NURSING CARE PLAN

OF PATIENT WITH COPD

Chronic Obstructive
Pulmonary Disease
BY:
ERNI SETIYORINI
Objectives
Define COPD.
Identify causes of COPD.
List the signs and symptoms of COPD.
Describe the management and care for
COPD.
List the complications of COPD.
Discuss relevant patient / family
education.
Definition
Chronic obstructive pulmonary disease
(COPD) is a group of conditions causing
the chronic or recurrent obstruction of
airflow. It can result from the combination
of symptoms associated with:
Chronic bronchitis
Emphysema
Asthma

Causes
The leading cause of COPD is smoking,
which can lead to the two most common
forms of this disease, emphysema and
chronic bronchitis.
Rarely, an enzyme deficiency called
alpha-1 anti-trypsin deficiency can cause
emphysema in non-smokers.
Chronic Bronchitis
Emphysema
Asthma

Nursing Assessment
Nasal
Cyanosis
Dyspnea
Decreased respiratory effort
Accessory muscle use
Decreased breath sounds
Decreased oxygen saturation
Signs and Symptoms COPD
Conditions
Chronic
bronchitis

Dyspnea
Cyanosis
Prolonged expiration
Scattered crackles,
rhonchi and wheezing
Cardiac dysrhythmias
Increased mucus
production
Productive cough
Increased anterior-
posterior diameter
Peripheral edema
Normal respiratory rate
Signs and Symptoms COPD
Conditions
Emphysema
Dyspnea
Barrel chest
Use of accessory muscles
Increased AP diameter of
chest
expiratory wheezes
Patient may look pink and
puffy
Tachypnea
Breathing through pursed lips
Signs and Symptoms COPD
Conditions
Asthma
Prolonged expiratory time
Pursed lips
Wheezing with decreased
breath sounds
Cough
May have upper airway rhinitis,
sinusitis or nasal polyps
Dyspnea
Decreased PEFR
Accessory muscle use
Increased work of breathing
Decreased oxygen saturation
Contributing Factors Associated
With COPD


History of smoking
Occupation (certain occupations have
increased risk for lung disease related to
environmental work conditions)
History of lung disease
Allergies
Recent pulmonary infection



CXR - positive findings include hyperinflation of
the lung, cardiac enlargement, flattened
diaphragm, congested lung fields
PEFR (peak expiratory flow rate) - will measure
the expiratory ability and help assess condition
improvement after treatment.
Pulse oximetry
ABG - decreased pao
2
; Increased pco
2

Diagnostic Procedures
Diagnostic Procedures
CBC with differential - increased WBC
indicative of infection; eosinophilia
indicative of asthma
Sputum cultures - specifically identify
infectious agent
Enzymes - may show decreased level of
antitrypsin

Nursing Interventions
Allow the patient to assume a position of comfort
for easiest breathing.
Begin O
2
therapy based on the patient's
condition. Continue to monitor oxygen delivery,
especially if the patient is showing signs of
chronic bronchitis. High-flow oxygen could
cause the opposite effect desired, making the
patient lose the drive to breathe. A Venturi mask
is the most precise method of delivering exact
amounts of oxygen.

Nursing Interventions
Continuously monitor vital signs, including
oxygen saturation.
Prepare for more aggressive measures in
case the patient's condition worsens.
Greater ventilatory support may become
necessary.
Continuously monitor for cardiac
dysrhythmias.
Nursing Interventions
If the patient is in respiratory failure, begin
high-flow oxygen delivery regardless of
history.
Obtain IV access. Fluids are frequently
given to help liquefy secretions.
Nursing Interventions
Commonly ordered medications include:
1. Nebulized inhalers - medication is
inhaled by the patient.
2. Bronchodilator - stimulates b-receptors
for bronchodilation. Medication is inhaled
through the mouth. The dosage differs,
based on the type of bronchodilator used
as well as the patient's age and acute or
chronic condition.



Nursing Interventions
3. Corticosteroids - decrease inflammation
of epithelial cells in asthma.
4. Antibiotics may also be given if an
infectious process is suspected.
Administer as ordered by the physician,
and discuss administration with the
patient to ensure that antibiotic therapy is
continued when the patient is released, if
needed.

Patient Management
Helpful breathing techniques, such as
pursed-lip and diaphragmatic breathing
How to position the patient's body for
optimal air exchange
Changing eating habits so he or she eats
small, frequent meals rather than large
meals


Patient Management
The importance of exercise
The need to cough up sputum
Keeping the body hydrated
Avoiding known triggers
Medication compliance
Complications
A prompt, accurate assessment to identify
signs and symptoms of COPD, combined
with the appropriate treatment, can help
prevent serious complications associated
with this condition.

Respiratory acidosis
Alternative Names
Chronic respiratory acidosis; Ventilatory
failure; Respiratory failure; Acidosis -
respiratory
Definition

Respiratory acidosis occurs when the
lungs cannot remove all of the carbon
dioxide (a normal by-product of
metabolism) produced by the body.
Because of this disturbance of the acid-
base balance, body fluids become
excessively acidic.


Causes
Nearly any lung disease may lead to
respiratory acidosis. Chronic obstructive
pulmonary disease (COPD) is a major
cause of respiratory acidosis. COPD is
most often caused by cigarette smoking.
Symptoms
Symptoms of the diseases that cause
respiratory acidosis are usually noticeable,
and may include shortness of breath, easy
fatigue, chronic cough, or wheezing.
When respiratory acidosis becomes
severe, confusion, irritability, or lethargy
may be apparent.

Signs
A chest x-ray or CAT scan may be done to
diagnose possible lung disease
Pulmonary function tests may help
diagnose lung disease
Arterial blood gases help assess the
severity of the respiratory acidosis, and
may detect abnormal oxygen levels
Nursing Care
Smoking cessation is extremely important
Bronchodilator drugs may reverse some
airway obstruction
Oxygen may be necessary if the blood
oxygen level is low
Non-invasive positive-pressure ventilation
or mechanical ventilation may be
necessary if the respiratory acidosis is
severe

Complications
Respiratory acidosis may be a sign of
respiratory failure, with dangerously low
blood oxygen levels.
Excessive respiratory acidosis may lead to
confusion, lethargy, or poor organ function
-- in extreme cases, low blood pressure
and shock may result.
Patient & Family Education
Call your health care provider if you have
symptoms of lung disease.
Call 911 or get to an emergency room if
you suspect you have severe respiratory
acidosis -- this is a MEDICAL
EMERGENCY.
Patient & Family Education
Not smoking -- or quitting if you smoke --
can prevent the development of many
severe lung diseases that can lead to
respiratory acidosis. Obese patients may
prevent obesity hypoventilation syndrome
by losing weight