chronic obstructive pulmonary disease (COPD)

obstructive pulmonary disease

• asthma

• COPD

• cystic fibrosis

COPD

• preventable, treatable, but often progressive disease characterized by persistent airflow limitation

• associated with enhanced chronic inflammatory response in airways and lungs

• primarily caused by cigarette smoking and other noxious particles and gases

• previously considered a combination of chronic bronchitis and emphysema

COPD pathophysiology

• long-term disease that causes ongoing inflammation in the airways, alveoli, and blood vessels in lungs

• makes it hard ti breathe out air fully

• lungs lose natural elasticity

• airways become blocked due to too much mucus, edema of lining, and tightening of muscles around airways (bronchospasm)

clinical manifestations of COPD

• chronic intermittent cough (often first symptom)

• increased anteroposterior diameter of chest due to hyperinflation (barrel chest)

• breath sounds

  • decreased

  • wheezing, rales, or ronchi

• prolonged expiration

• signs of advanced disease include

  • pursed lip breathing

  • neck vein distention/peripheral edema (may indicate pulmonary HTN)

  • cachexia, fatigue, anorexia, weight loss

diagnostic studies for COPD

• history and physical exam

• spirometry

• cxr (not diagnostic)

• serum a1-antitrypsin levels

• ABGs

• 6 minute walk test

• COPD assessment test (CAT) or clinical COPD questionnaire (CCQ)

clinical course of COPD

• slowly worsens over time

• irreversible airflow limitation

• exacerbations

  • sudden worsening of symptoms (triggers like infection, air pollution)

  • may require hospitalization

  • often increase in frequency as disease progresses

• disease stages (based on severity)

  • mild → moderate → severe → very severe

  • based on lung function tests

COPD related nursing problems

• activity intolerance

• ineffective breathing pattern

• ineffective airway clearance

• impaired gas exchange

• anxiety

• poor nutritional status

COPD related nursing implications

• smoking cessation = single most effective and cost effective intervention to reduce risk for COPD and disease progression

• teach influenza and pneumonia vaccine adherence

• teach early detection of respiratory infections

• inhaler therapy = mainstay for COPD self-management/adherence is critical

  • long acting beta agonist (mainstay of treatment)

  • long acting muscarinic antagonist

  • inhaled corticosteroids

• O2 administration - target O2 sat 88-92%

• teach tripod position and pursed lip breathing

• review cough techniques

• teach energy conservation and relaxation exercises

• will need extra calories for increased WOB

• provide psychosocial support

management of acute exacerbation

• worsening of dyspnea, cough or sputum beyond typical variations that require a change in treatment plan

• oxygen is mainstay of hospital treatment when hypoxemia is present

  • keep O2 sat >90%

  • oxygen should never be withheld

  • noninvasive ventilation (positive pressure ventilation) when hypercapnic

• bronchodilators

• chest physiotherapy

• possibly antibiotics