COPD

Question 1

Symptoms/Clinical Presentation

Answer 1

• dyspnea, difficulty breathing, or shortness of breath and limitations in activity.
• Cough
• Weight Loss and Fatigue
• Respiratory Effort
• Hypoxemia and Hypercapnia
• Bluish-red colour of skin
• Polycythemia and cyanosis
• Symptoms are usually insidious in onset and progressive.
• People with COPD often display characteristics of both chronic bronchitis and emphysema.
• 9.7% of Canadians >35 years of age have COPD.

Question 2

COPD: Pathophysiology

Answer 2

• chronic inflammation of the airways, respiratory bronchioles, alveoli, and pulmonary blood vessels
• reversible airflow limitation during forced exhalation
• caused by loss of elastic recoil and airflow obstruction from mucus hypersecretion

The inflammatory process starts

1) inhalation of noxious particles (e.g. cigarette smoke)
2) causes the release of inflammatory mediators that damage lung tissue.
3) causes tissue destruction and disrupts the normal defense mechanisms and repair process of the lung.
4) irritating effect causes hyperplasia which
a) increases mucus production
b) causes difficulty in clearing secretions.

Supporting structures of lungs are destroyed.

• Air goes in easily but remains in the lungs.
• Bronchioles tend to collapse.
• Causes barrel-chest look.

Common characteristics

• Mucous hypersecretion
• Dysfunction of cilia
• Hyperinflation of lungs
• Gas exchange abnormalities

Question 3

COPD: Diagnostic tests

Answer 3

• Diagnosis confirmed by pulmonary function tests
Chest x-rays, spirometry, history, and physical examination are also important in the diagnostic workup.

• Spirometry typical findings
Reduced FEV1/FVC ratio
Increased residual volume

• ABG typical findings
 Low PaO2
↑ PaCO2
↓ pH
↑ Bicarbonate level found in late stages of COPD

• Walk test (6 min.) to determine O2 desaturation in the blood with exercise
• ECG can show signs of right ventricular failure.

Question 4

COPD Risk factors

Answer 4

• Cigarette smoking (even 2nd hand)
• Occupational chemicals and dusts
• Infection
• Heredity
• Aging

Question 5

COPD Complications

Answer 5

1. Cor pulmonale
2. Acute exacerbations of COPD
3. Acute respiratory failure
4. Depression, anxiety, and panic

Question 6

COPD Treatments

Answer 6

• O2 therapy. Long-term continuous (more than 15 hr/day) oxygen therapy (LTOT) increases survival and improves exercise capacity
• Smoking cessation
•Drugs
>  Bronchodilators
> Long-acting anticholinergic 
> Inhaled corticosteroid therapy
• Humidification (O2 has a drying effect on the mucosa)
• Lung volume reduction surgery 
• Lung transplantation 
• Nutritional therapy (for weight loss)

Question 7

list Airway Clearance Techniques

Answer 7

Diaphragmatic Breathing
Postural Drainage
Percussion
Vibration (facilitate movement of secretions to larger airways.)
High-Frequency Chest Wall Oscillation ( high-frequency airwaves dislodge mucus from the airways)

Question 8

Health Promotion

Answer 8

> Abstain from or stop smoking
Avoid or control exposures to occupational and environmental pollutants and irritants
Early detection of small-airway disease
Early diagnosis and treatment of respiratory infection
Awareness of family history of COPD and AAT deficiency

Question 9

Nursing Management
Assessment
Diagnoses
Planning

Answer 9

Nursing Assessment
Complete health history and complete physical assessment (subjective and objective data obtained related to COPD)

Nursing Diagnoses
Ineffective airway clearance
Impaired gas exchange
Ineffective breathing pattern
Imbalanced nutrition: less than body requirements
Disturbed sleep pattern
Risk for infection

Planning
Prevention of disease progression
Ability to perform ADLS
Relief from symptoms
Improvement in exercise tolerance
Prevent and treat exacerbations
Improved quality of life
Reduction in premature mortality

Question 10

COPD medications

Answer 10

Bronchodilators (mild-moderate)
Corticosteroids (FEV1 less than 60%)
Roflumilast

Question 11

CODP nutritional considerations

Answer 11

Weight loss and malnutrition are common with COPD
Use a bronchodilator before meals
Rest before eating
5 – 6 small meals
Possible hypermetabolism
1.2 – 1.3 times normal kilocalorie requirements to maintain weight
High calorie, high protein, taken between meals
2 – 3 L fluid intake between meals
Cold food may cause less fullness than hot foods.

Question 12

Nursing Interventions/Evaluation

Answer 12

Nursing Interventions
• Provide ventilation assistance to promote gas exchange, oxygenation, and perfusion.
• Teach cough enhancement techniques to promote expectoration of secretions.
• Encourage use of airway clearance techniques and provide airway management as necessary.
• Provide oxygen therapy and administer medication to prevent and treat hypoxemia.
• Monitor for signs of malnutrition and educate patients about proper nutrition and calorie intake.

Evaluation
• The nurse determines that treatment was effective if the patient:
• Experiences a return to baseline respiratory function
Demonstrates an effective rate, rhythm, and depth of respiration
• Maintains a clear airway
• Experiences clear breath sounds

Question 13

Patient Education

Answer 13

• Activity considerations – exercise training leads to energy conservation.
• Sexual activity
Plan when breathing is best.
Use slow, pursed li[ breathing
Refrain after strenuous activity
Do not assume dominant position or prolong foreplay.
• Sleep
Can be difficult because of medications, postnasal drip or coughing (what might help this?)
• Psychosocial considerations
Healthy coping is difficult
May feel guild, depression, anxiety, social isolation, denial and dependence