Chronic obstructive pulmonary disease (COPD): Nursing process (ADPIE)

James Robyn is a 67-year-old male client who was brought to the emergency department, or ED, with a 3-day history of exertional breathlessness, wheezing, fatigue, and a worsening productive cough.

He states he has been having increased difficulty with normal day to day activities such as eating, talking and going up the stairs.

He has a history of cigarette smoking, two packs per day, since he was 25 years old.

However, he quit smoking a year ago after being diagnosed with chronic obstructive pulmonary disease, or COPD.

COPD, or chronic obstructive pulmonary disease, is a type of lung disease where chronic inflammation causes damage to the lungs and obstructs airflow.

It’s usually caused by inhalation of toxic substances, like tobacco smoke, or occupational pollutants like dust and silica.

In some people an autosomal dominant disorder called alpha-1 antitrypsin deficiency results in breakdown of the lung parenchyma by an enzyme called elastase.

COPD is characterized by long-term inflammation of the bronchial tubes, referred to as chronic bronchitis, and alveolar destruction, referred to as emphysema.

Most people diagnosed with COPD have elements of both chronic bronchitis and emphysema.

Chronic inflammation of the bronchial tubes in COPD causes a hypersecretion of mucus by the respiratory goblet cells.

The mucus then forms a plug that obstructs the airways causing air trapping, and it also causes chronic productive cough.

Obstruction of the bronchi can also cause exertional dyspnea, which can progress to resting dyspnea, fatigue, wheezing and chest tightness.

Destruction of the alveolar sacs impairs gas exchange, resulting in hypoxemia and hypercapnia.

Loss of elastic recoil causes collapse of the airways during exhalation, trapping the air and dilating the airspaces.