COPD Clinical Practices and Management

COPD Practice

• Pathophysiology of COPD: A persistent productive cough (lasting at least 3 months for 2 consecutive years) is most associated with chronic bronchitis in COPD.
• Clinical Manifestations of Emphysema: Pursed-lip breathing is a key symptom of emphysema in COPD patients. This is a compensatory mechanism to promote expiration and reduce air trapping.
• Risk Factors for COPD: Smoking is the leading cause of COPD, accounting for approximately 80% of cases.

Diagnostic Testing

• Pulmonary Function Test (PFT) Findings in COPD: A decreased FEV1/FVC ratio is a key finding in COPD, indicating obstructive airflow limitation.

Pharmacologic Therapy

• Beta-2 Adrenergic Agonist Therapy in COPD: The primary therapeutic action of a beta-2 adrenergic agonist is to relax bronchial smooth muscles and relieve bronchospasm.

Nursing Education for MDI Use

• Using Metered-Dose Inhalers (MDIs): Holding the breath for 5-10 seconds after inhalation allows for better medication absorption in the lungs.

Side Effects of Beta-2 Agonists

• Potential Side Effects: Insomnia and nervousness are common side effects of beta-2 adrenergic agonists.

Nonpharmacologic Management

• Interventions for COPD Patients: Postural drainage uses gravity to remove secretions from the lungs, helping loosen secretions.

Oxygen Therapy

• Cautious Use in COPD: Oxygen therapy must be used cautiously in COPD patients with chronic hypercarbia to avoid suppressing their hypoxic drive to breathe.

COPD Exacerbation Management

• Common Cause of COPD Exacerbations: Viral or bacterial infections commonly trigger COPD exacerbations.

COPD Nursing Actions

• Promoting Airway Clearance: Encouraging fluid intake of more than 2000 mL/day helps to thin mucus, promoting easier expectoration.

Clinical Manifestations of COPD

• Hallmark Sign of Chronic Bronchitis: Cyanosis is a common and reliable symptom/indication of chronic bronchitis in COPD, caused by inadequate oxygenation.

Pharmacologic Therapy (continued)

• Tiotropium Bromide (Spiriva): This is an anticholinergic bronchodilator. It's used to relax bronchial muscles and reduce mucus production.

Nonpharmacologic Therapy (continued)

• Dietary Advice for COPD patients: A high-calorie, high-protein diet helps meet the increased energy demands of breathing.

Smoking Cessation

• Benefits of Cessation: Stopping smoking prevents further lung damage, slowing the progression of the disease.

Oxygen Therapy (continued)

• Important Considerations for Oxygen Use: It is important to avoid using petroleum jelly with oxygen therapy as it can be flammable.

Risk Factors (continued)

• Modifiable Risk Factor: Smoking is a modifiable risk factor for COPD.

Pursed-Lip Breathing

• Purpose for COPD Patients: Pursed-lip breathing helps prevent airway collapse during expiration, reducing air trapping.

Activity Management

• Goal of Activity Pacing: Pacing activities helps to decrease fatigue in COPD patients.

Corticosteroid Use

• Important Instruction Regarding Inhaled Corticosteroids: Patients should rinse their mouth after using inhaled corticosteroids to prevent oral thrush.

Anxiety in COPD

• Cause of Anxiety: The progressive, irreversible nature of COPD contributes to anxiety in patients.

Surgical Interventions

• Surgical Option for Severe COPD: Lung volume reduction surgery is a surgical option for severe COPD to improve respiratory function.

COPD Diet (continued)

• Nutritional Needs for COPD: High-calorie, high-protein diets are essential to meet the increased energy demands of breathing.

COPD and Infection

• Preventing Respiratory Infections: Avoiding crowds and sick contacts is a critical preventative measure against respiratory infections for COPD patients.

Medication Monitoring

• Theophylline Therapeutic Range: The therapeutic range for theophylline in COPD is 10-20 mcg/mL.

COPD Exacerbations

• Symptom of COPD Exacerbation: Increased dyspnea (shortness of breath) is a hallmark sign of COPD exacerbations.

Patient Positioning

• Optimal Position for Dyspnea: High Fowler's position is the best for a patient experiencing dyspnea as it maximizes lung expansion.

Mucolytic Therapy

• Purpose of Mucolytics: The primary purpose of mucolytics is to thin and loosen mucus, facilitating expectoration.

Monitoring ABGs

• ABG Finding Consistent with COPD: Respiratory acidosis is a common finding in COPD patients due to CO2 retention.

Long-Term Goals

• Realistic Long-Term Goal: Maintaining oxygen saturation above 90% is a realistic long-term goal for COPD patients.