Chronic Obstructive Pulmonary Disease (COPD)


Refers to respiratory conditions that produce obstruction of air flow; includes emphysema, bronchitis, bronchiectasis, and asthma.

Emphysema

  1. General information
    1. Enlargement and destruction of the alveolar, bronchial, and bronchiolar tissue with resultant loss of recoil, air trapping, thoracic overdistension, sputum accumulation, and loss of diaphragmatic muscle tone
    2. These changes cause a state of carbon dioxide retention, hypoxia, and respiratory acidosis.
    3. Caused by cigarette smoking, infection, inhaled irritants, heredity, allergic factors, aging
  2. Assessment findings
    1. Anorexia, fatigue, weight loss
    2. Feeling of breathlessness, cough, sputum production, flaring of the nostrils, use of accessory muscles of respiration, increased rate and depth of breathing, dyspnea
    3. Decreased respiratory excursion, resonance to hyperresonance, decreased breath sounds with prolonged expiration, normal or decreased fremitus
    4. Diagnostic tests: pCO2 elevated or normal; pO2 normal or slightly decreased
  3. Nursing interventions
    1. Administer medications as ordered.
      1. Bronchiodilators: aminophylline, isoproterenol (Isuprel), terbutaline (Brethine), metaproterenol (Alupent), theophylline, isoetharine (Bronkosol); used in treatment of bronchospasm
      2. Antimicrobials: tetracycline, ampicillin to treat bacterial infections
      3. Corticosteroids: prednisone
    2. Facilitate removal of secretions.
      1. Ensure fluid intake of at least 3 liters/day.
      2. Provide (and teach client) chest physical therapy, coughing and deep breathing, and use of hand nebulizers.
      3. Suction as needed.
      4. Provide oral hygiene after expectoration of sputum.
    3. Improve ventilation.
      1. Position client in semi- or high-Fowler's.
      2. Instruct client to use diaphragmatic muscle to breathe.
      3. Encourage productive coughing after all treatments (splint abdomen to help produce more expulsive cough).
      4. Employ pursed-lip breathing techniques (prolonged, slow relaxed expiration against pursed lips).
    4. Provide client teaching and discharge planning concerning
      1. Prevention of recurrent infections
        1. avoid crowds and individuals with known infection.
        2. adhere to high-protein, high-carbohydrate, increased vitamin C diet.
        3. receive immunizations for influenza and pneumonia.
        4. report changes in characteristics and color of sputum immediately.
        5. report worsening of symptoms (increased tightness of chest, fatigue, increased dyspnea).
      2. Control of environment
        1. use home humidifier at 30%-50% humidity.
        2. wear scarf over nose and mouth in cold weather to prevent bronchospasm.
        3. avoid smoking and others who smoke.
        4. avoid abrupt changes in temperature.
      3. Avoidance of inhaled irritants
        1. stay indoors if pollution levels are high.
        2. use air conditioner with high-efficiency particulate air filter to remove particles from air.
      4. Increasing activity tolerance
        1. start with mild exercises, such as walking, and gradually increase amount and duration.
        2. use breathing techniques (pursed lip, diaphragmatic) during activities/exercises to control breathing.
        3. have oxygen available as needed to assist with activities.
        4. plan activities that require low amounts of energy.
        5. plan rest periods before and after activities.


Bronchitis

  1. General information
    1. Excessive production of mucus in the bronchi with accompanying persistent cough.
    2. Characteristic changes include hypertrophy/hyperplasia of the mucus-secreting glands in the bronchi, decreased ciliary activity, chronic inflammation, and narrowing of the small airways.
    3. Caused by the same factors that cause emphysema.
  2. Medical management: drug therapy includes bronchodilators, antimicrobials, expectorants (e.g., Robitussin)
  3. Assessment findings
    1. Productive (copious) cough, dyspnea on exertion, use of accessory muscles of respiration, scattered rales and rhonchi
    2. Feeling of epigastric fullness, slight cyanosis, distended neck veins, ankle edema
    3. Diagnostic tests: increased pCO2, decreased pO2
  4. Nursing interventions: same as for emphysema


Bronchiectasis

  1. General information
    1. Permanent abnormal dilation of the bronchi with destruction of muscular and elastic structure of the bronchial wall
    2. Caused by bacterial infection; recurrent lower respiratory tract infections; congenital defects (altered bronchial structures); lung tumors; thick, tenacious secretions
  2. Medical management: same as for emphysema.
  3. Assessment findings
    1. Chronic cough with production of mucopurulent sputum, hemoptysis, exertional dyspnea, wheezing
    2. Anorexia, fatigue, weight loss
    3. Diagnostic tests
      1. Bronchoscopy reveals sources and sites of secretions
      2. Possible elevation of WBC
  4. Nursing interventions: same as for emphysema

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