COPD (Chronic Obstructive Pulmonary Disease) - NCLEX Review Part 1

Overview

• COPD is a pulmonary disease causing chronic obstruction of airflow from the lungs.
• Part 1 covers pathophysiology, signs, symptoms, types, and diagnosis of COPD.
• Part 2 will cover medications and nursing interventions.

Definition

• COPD leads to limited airflow due to chronic inflammation and narrowing of bronchioles.
• Causes excessive mucus production, reducing oxygen intake and CO2 exhalation.

Key Points

• Limited Airflow: Inflammation and mucus block air pathways.
• Difficulty Exhaling: Loss of elasticity in alveolar sacs causes improper gas exchange.
• Irreversible Condition: Managed through lifestyle changes and medications.

Causes

• Mainly environmental irritants (e.g., smoking, air pollution, occupational hazards).
• Gradual onset, often noticed in middle age with symptoms like shortness of breath and chronic cough.

Types of COPD

Chronic Bronchitis (Blue Bloaters)

• Characteristics: Cyanosis (blue lips/skin), edema, right-sided heart failure.
• Pathophysiology:
  • Inflammation and mucus production narrow airways.
  • Gas exchange is impaired, leading to hypoxemia and hyperinflation of lungs.
  • Diaphragm flattening causes increased use of accessory muscles.
  • Leads to respiratory acidosis and pulmonary hypertension.

Emphysema (Pink Puffers)

• Characteristics: Pink complexion, rapid breathing (puffing).
• Pathophysiology:
  • Alveolar sacs lose elasticity, impairing gas exchange.
  • Air trapping in alveoli leads to lung hyperinflation.
  • Diaphragm flattening, increased use of accessory muscles.
  • Barrel chest appearance.
  • Hyperventilation compensates for low oxygen levels.

Signs and Symptoms (Mnemonic: LUNG DAMAGE)

• L: Lack of energy due to low oxygen.
• U: Unable to tolerate activity, severe shortness of breath.
• N: Poor nutrition due to energy spent on breathing.
• G: Abnormal gases (high CO2, low O2).
• D: Dry/productive cough (chronic).
• A: Accessory muscle use for breathing.
• M: Modified skin color (cyanosis to pink).
• A: Anterior-posterior diameter increase (barrel chest).
• G: Tripod position for easier breathing.
• E: Extreme dyspnea.

Complications

• Heart disease and right-sided heart failure.
• Spontaneous pneumothorax (lung collapse).
• Increased risk of lung infections and cancer.

Diagnosis

• Spirometry: Measures lung capacity and exhalation speed.
  • FVC: Forced Vital Capacity, indicates restrictive breathing.
  • FEV1: Forced Expiratory Volume, indicates disease severity.

Next Steps

• Review Part 2 for medications and nursing interventions.
• Take the NCLEX review quiz for further practice.