Med-Surg Respiratory System, part 5: COPD

August 23, 2021 Updated: December 29, 2021 7 min read

In this article, we explain everything you need to know about COPD for the NCLEX, your Med-Surg exams, and your nursing practice.

The Med-Surg Nursing video series follows along with our Medical-Surgical Nursing Flashcards, which are intended to help RN and PN nursing students study for nursing school exams, including the ATI, HESI, and NCLEX.

Chronic Obstructive Pulmonary Disease (COPD) is an irreversible respiratory disease that is a combination of emphysema and chronic bronchitis, leading to airflow obstruction and difficulty breathing.

When studying disorders of the respiratory system, it's important to remember that COPD is irreversible while asthma is reversible.

Emphysema

Emphysema is one of the diseases that comprises COPD, and it causes destruction of the alveoli, decreases lung elasticity, and causes hyperinflation and air trapping.

Bronchitis

Bronchitis is another one of the diseases that comprises COPD and it causes inflammation of the airways and hypersecretion of mucus.

Pathophysiology

Remember that COPD is a combination of emphysema and bronchitis. Emphysema causes destruction of the alveoli, which leads to decreased lung elasticity, and hyperinflation and air trapping in the lungs. Bronchitis causes inflammation of the airways and hypersecretion of mucus.

These two changes together lead to hypoventilation, hypoxemia, and hypercapnia, which is retention of carbon dioxide in the lungs.

Risk factors

The number one risk factor for COPD is smoking. Other risk factors associated with COPD include smoking, air pollution, occupational chemical exposure or dust exposure, and infection.

Signs and symptoms

Signs and symptoms of COPD include cough, excess sputum (phlegm), dyspnea (difficulty breathing), crackles or wheezing when breathing, barrel chest, use of accessory muscles to breathe, clubbing, cyanosis, hyperresonance due to trapped air, rapid and shallow respirations, decreased blood oxygen saturation, and tripod positioning.

Clubbing

Unfortunately by clubbing, we don't mean we're going out to hit the club and dance all night. The sign/symptom clubbing is enlargement of the tips of the finger with spoon-shaped nails.

Cyanosis

Cyanosis is a bluish discoloration of the skin resulting from inadequate oxygen.

Barrel chest

A barrel chest is a chest resembling the shape of a barrel, meaning that it is rounded and bulging outward. This is due to the lungs being hyperinflated for an extended period of time.

Hyperresonance

Resonance is the normal sound heard during percussion on healthy lungs. Hyperresonance is louder and lower pitched sounds, and can indicate excess air.

Tripod positioning

Tripod positioning would be a person who is sitting, leaning forward with their elbows or forearms on their knees/quadriceps. A person doing the tripod position while standing would be bent at the knees with their hands on their knees.

Labs & Diagnostics

The labs and exams that would be performed to diagnose COPD include an arterial blood gas (ABG), polycythemia, a chest x-ray, and pulmonary function tests.

ABG to diagnose COPD

An arterial blood gas exam would be done before diagnosing COPD. The ABG exam would look for decreased blood oxygen saturation (SpO₂) and increased partial pressure of carbon dioxide (PaCO₂) and decreased partial pressure of oxygen (PaO₂)

Normal SpO₂ is between 95 and 100%, and patients with COPD typically have a much lower SpO₂, often in the low 90s.

We've created Arterial Blood Gas Interpretation Flashcards to make understanding ABG results easy and intuitive.

Polycythemia

Polycythemia is a condition marked by increased red blood cell count due to chronic hypoxia.

Treatment

Treatment options for COPD include inhaled bronchodilators like salmeterol and albuterol, anticholinergics like ipratropium, corticosteroids like beclomethasone, mucolytics like acetylcysteine, and oxygen therapy.

Systemic corticosteroids like prednisone or hydrocortisone may be prescribed for exacerbations of COPD.

These are just some of the many important medications covered in our Pharmacology Flashcards for Nursing Students.

Nursing care

When providing care for a patient with COPD, place the patient in an upright position where it is easier to breathe due to less stress on the lungs. Administer oxygen as prescribed via an oxygen delivery device. Monitor for complications, including right-sided heart failure, which in the case of COPD is heart failure due to lack of oxygen.

Patient teaching

Patient teaching for COPD can include instruction on smoking cessation, specialized breathing techniques that allow for easier breathing (abdominal and pursed lip breathing), effective coughing (coughing specifically so mucus is produced and removed rather than coughing uncontrollably which causes spasms and trapped mucus), and an incentive spirometer to practice controlled deep breathing.

A patient with COPD can be counseled on a diet of small and frequent meals, increasing fluids, and eating a high calorie and high protein diet. Breathing involves our muscles, and the breathing muscles of patients with COPD have to work much harder to breathe effectively. Muscles require calories and protein to work, therefore, patients with COPD have a critical need for fuel to breathe.

Also, a patient with COPD who has a home oxygen tank should be instructed on home oxygen safety. This is sort of similar to firearm safety, in that you have a potentially lethal device in your home, and so responsible ownership requires safety knowledge and adherence. Oxygen is a safe gas, but concentrated pure oxygen creates more risk for a fire in the home. Fire needs oxygen to burn, and anything that catches fire will burn much faster and much hotter. We cover home oxygen safety tips in our Fundamentals of Nursing Flashcards.


Full Transcript

Hi, I'm Cathy with Level Up RN. In this video, I am going to talk about COPD and at the end of the video, I'll give you guys a little quiz to test your knowledge of some of the key concepts I'll be covering in this video.

So chronic obstructive pulmonary disease is a combination of two conditions. It's a combination of emphysema and chronic bronchitis, and these two things together lead to airway obstruction and COPD is irreversible. So this is differentiated from asthma, which we talked about in my previous video, which is reversible and intermittent. With COPD, it is irreversible. So let's talk about the pathophysiology. So with emphysema, we have destruction of the alveoli in the lungs, and this leads to decreased lung elasticity. It also causes hyperinflation and air trapping in the lungs. With bronchitis, we have inflammation of the airways and hypersecretion of mucus.

So these two changes together lead to hypoventilation, hypoxemia, and hypercapnia, which is the retention of carbon dioxide in the lungs. So in terms of risk factors, smoking is the big one, smoking is the number one risk factor for COPD. Other risk factors include air pollution and occupational chemicals or dust. In terms of the signs and symptoms of COPD, your patient will likely present with a cough, you may see them have excess sputum, when you listen to their lungs, they may have crackles and wheezes, and then when you percuss their chest, you may hear hyper resonance. So that is due to that trapped air. Other signs and symptoms include a barrel chest, use of accessory muscles when they're breathing, clubbing, which is kind of enlargement of the tips of the finger with like spoon-shaped nails. In addition, they may have cyanosis and rapid, shallow respirations. And then in order to breathe more effectively, you may see them in a tripod position, so this is like where they're kind of leaning over a table like this, and it just makes it easier for them to breathe because of that dyspnea associated with COPD.

Let's now talk about the diagnosis of COPD. So a patient with COPD will have a decreased oxygen saturation, or SpO2. So normally we would expect patients to have an SpO2 between 95 and 100%, with COPD, they will have a much lower SpO2, like in the low 90s, and that is expected for a patient with this condition. Also, if we run an arterial blood gas, we'll find an increase in PaCO2 and a decrease in PaO2. And then other tools we can use to diagnose COPD include pulmonary function tests, as well as a chest x-ray. Medications that can be used with COPD include bronchodilators, anticholinergics, corticosteroids, mucolytics, and oxygen therapy as well. In terms of nursing care, you're going to want to place the patient in an upright position because it's easier for them to breathe that way, you're going to administer oxygen as ordered by the provider, and you're going to monitor for complications, which can include right-sided heart failure.

There's a lot of teaching you need to do with your patient as well. So, first of all, if your patient is a smoker, we need to strongly encourage them to stop smoking. We want to teach them effective breathing techniques to help relieve their dyspnea, so this includes abdominal and pursed-lip breathing. We also want to teach effective coughing and how to use an incentive spirometer. And I see patients sometimes trying to blow into their incentive spirometer at the hospital, so you've got to teach them to suck in, right? So you breathe in with an incentive spirometer, so there's breathe in and incentive spirometer. And they should do this 10 times an hour while they're awake. And then in terms of their diet, we want to encourage them to consume small, frequent meals, increase their fluid intake, and also increase their calories and protein intake. And then we also want to teach them oxygen safety if they're going to need to go home with oxygen therapy. So they should hang a no smoking sign at their door, they need to wear cotton clothing and have cotton bedding, that type of thing.

All right. Time for a quiz. I have three questions.

First question, COPD includes which two conditions?

If you said emphysema and chronic bronchitis, you are correct.

Question number two, what is the number one risk factor for COPD?

The answer is smoking.

Question number three, when you percuss the lungs of your patient with COPD, what do you expect to hear?

The answer is hyper resonance, and that is due to the trapped air that we have with COPD.

Hope this video has been helpful and hopefully you enjoyed that quiz as well. I'll see you soon on another video.


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