COPD Case Presentation

CHRONIC OBSTRUCTIVE PULMONARY DISEASE

Bola Kwentua

Definition

Chronic obstructive pulmonary disease (COPD) is a lung disease in which your lungs become inflamed or damaged, preventing air from flowing in and out normally.

It results from constantly inflamed and irritated airways in your lungs

Two forms of COPD Chronic bronchitis: a disease of

the airways defined by the presence of cough and sputum production for at least 3 months in each of two consecutive years.

Forms of COPD contd

Emphysema :the walls between many of the air sacs are damaged, causing them to lose their shape and become floppy.

This damage also can destroy the walls of the air sacs, leading to fewer and larger air sacs instead of many tiny ones.

STAGES OF COPDStage 1: Mild COPD: Mildly reduced airflow; sometimes, a chronic cough and sputum production

Stage 2: Moderate COPD: Worsening airflow; shortness of breath typically brought on by exertion

Stage 3: Severe COPD: Further worsening of airflow; greater shortness of breath, reduced quality of life

Stage 4: Very Severe COPD: Severe reduction in airflow; chronic respiratory failure; greatly reduced quality of life

Clinical Manifestations/ Symptoms

Dyspnea Chronic cough Increased sputum wheezing Fatigue Respiratory

Infections

Risk Factors Associated with COPD

Smoking Occupational

exposures Air pollution Heredity Second hand

smoking Aging

Treatments Bronchodilators Corticosteroids Anticholinergics Long term oxygen therapy (LTOT) Good Nutrition Lung Transplant Pulmonary Rehabilitation

Physical Assessment & History General: JP is a 68 year old African American woman presented

to the ED for dyspnea (shortness of breath). Temp: 97.3; BP 124/58; HR: 83; RESP: 20; PULSE: 98 Smoker for 15years. Dyspnea (shortness of breath)-: Dyspnea (shortness of breath)

is a symptom of many pulmonary and cardiac disorders, particularly when there is decreased lung compliance and or increased airway resistance. The right ventricle of the heart is affected ultimately by lung disease because it must pump blood through the lungs against greater resistance. This patient has a history of severe chronic obstructive pulmonary disease (COPD) and dyspnea is a symptom of it

HX : bilateral pulmonary congestion, hypertension, respiratory failure, obstructive sleep apnea, pneumonia, asthma.

Nursing Diagnosis #1 Activity intolerance related to imbalance between oxygen

supply and demand as evidenced by exertion dyspnea and verbal reports of fatigue.

INTERVENTION Observe pt tolerance to activity Use supplemental oxygen Assist in controlled breathing exercise to help reduce end

expiratory volume and breathlessness. GOAL Patient will adhere to prescribed physical activity by

ambulating with the physical therapist on the hospital floor during this shift

OUTCOME Partially met. Pt ambulated from bed to room door, but

complained of fatigue and exhaustion.

Nursing Diagnosis #2 Impaired gas exchange related to ventilation-

perfusion inequality as evidenced by abnormal arterial blood gases and arterial pH.

INTERVENTION Position pt in semi-fowler’s position

Monitor respiratory rate, depth and effort with use of accessory muscles, nasal flaring and abnormal breathing pattern.

Observe for cyanosis of the skin

GOALS Pt will demonstrate improved ventilation and adequate

oxygenation with blood gas level within normal parameters for pt

Nursing diagnosis #3 Ineffective airway clearance related to bronchospasm,

increased mucus, ineffective cough, infection as evidenced by ineffective cough , presence of abnormal breath sounds

Interventions Assist patient to semi-fowler position Encourage with pursed-lip breathing exercises Administer medication as prescribed.

Outcome Pt will demonstrate behaviors to improve

airway clearance

Epidemics/ Statistics According to CDC…. COPD is the fourth leading cause of death,

illness, and disability in the United States.

In 2000, 119,000 deaths, 726,000 hospitalizations, and 1.5 million hospital emergency departments visits were caused by COPD.

(http://www.cdc.gov/copd/facts.htm)

References Ackley, Betty. (2008). Nursing Diagnosis

Handbook. An Evidence-Based Guide to planning Care. Missouri, MO: Elsevier

Center for Disease Control. (2010). Heart Disease Facts. Retrieved May1,2010 from http://www.cdc.gov/copd/facts.htm

Porth, Carol. (2007). Essentials of Pathophysiology. Philadelphia, PA: Lippincott & Wilkins