relieve inflammation

and edema
Antibiotics if secondary infection
Cromolyn sodium not used during acute
attack; inhaled; inhibits histamine release
in the lungs and prevents attack

15

Chronic Bronchitis
Is

an inflammation
of bronchioles that
impairs airflow.
16

 May

be
oAcute when the bronchus
becomes inflamed
oChronic results when
inflammation occurs several
times a year; can be diagnosed
by the presence of cough that
persists for 3 months a year for
2 years
17

Etiology
Exposure

to pulmonary irritants
Infections including RTI and
influenza

18

PATHOPHYSIOLOGICAL PROCESS
Causes : Cigarette
Smoking

RTI

INFLAMMATION

Environmental
Pollutants
Bradykinin

Fluid / Cellular
Exudation

Edema of Mucous
Membrane

Capillary
Permeability

Hypersecretion
of Mucus

Histamine
Prostaglandin

Persist
ent
Cough
19

 Signs

and symptoms
Coughing
Excessive sputum production
Rhonchi
Shortness of breath

20

Nursing Interventions
Eliminate

/ minimize patients
exposure to irritants and people with
RTI.
Clear airways with chest physical
therapy or suctioning as ordered.
Mucolytics as prescribed.
Deep-breathing exercises.
Patient teaching about adequate
nutrition and medication therapy.
21

Pulmonary
Emphysema

22

Description
Terminal

stage of COPD
Overdilated alveoli and
bronchioles
Damage to alveoli and failure
of alveolar diffusion
NSg. Dx: Imp. Gas Exchange
ABG: paO2
paCO2

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Etiology

Predisposing Fxs:
A-ge
H-eredity (low alpha1 antitrypsin)
A-uto-Immune tendency

Precipitating Fxs:

B- ronchitis, chronic
A-ir Pollution
S-moking
A-sthma, chronic

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Signs and Symptoms

25

Based on Types:
CENTRIBULAR

Blue Bloater Stage

1st stage
Most bronchioles and
alveoli plugged with mucus
Central airway dilated
Danger: Cor Pulmonale
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 Blue

Bloater Type
Cyanotic
Edematous
W/ prod. Cough
D.O.E.
Weakness
Nail Clubbing
ABG: Resp. Acidosis
S/S of hypoxia
S/S of R-sided CHF
Barrel-shaped chest
27

 PAN-LOBULAR

2nd stage
Most alveoli and
bronchioles dilated
Mucus expelled
Hyperventilating
(compensation to high
pCO2)
28

 Pink

Puffers
Pinkish skin color
Emaciated
Non-productive cough
Severe weakness
Anorexia
Dyspnea
ABG: Resp. Alkalosis
29

Common Signs and Symtoms

(Both Types)
Easy

fatigue
Pursed lip breathing
Barrel Chest
Dyspnea, orthopnea
Retractions
Prolonged I:E ratio
Wheezing on expiration
Clubbing
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Nursing Interventions
NDx1: Gas Exchange, Imp. R/t
ventilation: perfusion
mismatching (Physiologic
shunting)
Goal 1: Normal ABG values
2: No Hypoxia

31

Monitor: ABGs, s/sx of resp.

acidosis. s/sx of hypoxia, pulse
oximeter (O2 sat)
Give bronchodilators as ordered
(p.o., IV, rectal, nebulizer).
Check side effects:

Dysrhythmias
HR, BP
Excitation (L.O.C.)
N&V
Tremors
32

Low flow O2 therapy with venturi

mask at 24-30% concentration or
nasal cannula at 1-3 L/min
Good humidification
Liquify secretions
Suction PRN
Avoid narcotics- depress RR

33

NDx2: Airway clearance,

Ineffective r/t chronic asthma,
bronchitis, smoking, pollution
Goal 1: Open airway
Goal 2: Adequate ventilation

34

Assess: VS, cough, record

consistency of sputum
secretion, s/sx of hypoxia
Increase fluids p.o.-6-10
glasses (3L)/day unless C.I.
Nebulization as ordered
Mucolytics as ordered
Avoid milk, creams
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Respiratory therapy
Antibiotics or antihistaminics as
ordered
Position: High fowlers lean
forward. Use overbed table
Administer steroids as ordered to
decrease swelling of airway

36

NDx3: Breathing pattern, impaired

r/t airway obstruction
Goal 1: Improve pattern of
breathing or ventilation
Goal 2: Relief of Dyspnea

37

Position
Pursed-lip breathing
Blow bottle exercises
IPPB with nebulization
Alternate activities with rest

38

Teach use of inspiratory muscle

traininer (use 10 min/day to
strengthen respiratory muscles)
Teach to coordinate diaphragmatic
breathing with activity
Use controlled breathing while
bending, walking, bathing
Teach postural drainage
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NDx4: High Risk : Complications

Goal 1: Prevent complications:
CO2 Narcosis
Resp. acidosis
Cor Pulmonale
Respiratory Failure
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Ensure low flow O2

Monitor ABG
Fluid intake= 1.0-1.5 l/day if w/ Rsided CHF or pulmonary edema
Diuretics as ordered
IVF tkvo-use D5W
Tracheostomy tube if necessary
41

NDx5: Ineffective
Individual/Family Coping
Goal 1: Optimum coping level

42

Encourage catharsis
Involve in self-care and improve
self-esteem
Allow to make decisions about his
care (shaving, bathing , eating, etc)
Adopt a hopeful and encouraging
attitude towards pt
Encourage activity to level of
tolerance to improve self-esteem
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Monitor compliance to regimen

Allow use of O2 during activities
Teach relaxation tech, energy
conservation
Gradually increasing exercise
program using an insp. Resistive
device (blow bottle)
Pulmonary Rehab. Tech
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LUNG CANCER

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Description
Refers

to malignant tumor
growth within the bronchial
tissue or lung parenchyma.
Types include:
Squamous cell 35 50% of all
lung cancers.
Adenocarcinoma 15 35% of all
lung cancers.
Small cell (oat cell) 20-25% of all
lung cancers
Large cell 10-15% of all lung
cancers
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Etiology and Incidence

Predisposing

factors chronic
exposure to pulmonary irritants

Family

history of lung cancer

Tend

to have poor prognosis, unless

it is very well defined and removed
by surgery.
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Pathophysiology
As the lung tissue experiences
irritation, it undergoes a series of
changes and eventually gives rise
to a tumor.
Metastases can occur, especially
when the mother tumor is near
areas of lymph drainage.
Some tumors secrete hormones:
ADH reabsorption of water
ACTH stimulates adrenal glands
to produce steroids

48

 Symptoms

may include:

Cough
Wheezing
Shortness of breath
Chest pains
Hoarseness
Dysphagia (compression of
esophagus)
Weight loss
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Nursing Interventions
Prepare the patient for surgery if
tumor is small enough to be removed
Prepare patient for planned
treatments chemotherapy /
radiation therapy
Analgesics as ordered to control pain
Adequate oxygenation through
oxygen therapy or planned activityrest
Maintain nutritional status
Provide emotional support to the
patient and family
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