Is a term that to group
resistance to expiratory
C.O.P.D includes chronic
Is a chronic inflammation of
lower respiration tract
characterized by :
Excessive mucous secretion.
Dyspnea associated with
recurring infection of the
lower respiratory tract.
Is a complex lung disease
Destruction of the alveoli.
Enlargement of distal
Breakdown of alveolar wall.
Excessive secretion of
muocus and chronic infection
within the airway “ infection,
Hypertrophy of muocus gland
Increase in sizn and number of mucous producing
elements in bronchi
“ mucous glands & goblet cells”
Inflammation and edema
Narrowing and obstruction of air
Increase in size of airspace distal to the terminal
Loss of alveolar wall “ elastic recoil of the lung”
A- chronic bronchitis:
Usually insidious developing
over a period of years.
productive cough lasting at
least 3 months a year for 2
Production of thick, gelatinous
sputum which increased during
Wheezing and dyspnea as
B- Emphysema “ pulmonary
gradual onset and steadily
Dyspnea decrease exercise
Cough may be minimal
except with respiratory
1. Respiration force technique “RFT” demonstrate
Reduce Force ExpirationVolume “FEV” to
ForceVital capacity “FVC”
2. ABGs show :
decreased PaO2, PH, and Increased PaCO2
3. Chest x-ray :
hyperinflation, flattened diaphragm
increased retrosternal space
4. Alpha antitrypsin “Genetically”
deficiency in Genetic pulmonary emphysema.
Reverse airflow obstruction
1. Stopped of smoking
2. Bronchodilators drug
3. Antibiotics for respiratory infection
4. Corticosteroid used in acute exacerbation for
5. Chest physical therapy “ postural drainage,
6. Low flow oxygen therapy for patient with sever
7. Pulmonary rehabilitation to reduce symptoms
that limit activity
When pt with COPD need Mechanical
Pt with COPD may need mechanical ventilation if
he / she have of sign & symptoms:
7. Central cyanosis
8. Shortness of breathing at rest
All of these sign & symptoms may signal
for respiratory failure
more than 55%
Decrease PH more
Exposure history to drug, occupational or air
Note amount, color & consistency of sputum.
Inspect for use of accessory muscle.
chest muscle, neck muscle, abdominal muscle,
“abdominal muscle used during expiration.
Note barrel chest.
Auscultation for decreased/ absent of breathing.
Decreased heart function.
Ask for heart disease.
1- Improve airway clearance
a) Removing all pulmonary irritant “stop
smoking, pt’s room free from dust”.
b) Administer bronchodilator.
c) Use postural drainage.
d) Keep secretion liquid by:
- highly of fluid intake
- inhalation of nebuliger
- avoid irritant drug if these
it increase sputum secretion
2- improve breathing pattern
a) Teach pt to make breathing retaining
exercise to stregth diaphragm and
b) Teach pt to use: low costal,
diaphragmatic muscle , abdominal
breathing in slow way. “slow in
relaxed breathing to reduce
respiratory rate & decrease energy
cost of breathing”.
c) Teach pt for relaxation exercise to
3- Control infection
a) Recognized early
manifestation of respiratory
infection “ increased
dyspnea, fatigue, change in
color, amount & character of
b) Obtain sputum culture and
antibiotic as culture.
4- Improve Gas exchange
a) report restlessness, aggressive, anxiety,
confusion, shortness of breathing a rest,
central cyanosis which indicate to acute
respiratory insufficiency &may signal
b) Review ABGs.
c) Give low flow oxygen as prescribed.
d) If CO2 retention occurseek forincubation
5- Improving nutrition
a) Ask about nutritional history &weight.
b) Encourage to frequent small meals if pt is
dyspnea, because heavy meal increase
abdominal contents may press in diaphragm
and impede breathing.
c) Offerliquid nutritional supplements to
improve caloric intake &counteract weight
d) Avoid foods producing abdominal discomfort.
e) Encourage pursed-lip breathing between bites
if pt is dyspnic
6- Increase activity intolerance
a) Arrange forexercise regimen &physical
b) Enhance delivery of oxygen to tissue.
c) Allows a higherlevel of functioning with
7- Improving sleep pattern
a) Maintain a balanced schedule of activity and
b) Use oxygen therapy.
c) Avoid the use of sedatives that may cause
8- Enhancing coping
a) Understand that the shortness of breathing &
fatigue make pt irritable, anxious, depress &
feeling with helpless /hopelessness
b) Demonstrate a positive and interested approach to
- Be good listener&show that you care.
- Be sensitive to pt fears, anxiety,
c) Strength the pt self image
d) Allow to the pt to express feeling.
e) Support the family members.
A. General education :
- Explain of disease forpt &family “ expect, treat &
- Review with pt the goal of treatment.
- Work with pt to set Goals.
B. Avoid exposure to respiratory irritant.
C. Prevent & treat respiratory infection
- Avoid to exposure to person with respiratory
- Avoid crowds with poorventilation.
- Advise pt how to recognize &report evidence of
respiratory infection “ amount, color, consistency of
D) Reduce bronchial secretions:
- Maintain an adequate fluid intake.
- Use bronchodilators
- Teach about postural drainage
exercise every position from 5 to 15