COPD Part 2: Nursing Interventions and Medications

Introduction

• This lecture covers the nursing interventions and medications for COPD.
• Part 1 covered pathophysiology, types, signs and symptoms, complications, and diagnosis.
• Notes and quizzes are available in the description.

Nursing Interventions

Monitoring Respiratory System

• Lung Sounds and Suction:
  • Listen to lung sounds.
  • Assess need for nasotracheal suction based on breathing effort and oxygen saturation.
• Sputum Production:
  • Monitor and possibly collect sputum culture.
• Oxygen Saturation:
  • Maintain between 88-93%.
  • COPD patients are stimulated to breathe by low oxygen levels.
  • Avoid over-oxygenation to prevent hypoventilation and CO2 toxicity.

Administering Oxygen

• Prescribed by the physician, typically 1-2 liters.

Breathing Techniques

• Pursed Lip Breathing:
  • Helps during dyspneic episodes by increasing oxygen levels and encouraging longer exhalation.
• Diaphragmatic Breathing:
  • Uses abdominal muscles instead of accessory muscles.
  • Strengthens diaphragm, slows breathing rate, and conserves energy.

Breathing Treatments

• Administer nebulizer treatments and inhalers.
• Know the difference between long-acting and short-acting bronchodilators.

Patient Education

Nutrition

• High-Calorie, High-Protein Diet:
  • Small, frequent meals to avoid over-inflating lungs.
  • Stay hydrated (2-3 liters per day) to thin mucus.

Avoiding Triggers

• Stay away from sick people and air pollutants.
• Avoid extreme weather conditions.
• Smoking Cessation: Importance of quitting and avoiding secondhand smoke.

Vaccinations

• Stay up-to-date with flu and pneumonia vaccines.

Medications for COPD

Drug Categories

• Corticosteroids:

  • Decrease inflammation and mucus production.
  • Examples: Prednisone, Solu-Medrol, Pulmicort, Symbicort.
  • Side Effects: Easy bruising, hyperglycemia, risk of infection, osteoporosis.
  • Use bronchodilator before corticosteroid inhaler.
  • Rinse mouth after corticosteroid inhaler use.

• Phosphodiesterase-4 Inhibitors:

  • Example: Roflumilast (Daliresp).
  • Decreases COPD exacerbations, not a bronchodilator.
  • Side Effects: Monitor for suicidal thoughts, weight loss.

• Methylxanthines:

  • Example: Theophylline.
  • Relax smooth muscle for long-term treatment.
  • Monitor therapeutic range (10-20 mcg/mL).

• Short-Acting Bronchodilators:

  • Examples: Albuterol, Atrovent.
  • Used for immediate relief in emergencies.

• Long-Acting Bronchodilators:

  • Examples: Salmeterol, Spiriva.
  • Used regularly for long-term control.
  • Side Effects: Increased heart rate, urinary retention, dry mouth, blurred vision.

Conclusion

• Don't forget to review Part 1 and take the quiz.
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