Running head: CHRONIC OBSTRUCTIVE PULMONARY DISEASE 1

Chronic Obstructive Pulmonary Disease

Carlie Eaves

Brigham Young University-Idaho

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Chronic Obstructive Pulmonary Disease

Educational packet and care plan specifically designed for the use of Ms. Bloomsfield to

assist in the control and management of Chronic Obstructive Pulmonary Disease (COPD) and

hypertension, related to 20+ pack years of cigarette smoking and recent cough and SOB during

exercise. The plan outlines causes, risk factors and other background for the patient conditions

and treatment goals, interventions, and expected outcomes.

Causes of Condition

COPD

COPD is a chronic condition of the lungs that results in decreased forced expiratory

volume and a decreased forced expiratory volume to forced vital capacity ratio. This simply

means that there is air trapped in the lungs even after total forced expiration. This condition is

caused by, “cigarette smoking and other noxious particles and gases,” (Lewis, Dirksen,

Heitkemper, Bucher, Harding, & Jeff, 2017, p. 557). The other particles and gases can include

pollution, occupational chemicals, and smoke from second-hand sources, such as living with or

being in a close proximity to a person who smokes on a regular basis. Smoking causes COPD by

damaging the respiratory tract and its defense mechanisms. Effects of smoke on the respiratory

tract include destruction of the mucocilliary escalator, which removes secretions from the lungs,

“abnormal dilation of the distal air space with destruction of alveolar walls,” (Lewis et. al., 2017,

p. 557) decreases in the enzymes necessary to protect the lungs, and increased growth of the cells

in the lungs (Lewis et. al., 2017). These physiological changes increase the risk of developing

COPD and other lung diseases.

Hypertension
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Primary hypertension is “elevated BP without an identified cause,” (Lewis et. al., 2017,

p. 684). Secondary hypertension, on the contrary, has a specific cause that can be corrected with

treatment. These causes include, “cirrhosis, coarctation or congenital narrowing of the

aorta…endocrine disorders…neurologic disorders…renal disease…sleep apnea,” (Lewis et. al.,

2017, p. 684) and more. These can be treated to subsequently decrease the blood pressure.

Incidence of Disease

COPD

COPD incidence has risen drastically in the United States over the last few years, “an

estimated 12.7 million adults in the United States over age 18 have COPD,” (Lewis et. al., 2017,

p. 557). The disease is not only prevalent, it is also causing death and discomfort to those

affected, “according to the World Health Organization (WHO), it is the fifth most common cause

of death and the 10th most burdensome disease,” (Afonso, Verhamme, Sturkenboom, &

Brusselle, 2011, p. 1873). This disease affects more men than women, however the incidence in

women has been rising recently, “probably due to increased number of women smoking

cigarettes,” (Lewis et. al., 2017, p. 557). There is a direct correlation to the number of people,

especially women, who smoke, and the incidence of COPD. This is resulting in increased

hospitalizations and exacerbations of this disease.

Hypertension

Hypertension, often known as the silent killer due to its particularly devastating effects on

the heart, “affects one in three adults in the United States,” (Lewis et. al., 2017, p. 681). National

averages have been increasing with the rise in fast food, cheap and easy microwavable meals,

and a more quickly paced lifestyle for the majority of American citizens over the last few years.

Risk Factors
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COPD

COPD risk factors include genetic, environmental, and personal components that all

increase the likelihood of developing the condition and experiencing more exacerbations. One

personal preference that has been observed to increase incidence is smoking, “more women with

COPD or asthma smoke, and that such women have higher nicotine addiction levels, [which]

may in part explain why the prevalence of COPD and asthma is increasing more among women

than men,” (Vozoris & Stanbrook, 2011, p. 483). This risk factor is modifiable, as a patient can

use several different resources and overcome their smoking habit. Other factors, however, are not

possible to adjust, such as the genetic alpha 1-antitrypsin (AAT) deficiency, which,

“approximately 3% of all people diagnosed with COPD may have undetected AAT deficiency,”

(Lewis et. al., 2017, p. 558). The normal function of AAT is to protect lung tissue during times

of inflammation, caused by smoking or infection. When AAT is deficient then the lung is more

likely to be damaged, resulting in COPD and other conditions. Additional unmodifiable risk

factors include age, male gender, and the presence of asthma (Lewis et. al., 2017).

Hypertension

Many of the risk factors for hypertension, such as alcohol intake, tobacco use, excessive

dietary lipids and sodium, obesity, stress, and lifestyle. With simple interventions, these risk

factors can be decreased, in turn, decreasing blood pressure. Other risk factors include age,

family history, and ethnicity (African Americans have higher incidences).

Disease Impact on Patient and Family

COPD and hypertension adversely affect many aspects of patient and family life,

including social interactions, exercise and recreational activities, and travel. Patients with COPD

experience shortness of breath, are easily fatigued and have difficulty performing physical
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activity. For the specific patient, Ms. Bloomfield, her ability to camp and view the stars is

affected by her smoking habits. With the progression of COPD and hypertension, Ms.

Bloomsfield could become restricted in her ability to camp outside and study the stars. She is at

higher risk for cardiac events and complications with her hypertension, which could make it

risky to camp outside and be far from medical care. The patient will need to adjust her lifestyle

to compensate for energy lost with COPD, for example, the patient may need to rest for several

minutes before eating and may tire before the meal is finished. This may make the patient

embarrassed and decrease her desire to eat with friends or family. In addition, increased fatigue

may cause the patient to buy more meals instead of cooking, which could exacerbate her

hypertension.

Controlling Disease Factors

The patient may have difficulty controlling her COPD and hypertension due to her

smoking habit, which has been difficult for her to quit. Even after quitting, the patient may have

difficulty staying clean of cigarettes due to the increased smell of smoke in the house and on

clothing. In addition, because the patient has smoked for so long, many of her habits include

smoking, which makes it difficult to stop. Patient is not married, which may make it difficult to

cook healthy meals for self. This could contribute to hypertension due to the high sodium content

in fast foods and quick meals. Finally, shortness of breath may make it difficult for patient to

continue exercise. The following care plan was prepared to address these factors.

Care Plan

The care plan for Ms. Bloomsfield was individualized to her specific needs. Several goals

outlined include:

Goal #1 Health Promotion Activities

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Health promotion activities specific for the patient include involvement in a smoking

cessation program, which includes a support group for those who are in the process of quitting,

regular exercise as planned by the patient, and adjustments to the patient’s diet, as coordinated

with the dietician. These activities combined will decrease progression of the disease, help the

patient regulate her blood pressure, and assist the patient to remain active while living with the

disease.

Goal #2 Disease Prevention Interventions

Disease prevention interventions include wearing a mask when camping in locations near

wildfires. The patient will be educated on the air pollution rating scale and how to tell when the

air quality is low. This will help the patient decide whether or not to go outside on certain days.

Goal #3 Illness Management for Acute Episodes

For acute episode management, the patient should be educated on medications used for

hypertension and breathing treatments as prescribed by the doctor. Hypertensive medications will

decrease and regulate blood pressure, however, in an acute episode of high blood pressure, medical

advice may be required. Breathing treatments will help the patient to open her airways and excrete

any extra air. In addition, when breathing becomes difficult, patient will be encouraged to use

pursed lip breathing to increase carbon dioxide excretion, and tripod positioning to increase ease

of respirations.

Goal #4 Treatment Options and Teaching Tools

The patient has many options for treatment, including dietary consults, exercise programs

at the gym, and smoking cessation support groups. Exercise programs with friends or family and

specific incentives to complete programs are very useful. Teaching tools include online diet plans

and tracking tools, in addition to brochures and handouts about exercise and the DASH diet.
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Conclusion

In conclusion, as the patient applies concepts in the care plan, she will decrease

exacerbations of COPD and hypertension and enjoy a higher quality of life.

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References

Afonso, A. S. M., Verhamme, K. M. C., Sturkenboom, M. C. J. M., & Brusselle, G. G. O.

(2011). COPD in the general population: Prevalence, incidence and survival. Respiratory

Medicine, 105(12), 1872-84.

doi:http://dx.doi.org.byui.idm.oclc.org/10.1016/j.rmed.2011.06.012

Lewis, S., Dirksen, S. R., Heitkemper, M., Bucher, L., Harding, M. M., Jeff. (2017). Medical-

Surgical Nursing: Assessment and Management of Clinical Problems, Single Volume,

10th Edition. [Pageburstl]. Retrieved

from https://pageburstls.elsevier.com/#/books/9780323328524/

Vozoris, N. T., & Stanbrook, M. B. (2011). Smoking prevalence, behaviours, and cessation

among individuals with COPD or asthma. Respiratory Medicine, 105(3), 477-84.

doi:http://dx.doi.org.byui.idm.oclc.org/10.1016/j.rmed.2010.08.011