Respiratory disorder
(COPD)
Adult health nursing
Specific Objectives:-
• At the end of this lecture ,the
student will be able to.
• Apply the nursing process to care for a
patient with COPD
Outline
• Nursing process to care for a
patient with COPD
OBSTRUCTIVE DISORDERS
Chronic
Obstructive Asthma
PulmonaryDisease
(COPD)
COPD
• COPD is a group of pulmonary disorders
characterized by difficulty exhaling
because of airways that are narrowed
or blocked by inflammation and mucus
and because the loss of elastic fibers
causes an increase in compliance.
• More effort is required for the
weakened alveoli to push air out
through obstructed airways.
COPD
COPD included:-
Chronic bronchitis.
Emphysema
CHRONIC BRONCHITIS
• Chronic bronchitis is similar to acute
bronchitis, with symptoms occurring for
at least 3 months of the year for 2
consecutive years.
• Chronic bronchitis is characterized by
excessive mucus secretion, cough and
dyspnea.
EMPHYSEMA
Emphysema is a
chronic condition
involving distention of
alveoli with
destruction of
alveolar walls resulting
in airway narrowing
and decreased lung
elasticity
COPD
Etiology
Smoking is the single most
important risk factor for COPD.
Etiology
Prevention
• Avoidance of smoking and other inhaled
irritants.
• Persons who are prone to respiratory
infections should be immunized against
common viral agents.
• All persons with acute respiratory
infections should receive proper
treatment
Signs and Symptoms
• Classic symptoms of COPD are chronic
cough with or without sputum production.
• Progressive dyspnea on exertion.
• Patients exhibit prolonged exhalation
because of obstructed air passages and
reduced elastic recoil.
• Air trapping causes the lungs to become
hyperinflated, which in turn leads to the
classic barrel-shaped chest.
• Weight loss
Signs and Symptoms cont.
• The patient with chronic bronchitis has:-
• Chronic productive cough.
• Shortness of breath.
• Activity intolerance.
• Symptoms may initially be worse in the
winter months.
• Crackles and wheezing are often noted on
auscultation and may improve after
coughing.
Signs and Symptoms cont.
• The most characteristic symptom of
emphysema is:-
• Shortness of breath.
• Activity intolerance.
• Use of accessory muscles of respiration
• Diminished breath sounds.
Complications
of emphysema
• Developing large air spaces within the
lung tissue (bullae) or adjacent to the
pleurae(blebs). These are like blisters
that can rupture and cause the lung to
collapse.
• Right-sided heart failure.
• Death usually results from respiratory
infection or respiratory failure
Bullae
Diagnostic Tests
• History and physical examination
• Incenteve spirometr.
• Chest x-ray.
• Blood gas analysis.
• Sputum culture.
Therapeutic Measures
Focus on :-
• Relieve symptoms.
• Improve exercise tolerance.
• Improve health status.
• Prevent disease progression.
• Reduce mortality .
• Cessation of cigarette smoking.
Therapeutic Measures
• Stopping smoking.
• Avoid respiratory irritant.
• Oxygen therapy.
• Medications.
• Pulmonary rehabilitation programs.
• Surgery
Student activity
• Write nursing care plane for
patient with COPD .
• Summarize nursing intervention for
patient with COPD.
Bronchial Asthma
Asthma is a reversible lung disease ▪
characterized by obstruction or
narrowing of the airways, which are
typically inflamed and hyperresponsive
to a variety of stimuli.
Bronchial Asthma
• There are two kinds of asthma:
• Extrinsic asthma
• Intrinsic asthma
Extrinsic asthma
➢ Extrinsic asthma, also known as
atopic, caused by allergens such
as pollen, animal dander, mold,
or dust.
➢Often accompanied by allergic
rhinitis and eczema.
Intrinsic asthma
• Intrinsic asthma, also known as
nonatopic, caused by a nonallergic
factor such as following a respiratory
tract infection, exposure to cold air,
changes in air humidity, or respiratory
irritants.
Causes
➢ The cause of asthma is not known
➢ But there are risk factors causes inflammation in
the airways, which then leads to asthma symptoms.
• Infections such as colds, flu, or pneumonia
• Allergens such as food, pollen, mold and dust
• Exercise and Smoking, perfumes, or sprays
• Air pollution and toxins
• Weather, especially extreme changes in
temperature
• Drugs (such as aspirin,)
• Emotional stress and anxiety
• Singing, laughing, or crying
Signs and Symptoms of asthma
• Chest tightness
• Coughing with thick, clear, or yellow mucus
• Diaphoresis
• Nasal flaring
• Pursed-lip breathing
• Sudden dyspnea
• Tachycardia
• Tachypnea
• Use of accessory muscles for breathing
• Wheezing accompanied by coarse rhonchi
• Cyanosis (late sign)
• Trouble some cough at night
Signs and Symptoms of asthma
Diagnostic evaluation
• Patient history
• Physical assessment.
• Chest X- ray.
• Arterial blood gases.
• Peak flow measurements
• Spirometer; to measures the amount of air able
to breathe in and out and the time it takes to
exhale completely after take a deep breath
• Lung function tests
• Blood tests to measure eosinophil count (a type
of white blood cell.
Medical treatment
• Administer oxygen an acute attack.
• Administer bronchodilator such as ventolin
and aminophylin.
• Administer antihistamine, antibiotic,
expectorants and steroid.
• Administer nebulizer inhalation during
acute attack.
• Intravenous fluid .
Nursing diagnosis
✓Impaired gas exchange
✓ Ineffective airway
clearance
✓ Ineffective tissue perfusion
Nursing intervention
• Monitor respiration: patient’s
respiratory status can
continue to deteriorate;look
at respiratory rate, effort,
use of accessory muscles,
skin color, breath sounds.
•
Nursing intervention CONT.
• Place patient in high Fowler’s
position to ease respirations.
• Monitor vital signs, look for
changes in BP, tachycardia,
tachypnea.
• Explain to the patient:
• How to use a peak flow meter.
Nursing intervention
• Administer the prescribed treatments
and assess the patient’s response.
• Place the patient in high Fowler’s
position.
• Administer prescribed humidified
oxygen.
• Monitor the patient’s vital signs,
especially respiratory status.
• Monitor serum theophylline levels.
Nursing intervention CONT.
• Observe for signs and symptoms of
theophylline toxicity (vomiting,
diarrhea, and headache).
• Perform postural drainage and chest
percussion.
• Provide emotional support
• Review arterial blood gas levels ,
pulmonary function test results, and
SaO2 readings
Nursing intervention CONT
• Eliminate all pulmonary irritants,
particularly cigarette smoke.
• Encourage the patient to avoid passive
and negative smoking.
• Encourage the patient to eat well
balance diet contain high protein .
• Give inhalations of nebulized saline to
humidify bronchial tree and liquefy
sputum.
Nursing intervention CONT
• Teach the patient to avoid known
allergens and irritants
• Describe prescribed drugs, including
their names, dosages, actions adverse
effects, and special instructions.
• Teach the patient how to use a
metered-dose inhaler.
Nursing intervention CONT
• ◗ Tell the patient to seek immediate
medical attention if he develops fever
above 100º F (37.8º C), chest pain,
shortness of breath without coughing or
exercising, or uncontrollable coughing
• Encourage the patient to drink at least
(3 L) of fluids daily to help loosen
secretions and maintain hydration.
