NURSING CARE ON PATIENT WITH

CHRONIC OBSTRUCTIVE
PULMONARY DISEASE
(COPD)

Laily Hidayati, S.Kep., Ns., M.Kep.

Medical-Surgical Nursing Division
Faculty of Nursing
Free- Airlangga
PowerpointUniversity
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 What is?

Chronic obstructive pulmonary disease

(COPD) is :
 a preventable and treatable disease state
 characterized by air flow limitation, that is
 not fully reversible
 usually progressive (with some significant
extrapulmonary effects)

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 Cause

Air flow limitation is usually progressive and

is associated with:
an abnormal inflammatory response of
lungs to
noxious particles or gases,
primarily caused by cigarette smoking

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 Pathophysiology

In COPD, less air flows in and out of the airways

because of one or more of the following:

1.The airways and air sacs lose their elastic quality.

2.The walls between many of the air sacs are
destroyed.
3.The walls of the airways become thick and
inflamed.
4.The airways make more mucus than usual, which
tends to clog them.
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http://www.nhlbi.nih.gov/ Page 5
 Component of COPD

• The definition include chronic

bronchitis ,emphysema with airflow
limitation.

• The definition exclude other causes of

chronic airflow obstruction such as
pulmonary cystic fibrosis , diffuse
panbronchiolitis and bronchiectasis etc.

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 Chronic Bronchitis

• Chronic bronchitis is defined

clinically as the presence of a
cough productive of sputum not
attributable to other causes on
most days for at least 3 months
over 2 consecutive years.
• Clinical and epidemiological term

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 Chronic Bronchitis

• Chronic nonspecific inflammation

• Symptoms of cough and sputum
production with or without gasping
• Recurrent attacks
• Chronic proceeding

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 Classification of Chronic Bronchitis

Simple type
of Chronic Cough
Bronchitis Sputum expectoration
(without
gasping)

Chronic Cough
Bronchitis Sputum expectoration
with Gasping
gasping

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 Stages of Chronic Bronchitis

Stages Time Courses

Exacerbation In a week

Chronic lag One month or longer

phase
stable Lasts for two months

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Diagnosis of chronic bronchitis
• Cough & Sputum expectoration &
Gasping
• Three months /per two year or
longer
• Exclude other lung and heart
disease
If shorter than three months /per year
then definite objective evidences are
demanded (such as X-Ray and lung
function et al.)toFree
diagnose.
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Obstructive Emphysema

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 Definition of Emphysema

• Pulmonary emphysema
(a pathological term)
is characterized by
abnormal,permanent enlargement of
air spaces distal to the terminal
bronchioles ,accompanied by
destruction of their walls and
hyperdistension leading to reduction
in lung elastics recoil and airway
obstruction.
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 Classification of Emphysema

Obstructive Emphysema

senile
Emphysema emphysema(Physiological)
without Interstitial Emphysema
Obstruction
Compensating Emphysema

Scarred Emphysema
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 PERBANDINGAN ASMA
DENGAN PPOM ( PPOK )

ASMA PPOM
ETIOLOGY Alergy / Iritasi Akut Rokok / Polusi Udara
Saluran Pernapasan Infeksi berulang saluran napas

UMUR Anak – Dewasa – Tua Tua >= 40 Tahun

PENCETUS Paparan Alergen ISPA Akut

SERANGAN bahan hirup/makanan Polusi Udara
SESAK Perubahan Cuaca Lain2 : seperti pada asma (jarang)
ISPA
Stres : - Fisik
- Psikis
IMUNITAS
SELULER CD4+ CD8+
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djois
 COPD 2008
Classification & Treatment

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 COPD 2008
Managing Stable Disease

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Wise R, Tashkin D. AJM 2007;120:S4 Page 17
 How can COPD be prevented?

• Early detection of COPD might change its course

and progress.
• A simple test can be used to measure pulmonary
function and detect COPD in current and former
smokers aged 45 years and older and anyone with
breathing problems.
• Avoid tobacco use or inhaling tobacco smoke, home
and workplace air pollutants, and respiratory
infections to prevent early development of COPD
• Immunisations/vaccination of influenza (usually two
type A and one type B)
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NURSING CARE

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 ASSESMENT

Focuses Data:
History : exposure of risk factor
Activity
1. Fatigue, weakness
2. Activity intolerance , b/ hard breathing
3. Abnormal sleeping position (semifowler)
4. Dipsnea (even in rest)
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 Cont’d…

Breathing
1. Short and high frequency of breathing
2. Increasing breathing work
3. Additional breathing muscles
4. ICS retractions

Nutritions
1. Nausea/vomitting
2. Loss appetite
3. Loss of body weight,
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 Physical Examination (PE)
Patients may show a range of phenotypic clinical pictures:
 PE can be normal especially in patients with mild disease
 features of advanced airflow obstruction:
1. peripheral and central cyanosis,
2. hyperinflated chest,
3. pursed lip breathing,
4. accessory muscleuse,
5. wheeze,
6. diminished breath sounds, and
7. paradoxical movement of the lower ribs.
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 PE cont’d …

 Some patients with severe COPD may show signs

consistent with cor pulmonale :
1. raised jugular venous pressure,
2. loud heart sounds due to P2 pulmonary hypertension,
3. tricuspid regurgitation,
4. pitting peripheral oedema, and
5. Hepatomegaly

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 PE cont’d …

 Look for skeletal muscle wasting and cachexia, which may

be present in those with advanced disease.
 Finger clubbing is not found in COPD, and its presence
should prompt thorough evaluation to exclude a cause such
as lung cancer, bronchiectasis, or idiopathic pulmonary
fibrosis.
 At presentation, record the weight and height and calculate
the body mass index.

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*Percussion :
• Hyperresonant
• depressed diaphragm,
• dimination of the area of absolute cardiac
dullness.

*Auscultation:
• Prolonged expiration ；
• reduced breath sounds;
• The presence of wheezing during quiet
breathing
Crackle can be heard if infection exist.
• The heart sounds are best heard over the
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 NURSING DIAGNOSE

1. Ineffective airway clearance

2. Ineffective breathing pattern
3. Impaired gas exchange
4. Altered nutrition: less than body needs
5. Risk for infection

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 Nursing Interventions
1. Ineffective airway clearance
1) Breathing Physiotherapy:
- Postural drainage, clapping, vibrating
2) Nebulizing - Suctioning
3) Collaboration:
- Short & long acting bronchodilator
- Inhaled glucocorticosteroids
- mucolitics
- expectorant
4) Oxygen
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5) Pulmonary rehabilitations Page 31
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 COPD…
The End

Your Turn….Questions?

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Thank You for Your Attention
…

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