This document provides information on chronic obstructive pulmonary disease (COPD) including its definition, risk factors, pathophysiology, clinical manifestations, medical management, nursing management, and surgical options. COPD is characterized by persistent airflow limitation that is not fully reversible. It is mostly caused by smoking and results in changes like thickening of the airways and inflammation that narrow the lungs over time. Management involves treatments to improve ventilation and remove secretions, as well as strategies to prevent complications and promote overall health.

1. 1
COPD AND ACUTECOPD AND ACUTE
RESPIRATORYRESPIRATORY
FAILUREFAILURE

2. 22
Anatomy of Lower RespiratoryAnatomy of Lower Respiratory
TractTract

3. 3
MEANING
OF
CHRONIC OBSTRUCTIVE PULMONARY
DISEASE
• .
• Chronic obstructive pulmonary disease is a
group of progressive obstructive lung disorder
where airway resistance is increased with
reduced airflow ;may include diseases that
cause airflow limitation (eg emphysema
,chronic bronchitis , bronchiectasis )or a
combination of this disorder.[older definition]

4. MEANINGMEANING
OFOF
CHRONIC OBSTRUCTIVE PULMONARY DISEASECHRONIC OBSTRUCTIVE PULMONARY DISEASE
 Chronic obstructive pulmonary disease isChronic obstructive pulmonary disease is
a disease state characterrised by airflowa disease state characterrised by airflow
limitation that is not fullyreversible.limitation that is not fullyreversible.
 (NIH,2001 and GOLD 2002)(NIH,2001 and GOLD 2002)
( Newer definition)( Newer definition)
4

5. RISK FACTORS FOR CHRONICRISK FACTORS FOR CHRONIC
OBSTRUCTIVE PULMONARY DISEASE.OBSTRUCTIVE PULMONARY DISEASE.
 Exposure to tobacco smoke accounts forExposure to tobacco smoke accounts for
estimated 80% tp 90% of COPD).estimated 80% tp 90% of COPD).
 Passive smoking.Passive smoking.
 Occupational exposure.Occupational exposure.
 Ambient air pollution.Ambient air pollution.
 Genetic abnormalities, including a deficiencyGenetic abnormalities, including a deficiency
of alfhpa1- antitrypsin,an enzyme inhibitorof alfhpa1- antitrypsin,an enzyme inhibitor
that normally counteracts the destruction ofthat normally counteracts the destruction of
lung tissue by certain other enzymeslung tissue by certain other enzymes
5

6. 6
EtiologyEtiology
1)1) Cigarette smokingCigarette smoking
2)2) InfectionInfection
3)3) HeredityHeredity
4)4) AgingAging

7. 77
PathophysiologyPathophysiology
Pathologic changes in the lung consists of:Pathologic changes in the lung consists of:
1.1. Hyperplasia of mucous secreting glandsHyperplasia of mucous secreting glands
in the trachea and bronchiin the trachea and bronchi
2.2. Disappearance of ciliaDisappearance of cilia
3.3. Chronic inflammatory changes andChronic inflammatory changes and
narrowing of small airways.narrowing of small airways.
4.4. Altered function of alveolar macrophagesAltered function of alveolar macrophages
leading to increased bronchial infections.leading to increased bronchial infections.

8. 8
CLINICAL MANIFESTATIONSCLINICAL MANIFESTATIONS
► Frequent productive coughFrequent productive cough
► Broncho -spasm occur at the end of paroxysm ofBroncho -spasm occur at the end of paroxysm of
coughing.coughing.
► Frequent respiratory infectionsFrequent respiratory infections
► Dyspnea on exertionDyspnea on exertion
► Weight- normal or heavy setWeight- normal or heavy set
► Hypoxemia and hypercapniaHypoxemia and hypercapnia
► Blue bloaterBlue bloater
► PolycythemiaPolycythemia
► cyanosiscyanosis

9. 99

10. 1010

11. 1111
Medical management of COPDMedical management of COPD
 Treatment goals:Treatment goals:
1.1. Improve ventilationImprove ventilation
2.2. To facilitate the removal of bronchialTo facilitate the removal of bronchial
secretionssecretions
3.3. To prevent complicationsTo prevent complications
4.4. To slow the progression of clinicalTo slow the progression of clinical
manifestations.manifestations.
5.5. To promote health maintenanceTo promote health maintenance

12. 1212
Improve ventilationImprove ventilation
• 1. Pharmaco therapy
a) Broncho dilators
b) Cortico steroids
c) Antibiotics
d) Influenza and pneumococcal vaccines
e) Alpha 1 Antitrypsin therapy
f) Psycho active agents
g) Oxygen

13. 13
Remove bronchial secretionsRemove bronchial secretions
 Pulmonary hygienePulmonary hygiene
 Postural drainagePostural drainage

14. 1414
Promote exercisePromote exercise
Aerobic exerciseAerobic exercise
Progressively increased walkingProgressively increased walking
Breathing exerciseBreathing exercise

15. 1515
Control complicationsControl complications
 Edema and cor pulmonale areEdema and cor pulmonale are
treated with diuretics and digitalistreated with diuretics and digitalis
 Phlebotomy to reduce blood volumePhlebotomy to reduce blood volume

16. 16
Improve general health
 Stop smoking
 Minimize exposure to allergens
 Avoid high altitudes
 Adequate nutrition

17. 17
Oxygen therapyOxygen therapy
►Low flow delivery devicesLow flow delivery devices
►High flow delivery devicesHigh flow delivery devices
►Complications of O2 therapyComplications of O2 therapy
►InfectionInfection
►Oxygen toxicityOxygen toxicity
►CO2 narcosisCO2 narcosis
►Absorption atelectasisAbsorption atelectasis
►CombustionCombustion

18. 18
Respiratory therapyRespiratory therapy
Breathing retraining
Effective coughing techniques
Chest physiotherapy
Aerosol nebulization therapy

19. 19
Chest PhysiotherapyChest Physiotherapy

20. 20
Postural DrainagePostural Drainage

21. 2121
Surgical managementSurgical management
 BullectomyBullectomy
 Lung transplantationLung transplantation
 Lung volume reduction surgeryLung volume reduction surgery

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Nursing managementNursing management
 1. Nursing Assessment:1. Nursing Assessment:
Subjective data (health information,Subjective data (health information,
functional health pattern)functional health pattern)
Objective data (Head to foot examination)Objective data (Head to foot examination)

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Nursing diagnosis & interventionsNursing diagnosis & interventions
1.1. In effective air way clearance R/TIn effective air way clearance R/T
expiratory air flow obstruction.expiratory air flow obstruction.
 Maintain adequate hydrationMaintain adequate hydration
 Effective coughing techniques.Effective coughing techniques.

24. 24
Nsg. management cont….
2. Impaired gas exchange R/T
decreased ventilation and mucus
plugs.
 Monitor client’s respiratory rate,
pattern, ABG results
 Administer low flow oxygen
 High fowlers position
 Administer broncho dilators


25. 25
Cont..Cont..
► Teach s/s and consequences of hyper capniaTeach s/s and consequences of hyper capnia
► Avoid CNS depressant drugsAvoid CNS depressant drugs
3. Anxiety R/T acute breathing difficulty.3. Anxiety R/T acute breathing difficulty.
 Remain with the client during the episodes ofRemain with the client during the episodes of
breathing difficultybreathing difficulty
 Provide calm, quiet environment.Provide calm, quiet environment.
 Ensure ventilationEnsure ventilation
 Administer sedatives with caution (nonAdminister sedatives with caution (non
pharmaceutical methods of anxiety reduction)pharmaceutical methods of anxiety reduction)

26. 2626
Nursing Mx.cont….Nursing Mx.cont….
4. Activity intolerance R/T inadequate4. Activity intolerance R/T inadequate
oxygenation and dyspnea.oxygenation and dyspnea.
 Monitor the severity of dyspnea and O2Monitor the severity of dyspnea and O2
saturation following activity.saturation following activity.
 Stop or slow activity that leads to significantStop or slow activity that leads to significant
change in respiration.change in respiration.
 Maintain supplemental O2Maintain supplemental O2
 Schedule active exercise after resp. therapy.Schedule active exercise after resp. therapy.

27. 27
Cont…
Assist the client in scheduling gradual
increase in daily activities.
Avoid conditions that increase O2
demand.
Teach effective breathing techniques.
Instruct the client in energy
conservation techniques.

28. 2828
Cont….Cont….
5. Altered nutrition less than body5. Altered nutrition less than body
requirements R/T reduced appetite,requirements R/T reduced appetite,
decreased energy level and dyspnea.decreased energy level and dyspnea.
Mouth care before meals.Mouth care before meals.
Small, frequent meals high in protein &Small, frequent meals high in protein &
calories.calories.
Avoid gas producing foodAvoid gas producing food
Monitor the clients food intake, weight andMonitor the clients food intake, weight and
serum Hb, albumin levels.serum Hb, albumin levels.

29. 2929
Cont…Cont…
6. Disturbed sleep pattern R/T dyspnea and6. Disturbed sleep pattern R/T dyspnea and
external stimuli.external stimuli.
Promote relaxation.Promote relaxation.
Schedule care activities to allow periods ofSchedule care activities to allow periods of
uninterrupted sleep.uninterrupted sleep.
Avoid use of sleeping pills.Avoid use of sleeping pills.
Avoid stimulants e.g. caffeineAvoid stimulants e.g. caffeine
Maintain a consistent bed time and aMaintain a consistent bed time and a
regular bed time routine.regular bed time routine.
Recliner chair may be better in dyspnea.Recliner chair may be better in dyspnea.

30. 3030
Cont….Cont….
7. Interrupted family process R/T chronic illness of a7. Interrupted family process R/T chronic illness of a
family member.family member.
 Encourage participation of family members in theEncourage participation of family members in the
planning process.planning process.
 Family counseling if needed.Family counseling if needed.
 Encourage social support network.Encourage social support network.
 Provide family with anticipatory guidance.Provide family with anticipatory guidance.

31. 3131
Cont…Cont…
8. Risk for infection R/T ineffective8. Risk for infection R/T ineffective
pulmonary clearance.pulmonary clearance.
 Hand washing after contacting withHand washing after contacting with
the potentially infectious material.the potentially infectious material.
 Teach the client how to care forTeach the client how to care for
respiratory equipments used atrespiratory equipments used at
home.home.
 Teach the client and the family theTeach the client and the family the
manifestations of pulmonarymanifestations of pulmonary
infections.infections.

32. 3232
Cont…..Cont…..
9. Sexual dysfunction R/T dyspnea, reduced
energy.
Provide opportunity for the client to
discuss concerns.
Suggest measures that may facilitate
sexual activity
Encourage alternative forms of sexual
expression

33. 3333
Cont…..Cont…..
10. Decisional conflict R/T smoking10. Decisional conflict R/T smoking
cessationcessation
 Assess clients readiness to atop smokingAssess clients readiness to atop smoking
 Counseling and pharmaco therapyCounseling and pharmaco therapy
 Arrange follow up care.Arrange follow up care.

34. 3434
Cont….Cont….
11. Impaired physical mobility R/T de-11. Impaired physical mobility R/T de-
conditioning.conditioning.
 Use adaptive breathing techniqueUse adaptive breathing technique
during activity to decrease the workduring activity to decrease the work
of breathing.of breathing.
 Space the activities.Space the activities.
 Gradual increase of activities.Gradual increase of activities.
 Methods of conserving energy.Methods of conserving energy.
 Active and passive exercise toActive and passive exercise to
maintain adequate muscle mass.

35. 3535
Patient education and homecare.Patient education and homecare.
1.1. Teach adaptive breathing techniquesTeach adaptive breathing techniques
2.2. Airway clearance techniqueAirway clearance technique
3.3. Avoid contact with persons who haveAvoid contact with persons who have
URTI.URTI.
4.4. Importance of prescribed medicationsImportance of prescribed medications
5.5. Teach the family how to manage duringTeach the family how to manage during
acute attacks of dyspnea.acute attacks of dyspnea.
6.6. Report any change in the health status.Report any change in the health status.

36. 3636
Cont….Cont….
7.7. Avoid dust producing articles at homeAvoid dust producing articles at home
and stop smoking.and stop smoking.
8.8. Adequate fluid intakeAdequate fluid intake
9.9. Food choice modificationFood choice modification

37. 37
Complications of COPDComplications of COPD
1)1) Cor pulmonaleCor pulmonale
2)2) Acute exacerbation of Chronic BronchitisAcute exacerbation of Chronic Bronchitis
3)3) Peptic ulcer and gastro-esophagealPeptic ulcer and gastro-esophageal
refluxreflux
4)4) Acute respiratory failureAcute respiratory failure

38. 3838
Nursing interventionsNursing interventions
 Promote effective airway clearance and gasPromote effective airway clearance and gas
exchangeexchange
 Prevent complications of immobilityPrevent complications of immobility
 Monitoring and documenting altered tissueMonitoring and documenting altered tissue
perfusionperfusion
 Promote effective breathing patternPromote effective breathing pattern
 Reduce anxietyReduce anxiety
 Promote comfort.Promote comfort.

39. 3939