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Chronic Obstructive Pulmonary Disease Nursing Guide

COPD General Overview 

Chronic obstructive pulmonary disease (COPD) is a progressive lung disease described by airflow limitation that is not fully reversible and tissue destruction. COPD leads to breathing difficulties, persistent cough, mucus production, and frequent respiratory infections. Cigarette smoking is the leading cause, although environmental factors and genetic predispositions also contribute. Nurses help manage symptoms, prevent exacerbations, and educate patients about lifestyle changes to improve quality of life. 

COPD etiology and epidemiology 

Etiology: 

  • Cigarette smoking: The primary cause, accounting for 70% of COPD cases. 
  • Occupational exposure: Prolonged exposure to dust, chemicals, or fumes in the workplace can contribute to COPD. 
  • Environmental pollution: Long-term exposure to air pollutants (indoor and outdoor), including secondhand smoke, can cause COPD. 
  • Genetic factors: Alpha-1 antitrypsin deficiency, a genetic disorder, increases the risk of developing emphysema, even in nonsmokers. 
  • Respiratory infections: Severe or frequent childhood respiratory infections can predispose individuals to COPD. 

Epidemiology: 

  • COPD affects an estimated 300 to 400 million people worldwide and is the third leading cause of death globally. 
  • Smoking-related COPD primarily affects individuals over age 40. 
  • Women are increasingly being diagnosed with COPD, likely due to rising smoking rates among women and higher susceptibility to lung damage. 

COPD ICD-10 code 

The ICD-10 code for COPD is: 

  • J44.9 — Chronic obstructive pulmonary disease, unspecified  

COPD diagnosis 

A COPD diagnosis is based on symptoms, history of exposure to risk factors (such as smoking), and pulmonary function testing. 

Clinical assessment: 

  • Symptoms: Chronic cough, sputum production, shortness of breath, and frequent respiratory infections 
  • History: Smoking history, occupational exposures, and any previous respiratory conditions should be evaluated 

Diagnostic tests: 

  • Spirometry: This is considered the gold standard for diagnosing COPD. It measures the forced expiratory volume in one second (FEV1) and the forced vital capacity (FVC). A post-bronchodilator FEV1/FVC ratio of less than 70% confirms the presence of COPD. 
  • Chest X-ray: This helps rule out other conditions such as lung cancer or heart failure and can show hyperinflation of the lungs in severe COPD. 
  • Pulse oximetry: This evaluates oxygenation. 
  • Blood gas: This assesses the extent of gas exchange impairment. 
  • Alpha-1 antitrypsin testing: This is considered in patients with COPD who are young or have a family history of lung disease. 

COPD management 

The goals of managing COPD are to reduce symptoms, prevent exacerbations, and improve quality of life. COPD is a progressive disease, but interventions can slow its progression and manage complications. 

Lifestyle management: 

  • Smoking cessation: The most effective intervention to slow disease progression. Nicotine replacement therapy (NRT), counseling, and medications like varenicline can help patients quit smoking. 
  • Pulmonary rehabilitation: A multidisciplinary program that includes exercise training, nutrition advice, and education to help patients manage their symptoms and improve physical conditioning. 
  • Vaccinations: Annual influenza vaccinations and pneumococcal vaccines are recommended to reduce the risk of respiratory infections. 

Pharmacological management: 

  • Bronchodilators: First-line treatment to open airways. Short-acting beta-agonists (SABAs) like albuterol are used for acute relief, while long-acting beta-agonists (LABAs) and long-acting muscarinic antagonists (LAMAs) are used for maintenance. 
  • Antimuscarinics: Short-acting antimuscarinics agents (SAMA) used for acute relief and long-acting antimuscarinics (LAMA) for maintenance therapy. 
  • Inhaled corticosteroids (ICS): Often combined with LABAs to reduce inflammation and prevent exacerbations in moderate to severe COPD. 
  • Oxygen therapy: Prescribed for patients with severe COPD who have chronic hypoxemia (oxygen saturation <88%). Long-term oxygen therapy has been shown to improve survival. 
  • Phosphodiesterase-4 inhibitors (e.g., roflumilast): May be used in severe cases to reduce exacerbations in patients with chronic bronchitis. 
  • Azithromycin; May reduce number of exacerbations 

Management of exacerbations: 

COPD exacerbations are acute worsening of respiratory symptoms that can lead to hospitalization. They’re typically triggered by infections or environmental pollutants. 

  • Bronchodilators: Use of short-acting bronchodilators (SABAs or short-acting anticholinergics) should be intensified during exacerbations. 
  • Corticosteroids: Oral or intravenous corticosteroids reduce inflammation and shorten the recovery time from exacerbations. 
  • Antibiotics: Indicated if a bacterial infection is suspected (e.g., purulent sputum, increased sputum production). 
  • Non-invasive ventilation (NIV): Used in cases of acute respiratory failure to support breathing and reduce the need for intubation. 

COPD nursing care plan 

Nursing considerations 

Nurses must focus on symptom management, patient education, and preventing complications such as respiratory infections or exacerbations. 

Assessment 

  • Respiratory status: Monitor respiratory rate, oxygen saturation, lung sounds, and work of breathing. 
  • Signs of infection: Assess for fever, increased sputum production, changes in sputum color, or worsening dyspnea. 
  • Nutritional status: Many patients with COPD experience weight loss and muscle wasting due to the increased energy demands of breathing. 
  • Psychosocial status: Assess for anxiety and depression, which are common in patients with chronic illnesses. 

Nursing diagnosis/risk for 

  • Ineffective airway clearance related to increased mucus production and bronchoconstriction as evidenced by wheezing, coughing, and abnormal lung sounds. 
  • Impaired gas exchange related to airflow obstruction as evidenced by dyspnea, low oxygen saturation, and cyanosis. 
  • Activity intolerance related to imbalance between oxygen supply and demand as evidenced by fatigue and shortness of breath with exertion. 
  • Risk for infection related to weakened lung function and use of immunosuppressive medications (e.g., corticosteroids). 

COPD interventions 

  • Administer prescribed medications: Ensure bronchodilators and corticosteroids are used properly and educate patients on the correct use of inhalers and nebulizers. 
  • Monitor oxygen therapy: Administer supplemental oxygen as prescribed and monitor for signs of hypoxia. 
  • Promote effective airway clearance: Encourage coughing, deep breathing exercises, and the use of incentive spirometry to help clear secretions. 
  • Educate on smoking cessation: Provide resources and support for smoking cessation, including counseling, medications, and referral to smoking cessation programs. 
  • Support pulmonary rehabilitation: Encourage patient participation in pulmonary rehabilitation programs to improve lung function and quality of life. 
  • Infection prevention: Encourage vaccinations and reinforce hand hygiene to reduce the risk of respiratory infections. 

Expected outcomes 

  • The patient’s respiratory status improves as evidenced by clear lung sounds, effective coughing, and increased oxygen saturation. 
  • The patient adheres to prescribed treatments, including medications and oxygen therapy, with a reduction in COPD exacerbations. 
  • The patient demonstrates knowledge of smoking cessation strategies and actively participates in a cessation program. 
  • The patient reports improved exercise tolerance and participates in daily activities with less shortness of breath. 

Individual/caregiver education 

  • Medication use: Teach the proper use of inhalers, nebulizers, and oxygen therapy devices to ensure optimal drug delivery and symptom control. 
  • Smoking cessation: Provide information on the benefits of quitting smoking and resources available for support. 
  • Infection prevention: Emphasize the importance of hand hygiene, avoiding crowds during flu season, and getting vaccinated against influenza and pneumonia. 
  • Breathing techniques: Instruct patients on techniques, including pursed-lip breathing and diaphragmatic breathing, to help control breathlessness during activity. 
  • Energy conservation: Educate on ways to conserve energy during daily tasks to reduce fatigue and breathlessness. 

FAQs

Management of COPD

The goal of this course is to educate administrators and nurses who work in post-acute care settings on the management of COPD.

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Additional Information

Course Contributor

Ann Dietrich, MD, FAAP, FACEP.  Ann M. Dietrich, MD, FAAP, FACEP, Professor of Pediatrics and Emergency Medicine for the University of South Carolina School of Medicine Greenville, has over 30 years of experience in pediatric emergency medicine. Throughout her career, Dietrich has helped educate medical students, residents, fellows, and junior attendings, including as an educator at Ohio State University and the American College of Emergency Physicians. She also collaborated on several research projects, including one on concussions and one on improving mental healthcare for children. Dietrich helped develop guidelines on the impact of concussions on children and worked with trauma surgeons to enhance care for pediatric trauma patients.

Resources 

References 

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