Chronic obstructive pulmonary disease (COPD)

Definition COPD (chronic obstructive pulmonary disease), is a progressive disease that makes it hard to breathe. "Progressive" means the disease gets worse over time.

Key points COPD encompasses two diseases: emphysema and chronic bronchitis. Most clients who have emphysema also have chronic bronchitis. Emphysema is characterized by the loss of lung elasticity and hyperinflation of lung tissue (destruction of the alveoli), causing impaired gas exchange, and respiratory acidosis. Chronic bronchitis is an inflammation of the bronchi and bronchioles due to chronic exposure to irritants. COPD typically affects middle age to older adult

Risk Factors Cigarette smoking is the primary risk factor for the development of COPD. Alpha1-antitrypsin (AAT) deficiency Exposure to air pollution

Diagnostic and Therapeutic Procedures and Nursing Interventions Pulmonary Function Tests Chest X-ray; ◦ Reveals hyperinflation and flattened diaphragm in late stages of emphysema. ◦ Often not useful for diagnosis of early or moderate disease. Arterial Blood Gases (ABGs) ◦ Serial ABGs are monitored to evaluate respiratory status. ◦ Increased PaCO2 and decreased PaO2 ◦ Respiratory acidosis, metabolic alkalosis (compensation) Pulse Oximetry ◦ Monitor oxygen saturation levels. ◦ Less than normal (normal = 94 to 98%) oxygen saturation levels

Diagnostic and Therapeutic Procedures and Nursing Interventions Peak Expiratory Flow Meters ◦ Used to monitor treatment effectiveness. ◦ Decreased with obstruction; increased with relief of obstruction AAT levels are used to assess for AAT deficiency. Monitor Hgb & Hct to recognize polycythemia (compensation to chronic hypoxia). Evaluate sputum cultures and WBCs for diagnosis of acute respiratory infections. Chest physiotherapy uses percussion and vibration to mobilize secretions, and positioning

Assessments Signs and symptoms: ◦ Chronic dyspnea ◦ Chronic cough ◦ Hypoxemia ◦ Hypercarbia (hyprcapnia) ◦ Respiratory acidosis and compensatory metabolic alkalosis ◦ Crackles ◦ Rapid and shallow respirations

Assessments Use of accessory muscles Barrel chest or increased chest diameter Hyper-resonance on percussion (emphysema) Asynchronous breathing Thin extremities and enlarged neck muscles Dependent edema secondary to right-sided heart failure Pallor and cyanosis of nail beds and mucous membranes (late stages of the disease)

Assess/Monitor Client’s history (occupational history, smoking history) Respiratory rate, symmetry, and effort Breath sounds Activity tolerance level and dyspnea Nutrition and weight loss General appearance Vital signs Heart rhythm Pallor and cyanosis ABGs, SaO2, CBC, WBC, and chest x-ray results

NANDA Nursing Diagnoses Impaired gas exchange Ineffective breathing pattern Ineffective airway clearance Imbalanced nutrition Anxiety Activity intolerance Fatigue

Nursing Interventions Position the client to maximize ventilation (high-Fowler’s). Encourage effective coughing, or suction to remove secretions. Encourage deep breathing and use of incentive spirometer. Administer breathing treatments and medications as prescribed (like asthma)

Nursing Interventions Administer heated and humidified oxygen therapy as prescribed; Monitor for skin breakdown from the oxygen device. Why? Clients with COPD may need 2 to 4 L/min per nasal cannula or up to 40% per Venturi mask. Why? Instruct clients to practice breathing techniques to control dyspnic episodes.

Nursing Interventions Determine the client’s physical limitations and structure activity to include periods of rest. Promote adequate nutrition. Increased work of breathing increases caloric demands. Proper nutrition aids in the prevention of secondary respiratory infections. Provide support to the client and family. Encourage verbalization of feelings. Encourage smoking cessation if applicable.

Complications and Nursing Implications Respiratory Infection ◦ Results from increased mucus production and poor oxygenation. ◦ Administer oxygen therapy. ◦ Monitor oxygenation. ◦ Administer AB and other medications as prescribed. Right-sided Heart Failure (cor pulmonale) ◦ Air trapping, airway collapse, and stiff alveoli lead to increased pulmonary pressures. ◦ Blood flow through lung tissue is difficult. This increased work load leads to enlargement and thickening of the right atrium and ventricle.

Manifestations include Hypoxia, hypoxemia. Cyanotic lips. Enlarged and tender liver. Distended neck veins. Dependent edema. Nursing Interventions ◦ Monitor respiratory status and administer oxygen therapy. ◦ Monitor heart rate and rhythm. ◦ Administer positive inotropic and contractility medications as prescribed, like what? ◦ Administer IV fluids and diuretics to maintain fluid balance.