CHRONIC

OBSTRUCTIVE
DISEASE
TABLE OF CONTENTS
INTRODUCTION DISCUSSION OF
DISEASE PROCESS
DEMOGRAPHICS Chief Complaint
Diagnostic Examination and Results
Patient’s Profile
Management and Outcomes
Present Medical History Treatment/ Medication
Past Medical History Background of the Disease
Environmental History Pathophysiology
Personal History
NURSING DIAGNOSIS
Physical Examinations
Nursing Care Plan
KNOWLEDGE GAINED
FROM THE STUDY

SUGGESTIONS AND
RECOMMENDATIONS

REFERENCES
INTRODUCTIO
N The Global Initiative for Chronic Obstructive Lung
Disease(GOLD) has defined chronic obstructive pulmonary
disease (COPD) as “a preventable and treatable disease with
some significant extrapulmonary effects that may contribute to
the severity in individual patients. Its pulmonary component is
characterized by airflow limitation is usually progressive and
associated with an abnormal inflammatory response of the
lung to noxious particles or gases”(GOLD,2008,p.2).
DEMOGRAPHICS
 Patient’s Profile
Patient’s Name: RA
Gender: Female
Age: 46 years old
Address: Brgy. Dela Paz, Antipolo, Rizal
Civil Status: Widow
Educational Attainment: College Graduate
Religion: Roman Catholic
Admitting Diagnosis: COPD in Acute
Exacerbation
 PRESENT MEDICAL HISTORY
R.A. presents to the ER with a three-day history of progressive
dyspnea, cough and increased production of clear sputum. She usually
coughs up only a scant amount of clear sputum daily, and coughing is
generally worse after rising in the morning. The px denies fever, chills,
night sweats and blood in the sputum. She treated herself with Ultibro,
but respiratory distress increased despite multiple inhalations.
Upon arrival at the ER, there were bilateral wheezes heard with
auscultation, and the px was so short of breath and difficulty
completing a sentence without a long pause. She was placed on 1L
oxygen via nasal cannula and nebulized with Ipratropium Salbutamol
for 3 doses every 15 mins. She was also started on Antibiotics and
Corticosteroids.
PAST MEDICAL HISTORY
.
 History of Hypertension for 5 years with
maintenance (Irbesartan P.O 150mg 1 tab OD)
 History of PTB Clinically diagnosed on
intensive phase treatment(1st month)
Hemorrhoid operation last 2011
 Previously admitted diagnosed with COPD
last Nov 2021 and Feb 2022 with PTB at
the same hospital(Ultibro breezehaler 1
cap OD; HRZE P.O 3 tabs OD)
ENVIRONMENTAL HISTORY
 Urban living
 Municipal Water System
 Practice proper waste disposal
 (+) exposure to urban pollutants
 PERSONAL HISTORY
 Widow, 2 children
 Chronic smoker since 27 years old, 40
packs per day= 800 packs year
 Occassional drinker
 (-) illicit drug use
 (-) asbestos exposure
PHYSICAL
EXAMINATIONS
Measurements Findings Normal Findings Interpretation
Blood Pressure She has elevated BP
157/101mmHg
90/60-120/80 mmHg which is a result of low
  oxygen levels.

Respiratory He is experiencing DOB

27bpm 12-20cpm and trying to compensate
enough oxygen.

Pulse/Heart Rate 100bpm 60-100bpm Normal

Body Temperature 36.5 C 36.6C-37.5 C Normal

Damage from COPD
Oxygen Sat
sometimes keeps the tiny
94% 88-92%(COPD) air sacs in your lungs,
called alveoli, from getting
enough oxygen.
 PHYSICAL EXAMINATIONS
SKIN HEENT
• PERRLA
• Cold and dry • EOMS intact, Eyes anicteric,Normal
• (-) cyanosis, nodules, conjunctiva,Vision satisfactory with no
masses, rashes, itching, eye pain ,TMs intact
• (-) tinnitus and ear pain
and jaundice
• Nares clear
• (-) ecchymoses and • (+) pursed lip breathing
petechiae • Yellowed teeth
• Poor turgor • (+) mild JVD
• (-) cervical lymphadenopathy,
thyromegaly, masses, and carotid bruits
 PHYSICAL EXAMINATIONS
CHEST AND LUNGS
• Use of accessory muscles at
rest
• "Barrel chest" appearance
• Percussion hyper-resonant
• (+) bilateral wheezes
• (-) crackles and rhonchi
• (-) axillary and supraclavicular
lymphadenopathy
HEART
• Normal heart rate, 100bpm with normal
rhythm
• No rubs or murmurs
ABDOMEN
• (-) hepatosplenomegaly, fluid wave,
tenderness, and distension
• (-) masses, bruits, and superficial
abdominal veins
• Normoactive bowel sounds
 PHYSICAL EXAMINATIONS
GENITALIA AND MUSCLES AND EXT
RECTUM
• No gross deformities
• No back or flank tenderness • Equal pulses
• Normal female genitalia • With edema Gr. 1
• GCS 15
 DISCUSSION OF
DISEASE PROCESS
 CHIEF COMPLAINT
“Kinakapos ako ng hininga. Hindi ako
masyado makapagsalita,” as
verbalized by the patient upon
admitted at the ER.
DIAGNOSTIC EXAM AND
RESULTS PORTABLE CHEST AP:

FOLLOW UP STUDY SINCE FEB. 9, 2022

FINDINGS:

Lungs remain mildly hyperaerated.

Some haziness noted in the basal lungs, likely due to overlying chest
wall and breast soft tissue.
Heart is not enlarged.
Aorta is tortuous.
Diaphragm and cotosphrenic sulci are intact.
No other significant interval findings.
DIAGNOSTIC EXAM AND
RESULTS
DATE TIME FIO2 BPM PH PCO2 TC02 P02 BE HC03 SAT

2/18/22 12:22 1L NC 7.40 46 94% 2.4 26.4 99.5%

am

ABG results: Respiratory Acidosis Compensated

 SPUTUM CULTURE AND SENITIVITY.

Enterobacter cloacae is a member of the normal gut flora of many humans and is not usually a primary pathogen. Some strains have been
associated with urinary tract and respiratory tract infections in immunocompromised individuals.
 COMPLETE BLOOD COUNT.

Increased blood neutrophils in COPD were associated with increased pneumonia risk. These data suggest blood neutrophils may be a
useful marker in defining treatment pathways in COPD.
 CLINICAL CHEMISTRY

Hypokalemia is a well-documented side effect of therapy with parenterally administered epinephrine, albuterol, and
other adrenergic bronchodilators.
 SPIROMETRY RESULT

Method of assessing lung function by measuring the volume of air the patient can expel (expiration) from the
lungs after a maximal inspiration.Measure airflow obstruction to help make a definitive diagnosis of COPD 
 TREATMENT/ MEDICATIONS
(At home)
HRZE 1 tab P.O OD Since the patient is diagnosed with PTB Clinically diagnosed,
HRZE is the initial phase treatment for TB for 2mos.
Prednisone 10mg P.O. Helps in managing COPD exacerbations.
BID
Ultibro breezehaler 1cap Indicated as a maintenance bronchodilator treatment to relieve
OD symptoms in adult patients with chronic obstructive pulmonary
disease (COPD).
Salbutamol MDI 1 puff Used to relieve symptoms such as wheezings and
OD as needed bronchospasms.
Irbesartan 150mg P.O 1 Treatment for her elevated BP
tab OD
TREATMENT/ MEDICATIONS
(At the ER)
Hydrocortisone 200 The administration of corticosteroids has long been a mainstay of
mg IV STAT therapy for the treatment of an acute exacerbation
of COPD (AECOPD).

Ultibro breezehaler Indicated as a maintenance bronchodilator treatment to relieve

1cap OD symptoms in adult patients with chronic obstructive pulmonary
disease (COPD).
Ceftazidime 2g IV Ceftazidime have been increasingly used to treat Acute
every 8 hrs Exacerbations of Chronic Obstructive Pulmonary Disease
(AECOPD) due to their extended-spectrum covering Pseudomonas
aeruginosa.
Combivent Combivent is used to treat and prevent symptoms (wheezing and
nebulization for 3 shortness of breath) caused by ongoing lung disease (chronic
doses x 15 mins. each obstructive pulmonary disease-COPD
MANAGEMENT AND
OUTCOMES
BACKGROUND OF THE
DISEASE
COPD is a characterized by persistent
airflow limitation that is usually progressive
and associated with an enhanced chronic
inflammatory response in the airways and
lung to noxious particles or gases.
COPD can be divided into 2 clinical
phenotypes.
 According to the Global Burden
of Disease Study by the World
Health Organization, COPD may
become the third leading cause of
death worldwide by 2030.

COPD IS A GLOBAL HEALTH PROBLEM

COPD IN THE PHILIPPINES
COPD is one of the 10 leading causes of death in the Philippines. It
has a prevalence rate of 14% among Filipino adults aged 40 and
above.

Only 2% of the cases are diagnosed by doctors in contrast to the

overall prevalence.
BACKGROUND OF THE
DISEASE
Emphysema 

is defined pathologically as enlargement of

distal air spaces.
BACKGROUND OF THE
DISEASE
Chronic bronchitis 
is defined clinically as cough productive of
sputum occurring on most days in 3
consecutive months over 2 consecutive
years.
 ENVIRONMENTAL
GENETIC Cigarette smoke
Alpha-1 antitrypsin deficiency Occupational exposures to dust and chemicals
Chronic IV drug use

INFLAMMATION

Increase neutrophil Increase oxidative Mucus

elastase and matrix stress, inflammatory hypersecretion,
metalloproteinases mediators, cytokines Ciliary dysfunction

Destruction of Fibrosis and

alveolar walls and thickening of the Edema and smooth
capillaries bronchial walls muscle contraction

Impaired gas Air trapping on

Enlarged air spaces Narrowing of small
diffusion expiration
airways

Enlarged air spaces Enlarged air spaces

COMPLICATIONS OF COPD
People with COPD
● RESPIRATORY INFECTIONS.

are more susceptible to colds, the flu

and pneumonia. Any respiratory
infection can make it much more
difficult to breathe and produce
further damage to the lung tissue. An
annual flu vaccination and regular
vaccination against pneumococcal
COMPLICATIONS OF COPD
● LUNG . Smokers with chronic
CANCER

bronchitis have greater risk of

developing lung cancer than do
smokers who don't have chronic
bronchitis.

● DEPRESSION . Difficulty breathing can keep

NURSING DIAGNOSIS
Impaired gas exchange related to dyspnea,
mucus plug and decreased ventilation

Goal: Client will demonstrate improved

ventilation and adequate oxygenation
NURSING INTERVENTIONS
(Impaired gas exchange related to dyspnea, mucus plug and decreased ventilation)

 Assess respiratory rate, depth, note use of accessory

muscles, pursed lip breathing, inability to speak.
 Elevate head of bed, assist patient to assume sitting
position to ease work of breathing.
 Encourage deep slow or pursed lip breathing as
individually tolerated.
 Administer low-flow oxygen therapy (1-2L/min).
 Administer bronchodilators as ordered.
 Regularly monitor the client’s repiratory rate and
pattern, pulse oximetry, ABG results.
NURSING DIAGNOSIS
Activity intolerance related to inadequate
oxygenation and dyspnea

Goal: Client will improve activity tolerance

within hospitalization period
NURSING INTERVENTIONS
(Activity intolerance related to inadequate oxygenation and dyspnea)

 Monitor the severity of dyspnea and oxygen

saturation with and following activity
 Keep the patient in semi- fowler’s position
 Maintain supplemental oxygen therapy (1-2L/min).
 Assist the client in scheduling a gradual increase in
daily activity exercise
 Advise the client to avoid conditions that increase
oxygen demand such as temperature extremes,
excess weight and stress
 Instruct the client energy conservation techniques
such as pacing activities throughout the day
 Teach the client to use pursed-lip and diaphragmatic
breathing techniques
NURSING DIAGNOSIS
Ineffective airway clearance related to excess
production of secretions, retained secretions
and ineffective coughing

Goal: Client will maintain patent airway with

breath sounds clear within hospitalization
NURSING INTERVENTIONS
(Ineffective airway clearance related to excess production of secretions,
retained secretions and ineffective coughing)
 Monitor respiratory rate and ausculatet
breath sounds
 Assist the patient to assume position of
comfort
 Keep environmental pollution to
minimum eg, dust, feather pillows
 Encourage with abdominal or pursed lip
breathing exercises
 Administer medications such as
bronchodilators
 Perform chest physiotherapy
KNOWLEDGE GAINED FROM THIS STUDY

From this study, I learned how very serious COPD is.

• It was once that COPD was like a gradual suffocating in a pillow.

• Seeing RA experiencing shortness of breath during her hospitalization
or when speaking to me during making rounds made me realize that
even the slightest amount of energy requires oxygen.
• Imagine not being able to breathe to conduct the simplest activities of
daily living.
• In addition to other medical issues as RA had, it made me realize how
important nutrition energy is needed for healing.
• Medical compliance is also important to prevent exacerbations.
 SUGGESTIONS AND
RECOMMENDATIONS
REDUCE SYMPTOMS:
 Relieve symptoms
 Improve exercise tolerance
 Improve health status
REDUCE RISK:
 Prevent disease progression
 Prevent and treat exacerbations
 Reduce mortality
 PREVENTION OF COPD
• SMOKING CESSATION
• PHARMACOTHERAPY- Bronchodilators, Inhaled
corticosteroids, Antibiotics
• IMMUNIZATIONS – Influenza, Pneumococcal
• REHABILITATION AND EDUCATION- Respiratory
care instruction, Psychosocial support, Exercise
training
SUMMARY: COPD MANAGEMENT
education
DIAGNOSE  SPIROMETRY

education
REDUCE RISK  SMOKING CESSATION

education
REDUCE  PHARMACOTHERAPY
SYMPTOMS  PULMONARY REHAB

education  IMMUNIZE
REDUCE
 PREVENT EXACERBATIONS
COMPLICATIONS
 CONSIDER OXYGEN
REFERENCES