Running head: CHRONIC OBSTRUCTIVE PULMONARY DISEASE 1

Chronic Obstructive Pulmonary Disease: Teaching Plan for Damien

Courtney Eades

Brigham Young University Idaho School of Nursing

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This Photo by Unknown Author is licensed under CC BY-SA
Goals for Damien:
Together, we will work to prevent
exacerbations, slow progression
of the disease, continue living life
independently, and improve
quality of life (Lewis et al., 2017,
p. 572). I will teach you about your
medications and treatments to
encourage you to adhere to the
treatment plan to accomplish
these goals.
Patient Condition:
COPD is a disease manifest by a
chronic inflammatory response in
the lungs which decreases the
elasticity of the airways and
causes airway obstruction (Lewis
et al., 2017, p. 557). It is
irreversible and incurable, but is
manageable with
pharmacological and
nonpharmacological
interventions (Saunier, 2017, p.
258). COPD is the 3rd leading
cause of death in the United
States, and about 15.7 million
Americans have COPD (Saunier,
2017, p. 259).
Risk Factors:
The biggest risk factor for COPD
is smoking cigarettes (Lewis et
al., 2017, p. 557). Smoking
cigarettes damages the cells of
the lungs which leads to major
problems such as narrower
airways and more difficulty
clearing secretions (Lewis et al.,
2017, p. 557). There are also some
genetic predispositions for
developing the disease which is
evident because only 15% of
smokers get the disease (Lewis et
al., 2017, p. 557).
Problems the patient and
family will likely experience:
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Chronic
Obstructive
Pulmonary
Disease
Teaching Plan for
Damien
Exhalation becomes difficult from
the decreased elasticity in the
airways causing air trapping in the
lungs (Lewis et al., 2017, p. 559).
Resultant high levels of CO2 and
low levels of O2 lead to
exhaustion for the patient (Lewis
et al., 2017, p. 559). Also because
of air trapping, the lungs expand,
and the patient must breathe
while the lungs are in this
hyperinflated state (Lewis et al.,
2017, p. 559).
Manifestations of the disease
are
shortness of breath and
difficulty with activity,
a chronic, productive
cough,
a sensation that your
chest feels heavy
fatigue
(Lewis et al., 2017).
CHRONIC OBSTRUCTIVE PULMONARY DISEASE
Gradually, you may feel a need to
change your daily habits because
of the debilitating fatigue (Lewis
et al., 2017, p. 560). For example,
you may feel that you are not
able to take the stairs in
buildings. At times, this fatigue
requires family members to help
in the care of the patient which
affects the familys daily lives.
Be aware that anxiety and
depression often develop in
patients with COPD because of
fear of disease progression, social
isolation because of fatigue,
inability to keep job or take care
of self, etc. (Lewis et al., 2017, p.
574). Being aware of these
feelings can help you talk about
them, prevent further emotional
and mental breakdown, and
improve quality of life.
Getting enough sleep can
improve quality of life (Lewis et
al., 2017, p. 575). Sleeping can be
difficult in patients with COPD,
and therefore, sleep testing may
be recommended to develop
ways to improve sleep (Lewis et
al., 2017, p. 575).
Ambulatory/home care
environment:
Stairs in the home can become
difficult to navigate. Cooking,
cleaning, gardening, lawn work,
etc. may become problematic.
Occupational therapists may
need to be consulted for ways to
conserve energy while
performing activities of daily
living (Lewis et al., 2017, p. 573).
Simple ways are to sit down for as
much of these activities as you
can and to perform as many
activities in the tripod position as
possible (Lewis et al., 2017, p.
573). For example, you can put
your mirror flat on a table and
lean over it to shave (Lewis et al.,
2017, p. 573).
While walking or exercising in any
way try to perform pursed lip
breathing (Lewis et al., 2017, p.
573).
Keep ready prepared meals for
times that energy is not sufficient
for cooking (Lewis et al., 2017, p.
571).
A job with exposure to dust,
pollutants, or other irritants in the
air raises risks for acute
exacerbations. Brick laying may
expose you to dust and irritants.
Therefore, be careful and have
your inhaler ready while you are
at work.
Treatment:
Treatment may include
Oxygen therapy
Medications such as
bronchodilators,
corticosteroids, and
antibiotics
Pulmonary rehabilitation
(Saunier, 2017, p. 258).
Other treatment options include
CPAP or BiPap machines (Lewis
et al., 2017, p. 564).
During treatment, you will also
have tests run such as:
Arterial blood gases to
check oxygen and carbon
dioxide levels in the blood
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Sputum cultures to check
for infection and possible
pneumonia
Peak flow tests and
spirometry to measure
pulmonary function
6-minute walk test to
observe breathing during
activity
Chest x-ray
(Lewis et al., 2017).
Salbutamol is a bronchodilator
which means it relaxes the
airways and allows them to
expand and get more air (Lewis et
al., 2017, p. 562). This can reduce
the feeling of breathlessness and
help prevent exacerbations
(Lewis et al., 2017, p. 562). Your
doctor has prescribed that you
use your salbumatol inhaler every
4-6 hours as you feel it is needed.
It is very important to follow
treatment plan prescribed by
doctor to prevent exacerbations
and promote health.
Health Promotion/ Disease
Prevention:
The most important intervention
for anyone with COPD at any
level of severity is to quit smoking
(Lewis et al., 2017, p. 562). If you
quit smoking, you can prevent
future exacerbations as well as
substantially slow the progression
of the disease (Lewis et al., 2017,
p. 562). Therefore, the sooner a
patient with COPD quits smoking,
the better their pulmonary
function will be (Lewis et al.,
2017, p. 562). Resources for
smoking cessation can be found
in websites including
CHRONIC OBSTRUCTIVE PULMONARY DISEASE
www.lung.org, www.cancer.org,
and www.smokefree.gov (Lewis
et al., 2017, p. 147).
It is especially important for
patients with COPD to receive the
yearly influenza vaccine and the
pneumococcal vaccine because
they are at greater risk to develop
these infections (Lewis et al.,
2017, 562).
A combination of incentive
spirometry and coughing will also
be key to clearing secretions and
preventing the development of
pneumonia (Lewis et al., 2017, p.
569).
It is important that you are using
your inhaler correctly to get the
benefits from the medication.
1. Shake the inhaler
medication.
2. Take a deep breath and
exhale all the way.
3. Place your mouth around
the mouthpiece.
4. Press the button for
release of medication and
inhale slowly.
5. Hold that breath for 5-10
seconds.
6. Exhale through the nose
or pursed lips (Yoost &
Crawford, 2016, p. 855).
Recognizing acute episodes:
Acute exacerbations are common
for patients with COPD, and they
occur more frequently as the
disease progresses (Lewis et al.,
2017, p. 564).
According to Lewis et al. (2017),
the signs of an acute
exacerbations include increased
dyspnea [(difficulty breathing)],
increased sputum [(substance
coughed up)] volume, or
increased sputum purulence (p.
564). Recognizing these
symptoms and prompt
interventions can prevent
hospitalization (Lewis et al., 2017,
p. 564).
It is important to recognize the
signs of an exacerbation
emergency. According to Saunier
(2017), these signs and symptoms
include:
Fever, chills
Chest pain
Confusion or drowsiness
Severe shortness of
breath even at rest
(p. 260).
Strategies for more effective
breathing:
According to Damle, Shetye, and
Mehta (2016), pursed-lip
breathing keeps the airways more
open during expiration, creates
more positive pressure within the
lungs, and allows more air to
escape which will let you tolerate
more activity (p. 59).
To use pursed-lip breathing:
1. Inhale deeply and slowly
through the nose
2. Exhale through pursed lips
(as if you are whistling)
4
Make breathing out 3x
longer than inhaling
Do 8-10 repetitions, 3-4
times per day
(Lewis et al., 2017, p. 554).
Nutrition
Malnutrition is common among
patients with COPD because of
increased metabolic rate,
increased ventilator effort,
fatigue, decreased appetite, and
more (Lewis et al., 2017, p. 570).
To improve appetite and energy
at meal times, patients should
rest 30 minutes before a meal as
well as take their bronchodilator
inhaler prior to meals. Getting
exercise during the day as
tolerated can increase appetite.
You can consult with a dietician
to get advice on the best foods to
eat for best nutrition.
Maximizing Food Intake in
COPD
Eat high calorie foods first.
Limit liquids at mealtimes.
Rest before meals.
Try more frequent meals
and snacks.
Keep favorite foods and
snacks on hand.
Keep ready-prepared
meals available for times
when you have increased
shortness of breath.
Eat larger meals when you
are not as tired.
(Lewis et al., 2017, p. 571).
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References

Damle, S. J., Shetye, J. V., & Mehta, A. A. (2016). Immediate Effect of Pursed-lip Breathing

while Walking During Six Minute Walk. Indian Journal of Physiotherapy and

Occupational Therapy, 10, 56-61.

Lewis, S. L., Bucher, L., Heitkemper, M. M., Harding, M. M., Kwong, J., & Roberts, D. (2017).

Medical-Surgical Nursing Assessment and Management of Clinical Problems (10th ed.).

St. Louis: Elsevier.

Saunier, D. T. (2017). Creating an Interprofessional Team and Discharge Planning Guide to

Decrease Hospital Readmissions for COPD. Medsurg Nursing, 26, 258-262.

Yoost, B. L., & Crawford, L. R. (2016). Fundamentals of Nursing. St. Louis, Missouri: Elsevier.