Nurses Notes on COPD [Emphysema & Bronchitis]

CHRONIC OBSTRUCTIVE PULMONARY DISEASE (COPD)

 DEFINITION: Is a disease state in which airflow is obstructed by emphysema, chronic bronchitis or both. The airflow obstruction is usually progressive, irreversible, and associated with airway hyperactivity, resulting in narrowing of peripheral airways, airflow limitation and changes in the pulmonary vasculature.

 RISK FACTORS: cigarette smoking, air pollution and occupational exposure(coal, cotton and grain)

CLINICAL MANIFESTATIONS:

·          Dyspnea, cough and increased work of breathing

·          Dyspnea  on mild exertion advancing to dyspnea at rest

·          Weight loss

·          Symptoms are specific to disease: Bronchitis and Emphysema

 SYMPTOMS:

    BRONCHITIS-

·          Chronic cough and production of copious purulent sputum which has a quality of layering out into three layers on stranding, a frothy top layer, a middle clear layer and  a dense particular layer,

·          hemoptysis, clubbing of the fingers and

·          repeated episodes of pulmonary infection.

     EMPHYSEMA-

·          Dyspnea with insidious onset progressing to severe dyspnea with slight exertion.

·          Chronic cough, wheezing, dyspnea, fatigue, and tachypnea

·          On inspection “barrel chest” due to air traping, muscle wasting and pursed lip breathing

·          On auscultation, diminished breath sounds with crackles, wheezes, rhonchi and prolonged expiration

·          Hyperresonance with percussion and a decrease in fremitus

·          Anorexia, weight loss, weakness and inactivity

·          Hypoxemia and Hypercapnia, morning headache in advance stages

·          Inflammatory reactions and infections from pooled secretions.

 COMPLICATIONS:

·          Respiratory insufficiency or failure

·          Atelectasis

·          Pneumonia

·          Pneumothorax

·          Pulmonary HPN

 Medical management:

·          Bronchodilators

·          Oxygen Therapy including nighttime oxygen

·          Varied treatment specific to disease

 NURSING MANAGEMENT:

    I.ASSESSMENT

 ·          Assess risk factors

·          Obtain health history such as duration of respiratory difficulty, dyspnea, shortness of breath, wheezing, exercise, tolerance, fatigue, effects on eating and sleeping habits

·          Perform physical examination to obtain baseline data:

-       Pulse, RR, and rhythm

-       Contraction of abdominal muscles during inspiration

-       Use of accessory muscles to breathe, prolonged expiration

-       Cyanosis, neck vein engorgement

-       Peripheral edema

-       Cough, color, amount and consistency of sputum

-       Status of sensorium, increasing stupor, apprehension

 II.             NURSING DIAGNOSIS

·          Impaired gas exchange related to ventilation perfusion inequality

·          Ineffective airway clearance related to bronchoconstriction, increased mucus production, ineffective cough and bronchopulmonary infection.

·          Ineffective breathing pattern related to shortness of breath, mucus, bronchoconstiction and airway irritants

·          Self- care deficit related to fatigue secondary to increased work of breathing and insufficient ventilation and oxygenation.

·          Activity intolerance due to fatigue, hypoxemia and ineffective breathing pattern

·          Ineffective coping related to less socialization, anxiety, depression, lower activity level and inability to work

·          Deficient knowledge related to risk of smoking as evidenced by continuing at risk behaviors

III.            PLANNING

·          Improved gas exchange

·          Smoking cessation

·          Improved breathing pattern

·          Maximal self- management

·          Improved activity tolerance

·          Achievement of airway clearance

·          Impaired coping ability

·          Improved health related quality of life

·          Adherence to the therapeutic programs and home care

IV NURSING INTERVENTIONS:

   Improving Gas Exchange

·          Monitor Dyspnea and Hypoxia

·          Administer Medications and be alert  for potential side effects

·          Assess relief of bronchospasm through patient report of less dyspnea

·          Monitor prescribed oxygen effectiveness with pulse oximetry or arterial blood gas (ABG ) analysis

Achieving Airway Clearance

·          Encourage high fluid intake to liquefy secretions

·          Instruct patient in directed or controlled coughing

·          Provide chest physiotherapy with potential drainage and intermittent passive pressure (IPPB) when ordered

·          Instruct patient in effective breathing techniques

·          Measure expiratory flow rates

 Preventing Bronchopulmonary Infections

 ·          Instruct patient to report signs of infection and report any worsening of symptoms

·          Advise patient to avoid outdoor exposure during high pollen counts or significant air pollution because there may increase bronchospasm

·          Encourage immunization against hemophilus Influenzae and streptococcus pneumonia and pneumococcal vaccine every 5 to 7 yrs.

 IV.            EVALUATION:

 Expected patient outcomes:

·          Demonstrates improved gas exchange

·          Achieves maximal airway clearance

·          Improves breathing pattern

·          Maintains maximal level of self-care and physical functioning

·          Achieves activity tolerance and exercises and performs activities with less shortness of breath

·          Develops effective coping mechanisms and participates in a pulmonary rehabilitation program

·          Adheres to the therapeutic program