This document provides an overview of the management of patients with chronic obstructive pulmonary disease (COPD). It describes COPD as a disease characterized by chronic bronchitis and emphysema that causes airflow obstruction. The main risk factors are cigarette smoking, occupational exposures, and genetic factors. Symptoms include cough, sputum production, and dyspnea. Diagnosis involves pulmonary function tests, blood gas tests, and imaging. Treatment focuses on smoking cessation, bronchodilators, corticosteroids, antibiotics, oxygen therapy, and surgery for severe cases. Nursing management includes airway clearance techniques, breathing exercises, activity pacing, and monitoring for complications.

1. MANAGEMENTOF
PATIENTSWITH
LOWERRESPIRATORY
DISORDERS
‘’CHRONIC OBSTRUCTIVE
PULMONARYDISEASE
(COPD)’’
Jamilah Saad Alqahtani
Nurse Lecturer, MSN, TOT, OR Nurse
Specialist, RGN, BSN

2. Objectives
• At the end of the lecture, the student will be
able to
◦ Describe the patho-physiology of the disease.
◦ Discuss the major risk factors and clinical
manifestations of the disease.
◦ Use the nursing process as a framework for
patient care.
◦ Discuss medical , surgical and nursing
management of the disease.

3. Risk Factors of COPD
• Cigarette smoking
• Passive smoking
• Occupational exposure
◦ dust and chemicals
• Genetic abnormalities
◦ Lack of alpha 1-antitrypsin

4. A. Chronic Bronchitis
◦ Characterized by coughing and sputum production for at least 3 months in each
of 2 consecutive years
◦ Results in increased susceptibility to respiratory infections.

5. Problems in Chronic Bronchitis
◦ Impaired ciliary function resulting to a decrease in mucus clearance.

6. B. Emphysema
◦ An abnormal distention of the airspaces and destruction
of alveolar walls
◦ Results in impaired oxygen and carbon dioxide exchange
leading to hypoxemia and hypercapnia.
◦Main types:
◦ Panlobular (Panacinar)
◦ Destruction of respiratory bronchiole, alveolar duct, and alveolus.
◦ Centrilobular (Centriacinar)
◦ Affects the center of the secondary lobule

7. Types Emphysema

8. Clinical Manifestations
• COPD is characterized by three primary symptoms:
• cough
• sputum production
• dyspnea on exertion
• Weight loss
• Reduced activities
• Use of accessory muscles
• Barrel chest (Emphysema)
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9. Normal Chest Wall and Chest Wall Changes
with Emphysema

10. Assessment and Diagnostic Tests
• Pulmonary function test – assess respiratory function using spirometer
• Arterial blood gas (ABG) studies – assess oxygenation and gas exchange
• Chest x-ray –
• Computed Tomography (CT) Scan -
10

11. Medical Management
◦ Risk Reduction
◦ SMOKING CESSATION – most cost-effective intervention
◦ Setting a “quit date”
◦ Referral to a smoking cessation program
◦ Follow-up
◦ Pharmacologic therapy
◦ Bronchodilators (example: ventolin)
◦ Corticosteroids (example: fluticasone)
◦ Antibiotics
◦ Mucolytics
◦ Antitussive

12. Medical Management
• Oxygen Therapy – to improve oxygenation
◦ Pulse Oximetry is used to assess response to supplemental oxygen.
• Surgery (end-stage COPD)
Lung volume reduction surgery
Lung transplantation – costly and with shortage of donors

13. Nursing Management
◦ Assess the patient
◦ Achieve airway clearance
◦ Teach “huff” coughing
◦ Increase fluid intake as ordered
◦ Improve breathing patterns
◦ Teach breathing exercises (diaphragmatic and pursed-lip breathing)
◦ Improve activity tolerance
◦ Activity pacing and use of walking aids
◦ Monitor and manage complications (pneumonia and influenza)