Essential COPD Information and Management

Aug 17, 2024

COPD (Chronic Obstructive Pulmonary Disease) Overview

Key Concepts

  • COPD is a combination of emphysema and chronic bronchitis, leading to irreversible airway obstruction.
  • Differentiated from asthma which is reversible and intermittent.

Pathophysiology of COPD

  • Emphysema: Destruction of alveoli, causing decreased lung elasticity, hyperinflation, and air trapping.
  • Chronic Bronchitis: Inflammation of airways and hypersecretion of mucus.
  • Combined effects lead to:
    • Hypoventilation
    • Hypoxemia (low oxygen in blood)
    • Hypercapnia (retention of carbon dioxide)

Risk Factors

  • Smoking: Primary risk factor.
  • Air pollution and occupational exposure to chemicals or dust.

Signs and Symptoms

  • Cough and excess sputum
  • Lung sounds: Crackles and wheezes
  • Percussion: Hyper-resonance (due to trapped air)
  • Physical signs:
    • Barrel chest
    • Use of accessory muscles
    • Clubbing (enlarged fingertips with spoon-shaped nails)
    • Cyanosis
    • Rapid, shallow respirations
    • Tripod position: Leaning forward to ease breathing

Diagnosis

  • Decreased Oxygen Saturation (SpO2): Typically lower than normal ranges (below 95%)
  • Arterial Blood Gas changes: Increased PaCO2 and decreased PaO2
  • Diagnostic Tests:
    • Pulmonary function tests
    • Chest x-ray

Treatment

  • Medications:
    • Bronchodilators
    • Anticholinergics
    • Corticosteroids
    • Mucolytics
    • Oxygen therapy

Nursing Care

  • Position patient upright to facilitate easier breathing.
  • Administer oxygen as prescribed.
  • Monitor for complications such as right-sided heart failure.

Patient Education

  • Smoking cessation: Strong encouragement to quit smoking.
  • Breathing techniques:
    • Abdominal breathing
    • Pursed-lip breathing
  • Effective coughing techniques
  • Incentive spirometer usage: Inhale (not exhale) through spirometer, aim for 10 times per hour while awake.
  • Dietary advice:
    • Small, frequent meals
    • Increased fluid, calorie, and protein intake
  • Oxygen safety:
    • No smoking signs
    • Use of cotton clothing and bedding

Quiz Questions

  1. COPD includes which two conditions?
    • Answer: Emphysema and chronic bronchitis.
  2. What is the number one risk factor for COPD?
    • Answer: Smoking.
  3. When you percuss the lungs of your patient with COPD, what do you expect to hear?
    • Answer: Hyper-resonance due to trapped air.