COPD Management and Primary Care

This assignment delves into the critical topic of Chronic Obstructive Pulmonary Disease (COPD) management within primary care environments. It explores various aspects, including the pathophysiology of COPD, effective treatment strategies, the importance of symptom assessment, and the multifaceted roles of healthcare professionals, particularly registered nurses, in providing comprehensive patient-centered care.

Running head: NURSING CARE FOR COPD
Nursing Care for COPD
Name of the student:
Name of the university:
Author note:

1NURSING CARE FOR COPD
Table of Contents
Introduction: 2
Nursing intervention for COPD: 5
Health coaching, self-management, empowerment and advocacy: 10
Collaboration by registered nurse: 11
Conclusion: 12
References: 13

2NURSING CARE FOR COPD
Introduction:
The health care industry has advanced considerably in the past few decades and what used to
be an incurable morbidity, taking hundreds of lives; now there are different treatment options for
it. However, it also needs to be considered that despite all the technological revolution in the
health care industry, there still is a number of emerging public health concerns that mortality
rates are increasing rapidly (Lisspers et al., 2014). One of the most common of these health
priorities can be considered the chronic obstructive pulmonary disorder that targets more than
34% of the global population and this particular health disorder contributes to a large proportion
of mortality to the health care sector.
Chronic obstructive pulmonary disorder or COPD is a respiratory disease which can be
characterized by the blocked respiratory airways, shortness of breath and excessive sputum or
cough production. The patient suffering with COPD can be cared for optimally if a
multidisciplinary team having different experts belonging to different care sectors; ho can
address differential care needs of the patient. This assignment will attempt to evaluate all aspects
associated with caring for a patient suffering with COPD taking the help of a case study.
Interrelationship of complexity, chronicity and co-morbidity in healthcare
COPD is the chronic illness and is associated with various comorbidities such as diabetes
mellitus, cardiac disease, osteoporosis, hypertension, muscle weakness and other psychological
disorders (Mellado et al., 2016). Chronicity of the illness refers to the condition that is difficult to
be cured. Comorbidities are the medical condition that are associated and occur together with the
main illness. These comorbidities add to the complexity of the chronic disease. COPD is the

3NURSING CARE FOR COPD
complex disease, as the patient had to cope up with various other comorbidities, which increases
the length of the hospital study and exacerbation of COPD symptoms (Donner et al., 2017).
Therefore, it mandates the need of more than one drug to fight the comorbidities along with
COPD. Risk factors such as smoking, medication interaction, aging and lack of treatment of
comorbidities add to the complexity of the comorbidities and outcomes in the patients with
COPD. The complexity of the presentation of the symptoms makes it challenging for the
clinicians to mage the chronic disease (De Lucas-Ramos et al., 2017). Thus, the complexity,
chronicity and the comorbidity is interrelated in the health care and this concept must be clear to
the health care providers to rightly handle the upcoming challenges.
In the given study, Angela (COPD patient) was presented to her GP with increasing shortness
of breath, increased sputum production, which has changed to dark yellow with green staining.
Her condition is worsening daily. She is feeling unwell since several days. Her SaO2 is 84% on
room air, temperature 38.4 C, She is significantly dyspnoeic, struggling to say more than 5 words
without a breath. Her pulse is 104bpm and her BP remains elevated at 162/102mmHg. Due to
inadequate intake of the medication, her symptoms have exacerbated. Consequently, she had to
increase her antibiotics, nebulisers and oxygen therapy to maintain SpO2 above 92%. Due to
hospitalisation, her mental well-being is affected. She is more upset due to burden of illness,
inconvenience caused to her family, and at unable to care for daughters. Thus, chronic illness and
associated comorbidities makes treatment more complex that ultimately affected both the
physical and mental wellbeing.
Pathophysiology of COPD
COPD is characterised by airway inflammation, structural changes in the airway and
mucociliary dysfunction. As a consequent of exposure to the inhaled irritants such as polluted

4NURSING CARE FOR COPD
air, tobacco smoke a chronic inflammation of the airway and lung tissues occurs along with the
inflammation in the blood vessels (Celli, 2014). When the irritants are inhaled, it stimulates the
lymphocytes, neutrophils, CD8+ T-lymphocytes, and other inflammatory cells such as
macrophages, and B cells. These stimulated cells are activated to trigger a cascade (Celli, 2014).
Firstly, the inflammatory mediators are released such as interferon gamma, tumour necrosis
factor alpha, C-reactive protein, and interleukins (IL-1, IL-6, IL-8). These mediators can sustain
the inflammatory process. They induce range of systemic effects and leads to tissue damage
(Rodríguez-Roisin, 2014).
Secondly, the chronic illness leads to various structural changes in the lugs that limit the
airflow. The airway inflammation remain associated with the COPD due to airway remodelling.
The narrowing of the airway is caused by the peribronchial fibrosis, over multiplication of the
epithelial cells of the airways, damage of the airway and build-up of the scar tissues (Mitchell,
2015). This results in the loss of lung tissue elasticity. It is caused by the damage of the
structures that support alveoli. It results in collapse of small airways on exhalation. It causes
trapped air in the lungs and impedes airflow. This reduces the lung capacity (Pouwels et al.,
2017).
Thirdly, the mucous glands are enlarged by smoking and consequent inflammation. These
glands line the lung airway and upon enlargement, it leads to goblet cell metaplasia. Ultimately,
the region is filled with mucous secreting cells. COPD inflammation damages the mucociliary
transport system that cleans the airway mucus. Eventually mucous is accumulated in the airways
that blocks and worsen the airflow (Rogers, 2014).
The pathophysiology of COPD detailed above can be related with the case study. Angela
experiences dyspnoea and shortness of breath. Dyspnoea results due to airflow obstruction and

5NURSING CARE FOR COPD
exertion. The damage caused to lungs makes it hard to breath as the airflow is limited. It takes
more efforts to make air travel. The breathing irritants may have damaged the tiny air sacs within
the lungs. Therefore, the COPD patients develop emphysema. The shortness of breath is also
related to irritants and mucous that cause swelling and inflammation. In case of Angela,
shortness of breath can also be the sign of flare up or exacerbation. It may be also be caused by
the infections, Flu or pneumonia (Mitchell, 2015). The elevated blood pressure in Angela can be
related with the pulmonary hypertension due to arteries that transfer blood to lungs. It forces a
patient to breath faster (Rodríguez-Roisin, 2014).
Nursing intervention for COPD:
Nursing
diagnosis
Care goals Interventions Rationale Expected
outcome
Shortness of
breath or
dyspnoea.
 The patient
will retain
normal
breathing
pattern
 The patient
will
maintain
normal
respirator
rate.
 Placing the
patient in the
semi-fowlers
position.
 Performing
CPT or chest
physical
therapy to the
patient.
 Increasing the
fluid intake of
the patient
 This will
allow the
patient to
have
maximum
lung
expansion
and the
breathing
rate will
subsequently
The patient
experience
easier
breathing
exercise.
The patient
no longer
experience
s dyspnoea
and the
breathing
rate of the
patient

6NURSING CARE FOR COPD
 The oxygen
saturation
limit of the
patient will
increase.
considerably.
 Maintaining a
patent airway
technique,
and secrete
suctioning is
also
performed as
per the
discretion of
the medical
practitioner.
 Providing
respiratory
support to the
patient in
case of
aggravated
dyspnoea
(Punekar,
Shukla &
Müllerova,
2014).
increase.
 Increasing
the fluid
intake of the
patient will
liquefy the
secretions as
soon as
possible (van
der Molen &
Cazzola,
2012).
 As dyspnoea
is
characterized
by the
blocked
airways due
to the
accumulation
of sputum,
the
suctioning
returns to
normal.

7NURSING CARE FOR COPD
 Administerin
g cough
suppressant
medicines
and
analgesics if
the patient
experiences
pain and
discomfort in
the chest or
airway.
will remove
the excess
cough and
clear the
airways.
 In case the
dyspnoea of
the patient is
aggravated
and the
patient
cannot
breathe on
her own,
respiratory
support will
help in
stabilizing
her
condition.
 The cpugh
suprresants
will liquefy

8NURSING CARE FOR COPD
the
accumulated
cough and
the mild
analgesics
will help the
patent feel
comfortable.
Ineffective
airway
clearance
 Maintaining
the airway
patency of
the patient
with the
breathing
sounds
getting
clearer.
 Demonstrati
ng breathing
interventions
to the patient
to improve
airway
 Auscultation
of the
breathing
sounds of the
patient
checking for
wheezes,
crackles or
rhonchi.
 Assessment
of respiratory
rate taking
into accounts
both the
inspiratory
 It will
indicate if
the patient is
expressing
any
indication of
bronchospas
m.
 It will assess
whether the
patient has
tachypnea
(van der
Molen,
Miravitlles &
The airway
of the
pati9ent
will be
effectively
cleared.
The patient
will face
no
difficulties
in maintain
normal
breathing
pattern.

9NURSING CARE FOR COPD
clearance by
the means of
effectively
coughing
and
secretion
removal.
and
expiratory
ratio.
 Assessing the
presence of
air hunger in
the patient,
characterized
by
restlessness,
respiratory
distress, and
excessive
usage of
respiratory
muscles.
 Providing a
comfortable,
safe, warm
environment
for the patient
which is
absolutely
Kocks,
2013).
 Presence ofb
air hunger
i9n the
patient will
indicate at
the onset of
severe
respiratory
dysfunction
in the patient
aggravated
by any
infection of
allergic
reaction.
 A warm and
comfortable
environment
will help the
patient relax,
and the

10NURSING CARE FOR COPD
devoid of any
environmenta
l pollution
(van der
Molen,
Miravitlles &
Kocks, 2013).
 Administratio
n of
intervention
techniques
like oral
bronchodilato
rs, pursed lip
breathing
exercises,
suctioning,
bronchial
tapping while
coughing, etc.
absence of
any polluter
like dust,
smoke will
help in
minimizing
the infection.
 These
intervention
techniques
will help the
patient
breathe more
effectively
and facilitate
better airway
clearance
(Glaab et al.,
2012).
Risk for
infection
 The patient
will
communicat
 Monitoring
the
temperature
 The fever
might be
indicative of
The patient
will not
acquire
any

11NURSING CARE FOR COPD
e the
probable
risk factors
or
grievances.
 Identificatioj
and
administrati
on of
interventions
that reduce
the risk for
infection.
 Facilitating
changes in
the lifestyle
of the
patient to
promote safe
and
comfortable
environment
of the patient
 Observing the
nature, colour
and odour of
the sputum
(Davis et al.,
2015).
 Engaging the
patient in
effective and
hygienic
disposal of
sputum and
handwashing
.
 Administratio
n of oral
antibiotics if
presence of
infection is
confirmed.
the onset of
infection in
the patient.
 Presence of
odor, or
yellowish to
greenish
coloration in
the sputum is
indicative of
pulmonary
infection.
 Will reduce
the risk of
infection.
 Antibiotics
will
effectively
combat the
spreading
infection
(Lisspers et
al., 2014).
infection
while
staying in
the facility
and will
attain a
speedy
recovery.

12NURSING CARE FOR COPD
Health coaching, self-management, empowerment and advocacy:
COPD is the leading cause of death in many countries and most people are not aware of
the factors that exacerbate the symptoms. It is necessary for the patients to learn the COPD
conditions and factors of exacerbations. Learning about the comorbidities makes the patient
take better care of health. Therefore, coaching is necessary to aware patients on the indoor
and outdoor air pollutants that can block the airway. It will help the patients to avoid the risk
factors. Coaching the patient will help in the early detection, prevention, improved treatment
and care (Baker & Fatoye, 2017).
In case of Angela, she must be taught about the side effects of medications (oral
prednisolone, salbutamol) and signs that need immediate attention of the GP. She must be
educated on the self-management skills. Self-management of COPD includes smoking
cessation, self-care of exacerbations, participating in physical activities, performing breathing
exercises, maintaining proper diet, adhering to the medications prescribed by the GP (). It
will reduce the exacerbations as Angela is repeatedly admitted in hospital due to poor
medication adherence and delayed intervention. According to Lenferink et al. (2017)
comprehensive self-management is possible by coaching the patients and it has been found
effective to some extent in improving the quality of life. Reducing the exacerbation will
relive a Angela of anxiety and stress due to frequent hospitalisation. It will empower her to
have faith in her medication. It will increase her self-efficacy and participate actively in
treatment process.

13NURSING CARE FOR COPD
Collaboration by registered nurse:
Registered nurses are in the key position to manage the COPD patients. The nurse must
collaborate with the patients and her family members to enhance the care. The nurse must be
able to initiate life style management plan for Angela. The nurse must consult with the
dietician to develop appropriate diet plan for Angela. The nurse must collaborate with social
worker to help Angela deal with any other psychosocial factors hampering her health such as
caring for her daughters (Efraimsson et al., 2015). On addition addressing the funding issues
and recognising other barriers is necessary to improve the patient wellbeing. Since COPD
involves comorbidities, the registered nurse must collaborate with the pulmonologists
(optimising treatment), respiratory therapists (ventilator support therapies, inhaler training),
case managers (coordinate care needs after discharge) and information system specialists (for
designing the medication reconciliation plan) (Flinter et al., 2017).
Conclusion:
On a concluding note, it can be said that chronic obstructive pulmonary disorder or COPD is
a respiratory disease which can be characterized by the blocked respiratory airways, shortness of
breath and excessive sputum or cough production. There can be a varied reasons contributing to
the formation of this disease although the most common risk factors associated with this disease
are excessive smoking, past medical history of chronic asthma, and genetic inclination towards
developing this disease. COPD is associated with a highly specialized yet diverse care planning
and interventions must be aligned to the specific needs and requirements of the patient in order to
avoid any further complication.