Download Smeltzer Textbook of Medical Surgical Nursing

Guided Lecture Notes
Chapter 24: Management of Patients with Chronic Obstructive Pulmonary Disease
Learning Objective 1. Describe the pathophysiology of chronic obstructive pulmonary
disease (COPD).
 Introduce COPD by defining and briefly explaining the disorder using the new
definition provided by the Global Initiative for Chronic Lung Disease (GOLD).
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 that is not fully reversible. The airflow limitation is usually
progressive and associated with an abnormal inflammatory response of the lung to
noxious particles or gases” (GOLD, 2007 p. 2
 Briefly state the incidence of COPD.
 Note that COPD includes several diseases, chronic bronchitis and emphysema,
and that asthma is not considered COPD because this is characterized as a
reversible airway disorder, although person with COPD ay have concomitant
asthma. (Refer to PowerPoint slide 2)
 Explain the pathophysiology of COPD. (Refer to PowerPoint slide 3)
 Define and explain the pathophysiology of chronic bronchitis: a disease of the
airways, is defined as the presence of cough and sputum production for at least 3
months in each of two consecutive years. (Refer to PowerPoint slides 4-7)
 Define and explain the pathophysiology of emphysema: pathologic term that
describes an abnormal distention of the air spaces beyond the terminal
bronchioles and destruction of the walls of the alveoli (GOLD, 2007). (Refer to
PowerPoint slides 8-12)
Learning Objective 2. Discuss the major risk factors for developing COPD and nursing
interventions to minimize or prevent these risk factors.
 List and discuss the major risk factors for COPD. (Refer to PowerPoint slides 13
- 14)
 Explain nursing interventions to prevent or minimize these risk factors.
Learning Objective 3. Describe nursing management of patients with COPD.
 Describe the use of the nursing process when caring for patients with COPD.
 Discuss the assessment of patients with COPD. (Refer to PowerPoint slide 15)
 Discuss specific diagnoses common to patients with COPD. (Refer to
PowerPoint slide 16)
 Discuss collaborative problems common in patients with COPD. (Refer to
PowerPoint slide 17)
 Discuss planning and goals for patients with COPD. (Refer to PowerPoint slide
18)
 Discuss specific nursing interventions utilized for patients with COPD.
 Include in the discussion of improving gas exchange the use of supplemental
oxygen for the patient with COPD. Explain that oxygen may be used for long
1
term therapy, during exercise or to prevent acute dyspnea. Explain the Haldane
effect. (Refer to PowerPoint slides 19 - 21)
Learning Objective 4. Develop a teaching plan for patients with COPD.
 Discuss the development of a teaching plan for a patient with COPD. (Refer to
PowerPoint slides 22 - 24)
Learning Objective 5. Describe the pathophysiology of bronchiectasis and relate it to
signs and symptoms of bronchiectasis.
 Define bronchiectasis: chronic dilation of a bronchus or bronchi; the dilated
airways become saccular and are a medium for chronic infection. No longer
considered a category of COPD. (Refer to slide PowerPoint slides 25 - 26)
 Describe the pathophysiology of bronchiectasis and its relation to signs and
symptoms of bronchiectasis.
 Bronchiectasis may be caused by a variety of conditions, including
o Airway obstruction
o Diffuse airway injury
o Pulmonary infections and obstruction of the bronchus or complications of
long-term pulmonary infections
o Genetic disorders such as cystic fibrosis
o Abnormal host defense (eg, ciliary dyskinesia or humoral
immunodeficiency)
o Idiopathic causes
Learning Objective 6. Identify medical and nursing management of bronchiectasis.
 Discuss specific medical management utilized for patients with
bronchiectasis.(Refer to PowerPoint slide 27)
 Discuss specific nursing interventions utilized for patients with bronchiectasis.
(Refer to PowerPoint slide 28)
Learning Objective 7. Describe the pathophysiology of asthma.
 Define asthma: a disease with multiple precipitating mechanisms resulting in a
common clinical outcome of reversible airflow obstruction; no longer considered
a category of COPD
 Briefly discuss the incidence and symptoms. Note that asthma differs from other
obstructive pulmonary diseases in that it is a reversible disorder which has acute
exacerbations.
 Also note that allergy is the strongest predisposing factor for asthma. (Refer to
PowerPoint slide 29)
 List common triggers for asthma.
 Describe the pathophysiology of asthma (Refer to PowerPoint slide 30)
Learning Objective 8. Discuss medications used in the treatment of asthma.
 Discuss the medications used for asthma.
 List the specific drugs used for the management of asthma.
2


Include in the discussion the classifications, administration methods, specific drug
actions, indications, side effects and nursing interventions for the specific
medications. (Refer to PowerPoint slide 31 and Tables 24-2, 24-3 and 24-4)
Explain the use of and patient teaching for the use of metered dose inhalers.
(Refer to PowerPoint slide 32)
Learning Objective 9. Describe asthma self-management strategies.
 Discuss patient teaching for the self-management of asthma.
 Emphasize the need for daily therapy as part of self-care.
 Mention that a variety of teaching materials are available through sources such as
the National Heart, Lung and Blood institute. (Refer to PowerPoint slide 23)
 Explain the use of the peak flow meter. (Refer to PowerPoint slide 34)
Learning Objective 10. Describe the pathophysiology of cystic fibrosis.
 Describe the incidence and pathophysiology cystic fibrosis. (Refer to PowerPoint
slide 35)
3