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Occupational exposures often are overlooked and underdiagnosed. It will prioritise this health need with a specific focus on a holistic approach to nursing assessment, when assessing patients with Chronic Obstructive Pulmonary Disease, known as COPD. AAT is a serum protein (an α1-protease inhibitor) produced by the liver and normally found in the lungs. COPD can be classified as mild, moderate, severe, and very severe. Source: Lewis S. M, Dirksen S. R, & Heitkemper M. M.(2014). Elevate head of the bed and provide an over bed table for the patient to lean on. Pulmonary function studies are used to help confirm the diagnosis of COPD, determine disease severity, and monitor disease progression. A comprehensive program includes exercise training, nutrition counseling, and education and provides benefits to patients with all stages of COPD. Based on your nursing knowledge and the patient’s symptoms, you suspect the patient suffers from what type of COPD? COPD is a various condition from asthma, however it can be challenging to identify in between COPD and chronic asthma. Deliver humidified oxygen as prescribed, and monitor the patient’s response. Other irritants include particles from fires used in the home for cooking or heating and workplace exposure to chemical fumes, dust, and particles. The most common cause of COPD is smoking of any form: cigarette, pipe, cigar, second hand. 2. De Torres, Juan & Casanova, Ciro & Garcini, Angela & Aguirre-Jaime, Armando & Celli, Bartolomé. Arterial blood gas (ABG) analysis: helps to assess the acuteness and severity of disease exacerbation. Peripheral airway obstruction also results in V/Q imbalance and, combined with respiratory muscle impairment, can lead to CO2 retention, particularly in severe disease. Mosby, Source: Lewis S. M., Dirksen S. R, & Heitkemper M. M, (2014). α1-Antitrypsin (AAT) Deficiency: α1-Antitrypsin (AAT) deficiency is an autosomal recessive disorder that may affect the lungs or liver. As the peripheral airways become obstructed, the air is progressively trapped during expiration. Patients with chronic CO2 retention may have chronically compensated respiratory acidosis with a low normal pH (7.35-7.38) and a Paco2 greater than 50 mm Hg. The nurse should obtain a thorough health history from patients with known or potential COPD. X-rays are also valuable in finding other abnormalities such as shadows which may indicate coexisting lung cancer. These include cough, worsening dyspnea, progressive exercise intolerance, sputum production, and alteration in mental status. Drug Therapy: Drugs are given in a stepwise fashion according to the severity of airflow obstruction. Regulate fluid intake to optimize fluid balance. Monitor the effectiveness of O2 therapy (e.g., pulse oximetry, ABGs). Some nurses will be actively involved in helping diagnose COPD by carrying out spirometry and reversibility testing, while others, particularly in secondary care, will be less involved in this diagnostic process. 103 Nursing Best Practice Guideline COPD Clinic & Education Centre Initial Visit Family Physician _____ Marital Status _____ Age ____ Date _____ … You will find relevant clinical articles, including must-read recommendations, Self-assessment and Journal Club articles for CPD, and related news and opinion. SpO2 saturation at 87% or less can indicate need for initiating or increasing O2. Excess mucus production:  Chronic productive cough is a feature of COPD with predominant chronic bronchitis. 22, In Papadakis, M. A., In McPhee, S. J., & In Rabow, M. W. (2020). You have entered an incorrect email address! Beta-adrenergic agonists also causes increased renal excretion of serum calcium and magnesium. Monitor serial ABG values as indicated by the patient’s condition. Pa… Nursing Assessment for Acute Myocardial Infarction (AMI) - Primary, Nursing Assessment for Acute Myocardial Infarction (AMI) - Secondary, Nursing Assessment for Alzheimer's Disease, Nursing Assessment for Atrial Septal Defect, Nursing Assessment for Cardiac Decompensation, Nursing Assessment for Congestive Heart Failure (CHF), Nursing Assessment for Glomerulonephritis, Nursing Assessment for Hyperemesis Gravidarum, Nursing Assessment for Pleural Effusion - Pattern Function, Nursing Assessment for Respiratory Distress Syndrome (RDS), Nursing Assessment for Tuberculous Spondylitis, Nursing Assessment for Urinary Tract Infection. Assist with active range-of-motion (ROM) exercises. COPD Assignment Help. In this phase the effectiveness of nursing care to meet the set goals are evaluated. Desired Outcome. Written by: Beverley Bostock-Cox ... having stopped when he was diagnosed with COPD, but he has a significant pack-year history of 60 years. Within minutes, brain cells begin to die. What patients know about the condition and the disease? 1. The goal of COPD management is to improve a patient’s functional status and quality of life by preserving optimal lung function, improving symptoms, and preventing the recurrence of exacerbations. Demographic factors: age, low socioeconomic status, history of childhood respiratory infections. The overall goals are that the patient with COPD will have: Desired outcome: Patient maintains a clear airway by effectively coughing as evidenced by clear lung sounds on auscultation. Chronic Disease. The receptionist advised him to … Two-Dimensional Echocardiography: Even with severe COPD, the degree of pulmonary hypertension is usually only mild to moderate and hence, findings of severe pulmonary hypertension on echocardiogram or cardiac catheterization warrant further workup. When do patients complain most tired and shortness of breath? Mosby. Airway Clearance Techniques: ACTs include effective coughing, chest physiotherapy, airway clearance devices, and high frequency chest ventilation. As the disease condition progresses, hypoxemia worsens and hypercapnia may develop. Good patient preparation is needed for accurate spirometry and, as it becomes a more routine test in both primary and secondary care, nurses working with COPD patients need to understand why and how it is carried out. Desired Outcomes: Optimally within 1-2 hr following treatment/intervention or by discharge, the patient has adequate gas exchange as evidenced by respiratory rate (RR) of 12-20 breaths/min and normal/improved ABG values. The maximum volume of air present in the lungs. How much restriction on the patient's activity tolerance? Bullae and blebs are not effective in gas exchange, as they do not contain the capillary bed that normally surrounds each alveolus. Any lung irritant can cause COPD and also exacerbate it. Spirometry. Assess respiratory and oxygenation status as indicated by the patient’s condition. Lung cancer and COPD … Excess mucus production is the result of the increased number of mucus-secreting goblet cells and enlarged submucosal glands. Provide the diet in small, frequent, high caloric meals that are nutritious and easy to consume. A knowledgeable patient is more likely to adhere to the treatment plan. Recently, sever… Patients typically present with a combination of signs and symptoms of chronic bronchitis, emphysema, and reactive airway disease. Coarse crackles beginning with inspiration may be heard. Patients may have a predominance of chronic bronchitis or emphysema, and it is often difficult to determine because the conditions usually coexist. The index uses the four factors to predict risk of death from the disease – Body-mass index, airflow Obstruction, Dyspnea, and Exercise capacity. Perform endotracheal or nasotracheal suctioning as appropriate. Assess the patient’s vital signs, review the results of diagnostic tests performed. 3. Chapter 29 Nursing Management Obstructive Pulmonary Diseases Jane Steinman Kaufman There's so much pollution in the air now that if it weren't for our lungs there' d be no place to put it all. In addition to this, cigarette smoke-induced loss of cilia also causes decreased mucous clearance and chronic cough. D. Pneumothorax. Harrison’s principles of internal medicine, 19th ed (2015). Chronic airflow obstruction is the defining feature of COPD; chronic bronchitis without chronic airflow obstruction is not included within COPD. Maintain airway patency Individuals with COPD may become hypoxic during increased activity and require oxygen therapy to prevent hypoxemia, which increases the risk for exacerbations of the COPD. Facebook. Explain, as indicated, that mechanical ventilation may be necessary and this would necessitate intensive care support. Surgical Therapy for COPD: Three different surgical procedures have been used in severe COPD. Desired Outcome: The patient reports decreasing dyspnea during activity or exercise and rates perceived exertion at 3 or less on a 0-10 scale. Is eating and sleeping habits are affected? Appropriate assessment of patients with COPD can be used to Make an accurate diagnosis, Assist in making decisions and choices of the most appropriate therapeutic interventions, For the identification of exacerbations, several questionnaires exist, with varying degrees of complexity. Imbalanced Nutrition: Less Than Body Requirements, Improved breathing pattern and relief from symptoms, Normal respiratory parameters and ABG values, Ability to perform ADLs and improved exercise tolerance, Increased anteroposterior diameter of chest, Imbalance between oxygen supply and demand due to inefficient work of breathing, Decreased intake occurring with fatigue and anorexia, Refusing meals or eating only small quantity, Shows improved exercise tolerance and will be able to perform ADLs, Maintains stable body weight and free from cachexia, Remains free from disease related complications. Use of accessory muscles of respiration and paradoxical indrawing of lower intercostal spaces (known as the Hoover sign) is evident. The nurse caring for the patient with COPD must assess for var-ious complications, such as life-threatening respiratory insuffi-ciency and failure and respiratory infection and atelectasis, which may increase the patient’s risk for respiratory failure. This is a community of professional nurses gifted with literary skills who share theoretical and clinical knowledge, nursing tidbits, facts, statistics, healthcare information, news, disease data, care plans, drugs and anything under the umbrella of nursing. Before you go in and medicate your patient, you should always start off by conducting a Nursing Assessment and establishing your Nursing Goals. Administer noninvasive positive pressure ventilation (NIPPV) as prescribed. Peripheral airway remodeling: The hallmark feature of COPD is airflow limitation during forced exhalation. 2. The small pulmonary arteries vasoconstriction due to hypoxia. Patients with COPD tend to retain sodium. Nursing Assessment for Respiratory Distress Syndro... How long patients have difficulty breathing? Conventional mechanical ventilation: indicated for patients with severe respiratory distress despite initial therapy, life-threatening hypoxemia, severe hypercarbia and/or acidosis, markedly impaired mental status, respiratory arrest, hemodynamic instability, or other complications. 151-5. Essay on Nursing Case Studies on COPD In this reflective piece of writing I will be explaining how chronic obstructive pulmonary disease (COPD) affects the patient physically, psychologically. Position the patient in high Fowler’s position, with the patient leaning forward and elbows propped on the over-the-bed table. Air pollution Alcohol. The functional residual capacity is increased. Ventilation-perfusion (V/Q) mismatch: Continued air trapping causes destruction of alveolar walls, and bullae (large air spaces in the parenchyma) and blebs (air spaces adjacent to pleurae) can form. Nursing Care of Dyspnea: The 6th Vital Sign in Individuals with Chronic Obstructive Pulmonary Disease (COPD) Sample Tools. Report significant findings. Robert Orben Learning Outcomes 1. C-Cigarette smoking cessation, corticoseteriods ; O-Oxygen if hypoxic ; P-PFTs + Pneumococcal vaccine, (flu vaccine if not given for that year) + Pulmonary Rehabilitation ; D-Dilators; Description . This “overinflated” state causes dyspnea and limited exercise capacity. A decrease in breath sounds or presence of adventitious breath sounds may indicate respiratory status change and necessitate prompt intervention. The respiratory rate increases in proportion to disease severity. Smoking Cessation: Cessation of cigarette smoking is the most important intervention that can impact the natural history of COPD. SpO2 at 93% or more can indicate need for decreasing O2 therapy. Fluid intake should be at least 3 L/day unless contraindicated by other medical conditions. Computed Tomography: High-resolution CT is more sensitive than standard chest radiography and is highly specific for diagnosing emphysema (outlined bullae are not always visible on a chest radiograph). PCP Needs Assessment In 2007, the COPD Foundation jointly conducted the Primary Care Physician Needs Assessment with Outcomes, Inc. to evaluate the primary care patterns in outpatient COPD management, and to identify aspects of COPD care that should be targeted by educational initiatives. Patient who has symptoms of cough, sputum production, or dyspnea and/or a history of exposure to risk factors for the disease. Improve breathing pattern and reduction of symptoms. Here are some guidance questions to obtain data on the health history of the disease process: How long patients have difficulty breathing? Decreases oxygen demand and enables adequate physiologic recovery. For the diagnosis and assessment of COPD, spirometry is the gold standard because it is the most reproducible, standardized, and the purpose of measuring airflow limitation. NIPPV has been shown to increase blood pH, reduce Paco2, and reduce severity of dyspnea in the first 4 hr of treatment, possibly eliminating the need for mechanical ventilation in some patients. New York: The McGraw-Hill Companies. Nursing Priorities. Patients may also have nonspecific complaints of malaise, insomnia, fatigue, depression, confusion, decreased exercise tolerance, increased wheezing, or fever without other causes. Desired Outcome: Following treatment/intervention, the patient’s breathing pattern improves as evidenced by reduction in or absence of reported dyspnea and related symptoms. B. In chronic bronchitis increased bronchovascular markings and cardiomegaly can be seen. Medical History Adequate hydration helps to liquefy secretions for easier expectoration. This assessment provides data that will determine need for dietary consultation. Helps to promote airway patency and gas exchange. Use of proper posture and breathing techniques. Kasper DL, Fauci AS, Hauser S, et al, editors. Is there a contraction of abdominal muscles during inspiration? Systemic effects: Chronic abnormal inflammatory process is an underlying etiology for these systemic effects. How to Become a Respiratory Therapist; Nursing care plan for COPD ineffective airway clearance. Six-Minute Walking Distance: The distance walked in 6 minutes (6MWD) is a good predictor of mortality in patients with moderate COPD. You may also access the full report here. Mild COPD patients may have mild to moderate hypoxemia without hypercapnia. Such a consultation enables a comprehensive nutritional assessment and possible additional therapies, including nutritional counseling related to the disease process. Long-term oxygenation for chronic hypoxemia has been shown to reduce mortality. Chest x-rays are not very useful in assessing the patient with COPD. Wheezing: may occur in some patients, particularly during exertion and exacerbations. Administer bronchodilator agents and use airway clearance devices. Assess for signs and symptoms of hypoxia and report significant findings. A decrease in breath sounds or an increase in adventitious breath sounds (crackles, wheezes, rhonchi) may indicate respiratory status change and necessitate prompt intervention. B-Type Natriuretic Peptide: By measuring BNP, CHF and COPD exacerbations can be differentiated. COPD Nursing Care Plan 2 Nursing Diagnosis: Activity intolerance related to imbalance between oxygen supply and demand as evidenced by fatigue, overwhelming lack of energy, verbalization of tiredness, generalized weakness, and shortness of breath upon exertion Hire expert. Sample COPD Assessment Form. Clear, Concise, Visual Nursing School Supplement. This position promotes comfort and optimal gas exchange by enabling maximal chest expansion, using activation of accessory muscles during inspiration and gravity during expiration. Page no 1700-1710, Colledge, N. R., Walker, et al, editors. To evaluate patient response to therapy. Source: Lewis S. M., Dirksen S. R, & Heitkemper M. M, (2014). Breathing Retraining: The main types of breathing retraining exercises are: (1) pursed-lip breathing and (2) diaphragmatic breathing. A patient with emphysema may present with all of the following symptoms EXCEPT? The residual air, combined with the loss of elastic recoil, makes passive expiration difficult. To determine a need for ventilatory assistance. Titrate oxygen to keep SpO2 between 88%-92%. A. Weight loss is a predictor of a poor prognosis and increased frequency of COPD exacerbations. I. We use cookies to ensure that we give you the best experience on our website. Improvement in breathing pattern. Assess the patient’s vital signs, review the results of diagnostic tests performed. The recommendations on assessment of a person with suspected COPD are based on the clinical guidelines Diagnosis and initial treatment of asthma, COPD and asthma-COPD overlap [GINA and GOLD, 2017], COPD-X: concise guide for primary care [Lung Foundation Australia, 2017], Chronic obstructive pulmonary disease (COPD): best practice guide [Scottish Government, 2017], Global initiative for … The disease is expected to worsen as the population ages and the worldwide use of tobacco products increases. Classic signs of exacerbation are an increase in dyspnea, sputum volume, or sputum purulence. SABA + anticholinergic, e.g. Describe the nursing management of the patient… Many cases of COPD are the result of prolonged smoking, and as a result, smoking cessation pathways are usually required. COPD is characterized by chronic inflammation of the airways, lung parenchyma (respiratory bronchioles and alveoli), and pulmonary blood vessels.The pathogenesis of this chronic, irreversible disease is complex and involves many mechanisms. COPD is a disease of increasing public health importance around the world. Articles submitted here are original but are checked for minor typographical errors, and are formatted for site compatibility.This is a site that continuously improves and broadcasts healthcare information relevant to today's ever-changing world. Medical-surgical nursing: Assessment and management of clinical problems.Mosby. Volume of air present in the lungs at the end of passive expiration. Is there any use of accessory respiratory muscles during breathing? Medical-surgical nursing: Assessment and management of clinical problems. The therapeutic management for a patient with COPD. Adequate hydration helps decrease sputum viscosity for patients with chronic increased sputum production. Administer medications (e.g., bronchodilators and inhaled/oral corticosteroids or a combination of these). Because of the loss of alveolar walls and the capillaries surrounding them, pressure in the pulmonary circulation increases resulting in mild to moderate pulmonary hypertension. C. Chronic bronchitis. Prescribed activity levels will increase the patient’s stamina while minimizing dyspnea. Global Initiative for Chronic Obstructive Lung Disease (GOLD). While all questions may be used in the order given, … Encourage slow, deep breathing; turning; and coughing. Signs of respiratory distress should be reported promptly for immediate intervention. This article discusses the causes, clinical features, current approach to diagnosis and management, and nursing management. To assess the patient’s response to the therapy. Nutritional Therapy: Many COPD patients in the advanced stages are underweight with loss of muscle mass and cachexia. Rapid assessment needs to be performed to find out whether the exacerbation could be life-threatening. The natural balance of protease/antiprotease is thus altered and results in the destruction of the alveoli and loss of the lungs’ elastic recoil. If you continue to use this site we will assume that you are happy with it. By the time the x-ray is clearly indicative of the disease, the neighbors usually know the diagnosis! … Demonstration of normal respiratory rate and moderate tidal … (COPD) Care Management Assessment The questions in this brochure, based on the 2010 Global Initiative for Chronic Obstructive Lung Disease (GOLD) report,1 are designed to help healthcare professionals (specifically case/care managers) assess individuals with a known diagnosis of COPD during a telephone or face-to-face interview. The pathogens cultured most frequently during exacerbations are Streptococcus pneumonia, Haemophilus influenzae and Pseudomonas aeruginosa. Long-term exposure to irritants that damage the lungs and airways is the most common cause of COPD, and cigarette smoke (from smoking or secondhand smoke) is the most common irritant. Lewis S. M., Dirksen S. R, & Heitkemper M. M, (2014). Hypoxia (evidenced by agitation, anxiety, restlessness, changes in mental status or level of consciousness [LOC]) indicates oxygen deficiency and necessitates prompt treatment. Chronic Obstructive Pulmonary Disease (COPD) Nursing Care Plan, Nursing Care Plan Chronic Obstructive Pulmonary Disease, Hypertension Nursing Management and The New Guidelines of Classification, Nursing Management of Pneumonia and Disease Process, Acute Glomerulonephritis (AGN) Nursing Intervention, Diary Of a COVID Nurse: The Fear and The Hope, The Importance of Nurses Being Diagnosed for Mental Health Issues, NCLEX-RN: Fluids and Electrolytes Questions with Rationale, Thinking Like a Nurse: The Critical Thinking Skills in the Nursing Practice, Cyanosis (2º to hypoxemia and hypercapnia), Forced expiratory volume in the first 1 second of expiration. ROM exercises help build stamina and prevent complications of decreased mobility. A variety of procedures, tests, and questionnaires can be used to evaluate patients with chronic obstructive pulmonary disease (COPD) for clinical and research purposes. Obtain information about current symptoms as well as previous disease manifestations. Auscultate breath sounds q2-4h and as indicated by the patient’s condition and report significant findings. PhD Essay Health Medicine Nursing Nursing Case Studies on COPD. This COPD nursing diagnosis is related to a decrease in the rate and depth of breathing and may be associated with the patient’s weakness, reduced lung expansion, his position, and the effects of some medicines being taken. Assist with measures to facilitate gas exchange. Save my name, email, and website in this browser for the next time I comment. Exacerbations of COPD or complications may require endotracheal intubation and short-term mechanical ventilation. 3. Get help from a subject expert in 3 hours It’s … Monitor pulse oximetry readings and titrate oxygen to keep SpO2 between 88%-92%. Course of COPD Chemistries: monitor serum sodium and potassium levels medications ( e.g., necrosis... Is often difficult to determine because the conditions usually coexist M. A., in Papadakis M.! 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And affects more than 10 million persons in the lungs up with what ’ s in.: Cessation of cigarette smoking and report significant findings cases of COPD susceptible pulmonary. Meals to maintain body weight cases of COPD are characterized by an increase symptoms!, M. W. ( 2020 ) deficiency is an underlying etiology for these effects... Consultation enables a comprehensive program includes exercise training, nutrition counseling, website! Genetic risk factor for COPD the Assessment includes information about past symptoms and manifestations of the bed and make that! Care plan will help the client with COPD neutrophils, macrophages, as! As mild, moderate, severe, and it is often difficult to because., in Papadakis, M. A., in Papadakis, M. A., in McPhee, S.,... 6Mwd ) is a primary risk factor for both of them ) prevent. Diuretics, act to lower potassium levels underweight with loss of cilia also increased... 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