Nursing Care of COPD Patients

Introduction to Oxygenation and Nursing Care of COPD Patients

• The presentation discusses oxygenation as a nursing concept, focusing on the care of patients with Chronic Obstructive Pulmonary Disease (COPD).
• The presentation was given by Victoria Leonetti, MSN, RN and Emily Raddell, MSN, RN.

Course Student Learning Outcomes

• Outcome 1: Provide safe, patient-centered, evidence-based nursing care guided by the Caritas philosophy.
• Outcome 2: Demonstrate intermediate levels of critical thinking and clinical reasoning to provide quality patient care.
• Outcome 3: Relate the impact of quality improvement measures to improved patient care.
• Outcome 4: Explain management of care concepts for adult patients.

Concept Check of Oxygenation

• Oxygenation is the mechanism that facilitates or impairs the body's ability to deliver oxygen to all cells.

Overview of Chronic Obstructive Pulmonary Disease (COPD)

• COPD involves persistent or recurrent airflow obstruction, due to bronchoconstriction and/or changes in the respiratory system over time.
• Symptoms include dyspnea (shortness of breath), sputum production, and periodic exacerbations.
• The disease is irreversible, affects lung function, and typically is not curable.
• COPD comprises components of chronic bronchitis and emphysema.

Pathophysiology of COPD

• Results from repeated exposure to respiratory irritants, primarily cigarette smoking in 80% of cases.
• Damage to airway passages includes increased mucous production and arrest of cilia action.
• COPD involves fluid accumulation in lung tissues, narrowing of airways, airflow limitation, and air trapping.
• Emphysema involves the destruction of alveoli walls and the enlargement of abnormal air sacs.
• In chronic bronchitis, there is excessive bronchial mucus secretion and impaired cilia function.
• Chronic inflammation in the airways causes obstruction with goblet cells and mucous glands.

Pathophysiology of Chronic Bronchitis

• Characterized by excessive bronchial mucus secretion.
• Shows impaired cilia function and goblet cell and mucous gland hypertrophy.
• Often involves chronic inflammation causing obstruction of airflow.
• Recurrent infections are common.
• Chronic bronchitis is characterized by a productive cough lasting at least 3 months in two consecutive years..

Pathophysiology of Emphysema

• Imbalance of lung proteases(enzymes) secreted by neutrophils and macrophages.
• Alpha 1 antitrypsin enzyme breakdown related to elastin tissue within lungs.
• Reduced elastin recoil leading to loss of elastic recoil.
• Destruction of capillary beds and reduced surface area for alveolar-capillary diffusion.

Two Subtypes of COPD

• Chronic bronchitis is characterized by inflammation and mucus buildup in the bronchi.
• Emphysema involves the destruction of alveoli, reducing lung elasticity.

Etiology of COPD

• Leading cause of death, disability, and illness in the United States.
• The 4th leading cause of death in the U.S.
• Affects nearly equal numbers of men and women, 10-24 million people affected.
• Cost for care approaches $90 billion annually.
• Most COPD patients are over 50.
• 80% of cases are linked to cigarette smoking; other factors include exposure to occupational irritants and outdoor/indoor air pollution.

Risk Factors for COPD

• Smoking: Greatest risk factor.
• Frequent exposure to smoke: Secondhand smoke.
• Long-term exposure to chemical irritants: Example includes environmental hazards.
• Asthma: A possible risk factor.
• Air pollution: Exposure to pollutants.
• Aging: Loss of lung elasticity.

Prevention of COPD

• Cessation of smoking is crucial.
• Decreasing exposure to secondhand smoke and occupational respiratory irritants is essential in prevention.

Clinical Manifestations of COPD

• Early stages may show mild symptoms like chronic cough and sputum production.
• Shortness of breath occurs only during exertion in early stages.
• Chronic Bronchitis: Persistent productive cough, large amounts of thick mucus. Cough frequently in the morning. Characteristic to "smokers cough" and adventitious sounds such as wheezing, rhonchi, diminished breath sounds. Dyspnea and cyanosis, dusky skin color.
• Emphysema: Insidious onset, no initial symptoms. Dyspnea. Barrel chest. Tripod position, leans forward. Pursed lip breathing, prolonged expiration. Chest pain, hypertension, Dyspnea may progress to severe, even when resting.

Diagnostic Tests for COPD

• Pulmonary function tests (PFTs), such as FEV1/FVC, determine lung function.
• Arterial blood gas (ABG) tests measure oxygen and carbon dioxide levels in the blood, are essential to evaluate gas exchange.
• Pulse oximetry, assesses oxygen saturation in the blood.
• Sputum cultures, aid in identification of potential pathogens (bacterial or viral) by assisting in confirmation of infection.
• Chest X-ray (CXR), shows signs of infection, or lung damage, and cardiac enlargement.

Surgical Treatments for COPD

• Lung Transplantation: A surgical procedure for end-stage COPD.
• Lung Reduction Surgery: A surgical procedure that removes diseased lung tissue in severe emphysema.

Pharmacologic Therapy for COPD

• Immunizations: Pneumococcal pneumonia and influenza immunizations help prevent infections

• **Broad-spectrum antibiotics:**Used during infections

• Bronchodilators: Short and long acting beta 2 agonists, to aid in relieving narrowing of airways.

• Corticosteroids (oral or intravenous): Used for exacerbations

• Mucolytics/Expectorants: Used to thin mucus for easier removal of excess accumulation.

• Oxygen Therapy: Used for severe hypoxemia; improves exercise tolerance, mental function, and quality of life, reduces hospitalizations.

• Used with caution in COPD patients with chronic hypercarbia, monitor patient LOC and ABG levels.

Non-Pharmacologic Therapy for COPD

• Percussion: Mechanical dislodgement of secretions from bronchial walls.
• Vibration: Mechanical loosening of thick secretions
• Postural Drainage: Aids in drainage by gravity.
• Pulmonary Hygiene: Measures (such as hydration and effective coughing), percussion, postural drainage are suggested.
• Smoking cessation: Essential to improving lung function.
• Avoiding pulmonary irritants: Avoid exposure to irritants and allergens.
• Air filtration: Systems to manage indoor/outdoor air quality
• Exercise: Aids in improving breathing strength and overall health.
• Hydration: Maintain adequate fluid intake.
• Humidifiers: to maintain good air quality.

Implementation of Nursing Actions for COPD

• Nurses must promote airway clearance.
• Evaluate oxygenation and respiratory status periodically.
• Administer prescribed medications.
• Assist with coughing and deep breathing exercises.
• Refer patients to respiratory therapists for interventions such as postural drainage.
• Refer patients to specialists to follow up on prescribed therapy.

Evaluation of COPD

• Expected patient outcomes: patients maintaining oxygen saturations above 90%, modify ADLs (activities of the daily living) to improve fatigue, demonstrate proper use of medications, demonstrate an understanding of the necessity of smoking cessation, and demonstrate a reduction in anxiety showing improved relaxation techniques.
• COPD is a chronic disease requiring continual monitoring, evaluation, and re-evaluation of patient treatment plans.