Acute COPD- Assessment

Question 1

COPD exacerbation assessment: History

Answer 1

Onset and cause of exacerbation (compared to baseline)
Severity of symptoms
If the patient is on O2 at home
If the patient smokes

Question 2

COPD exacerbation assessment: subjective symptoms

Answer 2

increased sputum volume, purulent sputum, acutely worsening dyspnea, chest tightness, increased bronchodilator use, malaise/fatigue, decreased exercise tolerance

Question 3

COPD exacerbation assessment: PE and vitals

Answer 3

level of consciousness, TEMPERATURE (fever), tachypnea, tachycardia, O2 sat

Question 4

COPD exacerbation assessment: PE respiratory exam

Answer 4

wheezing/rhonchi, decreased breath sounds

Question 5

COPD exacerbation assessment: labs

Answer 5

Possible ABG, VBG (use bicarb and pH)
WBC for viral/bacterial infections, steroids
Electrolytes: K, Mg depending on bronchodilator used, glucose (steroids)
Vitamin D: supplement if there’s deficiency (<10ng/ml, 25nM)

Question 6

COPD exacerbation assessment: diagnostics

Answer 6

Sputum sample: gram stain/culture
Chest x-ray

Question 7

Indications for hospital assessment

Answer 7

Severe symptoms such as sudden worsening of resting dyspnea, high respiratory rate, decreased oxygen saturation, confusion, drowsiness

Acute respiratory failure

Onset of new physical signs (cyanosis, peripheral edema)

Failure of an exacerbation to respond to initial medical management

Presence of serious comorbidities (HF, newly occurring arrhythmias, etc.)
Insufficient home support