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Dear Ms. Bloomfield,

It was a privilege to discuss you your desire to quit smoking in order to control you
recently diagnosed COPD. Although it may be a difficult road ahead, I am confident that you
will be able to accomplish this goal. I would also like you to know that the staff at the Country
Corner Clinic and I are here if you need help along the way. Below I have outlined the major
points of our conversation along with other reference material. Again, I am here to help you
through this journey. Either I or another nurse here at the clinic will always be available if you
have further questions.

-Cassity Clay, SN.

What is COPD and What Causes it?

Chronic obstructive pulmonary disease,

commonly known as COPD, is a progressive disease
where excess air gets trapped in the lungs due to
chronic inflammation of the airways as seen in the
picture to the right (Lewis et al., 2017, p. 557). COPD,
which is more common in women, is the third leading
cause of death in the United States and affects 30
million people nationwide (COPD foundation, 2017).
Common causes of COPD include smoking, air
pollution, chemical fumes, and dust particles (National
Heart, Lung, and Blood institute, 2017). The number
one leading cause of COPD is cigarette smoke. The
National Heart, Lung, and Blood institute, 2017.
smoke causes damages to the elastic tissue in the lung
which makes it tough for them to recoil during exhalation.
Due to this loss of elastic tissue in the lungs your body has compensated by making expiration an
active process which is discussed below.

How Does Inspiration and Expiration of Air Work in COPD?

The inspiration and expiration process can be compared to filling a balloon with air.
When you fill a balloon with air you are actively using your muscles in order to do so. This is the
same mechanism used when you inhale a breath of air. The main muscle that aids in this process
is the diaphragm, which is a dome-shaped muscle that lies directly under the lungs. On the other
hand, deflating the balloon should not require any effort. However, this process of passive,
meaning no effort is required, expiration is hindered in COPD. Due to the inflammation of the
airways, expiration becomes an active process like inspiration, meaning muscles that normally
wouldnt be used are put to work to expel residual air in the lungs. This causes you to feel
especially tired during exercise because you have to work twice as hard in order to breathe
(BreathinStephen, 2013).
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How does/will COPD Affect me and my Family? Is it Contagious?

COPD is not a contagious disease as it is not caused by a virus or bacteria. However, it

can still have detrimental impacts on your personal life, especially if it continues to progress. You
have expressed and noticed that activities, such as exercise, now require a great deal of effort.
Your goal to quit smoking is imperative to keep such symptoms from becoming progressively
worse. If your lifestyle remains unchanged, smaller tasks, such as walking or climbing stairs, will
also cause you to feel exhausted as the disease progresses further.

How can I Control COPD at Home?

As we have previously discussed, smoking cessation will have the biggest impact on
disease progression. However, there are other factors in your surrounding environment that can
cause an increase in the severity of the disease. These factors include, pollutants, second hand
smoke, and inhalation of fine dust particles (Lewis et al., 2017, p. 562). Due to these other risk
factors, it is advised that you keep your distance from the irritants listed above. If being around
these irritants is unavoidable, you should wear a mask to protect yourself. Further, if you are
going to be in a very polluted area you should check the air quality for the day and plan
accordingly. In addition to unclean air in the environment, air contaminants may also be present
in the home, and you may want to consider purchasing an in-home air filter.

Health Management

Management of COPD includes breathing training, exercising, and staying hydrated.

Lets begin by discussing breathing techniques.

Pursed lip breathing: This method promotes the expiration of trapped air out of the lungs.

1. Begin by inhaling through the nose slowly and count to two. A deep breath is not needed.
2. Purse your lips as shown in the diagram below shows.
3. Exhale slowly while counting to four (Cleveland Clinic, 2017)
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Exercising and Hydration: It is also an important factor in health maintenance and has many
benefits. These benefits include; improved circulation, which allows the body to use more
oxygen; building energy levels, which allows you to participate in more activities without
becoming tired; and strengthening your heart and cardiovascular system. Also, exercising
actually improves COPD symptoms by strengthening upper respiratory muscles (Clevland
Clinic, 2017). Aerobic exercises, which require oxygen, are preferred for patients with COPD.
Such exercises include: Walking, swimming, running, dancing, skiing, and cardio machines. Try
to work up to exercising for at least 20-30 minutes each day. Staying hydrated is important in
order to thin the secretions in your airways for easier removal. Try to drink three liters of water a
day.

Acute Episode Prevention

Acute episodes of COPD are also known as flare-ups, in which you may have increased
trouble breathing and worsening symptoms (WebMD, 2016). In order to prevent these episodes,
it is important to:
Stay away from crowds during cold and flu season.
Get a yearly flu shot.
Check if you are due for you pneumococcal and pertussis vaccine.
Avoid touching your mouth, eyes, and nose in public in order to avoid germs.
Get plenty of sleep. When your body is tiered your immune system drops which increases
the risk for infection.
Drink plenty of water. Mucous build-up is a prime area for the growth of bacteria.
Maintain drug regimen.
Continue smoking cessation (COPD foundation, 2017).

Symptoms and Management of Acute Episodes

Symptoms of an acute episode of COPD include:

Wheezing more than what is normal for you.
Coughing more than normal.
Increased shortness of breath.
Fever.
Shallow or rapid respirations.
Confusion and excessive sleepiness.

If these symptoms occur and persist, make an appointment with Doctor Small to rule out an
infection. The initial treatment will be to increase the dosage of your albuterol inhaler in order to
open up the airways. Then, depending on the severity of the episode and if there is an underlying
infection, you may be prescribed antibiotics, oxygen supplementation, nebulizer treatments, and
possibly a steroid.
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Long-term Treatment

Since the main treatment for COPD is smoking cessation, you

have been prescribed a nicotine patch to help you during this
process. You will be started on a 21mg patch and the dosage will
be decreased over the course of 10-12 weeks. Below are the
instructions on how to use the patch:

1. Prepare an area of skin for the patch by cleaning and

drying it.
2. Remove packaging from patch and quickly place it on the skin, holding it for 10 seconds.
3. Remove the patch after 24 hours to decrease skin irritation.
4. Replace the patch in a new location to prevent skin irritation (Quit.com, 2016).

In addition to the nicotine patch, you have been prescribed an albuterol inhaler, which aids in
opening up the airways. Since your COPD is currently a very mild form, Doctor Small feels it is
only necessary for you to use the inhaler before exercise and at times when you are experiencing
extreme shortness of breath. However, due to your history of hypertension, overuse of your
inhaler can cause your blood pressure to rise. For this reason, do not exceed more than two puffs
a day. If you are still experiencing extreme shortness of breath after the use of the inhaler, call
911. Below I have outlined the instructions on how to use the inhaler.

1. Remove the cap from the inhaler and shake the contents of the inhaler vigorously.
2. Breathe out forcefully.
3. Put the inhaler in your mouth.
4. Begin breathing in slowly. As you do so, press down on the inhaler one time.
5. Continue to breath in slowly.
6. Hold your breath for 10 seconds.
7. If shortness of breath is not relieved, wait one minute and re-administer drug. (Lewis et
al., 2017, p. 549).
8. If you wish to view a live demonstration, I have provided a URL for a live video
demonstration. https://youtu.be/vb5DzrCONrA
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Works Cited

Breathinstephen. (2013, January 24). Air-trapping in COPD. Retrieved from

http://breathinstephen.com/life-after-the-blog/

Cleveland Clinic . (2017). COPD Guidelines For Exercise & Pulmonary Rehab. Retrieved from
https://my.clevelandclinic.org/health/articles/copd-exercise-and-activity-guidelines

Cleveland Clinic. (2017). Pursed Lip Breathing Techniques for COPD. Retrieved from
https://my.clevelandclinic.org/health/articles/pursed-lip-breathing

COPD Foundation. (2017). COPD Guidelines For Exercise & Pulmonary Rehab. Retrieved from
https://my.clevelandclinic.org/health/articles/copd-exercise-and-activity-guidelines

COPD Foundation. (2017). COPD Statistics Across America. Retrieved from

https://www.copdfoundation.org/What-is-COPD/COPD-Facts/Statistics.aspx

COPD Foundation. (2017). Staying Healthy and Avoiding COPD Exacerbations. Retrieved from
https://www.copdfoundation.org/What-is-COPD/Living-with-COPD/Staying-Healthy-
and-Avoiding-Exacerbations.aspx

Lewis, Sharon, Shannon Dirksen, Margaret Heitkemper, Linda Bucher, Mariann Harding,
Jeff. Medical-Surgical Nursing: Assessment and Management of Clinical Problems (pp.
557). Single Volume, 10th Edition. Mosby, 2017.

Lewis, Sharon, Shannon Dirksen, Margaret Heitkemper, Linda Bucher, Mariann Harding,
Jeff. Medical-Surgical Nursing: Assessment and Management of Clinical Problems (pp.
562). Single Volume, 10th Edition. Mosby, 2017.

Lewis, Sharon, Shannon Dirksen, Margaret Heitkemper, Linda Bucher, Mariann Harding,
Jeff. Medical-Surgical Nursing: Assessment and Management of Clinical Problems (pp.
549). Single Volume, 10th Edition. Mosby, 2017.

National Heart, Lung, and Blood institute. (2017, April 28). What Is COPD? Retrieved from
https://www.nhlbi.nih.gov/health/health-topics/topics/copd.

Quit.com. (2017). How to Use NicoDerm CQ. Retrieved from

https://www.nicodermcq.com/products/how-to-use-nicoderm-cq.html.

WebMD. (2016). Signs of a COPD Flare-Up. Retrieved from http://www.webmd.com/lung/10-

signs-copd-exacerbation#2.