Running head: CHRONIC OBSTRUCTIVE PULMONARY DISEASE 1

Chronic Obstructive Pulmonary Disease (COPD)

Deseret Bruno

Brigham Young University-Idaho

Nursing 322

Sister Ardern

June 10, 2016

CHRONIC OBSTRUCTIVE PULMONARY DISEASE (COPD) 2

Situation and Primary Diagnosis

Ms. Bloomfield is a 38-year-old female. She presented to the doctor with complaints

of a mild occasional productive cough that has been going on for 3-4 months. She also

reports shortness of breath when she exercises. Results of a physical exam and chest x-ray

show no abnormalities. A post-bronchodilator study, however, shows her FEV1 to be 85%

of predicted and her FEV1/FVC to be 65%. Ms. Bloomfield is diagnosed with early mild

Chronic Obstructive Pulmonary Disease (COPD).

Background

Ms. Bloomfield smoked a pack of cigarettes and has been doing so for 20 years. In

the last week of her diagnosis, she has reduced her intake to 10 cigarettes per day. She has a

history of hypertension. She is on the following medications to control hypertension:

Lisinopril, Metoprolol, and Hydrochlorothiazide.

Chronic obstructive pulmonary disease, or COPD is a group of progressive lung

diseases that cause airway obstruction (Pietrangelo, 2015). The two most common diseases

that COPD encompass are emphysema and chronic bronchitis. This can include one or both

of these diseases (Pietrangelo, 2015). COPD is progressive and irreversible. This means that

there is no cure, and no way to fix the damage it has already done. However, it can be

treated to lessen the symptoms and slow the progression (Stark, 2014). COPD is the third

leading cause of death in the United States. There are more than 15 million diagnosed cases

in the United Sates, and more than 210 million globally. It is more prevalent in older adults

aged 75 years or older (How Serious is COPD, n.d.). The main cause of COPD is tobacco

smoking. Other causes can include: second-hand tobacco smoke, exposure to harmful fumes,

and although rare, alpha-1-antitrypsin (AAt) deficiency (Pietrangelo, 2015). Risk factors
CHRONIC OBSTRUCTIVE PULMONARY DISEASE (COPD) 3

include: genetics (being susceptible to the AAt gene), gender (female), childhood chronic

lung infections, and occupation (occupations that come in contact with dusts, vapors,

chemicals and fumes) (Rosenberg, Kalhan & Manino, 2015). Signs and symptoms of COPD

include: breathlessness on exertion, wheezing, coughing, tachypnea and a barreled chest,

(Stark, 2016).

Teaching Plan for Ms. Bloomfield (COPD)

Concern 1:

Ms. Bloomfield reports that after four weeks of being diagnosed with early mild COPD she

has cut her cigarettes down to 10 per day. She is really motivated to quit.

Nursing diagnosis: Readiness for enhanced learning related to COPD as manifested by

motivation to quit smoking.

Goal: Ms. Bloomfield will completely cease smoking within 3 months.

Interventions and Education:

Praise Ms. Bloomfield for cutting her cigarette intake. Her decrease in the amount of

cigarettes smoked per day shows her desire to stop smoking.

Teach Ms. Bloomfield the importance of creating a cessation of smoking plan, and

have her write down a week by week plan to eliminate the 10 cigarettes she is

smoking per day. The goal of this plan should be abstinence from smoking. Plans

that involve tapering off cigarettes have proven successful. Tapering off cigarettes

means cutting the number of cigarettes smoked each day (Siegel, 2015).

Teach Ms. Bloomfield the three Ds of quitting smoking: delay, deep breathing, drink

water. When a craving comes to Ms. Bloomfield, she should delay smoking, practice
CHRONIC OBSTRUCTIVE PULMONARY DISEASE (COPD) 4

deep breathing while counting to ten, and drinking at least eight fluid ounces of water

(Siegel, 2015).

Teach Ms. Bloomfield about options for medications that are designed to help her

stop smoking. One medication that has been proven effective is varenicline

(Chantix). This drug is geared to reduce withdrawal symptoms. If interested, Ms.

Bloomfield would need to talk to the doctor to see if it is right for her. Other

medications include: nicotine patches, gum and lozenges (Siegel, 2015). It is

important for Ms. Bloomfield to be aware of her options if symptoms of withdrawal

become unbearable. This could also be a time to teach Ms. Bloomfield that her

medications used for hypertension should be continued and do not have bad effects

on her COPD (Chandy, Aronow & Banach, 2013).

Give Ms. Bloomfield contact information to support groups that are aimed to help

smokers quit, and encourage her to attend (Siegel, 2015).

Concern 2:

Ms. Bloomfield is an amateur astronomer. Whether this be for work, or as a hobby, this

sometimes puts her in situations where she is exposed to the smoke produced by forest fires.

Ms. Bloomfield has not been willing to quit this activity. Because forest fires produce

harmful fumes, this is something that should be addressed as a concern.

Nursing Diagnosis: Risk for prone health behaviors as related to exposing oneself to harmful

fumes.

Goal: Ms. Bloomfield will identify ways to reduce her risk prone health behaviors.

Interventions:
CHRONIC OBSTRUCTIVE PULMONARY DISEASE (COPD) 5

Teach Ms. Bloomfield that the harmful effects of the fumes she is exposing herself to

by participating in astronomy during peak forest fire seasons can cause her COPD to

progress at a faster rate (Stark, 2014).

Instruct Ms. Bloomfield to research when forest fires are occurring in the area, and if

they are, to stay indoors (EHS: Nursing Care Planning, n.d.).

Encourage Ms. Bloomfield to wear a mask or scarf over the mouth and nose if there

is no other way to prevent contact with dangerous fumes (EHS: Nursing Care

Planning, n.d.).

Concern 3:

Ms. Bloomfield reports shortness of breath when she exercises and a mild occasional

productive cough for the past 3-4 months.

Nursing Diagnosis: Ineffective Breathing Pattern related to COPD as manifested by shortness

of breath.

Goal: Patient will voice and demonstrate ways to reduce shortness of breath.

Interventions:

Give the patient positive feedback for exercising, because exercising enhances

breathing by improving muscle strength and stamina (Stark, 2016).

Teach Ms. Bloomfield pursed-lip breathing, and have her demonstrate proper

technique afterwards. Pursed-lip breathing is shown to help improve breathing. Ms.

Bloomfield can use this method during her exercise, and it can also be very effective

if exacerbations of COPD are ever experienced by Ms. Bloomfield (Stark, 2016).

Teach Ms. Bloomfield of medication options if symptoms worsen. These

medications include: corticosteroids, short-acting inhaled anticholinergics, short-

CHRONIC OBSTRUCTIVE PULMONARY DISEASE (COPD) 6

acting inhaled beta-2 agonists (SABA), and long-acting beta-2 agonists (LABA)

(Stark, 2014).

Concern 4:

Patient asks if there is anything else that can be done to help her.

Nursing Diagnosis: Readiness for enhanced self-health management related to COPD as

manifested by asking if there is anything else that can be done to help her.

Goal: Patient will voice the causes of COPD, and commit to make healthy lifestyle changes.

Interventions:

At this point, Ms. Bloomfield knows that smoking and exposure to forest fire fumes

worsen symptoms of COPD. However, it is also important to teach her that second-

hand smoke can also worsen the symptoms. Because there is a chance that perhaps a

family member or close friend smokes tobacco as well, it is important to teach her to

avoid being around them while they are smoking. This could be accomplished in

many ways such as setting a rule that no smoking is allowed in the house, and

educating family members of the effects that COPD has on Ms. Bloomfield (Stark,

2014).

Another lifestyle change that Ms. Bloomfield can be taught is to avoid respiratory

infections. These infections can worsen her case of COPD. To avoid these

infections Ms. Bloomfield should be taught to: wash her hands frequently, avoid

people who are sick, and to receive preventative shots such as the flu shot and the

pneumonia vaccine (Stark, 2014).

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References

Chandy, D., Aronow, W. S., & Banach, M. (2013). Current perspectives on treatment of

hypertensive patients with chronic obstructive pulmonary disease. Integrated Blood

Pressure Control, 6, 101109. http://doi.org/10.2147/IBPC.S33982

EHS: Nursing Care Planning Guides - Care Planner: Diagnosis: Knowledge deficit or Altered

health maintenance. (n.d.). Retrieved June 11, 2016, from

http://www1.us.elsevierhealth.com/SIMON/Ulrich/Constructor/diagnoses.cfm?did=2

25%7C226%7C227%7C228%7C229%7C230%7C231%7C232%7C233

How Serious Is COPD. (n.d.). Retrieved June 11, 2016, from http://www.lung.org/lung-

health-and-diseases/lung-disease-lookup/copd/learn-about-copd/how-serious-is-

copd.html

Kalhan, R., Mannino, D., & Rosenberg, S. (2015). Epidemiology of Chronic Obstructive

Pulmonary Disease: Prevalence, Morbidity, Mortality, and Risk Factors. Seminars in

Respiratory and Critical Care Medicine Semin Respir Crit Care Med, 36(04), 457-

469. doi:10.1055/s-0035-1555607

Pietrangelo, A. (n.d.). COPD by the Numbers: Facts, Statistics & You. Retrieved June 11,

2016, from http://www.healthline.com/health/copd/facts-statistics-infographic#3

Siegel, J. (2015). Smoking cessation. Salem Press Encyclopedia Of Health.

Stark, S. D. (2014). Chronic obstructive pulmonary disease (COPD). Magills Mecial Guide

(Online Edition).