Chronic Obstructive

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

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 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

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 Bronchiectasis- dilation of
bronchioles r/t chronic
airway obstruction
 Pulmonary Emphysema-
overdilatation 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

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 Possible Complications
 Pulmonary hypertension
 Respiratory insufficiency or
Respiratory failure
 Cor Pulmonale
 CO2 Narcosis
 Alveolar Rupture
Atelectasis
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Bronchial Asthma

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 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

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 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 non-
atopic asthma;
– onset usually > 35 years

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 Mixed Asthma
– Any age; any allergen; non-
specific stimuli

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 Pathophysiology
Allergens

Release of IgE by B-lymphocytes

IgE + mast cells (respiratory tract)

Damage to mast cells


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 Release of chemical mediators
(Histamine, bradykinin, serotonin,
prostaglandin)

 Capillary
Vasodilation Permebility

Hypotension Blood congestion

(Hyperemia)
Escape of
Colloids
Shock

Edema BV
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 Other signs and symptoms
– DOB
– Wheezing (classic)

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

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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

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Chronic Bronchitis
Is an inflammation
of bronchioles that
impairs airflow.

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 May be
o Acute – when the bronchus
becomes inflamed
o Chronic – 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

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 Etiology
 Exposure to pulmonary irritants
 Infections including RTI and
influenza

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 PATHOPHYSIOLOGICAL PROCESS

Causes : Cigarette
Smoking
INFLAMMATION
RTI
Environmental  
Pollutants
Bradykinin
Fluid / Cellular  Capillary Histamine
Exudation Permeability
Prostaglandin

Edema of Mucous Hypersecretion

Membrane of Mucus
Persist
ent
Cough

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 Signsand symptoms
– Coughing
– Excessive sputum production
– Rhonchi
– Shortness of breath

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 Nursing Interventions
 Eliminate / minimize patient’s
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.
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 Pulmonary
Emphysema

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 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 anti-trypsin)
– A-uto-Immune tendency
 Precipitating Fxs:
– B- ronchitis, chronic
– A-ir Pollution
– S-moking
– A-sthma, chronic

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Signs and Symptoms

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 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

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 PAN-LOBULAR

–2nd stage
–Most alveoli and
bronchioles dilated
–Mucus expelled
–Hyperventilating
(compensation to high
pCO2)
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 Pink Puffers
– Pinkish skin color
– Emaciated
– Non-productive cough
– Severe weakness
– Anorexia
– Dyspnea
– ABG: Resp. Alkalosis
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 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

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 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
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 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

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NDx2: Airway clearance,
Ineffective r/t chronic asthma,
bronchitis, smoking, pollution

Goal 1: Open airway

Goal 2: Adequate ventilation

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 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

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NDx3: Breathing pattern, impaired
r/t airway obstruction

Goal 1: Improve pattern of

breathing or ventilation
Goal 2: Relief of Dyspnea

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

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 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/ R-
sided CHF or pulmonary edema
 Diuretics as ordered
 IVF tkvo-use D5W
 Tracheostomy tube if necessary

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NDx5: Ineffective
Individual/Family Coping

Goal 1: Optimum coping level

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 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
 Predisposingfactors – 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

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 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 activity-rest
 Maintain nutritional status
 Provide emotional support to the
patient and family

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