LEGEND

Case Scenario
PREDISPOSING FACTORS
A 66-year-old man with a smoking history of one pack per day for the past 47 years presents with a chronic cough,
productive of yellowish sputum, for the past 2 years. According to the patient, he has been sleeping poorly due to his
difficulty breathing and appears lethargic. Upon examination, he appears in moderate respiratory distress, especially PRECIPITATING FACTORS
after walking to the examination room, and has pursed-lip breathing. Lung examination reveals a barrel chest and
poor air entry bilaterally, with moderate inspiratory and expiratory wheezing. The nurse noted, patient is unable to PATHOPHYSIOLOGY
speak in full sentences. Heart and abdominal examination are within normal limits.
MANIFESTATIONS
Vital signs are as follows:
T: 36.9 C
BP: 120/80 mmHg NURSING DIAGNOSIS
P: 85bpm
RR: 35 NURSING INTERVENTIONS

DIAGNOSTIC TESTS

- Smoker
- Second hand smoker
- Air pollution PREPARED BY:
- Occupational dust and chemicals Veegee Claire Suarez
- Recurrent respiratory infections Courtney Kate VIlas
Stephan Eduard Vilanueva

exposure to irritants

increased macrophage
phagocytosis

increased release of
inflammatory cytokines

activates neutrophils
and macrophages

alpha1-antitrypsin
recognition of deficiency screening test
Mucus glands inflammation

Decreased lung ability to

Neutrophil and
prevent damage to lung Genetic susceptibility (alpha-1
macrophage releases
tissue antitrypsin deficiency)
proteases

Hypertrophy Hyperplasia Goblet cell

Ciliary dysfunction
proliferation

elastase

increase mucus production

Dyspnea Spirometry

breakdowng of elastin

Hypoxmia

loss the ability to recoil

Chronic cough and Mucus obstruction
sputum production

loss of elastic tissue in

Arterial blood gas the small airways
Fatigue Wheezing Narrowed airway Hypercapnia
(ABG) measurement

loss of elastic tissue in

Activity Intolerance related to the alveoli
inadequate oxygenation and Dx: Ineffective airway air gets trapped
dyspnea clearance r/t mucus
obstruction in the airway decrease structural Dyspnea Spirometry
supports for airway
patency
hyperinflanted
Independent Interventions: Barrel Chest X-ray
lungs
·Assess and record respiratory rate, depth, note the use of accessory Independent Interventions: Hypoxemia
Wheezing narrowed airway
muscles, pursed-lip breathing, inability to speak or converse.
- Assess patient?s level of consciousness and ability to protect
·Assess and routinely monitor skin and mucous membrane color. own airway
- Have the patient lie on his side with a pillow under his head
·Position patient with head of bed elevated, in a semi-Fowler?s position
as tolerated. supporting the neck and another in between his legs. Make
sure to keep his back straight
·Offer health teaching and assist patient in performing deep breathing - Encourage deep breathing and coughing exercises airway collapses
and coughing exercises as tolerated. - Increase fluid intake
- Teach patient or the ?bantay? non-pharmacological airway
·Auscultate breath sounds, noting areas of decreased airflow and
adventitious sounds. clearance technique such as percussion, postural drainage,
and cupping and vibration
·Monitor patient?s behavior and mental status for onset of restlessness, - Assess patient?s significant other?s knowledge regarding the Arterial blood gas
agitation, confusion, and extreme lethargy. disorder, treatment plan, specific medications, and therapeutic hyperinflanted Hypercapnia
air gets trapped (ABG) measurement
procedures lungs
·Encourage expectoration of sputum and suction when needed.
- Do health teaching regarding smoking and the importance of
expectorating excretions Impaired Gas Exchange related
·Encourage the patient to ambulate as tolerated.
- Encourage early ambulation and change the patient?s position to Alveoli destruction
every 2 hours elastases starts
Dependent Interventions: X-ray Barrel Chest breaking down of the
Dependent Interventions:
Administer oxygen as ordered to maintain oxygen saturation above 90%. alveolar septa
- Suction nose mouth, and trachea as necessary
·Administer medications such as albuterol and levalbuterol as prescribed.
- Insert oral airway as per D.O Independent Interventions:
Provide oral hygiene and keep the oral mucosa hydrated
- Assist in procedures such as bronchoscopy or tracheostomy
Chronic cough and expansion and dilation - Monitor the severity of dyspnea and oxygen saturation with
when needed CT scan
of the acinus and following activity
- Administer medications such as expectorants, bronchodilators, sputum production
- Assess client?s activities of daily living as well as actual and
and mucolytic agents
perceived limitations to physical activity
- Stop or slow any activity that leads to significant respiratory
change
CHRONIC Fatigue - Encourage progressive activity and assist client in
BRONCHITIS scheduling a gradual increase in daily activities and
exercise
- Teach the client to use pursed-lip and diaphragmatic and
relaxation techniques
- Provide adequate ventilation in the room
- Instruct client in energy conservation techniques (e.g.
pacing activities, interspersed with adequate rest periods,
and alterinating high-energy and low-energy tasks)

Dependent Interventions:

- Administer/maintain supplemental oxygen as per D.O

Collaborative Interventions:

- Refer the client to the physiotherapy/ occupational therapy

team as needed.

CHRONIC
OBSTRUCTIVE
PULMONARY DISEASE EMPHYSEMA
(COPD)