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Slide1
Directions
Caring for the Patient with COPD Nursing Program1.5 CE1. This program is best viewed as “Slide Show”. 2. Before proceeding to the posttest, be sure you have completed the entire PowerPoint©.3. Exit the program and complete the posttest which is final step of this education. “Take Test” is a posttest. Remember, no attendance record is needed. Completion of the posttest will be sent electronically to your EduTracker record once a 100% is achieved. Print the CE Certificate of Completion for your records. Comments, questions, or suggestions can be directed to Maureen Cope or Ina Nechita in the COPD Care Coordination Office at 484-526-4227
This program is required for RNs on P5 & P6 and it is recommended for all RNs! Slide2
Caring for the Patient with Chronic Obstructive Pulmonary Disease
December, 2014Slide3
Objectives
At the conclusion of this program the learner will be able to:Identify COPD risk factors and the conditions that comprise it.Discuss diagnosis and staging of COPD.Differentiate between rescue and maintenance inhalers & proper technique of each. Identify non-pharmacological options for COPD treatment.Provide education to the patient on the COPD Zone Tool usage, which includes proper treatments for each zone. Describe the role of Pulmonary PALS Program in the care of the COPD patient.Slide4
Purpose
The purpose of the program is to provide RNs with information to enhance their knowledge for caring more effectively for patients with COPD and to provide guidelines and strategies for teaching patients to care for themselves.Slide5
What is
Chronic Obstructive Pulmonary Disease? COPD is a common preventable and treatable disease, characterized by
persistent airflow
limitation
.
It is
usually progressive and associated with an
enhanced chronic inflammatory response in the airways and lungs
due to
noxious particles or gases
.
Exacerbations
and comorbidities contribute to the overall severity in individual patients
.
Chronic
Bronchitis
&
Emphysema
are grouped under the generalized term COPD.
COPD
affects an estimated 24 million Americans
in all
fifty states.
Pennsylvania
ranks in the top third (#16)
for
COPD prevalence at 6.1%.
New Jersey has a lower prevalence rate of 4.3%.
Kentucky
has the highest COPD prevalence with a rate of 9.3%. Slide6
Risk Factors for Developing COPD
Smoking: COPD most often occurs in people age 40 and older with a history of smoking (either current or former smokers). As many as one out of six people with COPD have never smoked. Harmful pollutants: long-term contact with occupational chemicals, dust or fumes as well as household factors such as organic fuels from cooking and second hand smoke. Genetic factors: Alpha-1 Anti-trypsin deficiency (AATD) is the most commonly known genetic risk factor for emphysema. It is
caused by a deficiency of the
Alpha-1
Antitrypsin
protein.
- Without this protein
,
leukocytes begin
to harm the
lungs, causing lung deterioration. Because not all individuals with COPD have AATD, and because some individuals with COPD have never smoked, it is believed that there are other genetic predispositions to developing COPD. Slide7
A & P ReviewSlide8
Air
enters through the mouth or nose. After air passes through the trachea it branches off into the two bronchi. The entire airway is coated with hair-like structures called cilia. Combined with mucus, they sweep foreign particles from the lungs (with a cough or sneeze).
Within the lungs the bronchi split into
smaller tubules called bronchioles
. These tubes end in tiny round air sacs called
alveoli.
Image
from
:
http://www.nhlbi.nih.gov/health/health-topics/topics/hlw/system.html
Normal Lungs Slide9
Capillaries are the blood vessels that surround the alveoli. Oxygen from the alveoli enter into the capillaries to be disbursed into the circulatory system. The alveoli also give off carbon dioxide through the capillary wall
to be exhaled out of the lungs. The diaphragm is a large muscle that lies under the lungs and separates them from the organs below. As it moves down or flattens, the lungs expand and air is drawn in (inspiration). As the diaphragm relaxes, air leaves the lungs and they spring back to their original position (expiration).
http://www.bing.com/images/search?q=lungs+and+diaphragm&qs=IM&form=QBIR&pq=lungs&sc=8-5&sp=6&sk=IM5#view=detail&id=42C02D712C72E1EAF59699D3D064619BEE34509E&selectedIndex=22Slide10
Emphysema
Damage to the collagen and elastin fibers of the alveoli prevent them from expanding, causing air trapping. The alveoli weaken and eventually rupture causing reduced surface area for oxygen/carbon dioxide gas exchange. Normal patient presentation:
Barrel chested/flattened diaphragm due to hyperinflation of the lungs from air trapping
Nail clubbing and cyanosis due to chronic oxygen deprivation in advanced
stages
Decreased breath sounds due to air trapping
Typically thin physical appearance
Image from
http://gudhealth.com/emphysema.htmSlide11
Chronic Bronchitis
Irritation due to environmental triggers or infections causes the bronchial linings to become inflamed. The healthy cells are replaced by mucus-secreting cells. Irritants can also damage the cilia (hair like projections within the bronchioles) preventing the movement of excess mucus and irritants out of the lungs. The increased mucus causes bronchial and alveolar destruction leading to air trapping and
CO2 retention
.
Normal patient presentation:
Chronic productive cough of thick sputum for > 3 months x 2 consecutive years
Rhonchi
and
wheezing
Peripheral edema
Cyanotic
Usually overweight
Image
from:
http://www.thinkcopdifferently.com/en/About-COPD/What-is-COPD/Pathophysiology-of-COPDSlide12
DiagnosisSlide13
Diagnosis by Signs
& Symptoms Symptoms can vary from mild to severe: Chronic intermittent coughChronic sputum productionDyspnea - progressive and characteristically worsens with exercise.
Family
history of COPD Slide14
How is Spirometry used to diagnose COPD?
COPD causes air in the lungs to be exhaled at a slower rate and in smaller amounts compared to a normal healthy person. Measuring the ability to forcibly exhale air, called spirometry, can help determine the presence and severity of COPD. Spirometry can be done as part of a full pulmonary function test or by itself. FEV1 (forced expiratory volume in 1 second): measures how quickly the lungs can empty in one second. FEV1 naturally declines with age, but occurs at a must faster and more severe rate in those with COPD. FVC (forced vital capacity): amount of air which can be forcibly exhaled from the lungs after taking the deepest breath possible.Spirometry
SHOULD NOT
to be confused with
Incentive Spirometry
, a tool used to help keep lungs inflated. Incentive Spirometry is NOT recommended for COPD patients due to potential “air-trapping” in
hyper-inflated
lungs.Slide15
Diagnosis of COPD by Spirometry
“Spirometry is a method of assessing lung function by measuring the volume of air that the patient can expel from the lungs after a maximal inspiration.” ---Global Initiative for Chronic Obstructive Lung Disease (GOLD)Along with symptoms, spirometry helps to stage COPD severity and can be a guide to specific treatment steps.Spirometry is used to monitor disease progression. Intervals between measurements should be at least 12 months to be most reliable. It is not recommended to perform spirometry on a patient during an acute exacerbation of COPD. Slide16
Spirometry
Per GOLD guidelines, Spirometry is needed to make a firm COPD diagnosis. Slide17
TreatmentSlide18
COPD
Rescue Medications(Relievers)Short acting bronchodilators (SABAS)Provide quick relief of symptoms (wheezing, SOB) and should only be used when neededBronchodilator effects usually wear off within 4-6 hoursAdverse effects : tachycardia, tremors, hypokalemia ProAir HFA,
Ventolin HFA Proventil
HFA
Xopenex
HFA (Levalbuterol)
(
Albuterol) Slide19
Medications for COPD
Maintenance(Controllers) Long acting bronchodilators (LABAS): effect lasts 12 or more hoursconvenient and more effective at controlling symptomsAdverse effects: dry mouth, dysuria, constipation, headache, cold symptoms, cough, rapid heartbeat, nervousnessShould be taken every day in order to prevent exacerbations!
Spiriva
(
TiotropiuM)
Foradil
(formoterol
)
Combivent
Respimat
(
ipratropium/albuterol)
TudrzA
(
aclidinium)
Serevent
(salmeterol
)
Anoro Ellipta
(
umrclidinium/vilanterol
)Slide20
Medications for COPD
Maintenance Inhaled Corticosteroids (anti-inflammatory) - regular treatment improves symptoms, lung function & quality of life and reduces the frequency of COPD exacerbationsAdverse effects:associated
with higher prevalence of oral candidiasis
(thrush
), hoarse
voice,
and skin bruising
i
ncreased
risk of pneumonia
Flovent Discus
(Fluticasone)
Flovent HFA
(Fluticasone)
Pulmicort nebulizer
(Budesonide)
Should be used every day to prevent exacerbations! Slide21
Medications for COPD
Maintenance Combination Inhaled Corticosteroids/BronchodilatorAn inhaled corticosteroid combined with a long acting Bronchodilator is more effective than the individual components in improving lung function and health status and reducing exacerbations in patients with moderate to severe COPD.
Advair Diskus OR HFA
(Fluticasone/salmeterol
)
Symbicort
(Budesonide
/
Formoterol
)
Breo
Ellipta
(fluticasone and vilanterol)Slide22
Key Point
It is vital to teach patients the correct way to use their inhalers!Slide23
Metered
Dose Inhalers (MDIs)ShakeBreathe out, then hold
inhaler to lips
Spray 1 puff as you
b
reathe
in deeply for
5
seconds
.
Hold
for
count
of
10…
Breathe out
slowly…
Rinse mouthSlide24
Using MDIs with Spacers
Spacer:Device placed on the mouthpiece of an MDI (metered dose inhaler)Creates “space” between the mouth and the inhaler, allowing the medication to break into smaller droplets.Smaller droplets travel deeper into the bronchioles and do not require the patient to time his/her inhalation. Valved holding
chamber:
A specific type
of spacer
with a
one-way valve
close to the
mouthpiece
, holding the medication within the chamber to allow for a longer, deeper inspiration. Slide25
Proper Use of Inhalers
http://use-inhalers.com/The above link** will allow you to view short instructive videos on the proper use of various types of respiratory medication delivery devices. ** This link requires you to use an email address.** Please review the videos on the following devices (using the link above) so you can coach patients in their efforts to utilize them
effectively
!
Inhalers
with &
without use of spacers
Discus
devices (Advair, Serevent
)
Handihaler (Spiriva)
Ellipta
devices (Breo, Anoro)
Respimat (Combivent)Slide26
Nebulized Treatments
A nebulizer is a drug delivery device used to administer medication in the form of a mist inhaled into the lungs.Often used for patients with impaired cognitive abilities with poor inhaler technique, or for those with low inspiratory effort due to advanced pulmonary disease Medications used in the nebulizer may include inhaled bronchodilators, corticosteroids, & combination short acting bronchodilators Slide27
Nebulizer vs. Inhaler
Nebulizer Benefits:Easy to use No special technique requiredGood particle depositionMore effective for patients with low inspiratory effort. Challenges:Requires powerCan be noisyTakes time to completeRequires assembly and cleaningInhalerBenefits:Easy to carryPortable, lightweightQuick delivery of medicationChallenges:Requires coordination and proper technique for best resultsCommonly used incorrectlyMisuse can cause thrush
The benefit of each should be judged symptomatically and needs to be patient specific. A combination of the two methods can be used at different times throughout the
day.Slide28
Vaccinations
Influenza vaccination is recommended for patients with any chronic condition. Can reduce serious illness and death in COPD patients.Strains are adjusted every year for appropriate effectiveness and should be received annually. Pneumococcal polysaccharide vaccine has been shown to reduce the incidence of community-acquired pneumonia in COPD patients <65 years of age that have a low FEV1 of < 40%.COPD patients should be counseled to receive the pneumococcal vaccine at any age. Slide29
COPD: Therapeutic Mucous Clearance
DevicesFlutter ValvesRecommended for patients with COPD and Cystic Fibrosis who have dyspnea due to excessive mucus production.Assists the patient with mobilizing their secretions.Uses positive end pressure (PEP) therapy to create airway vibrations. This regulates the movement of mucus and transfers
it from
peripheral (small) airways
to
central (bigger) airways
where it can be easily coughed
out.Slide30
Coaching the Patient on Use of the Flutter Valve
Breathe in from the diaphragm through the mouthpiece, taking a larger than normal breathHold breath for 2-3 seconds Exhale actively, not forcefully through the device (exhalation should be 3-4 times longer than inhalation)Adjust dial to assure exhalation is 3-4 times longer than inhalationPerform 10-20 breathsRemove mouthpiece and perform 2-3 “huff” coughs to raise
secretions
Repeat 4 times
daily
Note: The Flutter can be used in conjunction with a nebulizer treatment. See package instructions for proper setup.Slide31
COPD Management: Putting it all together!Slide32
COPD: Stages
Stage I: Mild Rescue inhaler as neededSmoking cessationFlu and pneumonia vaccinationHealthy nutrition/Exercise
Stage
II: Moderate
Rescue
inhaler as needed or timed
basis
Controller
medication (Long acting
bronchodilator/corticosteriod)
Pulmonary
Rehab
Stage III:
Severe
Continue
same treatment as stage
II
Add supplemental
oxygen
Stage
IV: Very Severe
Bronchodilators/inhaled steroid
BiPAP/supplemental oxygen
Pulmonary Rehab
Lung
volume reduction
surgery
Psychological &
social
support
Nutritional counseling
OpiatesSlide33
COPD
Care ContinuumSlide34
Patient EducationSlide35
Education for the COPD Patient
COPD definition and diagnosisCOPD ZONE TOOLMedications: schedule, purpose, & side effectsInhalers: maintenance vs rescue, proper technique Smoking
cessation
Mucus clearance
Energy conservation/Pulmonary
Rehab
Nutrition therapy
Purse lipped breathing
Preventing respiratory infections
Oxygen
t
herapy & safety
Better Breathers
support
g
roupSlide36
Patient Education Using
Teach BackExample: have the patient SHOW the proper inhaler technique and TELL the purpose of the inhalerTake the opportunity to provide gentle correction, review, and/or praise for the concepts.For more information about Teach-back, see the education program called “
Patient
Education using
the Teach-Back Method
”
MyNET > Learning tab > Tracker Trainer linkSlide37
Documenting COPD Education
Assure completion, take credit for your work!Slide38
Have an Action Plan!!
Green Zone: Good to Go!Yellow Zone: Take Action! (prescribed medications, call your doctor)Avoid the Red Zone: call for an emergent appointment or go to the
Emergency
Room!
Warning signs of a problem
:
increased shortness of breath,
wheezing or coughing; increased
mucus or mucus that has an odor,
has changed color or
is bloody;
chest tightness that
does not go away with normal medications;
sore
throat or hoarseness;
fatigue
(more than
usual).
It is important for COPD patients to recognize their own usual signs of an exacerbation and
to follow
the action plan designed for them by their COPD
provider!Slide39
Preventing Infections
Influenza and pneumococcal pneumonia vaccinations are recommended by GOLD.Wash hands frequently with soap, water, and friction for 15 seconds, then rinse. Hand sanitizer may be used as an alternative to soap & water.Avoid touching your face with your hands -- this keeps bacteria away from the warm moist environment of the nose.Avoid people with colds and other respiratory infections. Avoid large crowds and air travel during flu season.Slide40
IMPACT of Smoking
Effects of smoking:COPDHeart diseaseStrokeCancersPneumoniaInfluenzaDamage to major organsDamages lung tissue and irritates airways: direct correlation to COPD Damages cilia to render them ineffective for clearing mucus, bacteria and dirt from the airways.
The effects of smoking
.
1992
2002
Smoking one
large cigar is the equivalent of smoking an entire pack of cigarettes!! Slide41
Chemicals Found in Tobacco Smoke
Ammonia: poisonous gas, cleaning agentFormaldehyde: preservativeCarbon monoxide: auto exhaust poisonHydrogen cyanide: in chemical weaponsAcetone: poisonous solventPolonium 210: radioactive
element
Benzoic Acid
Angelica root extract
:
causes
cancer in animals
Arsenic
:
used
in rat poison
Benzene
:
makes
dyes, synthetic rubber
Butane
:
gas
found in lighter fluid
Cadmium
:
used in car batteriesCyanide: deadly poisonDDT: banned insecticideLead: poisonous in high dosesMethanol: rocket fuelMethoprene: insecticide
Nicotine
:
addictive
drug, pesticide Slide42
Smoking Cessation=Abstinence
Pharmacotherapy DOUBLES quit rateNicotine Replacement Therapy (NRT)Reduces cravings/withdrawal symptomsProvides same positive effects of nicotineVery safe - same drug in a lower dose in a less addictive form over shorter period of timeFirst line medications:Nicotine GumNicotine PatchNicotine Lozenge
Nicotine Nasal Spray
Nicotine Inhaler
St. Luke’s Smoking
Cessation
484-526-2100Slide43
Smoking Cessation
=AbstinencePharmacotherapy DOUBLES quit rate Non-nicotine Replacement Therapy (NNRT) Bupropion (Zyban/Wellbutrin)Stimulates dopamine release from the brain, causing a “feel good” effectDoes NOT contain nicotineNot addictive but will reduce cravings and withdrawal symptomsVarenicline (Chantix)Blocks nicotine’s ability to bind to receptors
Lowers amount of dopamine into the brain
Adverse effects of NNRT include:
Headache
Nausea
Dry mouth
Insomnia
Slide44
Nutrition - Weight
Loss and COPDWeight loss can be common in people with COPD.Causes: Loss of appetite: “food does not taste good” Chewing, swallowing and breathing adds to dyspneaDrugs can interfere with nutrient absorptionBloating sensation due to swallowing air during acute dyspneaSlide45
Nutrition
The work of breathing consumes many calories in a COPD patient.Coughing, excessive mucus, chest discomfort can make it difficult for patients to eat. Balanced meals are important.
Many
patients require extra calories/protein to combat weight and muscle loss.Slide46
Optimal Nutrition for the COPD Patient
The following are some strategies to help COPD patients get optimal nutrition:Eat smaller, more frequent meals whenever hungryGet plenty of fluids: water, high calorie/high nutrient beveragesHomemade milk shakesMilk or cream based soups in moderationAvoid carbonated beverages (increases bloating)
High
calorie, nutritious foods
:
Healthy oils, cream cheese, margarine, butter, nut butters
Regular cheeses, salad dressings, dips, sour cream, ice cream
Yogurt, cottage cheese
Foods high in
protein: eggs
, milk, meats, poultry, fish, nuts, beans
Milk
has
calcium, protein, vitamins A
, D
,
& B
12
Foods with fiber:
whole
grains,
fruits, vegetables
Foods with nutrients: colorful fresh vegetables, enriched grainsSlide47
Suggestions to improve
food intake:Cook food until soft (to decrease work of chewing)Mince meatsDip harder/crunchier foods in liquidsChoose softer foods like pasta, mashed potatoes, thick or creamed soups, casserolesDrink milk shakes/eggnogsEat frequent, nutritious snacks instead of 3 large mealsSlide48
Dealing with Dyspnea
SOB makes everyday tasks take longer Encourage patients to maximize energy by planning activities in advance Important activities completed earlier with 20 – 30 min rest periods in betweenDo not wait until overtired to stop and restAllow plenty of time to do
activities
Encourage
patients to find ways to conserve energy:
Appliances to make work lighter
Using assistive devices to dress, shop
Wheeled carts to move things in the house and in
stores
Keep the items used most at waist level to avoid reaching and
bending
Pursed lip breathing (PLB):
p
ositive internal pressure can maintain higher airway pressures in the larger airways, preventing airway collapse
caused by emphysema
Avoid encouraging deep breathing, as this contributes to greater air trappingSlide49
Patient Education
for Pursed Lip BreathingRelax neck and shoulder musclesBreathe in for two (2) seconds through the nose, keeping the mouth closedBreathe out for four (4) seconds through pursed lips…if this is too long,
simply breathe out twice as long as you breathe
inSlide50
Increasing
Endurance & StrengthExercises Shoulder pressBiceps curl Side lift Leg raises Wand work Roller coaster waveStationary bicycle TreadmillSlide51
Oxygen Therapy & Safety
DO NOT smoke when oxygen in useKeep oxygen at least 10 feet away from open flames (includes gas range)Hang oxygen signs in clearly visible locations in the home settingDO NOT use petroleum based products on face and upper chest. Water based products
(i.e.: Aquaphor®) are acceptable for
lubrication of dry nasal
membranes
Use
electrical appliances with
caution
Avoid tripping/entanglement on tubing
Do
not store oxygen canisters
in closed spaces
Maintain working smoke detectors & monitor battery life
Keep
f
ire extinguishers nearbySlide52
Pulmonary Rehab
Pulmonary rehabilitation is a non-pharmacologic therapy that has emerged as a standard of care for patients with COPD & other chronic lung diseases.Pulmonary rehabilitation is a comprehensive, multidisciplinary, patient-centered intervention that includes patient assessment, exercise training, self-management education, and psychosocial support. Pulmonary rehabilitation is usually performed in outpatient, hospital-based settings lasting 6 to 12 weeks.Pulmonary rehabilitation should be considered in all COPD/chronic pulmonary patients who remain symptomatic or have decreased functional status despite optimal medical management.
Demonstrable improvement in lung function (spirometry results)
may not improve, however pulmonary rehabilitation allows the COPD patient
to
have:
-increased
exercise
tolerance
-reduced
dyspnea and
anxiety
-increased self-worth
-improvement
in health-related quality of
life
-reduced
hospital
admissionsSlide53
St. Luke’s Pulmonary Rehab Facilities:
Fountain HillBethlehemCoaldaleQuakertown Phillipsburg, NJ Slide54
Pulmonary PALS
Pulmonary PALS* is a program designed by the COPD & palliative care teams to help patients & significant others deal with the long term effects of symptomatic, advanced lung disease.* This is not Hospice*Goals are patient-centered to relieve suffering & manage symptoms while maintaining the best quality of life.
Patients
receive usual medical care enhanced by a team of healthcare providers with specialized knowledge in COPD & palliative care.Slide55
1) Chronic pulmonary conditions including COPD & ILD (Interstitial Lung
Disease)/pulmonary fibrosis confirmed via spirometry within the past 2 years.2) For patients with COPD: BODE index score of 6-10. (BODE predicts all cause mortality and
respiratory
related mortality with better accuracy than FEV1
alone) BODE index explanation in upcoming slide.
3)
Two or more hospitalizations in one year for respiratory related
diagnoses.
4
) Need
for continuous oxygen
therapy.
5) Pulmonary care: must be under the care of a pulmonologist
OR
have an evaluation by
a pulmonologist prior to enrollment.
Secondary
criteria:
6) Decline
in quality of
life – the patient is unable
to carry out
activities
of
personal value
due
to
impaired respiratory
status.
7)
Persistent respiratory functional
decline.
Pulmonary PALS Enrollment CriteriaSlide56
Pulmonary PALS
Team members include: Palliative medicinePulmonary medicine COPD Care Team coordinatorsHome Health Services (nursing, PT,OT, personal care aides & hospice liaison)
The
PALS Team collectively reviews each case individually to see if the patient with advanced COPD/lung disease & a high symptom burden would benefit from the program
. Slide57
What is the BODE index?
Body mass index - Airflow Obstruction - Level of Dyspnea - Exercise capacityVariable Points on BODE 012
3
FEV1 (%
predicted)
>=65
50-64
36-49
<=35
6 minute walk test
>=350 m
250-349 m
150-249 m
<=149
MMRC dyspnea scale
0-1
2
3
4
BMI
>21
<21
The BODE index is a predictor of COPD mortality by measurement of the following:Degree of pulmonary impairment (
FEV
1
)
Patient’s perception
of
dyspnea (MMRC
dyspnea scale
)
Distance walked
in six
minutes with responding SpO2 levels
BMI
BODE
predicts all cause mortality and
respiratory
related mortality with better accuracy than
FEV1 alone. Slide58
Patient
SupportSt. Luke’s COPD Care Team (484-526-4227) SLB, SLW, SLA - soon to be network-wide Maureen Cope, BSN, RN & Ina Nechita, BA, RRT St. Luke’s Better Breathers Club3rd Thursday of the month 6-7:30pmMOB, Anderson CampusInfo Link 1-866-STLUKES (785-8537)
St. Luke’s Pulmonary Rehab
Info Link 1-866-STLUKES (785-8537)
St. Luke’s Smoking Cessation
484-526-2100
COPD Foundation
www.copdfoundation.org Slide59
St.
Luke’s Better Breathers Support Group Offers patients the opportunity to learn ways to better cope with chronic pulmonary disease while getting the support of others who share in their struggles. Led by a certified Better Breathers facilitatorSupported by the American Lung Association
Provides education on various topics pertinent to lung health:
How COPD affects the lungs
Breathing techniques
Exercise
Talking with your physician
Medications and other treatment options
Medical tests
Supplemental
oxygen
Home health care
Lung transplants
Air pollutionSlide60
References
www.copdfoundation.orgwww.medline.govhttp://use-inhalers.comwww.goldcopd.comSlide61
Questions about this educational presentation ?
Maureen Cope, BSN, RN Ina Nechita, BA, RRT Nancy Leitgeb, RN, OCN Terrance Hill MPA, BS, RRT Terry Nemeth, MS, RN Clinical EducationSpecialist - SLUHRespiratory Therapy Dept.
St Luke’s Quakertown
COPD Care Coordination
Education Coordinator
St Luke’s Home Health
& Hospice Slide62
Thank You!
Close the PowerPoint© programTake Test This program awards 1.5 CEPrint a copy of the certificate for your filesQuestions about this educational program or COPD Care Coordination should be directed to Maureen Cope or Ina Nechita at 484-526-4227.