COPD is a progressive lung disease characterized by airflow obstruction caused by chronic bronchitis or emphysema. It is the fourth leading cause of death in the US. Symptoms include cough, sputum production, and shortness of breath. Management involves smoking cessation, bronchodilators, corticosteroids, oxygen therapy, and lifestyle changes. Nurses play a key role in assessing patients, educating on self-management, and providing interventions to improve breathing and nutrition.

2. By
Raghunandan Singh

3. COPD
DEFINITION
COPD is a disease state characterized by the
presence of airflow obstruction caused by
chronic Bronchitis or emphysema. The airflow
obstruction is generally progressive, may be
accompanied by airway hyperactivity, and may
be partially reversible.

4. INCIDENCE
COPD is the fifth leading causing factor of
death in the united stated states for all ages
and both genders; fifth for men and fourth
for women. More than 15 million persons in
the united status suffer from emphysema
and chronic bronchitis.

5. CHRONIC BRONCHITIS
Chronic bronchitis, a disease of the airways, is
defined as the presence of cough and sputum
production for at least 3 months in each of
two Consecutive years. In much case, smoke
or other environment pollutants irritates the
airways, resulting in hyper secretion of mucus
and inflammation.

6. CHRONIC BRONCHITIS

7. EMPHYSEMA
In emphysema, impaired gas exchanges
results from destruction of the walls of over
distended alveoli “emphysema in a
pathological form that describes an abnormal
distention of the air spaces beyond the
terminal bronchioles, with destruction of the
walls of the alveoli.

8. TYPES
1. Pan lobular (Panacinar)
2. Centrilobular

9. PAN LOBULAR (PANACINAR)
There is destruction of the respiratory
bronchiole, alveolar duct, and alveoli. All air
space within the lobule are essentially
enlarged, but there is little inflammatory
disease. The patient shows hyper inflated
(hyper expended) chest (barrel chest on
physical examination), dyspnea and weight
loss.

10. CENTRILOBULAR
In this from, pathologic changes takes place
mainly in the center of the secondary lobule.
In which the respiratory bronchioles enlarge,
the walls are destroyed and the bronchioles
became inflamed.

12. ETIOLOGY / RISK FACTORS
1)Cigarette Smoking
when cigarettes are smoked, Approximately
4000 chemicals and gases are inhaled into the
lungs.
2) Infection
3) Passive smoking
4) Occupational exposure
5) Air pollution
6) Heredity
7) Aging

15. CLINICAL MANIFESTATION
COPD is characterized by three primary symptoms
Cough (mucopurulent, scanty, mucoid)
Sputum production
Dyspnea on exertion
Weight loss
Hypoxemia during exercise
Cyanosis

16. Barrel shape chest

17. TYPICAL POSTURE OF COPD PERSON-EMPHYSEMA.

18. STAGE OF COPD
STAGE CHARACTERISITICS
O Normal Spirometry,
Chronic symptoms of
cough, sputum production
I (Mild COPD) FEV1/ FVC <70%
May or may not have
chronic symptoms of
cough, sputum production.

19. II (Moderate COPD) FEV1/ FVC <70%
May or may not have
chronic symptoms of cough
and sputum production.
III (Severe COPD) FEV1/FVC <70%
FEV1 30% predicted plus
respiratory failure or clinical signs
of right heart failure.
[FEV1 = volume of air that the patient can forcibly
exhale in 1 second to forced vital capacity (FVC).

20. DIAGNOSTIC FINDING
1. Extensive history collection
Exposure to risk factors
Past medical history
Family history of COPD
Pattern of symptoms development
History of previous hospitalizations
Current medical treatments
Potential for reducing risk factors

21. Physical examination
Spirometry: - to evaluate airflow obstruction.
ABG analysis
Chest X-Ray
Bronchodilator reversibility Test
Alpha1, antitrypsin deficiency screening
Pulmonary function Test
ECG
Echo – cardiogram

22. MANAGEMENT
MEDICAL MANAGEMENT
1.RISK REDUCTION
Smoking cessation is the single most
effective intervention to prevent COPD.

23. 2.PHARMACOLOGICAL THERAPY
A) BRONCHO DILATORS
a) Beta-adrenergic agonist agents
• Albuterol
• Terbutaline
b) Anticholinergic Agents
• Ipratropium bromide
• Oxitropium bromide
c) Methylxanthines
• Aminophylline
• Theophylline

24. B) CORTICOSTEROIDS
• Beclomethasone
• Budesonide
• Flunisolide
C) Alpha1antitrypsin augmentation therapy
D) Antibiotic agents
E) Anti tussive agents
F) Oxygen therapy

25. SURGICAL MANAGEMENT
1. BULLECTOMY

26. • It’s a surgical removal of bulla, which is an air
pocket in the lungs that is greater than one
centimeter in diameter . It occurs as a result of
lung tissue destruction . Their presence in the
lungs takes up space, causes pressure and
blocks the breathing.

27. 2. LUNG VOLUME REDUCTION SURGERY
3. LUNG TRANSPLANTATION

28. DIETARY MANAGEMENT
Liquid, blenderized diet may be given
Foods that require a great deal of chewing
should be avoided
Avoid exercise before and after eating
Avoid gas-forming foods
High protein and calorie diet given
Avoid high CHO diet
Avoid sodium if this is heart failure.

29. NURSING MANAGEMENT
ASSESSMENT
The nurses play a key role to manage the
client condition.
Assess the general and respiratory condition
of the patient.
Collect the important health information
Assess the functional health patterns
Physical examination.

30. NURSING DIAGNOSIS
1. Impaired gas exchange and airway clearance
due to chronic inhalation of toxin.
INTERVENTION
Evaluates current smoking status, educate
regarding smoking cessation
Provide comfortable position
Administer and teach appropriate use of
bronchodilators
Administer O2 to increase O2 saturation.

31. 2. Impaired gas exchange related to ventilation –
perfusion inadequately
INTERVENTION
Administer bronco dilators
Evaluate effectiveness of nebulizer
Instruct and encourage patient in diaphragmatic
breathing and effective coughing.
Administered O2
Instruct the patient to avoid smoking
Provide comfortable portion.

32. 3.Ineffective airway clearances related to bronco
constriction, increased mucus production.
INTERVENTION
Adequately hydrate the patient
Teach and encourage the use of diaphragmatic
breathing and coughing techniques.
Assist in nebulizer.
Avoid the smoking
Administer antibiotic

33. 4.Ineffective breathing pattern related to
shortness of breath, mucus and airway
irritants.
INTERVENTION
Facilitate deep breathing by elevating head
Provide semi fowler position
Encourage alternating activity with rest period

34. 5. Imbalance nutrition: less than body
requirement related to poor appetite
INTERVENTION
Monitor calorie intake, weight.
Provide menu suggestion for high protein &
calorie foods
Give high protein and calorie diet.
Provide liquid and frequent diet.
Plan periods of rest after food intake.

35. 6. Self care deficits related to fateful secondary
to increased work of breathing.
INTERVENTION
Teach patient to coordinate diaphragmatic
breathing with activity.
Encourage patient to begin to bathe self, walk
Teach about postural drainage.

36. 7. Activity intolerance due to fatigue,
hypoxemia.
INTERVENTION
Support the patient in establishing a regular
regimen of exercise.
Provide adequate ventilation

37. 8. Sleep pattern disturbance related to anxiety,
dyspnea, and hypoxemia.
INTERVENTION
Assess the sleeping habit, identify cause and
reduce them
Encourage exercise & activity during day time
Avoid day time sleeping
Instruct patient in maintaining an environment
conductive to rest.
Teach avoidance of alcoholic beverages, caffeine
products before bedtime.

38. 9. Deficient knowledge about self-management
to be performed at home.
INTERVENTION
Teach the patient about self-care.
Give strong message to stop smoking
Advise the patient to take regular treatment
Teach about exercise.

39. SUMMARY