General Objectives: After 1 hour and 30 minutes of varied lecture – discussion, the students from BSN III – I will

be able to gain a wider understanding and skills, and a positive attitude

towards the concept “Chronic Obstructive Pulmonary Disease”.

SPECIFIC CONTENTS TIME METHODOLOGY MATERIAL EVALUATION

OBJECTIVES ALLOTMENT USED

Specifically, the Human After 1 hour and 30

students from BSN III Resource: minutes of avried
– I will be able to: and thorough
• Time lecture – discussion,
Chronic obstructive pulmonary disease (COPD), also known as chronic obstructive lung 5 minutes Lecture – • Effort the students from
disease (COLD), chronic obstructive airway disease (COAD), chronic airflow limitation Discussion BSN III – I will be
(CAL) and chronic obstructive respiratory disease (CORD), refers to chronic bronchitis and Materials: able to come up
emphysema, a pair of commonly co-existing diseases of the lungs in which the airways with great
become narrowed. This leads to a limitation of the flow of air to and from the lungs causing • Laptop understanding
shortness of breath. In contrast to asthma, the limitation of airflow is poorly reversible and regarding the topic
usually gets progressively worse over time. In England, an estimated 842,100 of 50 million about Chronic
people have a diagnosis of COPD; translating into approximately one person in 59 receiving a Obstructive
diagnosis of COPD at some point in their lives. Pulmonary Disease.

1. Define the
following terms: 5 minutes Lecture – • Oral
Discussion Revalida

• Respiratory The integrated system of organs involved in the intake and exchange of oxygen and
System carbon dioxide between an organism and the environment. The organs that are involved in
breathing. These include the nose, throat, larynx, trachea, bronchi, and lungs

• Lungs The lung is the essential respiration organ in animals. In mammals and the more
complex life forms, the two lungs are located in the chest on either side of the heart. Their
principal function is to transport oxygen from the atmosphere into the bloodstream, and to
release carbon dioxide from the bloodstream into the atmosphere. This exchange of gases is
accomplished in the mosaic of specialized cells that form millions of tiny, exceptionally thin-
walled air sacs called alveoli. The lungs are a pair of breathing organs located with the chest
which remove carbon dioxide from and bring oxygen to the blood. There is a right and left
lung.
 • Oxygenation Oxygenation occurs when oxygen molecules (O2) enter the tissues of the body.

• Oxygen Oxygen is the element with atomic number of 8 and represented by the symbol O. It is
a member of the chalcogen group on the periodic table, and is a highly reactive non-metalic
period 2 elements that readily forms compounds (notably oxides) with almost all other
elements.

2.) State and Describe

the Anatomy of the 10 minutes Lecture –
Respiratory System Discussion
and its Function
1. Nasal Passages
The walls of the nasal passages are coated with respiratory mucous membranes
which contain innumerable tiny hair-like cells that act to move waves of mucus
toward the throat. Dust, bacteria, and other particles inhaled from the air are trapped
by the mucus in the nose, carried back, swallowed and dropped into the gastric juices
to nullify any potential harm they might do.
The organs of smell are made up of patches of tissue (the olfactory membranes)
about the size of a postage stamp and located in a pair of clefts just under the bridge
of the nose. Most air breathed in normally flows through the nose but only a small
part reaches the olfactory clefts, enough to get a response to an odor. When a person
sniffs to detect a smell, air moves faster through the nose, increasing the flow to the
olfactory clefts and carrying more odor to these sensory organs.

2. Mouth
The mouth is a passageway between the pharynx (the cavity connecting the nose,
mouth, and larynx) and the outside of the body. It can thus be used for breathing when
the nose is inadequate, as happens, for instance, during strenuous exercise.

3. Pharynx
A wide, fibromuscular passageway, commonly called the throat, which extends
from the base of the skullto the level of the sixth cervical vertebra. There, behind the
lower border of the cricoid cartilage, it becomes continuous with theesophagus. The
pharynx serves both the respiratory systemand the digestive system by receiving air
from the nasal cavity and air, food, and water from the oral cavity.

4. Epiglottis
The epiglottis is the flap of cartilage lying behind the tongue and in front of the
entrance to the larynx (voice box). At rest, the epiglottis is upright and allows air to
pass through the larynx and into the rest of the respiratory system. During swallowing,
it folds back to cover the entrance to the larynx, preventing food and drink from
entering the windpipe.

5. Larynx
The larynx is the portion of the breathing, or respiratory, tract containing the vocal
cords which produce vocal sound. It is located between the pharynx and the trachea.
The larynx, also called the voice box, is a 2-inch-long, tube-shaped organ in the neck.
6. Trachea
A tube-like portion of the breathing or "respiratory" tract that connects the "voice
box" (larynx) with the bronchial parts of the lungs. Each time we inhale (breathe in),
air goes into our nose or mouth, then through the larynx, down the trachea, and into
our lungs. When we exhale (breathe out), the air goes out the other way.

7. Right Upper Lobe

The right upper lobe bronchus is one of the three lobes the right lung is composed
of. It consists of three segments: the "apical", the "posterior", and the "anterior". The
lobes of the right lung are nourished by branches of arteries and veins which stem
from the thoracic branch, and these, in turn, stem from the descending aorta.

8. Right Bronchus
The right main bronchus is one of the air passage ways into the lungs.

9. Right Middle Lobe

The right middle lobe bronchus is one of the three lobes that composes the right
lung. It consists of the "lateral" and "medial" segments. The lobes of the right lung are
nourished by branches of arteries and veins which stem from the thoracic branch, and
these, in turn, stem from the descending aorta.

10. Right Lower Lobe

The right lower lobe bronchus is one of the three lobes that composes the right
lung. It has "superior", "medial basal", "anterior basal", "lateral basal", and a
"posterior basal" segments. The lobes of the right lung are nourished by branches of
arteries and veins which stem from the thoracic branch, and these, in turn, stem from
the descending aorta.

11. Pulmonary Vein

One of four vessels that carry aerated blood from the lungs to the left atrium of the
heart. (The four are the right and left superior and inferior pulmonary veins). The
pulmonary veins are the only veins that carry bright red oxygenated blood.

12. Left Bronchus

Primary division of the tracheobronchial tree arising as the left branch of the
bifurcation of the trachea, then passing in front of the esophagus and enters the hilum
of the left lung where it divides into a superior lobe bronchus and an inferior lobe
bronchus. It is longer, of narrower caliber, and more nearly horizontal than the right
 main bronchus, hence, aspirated objects enter it less frequently.

13. Left Upper Lobe

The left upper lobe has a "superior division", which consists of the "apical-
posterior" segment and the "anterior" segment, and an "inferior (lingular) division",
which contains the "superior" and "inferior" segments. The lobes of the left lung are
supplied by branches of arteries and veins which stem from the thoracic branch, and
these, in turn, stem from the descending aorta.

14. Pulmonary Arteries

A large artery originating from the superior surface of right ventricle and carrying
deoxygenated bloodfrom the heart to the lungs. The pulmonary artery is the exception
to the rule that arteries carry oxygenated blood from the heart to other parts of the
body.

15. Bronchioles
The bronchioles are the intermediate air passages within the lungs. They branch off
of the large bronchi and extend to the smaller branches of the alveolar ducts. Each
respiratory bronchiole subdivides into five or more alveolar ducts. The structure of the
bronchi, bronchioles, alveolar ducts, and alveoli is often called the ' pulmonary tree'
because its extensive branching resembles the limbs and leaves of a tall deciduous
tree.

16. Pleura
Membrane lining the thoracic cavity (parietal pleura) and covering the lungs
(visceral pleura). The parietal pleura folds back on itself at the root of the lung to
become the visceral pleura. In health the two pleurae are in contact. When the lung
collapses, however, or when air or liquid collects between the two membranes, the
pleural cavity or sac becomes apparent (see pleurisy). There are actually two pleural
cavities, the right and the left; each constitutes a closed unit not connected to the
other. The glistening surface of the pleura is made up of a sheet of flat cells, the
mesothelium, which covers an underlying layer of loose elastic tissue. The pleura
exudes a thin fluid that keeps it moist and lubricated.

17. Alveoli
The alveoli are the final branchings of the respiratory tree and act as the primary
gas exchange units of the lung. The gas-blood barrier between the alveolar space and
the pulmonary capillaries is extremely thin, allowing for rapid gas exchange. To reach
 the blood, oxygen must diffuse through the alveolar epithelium, a thin interstitial
space, and the capillary endothelium; CO2 follows the reverse course to reach the
alveoli.

18. Left Lower Lobe

This is the lower lobe of the left lung and is sometimes abbreviated as LLL. It is
important to remember that the lower lobe is primarily located toward the posterior
surface of the chest wall and very little is projected onto the anterior chest.

3.) State the 10 minutes Lecture –

Diagnostic Procedures Discussion
done for COPD.
➢ Pulmonary Function Test
Pulmonary function tests are confusing to many patients. And, as those with heart
disease are usually aware of their blood pressure and cholesterol levels, the
importance of knowing your numbers as they apply to pulmonary function tests
(PFTs) and COPD is commonly overlooked.
➢ Spirometry Testing
The most common of all pulmonary function tests is the spirometry test. It is
performed with a hand-held device called a spirometer and can easily be used by
patients with the assistance of an experienced technician. It is normally the clinician's
first choice when attempting to diagnose a respiratory problem. A convenient,
noninvasive procedure, spirometry can be performed in the privacy of your doctor's
office or any inpatient or outpatient facility.
Spirometry requires the patient, after all air has been expelled, to inhale deeply.
This maneuver is then followed by a rapid exhalation so that all the air is exhausted from the
lungs.
➢ Blood Tests
Blood tests measure the different types of blood cells or the amount of oxygen and
carbon dioxide in the blood. Others are used to check for low alpha-1-antitrypsin
levels, especially in a nonsmoker who shows symptoms of emphysema.
➢ Chest X-ray
These help to rule out pneumonia and lung cancer, and they also show heart size. If
 you have emphysema, chest X-rays can pinpoint areas where lung tissue has been
destroyed.
➢ Electrocardiogram
This test measures the electric activity of the heart and usually is done to make sure
your symptoms are not caused by a heart problem.
➢ Sputum Analysis
A small amount of mucus is collected and tested for respiratory infection.
➢ Exercise stress test
In this test, you walk on a treadmill while a specialist monitors the intensity of
your exercise. This test looks for any signs of coronary artery disease.

10 minutes Lecture –
4.) Enumerate the Discussion
Signs and Symptoms
of COPD
➢ Barrel Chest
One telling sign is the change in the shape of the chest, known as barrel chest. When
the lungs become enlarged, the diaphragm is displaced downward and is unable to contract
efficiently. Furthermore, the chest wall is enlarged, making accessory breathing muscles
(muscles in the neck, upper chest, and between the ribs) less efficient as well. These changes
contribute to shortness of breath. This becomes apparent when a person with COPD tries do
something with the arms raised above the head, such as changing a light bulb in a ceiling
fixture, and becomes short of breath
➢ Pursed-Lip Breathing
Because airflow out of the lungs becomes limited, exhalation takes longer. Because the
alveoli lose their elasticity, one tries to shorten the time needed for exhalation by forcefully
exhaling. Unfortunately, forced exhalation increases pressure on the lungs and causes
structurally weakened airways to collapse. To prevent airways from closing during forced
exhalation, pursed-lip breathing is used: The lips are narrowed together, which slows
exhalation at the mouth. This keeps positive pressure in the airways, thus preventing their
collapse and allowing some forced exhalation.
 ➢ Productive Cough
A productive cough is caused by inflammation and excessive amounts of mucus in the
airways. Coughing becomes less effective because of obstructed airflow.
➢ Cyanosis
People who have a poor supply of oxygen usually have a bluish tinge to their skin,
lips, and nailbeds, called cyanosis.
➢ Shortness of Breath (Dyspnea)
Dyspnea, the most common symptom of COPD, comes on gradually and is first
noticed during physical exertion or during acute exacerbations. It usually begins when patients
are in their 60s and 70s and slowly becomes more prominent. It is closely associated with lung
function decline and is not always associated with low oxygen in the blood.
➢ Chronic Cough
Chronic cough typically begins as a morning cough and slowly progresses to an all-
day cough. The cough usually produces small amounts of sputum (less than 60 mL/day) and is
clear or whitish but may be discolored. Sputum production decreases when one quits smoking.
➢ Wheezing
Wheezing is the high-pitched sound of air passing through narrowed airways. A person
with COPD may wheeze during an acute exacerbation or chronically. Sometimes the
wheezing is heard only at night or with exertion. Bronchodilators can relieve wheezing
quickly
➢ Hemoptysis
COPD is one of the more common causes of hemoptysis (coughing up blood). It
usually occurs during an acute exacerbation, when there is a lot of coughing with purulent
sputum (sputum containing pus). Usually, there are only very small amounts of blood
streaking the sputum. Hemoptysis may be a sign of lung cancer in a patient with COPD, so
any blood appearing in the sputum should be brought to a doctor's attention.
➢ Weight Loss
Patients with severe COPD work hard and burn a lot of calories just breathing. These
patients also become short of breath in the very act of eating, and so may not eat enough to
replace the calories they use.
➢ Lower Extremity Edema
In severe cases of COPD, pulmonary artery pressures increase and the right ventricle of the
heart contracts less efficiently. When the heart is unable to pump enough blood to meet the
needs of the kidneys and liver, edema (swelling) in the feet, ankles, and lower legs results. It
 can also cause the liver to become swollen and tender or fluid to accumulate in the abdomen
(ascites). A distended abdomen can be a sign of ascites.

5.) Conceptualize the 10 minutes Lecture –

Pathophysiology of Discussion
COPD
Pulmonary Hypertension

Affects pulmonary vasculature and causes thickening of the lining of the vessel and
hypertrophy of the smooth muscle.

Loss of alveolar attachments and elastic recoil

Cause scar tissue formation and narrowing of the airway lumen

Peribronchial fibrosis, exudates in the airway and over all airway narrowing
Stimulation in the production of goblet cells

Narrowing of the airways

(Trachea and bronchi)
Potential role of Coagulation and the Complement System in COPD; a complex cascade of
blood plasma proteins and platelet activation as molecular pertubations associated with
patients suffering from Chronic Obstructive Pulmonary Disease.
5.) Classify the Narrowing of the airways reduces the rate at which air can flow to and from the air sacs 10 minutes Lecture –
Common Cause of (alveoli) and limits the effectiveness of the lungs. In COPD, the greatest reduction in air flow Discussion
COPD occurs when breathing out (during expiration) because the pressure in the chest tends to
compress rather than expand the airways. In theory, air flow could be increased by breathing
more forcefully, increasing the pressure in the chest during expiration. In COPD, there is often
a limit to how much this can actually increase air flow, a situation known as expiratory flow
limitation.
If the rate of airflow is too low, a person with COPD may not be able to completely finish
breathing out (expiration) before he or she needs to take another breath. This is particularly
common during exercise when breathing has to be faster. A little of the air of the previous
breath remains within the lungs when the next breath is started. When this happens, there is an
increase in the volume of air in the lungs, a process called dynamic hyperinflation.
Dynamic hyperinflation is closely linked to shortness of breath (dyspnea) in COPD. It is
less comfortable to breathe with hyperinflation because it takes more effort to move the lungs
and chest wall when they are already stretched by hyperinflation.
Another factor contributing to shortness of breath in COPD is the loss of the surface area
available for the exchange of oxygen and carbon dioxide with emphysema. This reduces the
rate of transfer of these gasses between the body and the atmosphere and can lead to low
oxygen and high carbon dioxide levels in the body. A person with emphysema may have to
breathe faster or more deeply to compensate, which can be difficult to do if there is also flow
limitation or hyperinflation.
Some people with advanced COPD do manage to breathe fast to compensate, but usually
have dyspnea as a result. Others, who may be less short of breath, tolerate low oxygen and
high carbon dioxide levels in their bodies but this can eventually lead to headaches,
drowsiness and heart failure.
Advanced COPD can lead to complications beyond the lungs such as weight loss
(cachexia), pulmonary hypotension and right-sided heart failure (cor pulmonale).
Osteoporosis, heart disease, muscle wasting and depression are all more common in people
with COPD.
Several molecular signatures associated to lung function decline and corollaries of disease
severity have been proposed, a majority of which are characterized in easily accessible
surrogate tissue, including blood derivatives such as serum and plasma. A recent 2010 clinical
study proposes alpha 1B-glycoprotein precursor/A1BG Alpha-2 antiplasmin, apolipoprotein
A-IV precursor/AP04, and complement component 3 precursor, among other coagulation and
complement system proteins as corrollaries of lung function decline, although ambiguity
 between cause and effect is unresolved.
Acute exacerbations of COPD
An acute exacerbation of COPD is a sudden worsening of COPD symptoms (shortness of
breath, quantity and color of phlegm) that typically lasts for several days. It may be triggered
by an infection with bacteria or viruses or by environmental pollutants. Typically, infections
cause 75% or more of the exacerbations; bacteria can roughly be found in 25% of cases,
viruses in another 25%, and both viruses and bacteria in another 25%. Pulmonary Embolism
can also cause exacerbations of COPD. Airway inflammation is increased during the
exacerbation resulting in increased hyperinflation, reduced expiratory air flow and worsening
of gas transfer. This can also lead to hypo ventilation and eventually hypoxia, thus can lead to
insufficient tissue perfusion then cell necrosis.

6.) Elaborate the 20 minutes Lecture –

Medical Management Discussion
for COPD

➢ Quitting cigarette smoking

The most important treatment for COPD is quitting cigarette smoking. Patients who
continue to smoke have a more rapid deterioration in lung function when compared to
others who quit. Aging itself can cause a very slow decline in lung function. In
susceptible individuals, cigarette smoking can result in a much more dramatic loss of
lung function. It is important to note that when one stops smoking the decline in lung
function eventually reverts to that of a non-smoker.
1. Nicotine in cigarettes is addictive and therefore cessation of smoking can
cause symptoms of nicotine withdrawal including anxiety, irritability, anger,
depression, fatigue, difficulty concentrating or sleeping, and intense craving
for cigarettes. Patients likely to develop withdrawal syndrome typically
smoke more than 20 cigarettes a day, need to smoke shortly after waking up
in the morning, and have difficulty refraining from smoking in non-smoking
areas. However, some 25% of smokers can stop smoking without developing
these symptoms. Even in those smokers who develop symptoms of
withdrawal, the symptoms will decrease after several weeks of abstinence.
2. Buproprion (Zyban, Wellbutrin) is an antidepressant that has been found to
decrease cravings for cigarettes. It has been shown to be of benefit to patients
who want to quit smoking.
3. Varenicline (Chantix) is a medication is to aid in smoking cessation and has
 been approved for use in the US. Varenicline works in two ways; by cutting
the pleasure of smoking and reducing the withdrawal symptoms that lead
smokers to light up again and again. This medicine is taken over a 12 week
course and can work in ways that bupropion does not.
➢ Bronchodilators
Treating airway obstruction in COPD with bronchodilators is similar but not
identical to treating bronchospasm in asthma. Bronchodilators are medications that
relax the muscles surrounding the small airways thereby opening the airways.
Bronchodilators can be inhaled, taken orally or administered intravenously. Inhaled
bronchodilators are popular because they go directly to the airways where they work.
As compared with bronchodilators given orally, less medication reaches the rest of the
body, and, therefore, there are fewer side effects.
➢ Beta-agonists
Historically, one of the first medications used for asthma was adrenaline
(epinephrine). Adrenaline has a rapid onset of action in opening the airways. It is still
used in certain emergency situations for attacks of asthma. Unfortunately, adrenaline
has many side effects including rapid heart rate, headache, nausea, vomiting,
restlessness, and a sense of panic. Therefore, it is not used in the treatment of COPD.
Beta-2 agonists have the bronchodilating effects of adrenaline without many of its
unwanted side effects. Beta-2 agonists can be administered by MDI inhalers or orally.
They are called "agonists" because they activate the beta-2 receptor on the muscles
surrounding the airways. Activation of beta-2 receptors relaxes the muscles
surrounding the airways and opens the airways. Dilating airways helps to relieve the
symptoms of dyspnea (shortness of breath). Beta-2 agonists have been shown to
relieve dyspnea in many COPD patients, even among those without demonstrable
reversibility in airway obstruction. The action of beta-2 agonists starts within minutes
after inhalation and lasts for about 4 hours. Because of their quick onset of action,
beta-2 agonists are especially helpful for patients who are acutely short of breath.
➢ Anti-cholinergic Agents
Acetylcholine is a chemical released by nerves that attaches to receptors on the
muscles surrounding the airway causing the muscles to contract and the airways to
narrow. Anti-cholinergic drugs such as ipratropium bromide (Atrovent) dilate
airways by blocking the receptors for acetylcholine on the muscles of the airways and
preventing them from narrowing. Ipratropium bromide (Atrovent) usually is
administered via a MDI. In patients with COPD, ipratropium has been shown to
alleviate dyspnea, improve exercise tolerance and improve FEV1. Ipratropium has a
 slower onset of action but longer duration of action than the shorter-acting beta-2
agonists. Ipratropium usually is well tolerated with minimal side effects even when
used in higher doses. Tiotropium (Spiriva) is a long-acting and more powerful version
of Ipratropium and has been shown to be more effective.
➢ Methylxanthines
Theophylline (Theo-Dur, Theolair, Slo-Bid, Uniphyl, Theo-24) and aminophylline
are examples of methylxanthines. Methylxanthines are administered orally or
intravenously. Long acting theophylline preparations can be given orally once or twice
a day. Theophylline, like a beta agonist, relaxes the muscles surrounding the airways
but also prevents mast cells around the airways from releasing bronchoconstricting
chemicals such as histamine. Theophylline also can act as a mild diuretic and increase
urination. Theophylline also may increase the force of contraction of the heart and
lower pressure in the pulmonary arteries. Thus, theophylline can help patients with
COPD who have heart failure and pulmonary hypertension. Patients who have
difficulty using inhaled bronchodilators but no difficulty taking oral medications find
theophylline particularly useful.
➢ Corticosteroids
When airway inflammation (which causes swelling) contributes to airflow
obstruction, antiinflammatory medications (more specifically, corticosteroids) may be
beneficial. Examples of corticosteroids include prednisone and prednisolone
(Pediapred Oral Liquid, Medrol). Twenty to thirty percent of patients with COPD
show improvement in lung function when given corticosteroids by mouth.
Corticosteroids also can be inhaled. Inhaled corticosteroids have many fewer side
effects than long term oral corticosteroids.
Examples of inhaled corticosteroids include:
• Beclomethasone Diproprionate (Beclovent, Qvar, and Vanceril),
• Triamcinolone Acetonide(Azmacort),
• Fluticasone(Flovent),
• Budesonide(Pulmicort),
• Mometasone furoate(Asmanex), and
• Flunisolide(Aerobid).

➢ Herbal Treatments for COPD:

 1. Olive leaf - Olive leaf is one herb that eases symptoms of COPD. Olive leaf
reduces inflammation and aids in the treatment of COPD-related infection. Olive leaf
is a natural antibiotic with anti-inflammatory, anti-viral and anti-bacterial properties.

2. Serrapeptase - Research suggests that Serrapeptase is also helpful. There are many
success stories using this miracle natural enzyme. According to Robert Redfern,
"Serrapeptase is a naturally occurring, physiological agent with no inhibitory effects
on prostaglandins and is devoid of gastrointestinal side effects."

3. Cayenne - Cayenne is used because it has the ability to increase circulation and
improve breathing. A recipe for blood clearance: 1 cup of water, 1/4 teaspoon of
cayenne, 1 tablespoon of apple vinegar and 2 teaspoons of honey. Drink this slowly
throughout the day.

4. Other herbs that help ease COPD symptoms include astragalus, enchinacea,
ginseng, quercetin, thyme, milk thistle, eucalyptus and lobelia.

➢ Surgery

In rare cases, surgery may benefit some people who have COPD. Surgery usually is a
last resort for people who have severe symptoms that have not improved from taking
medicines.
Surgeries for people who have COPD that's mainly related to emphysema include bullectomy
(bul-EK-to-me) and lung volume reduction surgery (LVRS). A lung transplant may be done
for people who have very severe COPD.

• Bullectomy
When the walls of the air sacs are destroyed, larger air spaces called bullae form.
These air spaces can become so large that they interfere with breathing. In a bullectomy,
doctors remove one or more very large bullae from the lungs.

• Lung Volume Reduction Surgery

In LVRS, surgeons remove damaged tissue from the lungs. This helps the lungs work
better. In carefully selected patients, LVRS can improve breathing and quality of life.

• Lung Transplant
 A lung transplant may benefit some people who have very severe COPD. During a
lung transplant, your damaged lung is removed and replaced with a healthy lung from a
deceased donor.

A lung transplant can improve your lung function and quality of life. However, lung
transplants have a high risk of complications. These include infections and death due to the
body rejecting the transplanted lung.
If you have very severe COPD, talk with your doctor about whether a lung transplant is an
option. Discuss with your doctor the benefits and risks of this type of surgery.

7.) Specify and 10 minutes Lecture –

Elaborate the Nursing Discussion
Interventions
regarding COPD

• Independent

Independent nursing intervention:

1) nsg intervention: Position patient to facilitate ventilation/perfusion matching. Use

upright, high-Fowler’s position whenever possible
Rationale: High-Fowler’s position allows for optimal diaphragm excursion. When
patient is positioned on side, the good side should be down (e.g., lung with pulmonary
embolus or atelectasis should be up).

2) nsg interv.: Pace activities and schedule rest periods to prevent fatigue
Rationale: Even simple activities such as bathing during bed rest can cause fatigue
and increase oxygen consumption.

3) nsg interv.: Change patient’s position every 2 hours.

Rationale: This facilitates secretion movement and drainage.
Suction as needed. Suction clears secretions if the patient is unable to effectively clear
the airway.

4) nsg. Interv.: Encourage or assist with ambulation as indicated.

• Dependent Rationale: This promotes lung expansion, facilitates secretion clearance, and
stimulates deep breathing.

Dependent nursing intervention:

1) nsg intervention: Maintain oxygen administration device as ordered, attempting to

maintain oxygen saturation at 90% or greater.
Rationale: This provides for adequate oxygenation.

2) nsg interv.: Administer medication as prescribed by the physician

Rationale: A variety of medications may be used to decrease mucus and to improve
respiration.

3) nsg interv.: Provide supplemental humidification like nebulizer.

Rationale: Humidity helps reduce viscosity of secretions, facilitating expectoration,
and may reduce or prevent formation of thick mucus plugs in
bronchioles.

4) nsg. Interv.: Avoidance of sedative antianxiety agents unless specifically prescribed/

approved by physician treating respiratory condition.
Rationale: Patient may be nervous and feel the need for sadatives, these can depress
respiratory drive and protective cough mechanism.

5) nsg. Interv.: administer sup[lemental oxygen judiciously as indicated by ABG result

• Collaborative and patient tolerance.
Rationale: Prevent worsening of hypoxia.

Collaborative nursing intervention:

1) nsg intervention: Provide supplemental humidification; eg.,ultrasound nebulizer,

aerosol room humidifier.
Rationale: Humidity helps reduce viscosity of secretions,facilitating expectoration,
and may reduce/prevent formation of thick mucous plugs in bronchioles.

2) nsg interv.: Assist with respiratory treatments; eg., spirometry,chest physiotherapy.

Rationale: Breathing exercises helps enhance diffusion, aerosol/nebulizer medications
can reduce bronchospasmand stimulate expectoration. Postural drainage and
percussion enhance removal of excessive/sticky secretions and improve ventilation of
 bottom lung segments.

3) nsg interv.: Monitor/graph serial ABGs, pulse oximetry, chest x-ray.

Rationale: Establishes baseline for monitoring progression/regression of disease
process and complications.Note:Pulse oximetry readings detect changes in saturation
as they are happening, helping to identify trends possibly before client is symptomatic.
However, studies have shown that the accuracy of pulse oximetry may be questioned if
client has severe peripheral vasoconstriction.

4) nsg. Interv.: Prepare for additional referrals/intervention; eg. pulmonary specialist,

pulmonary rehabilitation program, surgical intervention, as appropriate.
Rationale: May be indicated to confirm diagnosis and optimize appropriate treatment.
A multidisciplinary approach including education and exercises training may be
helpful in improving client function and quality of life.