COPDCydnee Patterson, Ali Lubbers,

Nicole Newinger, Heidi Proudfoot & Kaitlin Oudshoorn

SenarioMr. D has a hx of emphysema andChronic bronchitis. He is 73 years

old & aretired farmer. Recently he has

foundthat he can no longer walk around

hisfarm without extreme SOB. He is

treatedat the outpatient clinic today forincreasing SOB, occuring even at

rest

Subjective Data Reports sputum production

increased over past week & color has changed to greenish/yellow

Has more sputum in morning & it gradually reduces throughout the day

Taking Salbutamol (Ventolin) inhaler & Fluticasone (Flovent) inhaler 2 puffs q6hrs

On no other meds @ this time

Objective Data Appears frail & older than stated age Labored breathing & visible use of

accessory muscles during respiration Sitting in orthopneic position & using

pursed-lip breathing VS: BP normal; P 96; R 28; T 38.8c AG: pH 7.36; PaO2 55 mm Hg; PaCo2

65 mm Hg Upon chest assessment: crackles in

lower lt. lobe; diffuse expiratory wheezing t/o chest; lower lt. lobe dull to percussion.

http://video.about.com/copd/COPD.htm

Chronic obstructive pulmonary disease (COPD) is a long term lung disease that usually includes emphysema and chronic bronchitis. It slowly damages the airways & air sacs making it difficult for the patient to breath. The disease includes symptoms such as shortness of breath, increased mucus and coughing. COPD cannot be cured, but it can be treated.

Triggers of COPD Viral Infection Bronchiolitis Deviation from diet Discontinuation of Meds Inhalation of environmental

inhalants Small airway mucosa hyperemia

PneumoniaCould Mr. D. have pneumonia?

Pneumonia is an inflammation of the lung tissue caused by a microbial agent. Conditions such as COPD, and especially bronchitis, put individuals at an increased risk for developing such infections as their defense mechanisms are weakened. This inflammation causes the accumulation of fluid in the lungs, and can cause symptoms such as:

Greenish- yellow sputum production Labored breathing with use of accessory muscles Shortness of breath Crackles on auscultation and dullness on percussion of

affected lobe Increased respiratory rate Increased temperature 

And Mr. D. has all of these symptoms! So could it be???

As the nurse… Smoking cessation Medication education Oxygen therapy Positioning Vaccinations Diet Exercise Breathing techniques

Now… lets try something…

ABG’sArterial Blood Gases Normal Ranges Critical Ranges

Partial Pressure of oxygen (Pa02)

75-100mm Hg (9.9-13.2 kPa)

<40 mm Hg

Partial Pressure of carbon dioxide (PaC02)

35-45 mm Hg 94.6-5.9 kPa)

<20 mm Hg

Ph 7.35-7.45 <7.2 or >7.6

Bicarbonate (HCO3) 20-29 mEq/L (20-29 mmol/L)

<10 mmol/L or 40 mmol/L

Oxygen Content (O2CT)

15-22 mL per 100 mL of blood (6.6-9.7 mmol/L)

Oxygen Saturation (O2Sat)

95%-100% (0.95-1.00) <60%

Common Nursing DxIneffective Airway Clearance r/t bronchoconstriction, increased mucous, ineffectie cought, infection

Auscultate breath sounds q1-4 hrs; Monitor resp patterns, depth, effort; Monitor ABG’s & O2Sats; Positioning; Deep breathing & coughing; Observe sputum

Impared Gas Exchange r/t ventilation-perfusion inequality

Monitor resp patterns, depth, rate, effort; O2Sats; Auscultate breath sounds q1-2 hrs; Monitor for cyanosis; Positioning; Deep breathing & coughing

Risk for Infection: due to status of respiratory secretions

Monitor for s/s of infection; Note & report lab values; Use hand hygiene; Use standard precautions; Encourage fluid intake

COPD TRIGGERS & PATHOLOGY

NURSING CARE

PNEUMONIA

100 100 100200 200 200300 300 300

JEPOARDY

Can you tell me how I got, how I got COPD?

Discontinuation of medicationOr a viral infectionCan you tell me how I got, how I got COPD?

Bronchiolitis or from switching your dietThis may have worsened your diseaseCan you tell me how I got, how I got COPD?

Being in a dusty placeTo much mucus in your airwaysThis can make it harder to breathSo this is how I got, how I got COPD… how I got COPD!!

ReferencesBarnett, M. (2008a). Management of end-stage chronic

obstructive pulmonary disease. British Journal of Nursing 17 (22). p. 1390-1394. Retrieved February 07, 2009 from Health Source: Nursing and Academic Edition Database.

Barnett, M. (2008). Nursing management of chronic obstructive pulmonary disease. British Journal of Nursing 17 (21). p.1314-1318. Retrieved February 07, 2009 from Health Source: Nursing and Academic Edition Database.

Causes and types of chronic obstructive pulmonary disorder (2009). Retrieved February 8, 2009, from http://video.about.com/copd/COPD.htm

Celona, A.F. (20. 02). Diagnosing and treating community-acquired pneumonia. Physician Assistant, 26(1), 38-50

Celona, 2002; Mayo Foundation, 2007; Smeltzer & Bare, 2004COPD (2009, January 8). Retrieved February 9, 2009, from

http://www.lung.ca/diseases-maladies/copd-mpoc_e.php

ReferencesCOPD-ALERT 2000. (2008). It’s a matter of breath and death!

Retrieved February 3, 2009, from http://www.copd-alert.com/COPD.html

Day, R., Paul, P., Williams, B., Smeltzer, S., & Bare, B. (2007). Brunner & Suddarth’s Textbook of Medical-Surgical Nursing. 1st Canadian ed. Philadelphia, PA: Lippincott Williams & Wilkins.

Essig, M. G. (2008). Seniors health: COPD's effect on the lungs. Retrieved February 8, 2009, from https://www.blueshieldca.com/hw/articles/hw_article.jsp?articleId=HWUG1539ABC&fromCategoryId=8&_requestid=1602421

Healthwise (2008, June 17). Arterial Blood Gases. Retrieved February 9, 2009, from http://www.webmd.com/a-to-z-guides/arterial-blood-gases

Smeltzer, S.C. & Bare, B.G. (2004). Brunner & Suddarth’s textbook of medical-surgical nursing. Philadelphia, PA: Lippincott Williams & Wilkins.

Tuder, R., Voelkel, N. (2000). COPD Exacerbation. Chest, 14, 376-379. Retrieved from www.chestjournal.org on Feb. 2, 2009.

Name 3 causes of COPD exacerbation.

Any of the following may exacerbate COPD: - Viral Infection- Brochiolitis- Deviation from diet- Discontinuation of Meds- Inhalation of environmental inhalants- Small airway mucosa - Hyperemia

What 3 conditions or diseases(HINT: One we discussed…) are commonly associated with COPD exacerbation.

Emphysema, Bronchiolitis, and Pneumonia.Asthma may also trigger COPD.

True or False:Morphine should never be given to patients with COPD because it dangerously slows their respirations.

False – True in that it does slow their respiration rates but in doing so, allows the breathing to be more efficient and reduces the feeling of breathlessness.

What two common vaccinations are always suggested to COPD patients?

S. Pneumonia & Influenza.

What are two types of breathing that are useful to teach to patients with COPD?

Pursed Lip and Abdominal breathing techniques.

What are other causes of pneumonia besides viral & bacterial infection?

Aspiration & Fungal.

Name three health risks that increase likely hood of getting pneumonia?

Pulmonary diseases, Smoking, Surgery, Trauma, Decrease immune system, Alcohol use, Hospitalization.

How does the respiratory system of a healthy individual differ from that of an individual with COPD?

In COPD the bronchial tubes become inflamed, narrowed and filled with mucous, lungs then loose elasticity and the alveoli burst creating large spaces.

Name three non-specific symptoms of pneumonia.

Headache, Dypsnea, Fatigue, Sweating, Chest pains, Chills, Cough, Decreased temperature in elderly.