Camarines Sur Polytechnic Colleges

Nabua, Camarines Sur

College of Health Sciences

PEREZ, NAJLA KAYE E. PEREZ DR. MODESTO P.

FUCIO, RN
BSN 3B CLINICAL
INSTRUCTOR

A 72- year old male with COPD presents to the emergency department with an acute exacerbation
marked by increased sputum production and shortness of breath. His oxygen saturation is 88% on room
air and he has diffuse inspiratory and expiratory wheezes bilaterally. In addition to oxygen and
bronchodilators, which one of the following is most appropriate for this patient?

a. No additional treatments c. Inhaled corticosteroids only

b. Systemic corticosteroids only d. Systemic corticosteroids and antibiotics

ASSESSMENT NURSING PLANNING NURSING RATIONALE EVALUATION

DIAGNOSIS INTERVENTIO
N
Subjective: After the nursing Independent: After the nursing
Impaired gas interventions, the interventions, the
“I am having exchange r/t pt will: Assess airway for patient was able to:
difficulties in obstruction of patency Maintaining the
breathing and airways by -demonstrate airway is -demonstrated
experienced improved always the first improved ventilation
secretions as
dyspnea a while ventilation and priority. and adequate
ago” as verbalized evidenced by oxygenation of tissues
adequate
by the pt. dyspnea oxygenation of by ABGs within
Instruct patient
tissues by ABGs concerning the patient’s normal range
Objective: within patient’s disposition of Although
-O2sat 88% normal range secretions (e.g., patient may find -manifested signs of
- acute raising and expectoration decreased respiratory
exacerbation - manifest signs effort AEB absence of
expectorating offensive and
marked by of decreased dyspnea
versus attempt to limit
increased sputum respiratory effort
swallowing) and or avoid it, it is
production AEB absence of -free of symptoms of
reporting changes essential that
- has diffuse dyspnea respiratory distress
in color, amount, sputum be
inspiratory and odor of secretions disposed of in a
expiratory wheezes -be free of safe manner. -maintained optimal
bilaterally symptoms of Changes in gas exchange
respiratory characteristics
distress. of sputum
- maintain optimal reflect
gas exchange. resolution of
pneumonia or
development of
secondary
Camarines Sur Polytechnic Colleges
Nabua, Camarines Sur
College of Health Sciences

infection.

Auscultate breath
sounds, noting Breath sounds
areas of may be faint
decreased airflow because of
and adventitious decreased
diseases should airflow or areas
be given oxygen of
cautiously.sounds consolidation.
Presence of
wheezes may
indicate
bronchospasm
or retained
secretions.
Scattered moist
crackles may
indicate
interstitial fluid
or cardiac
decompensation
Encourage .
expectoration of
sputum
Thick,
tenacious,
copious
secretions are a
major source of
impaired gas
Dependent: exchange in
small airways.
Administer
oxygen therapy

The purpose of
oxygen therapy
is to maintain
PaO2 above 60
mmHg. Oxygen
is administered
by the method
that provides
appropriate
 Camarines Sur Polytechnic Colleges
Nabua, Camarines Sur
College of Health Sciences

delivery within
the patient’s
tolerance.

ANATOMY AND PHYSIOLOGY

Respiratory System contains an organ that is
responsible for breathing. These includes the nose,
pharynx, larynx, trachea, bronchi and lungs. And
since lungs is the major part, it does two very
important things: it brings oxygen into our bodies,
which we need for our cells to live and function
properly; and it helps us get rid of carbon dioxide,
which is a waste product of cellular function.
Chronic obstructive pulmonary disease
(COPD) is a life-threatening condition that affects
your lungs and your ability to breathe. When you
inhale, air moves down your trachea and then
through two tubes called bronchi. The bronchi
branch out into smaller tubes called bronchioles.
At the ends of the bronchioles are little air sacs
called alveoli. At the end of the alveoli are
capillaries, which are tiny blood vessels. For
people with COPD, this starts with damage to the
airways and tiny air sacs in the lungs. Symptoms
progress from a cough with mucus to difficulty
breathing. The two main COPD conditions
are chronic bronchitis and emphysema. These
disease processes affect the bronchi and alveolar
walls, respectively. The end result of both is the destruction of lung tissue and obstruction of the airways
of the lung, leading to impaired gas exchange. The two conditions usually occur together, causing chronic
airflow limitation.

LUNGS WITHOUT
COPD
 Camarines Sur Polytechnic Colleges
Nabua, Camarines Sur
College of Health Sciences

LUNGS WITH COPd

CLINICAL MANAGEMENT
COPD Management
An effective COPD management plan includes four components:

1. assess and monitor disease

2. reduce risk factors
3. manage stable COPD
4. manage exacerbations

The goals of effective COPD management are to:

 Prevent disease progression

 Relieve symptoms
 Improve exercise tolerance
 Improve health status
 Prevent and treat complications
 Prevent and treat exacerbations
 Reduce mortality

THERAPEUTIC EFFECTS
INTERVENTIONS THERAPEUTIC
EFFECTS
Aminophylline Relaxes bronchial smooth
muscle, causing bronchodilation
and increasing vital capacity,
which has been impaired by
bronchospasm and air trapping;
in higher concentrations, it also
inhibits the release of slow-
reacting substance of
anaphylaxis and histamine
NURSING
CONSIDERATIONS
- Assess for hypersensitivity
- Administer to pregnant
women only when clearly
needed
- Tell pt. not to chew or
crush enteric-coated timed-
release forms.
- Maintain adequate
hydration
- Monitor for clinical signs
of adverse effects
 Camarines Sur Polytechnic Colleges
Nabua, Camarines Sur
College of Health Sciences
Bronchodilators Type of medication that make
breathing easier by relaxing the
muscles in the lungs and
widening the airways (bronchi).
They're often used to treat long-
term conditions where the
airways may become narrow
and inflamed, such as: asthma, a
common lung condition caused
by inflammation of the airways.
Chest Physiotherapy Physiotherapy treatment
techniques that address the
removal of secretion and
improve airway clearance
thereby help to improve
respiratory efficiency. Chest
physiotherapy is the term for a
group of treatments designed
to eliminate secretions thus
helps to decrease work of
breathing, promote the
expansion of the lungs, and
prevent the lungs from
collapse.
Deliver oxygen at 2-4 Oxygen therapy can help some
people with COPD to feel
liters better and be more active.
Because it increases the
amount of oxygen in a
patient's body, it can help to:
Decrease breathlessness.
Decrease fatigue.
Expectorants Thinning and loosening mucus
in the airways, clearing
congestion, and making
breathing easier.
- Assess for possible
contraindications: allergies
to prevent hypersensitivity.
- Perform physical
examination to establish
baseline data for assessing
the effectiveness of the
drug and occurrence of
adverse effects.
- Monitor vital signs
- Consider proper position
of patient
- Explain the procedure to
patient and tell them that
it will be uncomfortable
and tiring.
- Know the VS,
medications, medical
history of patient.
- Observe precautions in
administering oxygen
such as don’t smoke,
don’t use wools and
don’t wear clothes that
make static electricity
- Deliver 2 to 4 L of
oxygen and slow flow
- Assess and monitor
respiratory status
-Assess for hypersensitivity to
the drugs.
-Tell the patients should take
care to avoid irritants that
stimulate their cough.
-Additionally, the medication
can cause drowsiness. Patients
should avoid taking them with
other CNS depressants or
alcohol
-No eating or drinking for 30
 Camarines Sur Polytechnic Colleges
Nabua, Camarines Sur
College of Health Sciences
Fluids Helps to minimize mucosal
drying and maximize ciliary
action to move secretions.
minutes after syrup
-Encourage patient to cough
and deep breath
Stay hydrated (2-3 liters/day)
Ensure that the amount of
liquid is within the limits of
cardiac reserve and renal
function.