Overview
This lecture covers the key nursing interventions and medication management for patients with Chronic Obstructive Pulmonary Disease (COPD), focusing on patient monitoring, education, and drug regimens.
Nursing Interventions
- Monitor respiratory status: listen to lung sounds and assess for need for suctioning or oxygen therapy.
- Monitor sputum production and collect sputum cultures if ordered to check for infection.
- Keep oxygen saturation between 88–93% to avoid reducing respiratory drive.
- Administer prescribed oxygen, usually 1–2 L/min via nasal cannula.
- Teach purse-lip breathing (inhale, exhale through pursed lips) to improve exhalation and oxygenation.
- Teach diaphragmatic breathing (use abdominal muscles) to reduce accessory muscle use and conserve energy.
- Administer scheduled or as-needed inhalers and nebulizer treatments as ordered.
- Monitor for episodes of shortness of breath, especially with activity.
Patient Education
- Advise high-calorie, high-protein, small frequent meals to prevent full stomach impacting breathing.
- Encourage fluid intake of 2–3 liters/day (unless contraindicated) to keep mucus secretions thin.
- Avoid sick people, air irritants, and extreme weather (hot, cold, high humidity).
- Educate on the importance of smoking cessation and avoiding secondhand smoke.
- Ensure vaccinations are up to date: annual influenza and pneumonia every five years.
Medication Management
- Corticosteroids (e.g., prednisone, solu-medrol): decrease airway inflammation and mucus, can cause bruising, hyperglycemia, infection risk, and osteoporosis.
- Inhaled corticosteroids should be used after bronchodilator inhalers; patients must rinse their mouth afterward.
- Phosphodiesterase-4 inhibitors (e.g., roflumilast): decrease exacerbations; monitor for suicidal thoughts and weight loss.
- Methylxanthines (e.g., theophylline): bronchodilator, narrow therapeutic range (10–20 mcg/mL); monitor for toxicity and drug interactions.
- Short-acting bronchodilators (e.g., albuterol, atrovent): provide quick relief in acute symptoms.
- Long-acting bronchodilators (e.g., salmeterol, spiriva): used daily for maintenance; may cause tachycardia, urinary retention, dry mouth, and blurred vision.
Key Terms & Definitions
- COPD — chronic lung disease with airflow obstruction (includes emphysema and chronic bronchitis).
- Pursed-lip breathing — breathing technique to prolong exhalation.
- Diaphragmatic breathing — using abdominal muscles for breathing instead of accessory muscles.
- Bronchodilator — medication that relaxes airway muscles to widen the airways.
- Corticosteroid — medication that reduces airway inflammation.
Action Items / Next Steps
- Watch part 1 of the COPD lecture for foundational concepts.
- Take the NCLEX review quiz related to these lectures.
- Review relevant drug categories and side effects for exams.