Chronic Obstructive Pulmonary Disease (COPD) Part 3

COPD: PLANNING AND IMPLEMENTATION: GENERATE SOLUTIONS & TAKE ACTION      Improving gas exchange and reducing carbon dioxide retention Preventing weight loss Minimizing anxiety Improving endurance Preventing respiratory infection Monitoring Breathing Techniques Positioning Effective coughing O2 therapy Exercise Suctioning Hydration Surgery IMPROVING GAS EXCHANGE AND REDUCING CO2 RETENTION PURSED LIP BREATHING Medications Bronchodilators  Beta adrenergics  SABA (short acting)-Albuterol (rescue)  LABA (long acting)-Salmeterol and Formoterol (prevention)  Cholinergic antagonists (Ipratropium)(Atrovent)- long acting  Xanthines (theophylline/aminophylline). Used less. Need to monitor levels.  Corticosteroids (oral, IV, inhaled). Controller drugs.  Cromones  Cromolyn sodium (controller).  Leukotriene modifiers (Singulair)  Monoclonal antibodies (biologics)  Combo drugs (Breo/Trellegy) IMPROVING GAS EXCHANGE AND REDUCING CO2 RETENTION  Want to avoid hypercapnia respiratory failure..CO2 levels too high. (PaC02 >45).  High CO2 levels reduce respiratory drive. Can lead to respiratory arrest.  Safe sats strategy: Aim for O2 sats 88-92%  Deliver O2 by Venturi mask (control amount delivered)…(24 %-28%). Careful with NC delivery…uncontrolled pure O2 delivery COPD PATIENTS AND O2 ADMIN..CAREFUL!  Weight loss   Dyspnea management  Small meals 2-3 x/day, eat big meal when most hungry  Good food selection/high calorie foods  Pursed lip breathing and inhaler before eating. Anxiety prevention  Write down a plan  Pursed lip breathing/diaphragm breathing  Support people/counseling for anxiety  Hypnosis, relaxation techniques PREVENTING WEIGHT LOSS AND MINIMIZING ANXIETY  Decreasing Infection   Pneumonia complication Improving Endurance  Fatigue  Help with ADL’s  Energy conservation DECREASING INFECTION AND IMPROVING ENDURANCE  SMOKING CESSATION!  I-PREPARE model COPD: HEALTH PROMOTION AND MAINTENANCE COPD: CARE COORDINATION AND TRANSITION MANAGEMENT  Home care management    Use of oxygen Self-management education  Drug therapy  Breathing techniques Health care resources  Attain and maintain gas exchange at a level within his or her chronic baseline values  Achieve an effective breathing pattern that decreases the work of breathing  Maintain a patent airway  Achieve and maintain a body weight within 10% of his or her ideal weight  Have decreased anxiety  Increase activity to a level acceptable to him or her  Avoid serious respiratory infections COPD: EVALUATION: EVALUATE OUTCOMES NCLEX STYLE QUESTIONS COPD content QUESTION 1 A client with COPD who smokes 1 PPD presents for a routine appointment. Which client statement causes the nurse to suspect an increase in dyspnea? A. B. C. D. “I “I “I “I prop myself up at night to sleep.” decided to put on some makeup today.” have a productive cough in the morning.” have gained weight since I was here last.” ANS: A  Clients with COPD, who smoke, may have a productive morning cough. Weight loss (not gain) often occurs when dyspnea is increased due to the increased metabolic demand. A disheveled appearance may indicate an increase in dyspnea, if the client doesn’t feel well enough to perform ADLs. Sleeping propped up indicates that breathing may be worse while lying down. ANSWER TO QUESTION 1 QUESTION 2 The nurse is assessing a client with a chest tube following a pneumonectomy. Which assessment finding requires nursing intervention? A. Bandage around the posterior tube is loose. B. 2 cm of water is in the second chest tube chamber. C. The water in the water seal chamber rises and falls with inhalation/exhalation. D. Bubbling present in the water seal chamber when the client coughs. ANS: A  After lung surgery, two tubes, anterior and posterior, are used. Dressings around the wound should not be loose. Other findings are normal. ANSWER TO QUESTION 2 QUESTION 3 A client with a history of asthma reports shortness of breath. The nurse observes that the peak flowmeter indicates a peak expiratory flow (PEF) reading that is in the red zone. What is the priority nursing action? A. Obtain vital signs. B. Administer rescue drugs. C. Notify the health care provider. D. Repeat the PEF reading to verify results. ANS: B  A PEF reading in the red zone indicates a range that is 50% below the client’s personal best PEF reading and indicates serious respiratory obstruction. The client needs to receive rescue drugs immediately, and then the health care provider should be notified. Repeating the PEF reading and taking vital signs are also important, but doing so delays the administration of the rescue drugs. These can be done after rescue drugs are given. ANSWER TO QUESTION 3