COPD Priority Care Summary

Overview

Concise notes on COPD: definitions, risk factors, pathophysiology, signs/symptoms, labs/ABGs, complications, interventions, patient teaching, and priority care.

COPD Basics

• COPD: chronic air trapping with reduced gas exchange; inflammatory lung damage; high CO2.
• Not asthma: COPD is irreversible; asthma exacerbations are reversible.
• Two main types: emphysema (pink puffer) and chronic bronchitis (blue bloater).
• Primary risk factor: long-term smoking; also chronic irritant exposure (fumes, dust, smoke).

Pathophysiology

• Emphysema: alveolar destruction, loss of elasticity and surfactant, hyperinflation, air trapping.
• Chronic bronchitis: bronchial inflammation, smooth muscle hypertrophy, mucus hypersecretion, recurrent infections.
• Chronic air trapping leads to CO2 retention and hypoxemia.

Emphysema vs. Chronic Bronchitis: Clinical Features

• Emphysema (pink puffer): pink skin, pursed-lip breathing, barrel chest, minimal cough, tripod position.
• Chronic bronchitis (blue bloater): cyanosis, obesity, chronic productive cough, crackles/wheezes, peripheral edema due to cor pulmonale.
• Hyperresonance on percussion common in emphysema.
• Right-sided heart failure signs: edema, JVD, weight (water) gain.

Vital Signs and Physical Findings

• Expected SpO2 lower baseline: 88–93% in worsening/end-stage COPD.
• Clubbing of fingers indicates chronic hypoxia.
• Monitor for mental status changes: restlessness, decreased LOC, confusion suggest worsening hypoxia.

Labs and ABGs

• Elevated RBC count (polycythemia) compensates for chronic hypoxia; anemia uncommon.
• ABG trends: low PaO2 (hypoxemia), high PaCO2 (hypercapnia), respiratory acidosis.
• Key numbers: pH < 7.35 and PaCO2 > 45 indicate acidosis; PaO2 < 80 indicates hypoxemia.

Structured Summary of Key Values and Signs

Complications and Priorities

• Hypoxemic respiratory failure: from low O2.
• Hypercapnic respiratory failure: from high CO2; priority is BiPAP.
• First sign to monitor: mental status change signaling worsening oxygenation.

Priority Interventions in Hypercapnia

• Use BiPAP to improve ventilation and expel CO2; positive pressure enhances gas exchange.
• Avoid first-line use of bronchodilators, steroids, nebulizers, or simply adding oxygen in hypercapnic crisis.
• Excess oxygen can suppress respiratory drive, worsen CO2 retention.

Medications: Use and Avoid

• Avoid opioids in exacerbation: morphine, hydromorphone, hydrocodone, oxycodone; cause respiratory depression.
• Avoid benzodiazepines: alprazolam, diazepam; cause low and slow breathing.
• Ipratropium and short-acting bronchodilators may help airflow but not primary for hypercapnic failure.
• Albuterol: for dyspnea to dilate airways; not a replacement for BiPAP in CO2 crisis.
• Expectorant for mucus (bronchitis): guaifenesin before bedtime; cool mist humidifier at night.

Patient Teaching: Diet and Fluids

• Oral hygiene before meals to improve taste and moisture.
• Small, frequent meals; high-calorie, high-protein; avoid high carbohydrate loads.
• Avoid exercise 1 hour before and after meals to conserve oxygen.
• Avoid gas-forming foods: carbonated drinks, high-fiber items like broccoli and beans.
• Increase fluids: 8 glasses daily (2–3 L/day) to thin mucus; drink between meals to prevent bloating.

Vaccinations and Infection Reporting

• Pneumococcal vaccine every 5 years; annual influenza vaccine.
• Report increased sputum, fever, or worsening dyspnea promptly.

Breathing Techniques

• Pursed-lip breathing: inhale through nose 2 seconds; exhale through pursed lips 4 seconds.
• Purpose: reduce dyspnea, prevent airway collapse, reduce air trapping.
• Not for thinning secretions; that is addressed by huff coughing.

Huff Coughing Technique: Steps

• Sit upright with feet shoulder-width apart; lean forward.
• Deep, slow inhalation through the mouth using diaphragm.
• Hold breath 2–3 seconds; forcefully exhale.
• Repeat huff once or twice; avoid normal coughing.
• Rest 5–10 normal breaths; repeat until secretions clear.

NCLEX-Style Priorities and Pitfalls

• Elderly COPD with altered LOC, pH 7.21, PaCO2 75, PaO2 55: initiate BiPAP immediately.
• Do not default to oxygen alone or bronchodilators in hypercapnic failure.
• Question orders for opioids and benzodiazepines in acute exacerbations.
• Recognize baseline low SpO2 in COPD; avoid over-oxygenation.

Key Terms & Definitions

• Hypercapnia: high PaCO2 above 45 mm Hg.
• Hypoxemia: low PaO2 below 80 mm Hg.
• Respiratory acidosis: pH < 7.35 with elevated PaCO2.
• Cor pulmonale: right-sided heart failure secondary to pulmonary disease.
• Pursed-lip breathing: technique to prolong exhalation, reduce airway collapse.
• Huff coughing: diaphragm-driven forced exhalation to mobilize secretions.

Action Items / Next Steps

• Monitor LOC, ABGs, and SpO2 trends; expect lower baseline saturations.
• Prepare and initiate BiPAP for signs of hypercapnic failure.
• Avoid opioids and benzodiazepines in exacerbations; clarify unsafe orders.
• Reinforce diet, fluid, breathing techniques, and vaccination schedule with patients.
• Educate patients to report infection signs and adjust activity around meals.