BODE index: The BODE index is a multidimensional scoring system used to test patients who have been diagnosed with COPD and to predict mortality. What patients know about the condition and the disease? Adequate hydration helps to liquefy secretions for easier expectoration. Brunner & Suddarth’s. Peripheral airway obstruction also results in V/Q imbalance and, combined with respiratory muscle impairment, can lead to CO2 retention, particularly in severe disease. Serum Chemistries: Monitor serum sodium and potassium levels. Medical-surgical nursing: Assessment and management of clinical problems. Related articles of ours: What Does ICU Stand For? Show More COPD. Other irritants include particles from fires used in the home for cooking or heating and workplace exposure to chemical fumes, dust, and particles. Desired Outcome: The patient reports decreasing dyspnea during activity or exercise and rates perceived exertion at 3 or less on a 0-10 scale. Air pollution Physical activity Lifestyle and wellbeing. This chronic, abnormal inflammatory process causes tissue destruction and disrupts the normal defense mechanisms and repair process of the lung and finally results in structural changes in the lungs. 1. SpO2 at 87% or less can indicate need for O2 therapy. Severe AAT deficiency leads to destruction of lung tissues by proteases and can cause premature bullous emphysema. As the disease advances, the structure of the pulmonary arteries changes, resulting in the thickening of the vascular smooth muscle. 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. Nursing Assessment for COPD Exacerbation 1. Describe the etiology, pathophysiology, clinical manifestations, and collaborative care of asthma. Etiology: viral /bacterial infections, air pollution, ICU admission and mechanical ventilation for life-threatening exacerbations, Nursing assessment should include the following. A decrease in breath sounds or presence of adventitious breath sounds may indicate respiratory status change and necessitate prompt intervention. Does the … This results in a significant ventilation-perfusion (V/Q) mismatch and hypoxemia. FEV1 / FVC FEV1 / FVC Reduction of total personal exposure to tobacco smoke, dust labor and chemicals, and indoor and outdoor air pollutants are important goals to prevent the onset and development of COPD. A decrease in breath sounds or an increase in adventitious breath sounds (crackles, wheezes, rhonchi) may indicate respiratory status change and necessitate prompt intervention. Demonstration of normal respiratory rate and moderate tidal … Position the patient in high Fowler’s position, with the patient leaning forward and elbows propped on the over-the-bed table. Patients typically present with a combination of signs and symptoms of chronic bronchitis, emphysema, and reactive airway disease. Many cases of COPD are the result of prolonged smoking, and as a result, smoking cessation pathways are usually required. 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. 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. Airway Clearance Techniques: ACTs include effective coughing, chest physiotherapy, airway clearance devices, and high frequency chest ventilation. B-Type Natriuretic Peptide: By measuring BNP, CHF and COPD exacerbations can be differentiated. Fluid intake should be at least 3 L/day unless contraindicated by other medical conditions. Encourage slow, deep breathing; turning; and coughing. A patient with emphysema may present with all of the following symptoms EXCEPT? Explain, as indicated, that mechanical ventilation may be necessary and this would necessitate intensive care support. 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. A. Emphysema. COPD can be classified as mild, moderate, severe, and very severe. Alpha1-Antitrypsin: AAT should be measured in all patients younger than 40 years, in those with a family history of emphysema at an early age, or patients with emphysematous changes with no smoking history. Below you’ll find the key findings from this study. Source: Lewis S. M., Dirksen S. R, & Heitkemper M. M, (2014). Page no 1700-1710, Colledge, N. R., Walker, et al, editors. Assessment and management of an exacerbation of COPD. Desired Outcome. Report significant findings. Therefore, identification and correct assessment of COPD exacerbations is paramount, given it will strongly influence therapy success. 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. Source: Lewis S. M, Dirksen S. R, & Heitkemper M. M.(2014). Because of air trapping, the chest hyper expands and becomes barrel-shaped. B. Patients may have a predominance of chronic bronchitis or emphysema, and it is often difficult to determine because the conditions usually coexist. Sodium restriction may be indicated if there is accompanying heart failure. Hire expert. Current medical diagnosis & treatment 2020. He was due for a review of his COPD but telephoned the practice to cancel his appointment saying he had a chest infection, which was making him feel unwell. Nursing Assessment: Note for the number of times the patient has experienced such exacerbation in a year. Volume of air present in the lungs at the end of passive expiration. 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. Describe the nursing management of the patient… The therapeutic management for a patient with COPD. 103 Nursing Best Practice Guideline COPD Clinic & Education Centre Initial Visit Family Physician _____ Marital Status _____ Age ____ Date _____ … Auscultate breath sounds noting areas of decreased or absent ventilation and presence of adventitious sounds (crackles, wheezes, rhonchi). An effective nursing care plan will help the client with COPD to achieve the goals and the patient. 2 Assessment Education Centre Pulmonary Rehabilitation Access Centre Dietitian Social Worker Psychologist Other: Signature: Nursing Care of Dyspnea: The 6th Vital Sign in Individuals with Chronic Obstructive Pulmonary Disease (COPD) 102. 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. Fluids should be taken between meals (rather than with them) to prevent excess stomach distention and to decrease pressure on the diaphragm. Regulate fluid intake to optimize fluid balance. Administer medications (e.g., bronchodilators and inhaled/oral corticosteroids or a combination of these). Spirometry. Is there any use of accessory respiratory muscles during breathing? Occupational exposures often are overlooked and underdiagnosed. 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. To facilitate clearance of retained secretions and increase ease of breathing. How much restriction on the patient's activity tolerance? PaO2 likely will continue to decrease as the patient’s disease progresses. Prevention of infections: COPD patients are extremely susceptible to pulmonary infections. These inflammatory cells also attract other inflammatory mediators (e.g., leukotrienes) and proinflammatory cytokines (e.g., tumor necrosis factor). Delivering O2 with humidity will help minimize convective losses of moisture, decreasing dry mucous membranes and enhancing lung compliance. COPD heterogeneity: Gender differences in the multidimensional BODE index. Assess for signs and symptoms of hypoxia and report significant findings. Mosby Publications, Page no 580-590. 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 Here are some guidance questions to obtain data on the health history of the disease process: How long patients have difficulty breathing? 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. The natural balance of protease/antiprotease is thus altered and results in the destruction of the alveoli and loss of the lungs’ elastic recoil. 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 … As the disease condition progresses, hypoxemia worsens and hypercapnia may develop. Classic signs of exacerbation are an increase in dyspnea, sputum volume, or sputum purulence. Monitor pulse oximetry readings and titrate oxygen to keep SpO2 between 88%-92%. Use of proper posture and breathing techniques. 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, Coarse crackles beginning with inspiration may be heard. For patients who require an oxygen mask or NIPPV and are able to eat, consult with respiratory therapy for the most appropriate device to allow the patient to eat. Assess respiratory and oxygenation status as indicated by the patient’s condition. McGraw-Hill Education. Adequate hydration helps decrease sputum viscosity for patients with chronic increased sputum production. Systemic effects: Chronic abnormal inflammatory process is an underlying etiology for these systemic effects. Chest Radiography: Chest radiographs of emphysematous patients reveal signs of hyperinflation, including flattening of the diaphragm, increased retrosternal air space, and a long, narrow heart shadow. Deliver humidified oxygen as prescribed and monitor the patient’s response.. Delivering O2 with humidity will help minimize convective losses of moisture, decreasing dry mucous membranes and enhancing lung compliance. An FEV1/FVC ratio of less than 70% establishes the diagnosis of COPD, and the severity of obstruction (as indicated by FEV1) determines the stage of COPD. Medical-surgical nursing: Assessment and management of clinical problems. A comprehensive program includes exercise training, nutrition counseling, and education and provides benefits to patients with all stages of COPD. Start off by positioning your patient upright to help his breathing. Elevate head of the bed and provide an over bed table for the patient to lean on. Deliver humidified oxygen as prescribed, and monitor the patient’s response. Is there a contraction of abdominal muscles during inspiration? Barrel chest. However, the x-ray may show over-inflation of the lungs, which is common in emphysema. Patients with advanced disease may experience tachypnea and respiratory distress with simple activities. 2. Pulmonary function studies. A. Maintain prescribed activity levels, and explain rationale to the patient. Demographic factors: age, low socioeconomic status, history of childhood respiratory infections. Inflammation of central airways: Chronic exposure to cigarette smoke, noxious particles and gases causes abnormal inflammatory response throughout the proximal and peripheral airways, lung parenchyma, and pulmonary vasculature. Decreases oxygen demand and enables adequate physiologic recovery. Chronic Obstructive Pulmonary Disease (COPD) Nursing Care Plan Assist the patient to sitting position with head slightly flexed, shoulders relaxed, and knees flexed. Volume of air that can forcibly be expired in first 1 second, after full inspiration. International journal of chronic obstructive pulmonary disease. New York: The McGraw-Hill Companies. Patients with COPD tend to retain sodium. Request consultation from pulmonary rehabilitation. Prescribed activity levels will increase the patient’s stamina while minimizing dyspnea. Page no 655-660. This assessment provides data that will determine need for dietary consultation. On assessment, the patient has cyanosis in the lips and edema in the abdomen and legs. Allow at least 90 min between activities for undisturbed rest. Long-term oxygenation for chronic hypoxemia has been shown to reduce mortality. 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. In addition to this, cigarette smoke-induced loss of cilia also causes decreased mucous clearance and chronic cough. The nurse should obtain a thorough health history from patients with known or potential COPD. High-protein, high-calorie nutritional supplements can be offered between meals. Other common systemic diseases include cachexia (skeletal muscle wasting), osteoporosis, diabetes, and metabolic syndrome. Pulmonary hypertension may progress and lead to hypertrophy of the right ventricle of the heart (cor pulmonale) and may eventually lead to right-sided heart failure. Hypoxia (evidenced by agitation, anxiety, restlessness, changes in mental status or level of consciousness [LOC]) indicates oxygen deficiency and necessitates prompt treatment. Robert Orben Learning Outcomes 1. Auscultate breath sounds q2-4h and as indicated by the patient’s condition and report significant findings. All patients over age 40 with 10 or more pack-years of cigarette smoking. All information expressed here are courtesies of the respective authors. AAT is a serum protein (an α1-protease inhibitor) produced by the liver and normally found in the lungs. Helps to promote airway patency and gas exchange. Wheezing: may occur in some patients, particularly during exertion and exacerbations. See more ideas about copd, chronic obstructive pulmonary disease, copd awareness. Drug Therapy: Drugs are given in a stepwise fashion according to the severity of airflow obstruction. Maintain airway patency Objective Assessing the effectiveness of the Assessment of Burden of COPD (ABC) tool on disease-specific quality of life in patients with chronic obstructive pulmonary disease (COPD) measured with the St. George's Respiratory Questionnaire (SGRQ), compared with usual care. (2007). COPD management Nursing Mnemonic. A diet high in calories and protein, moderate in carbohydrate, and moderate to high in fat is recommended and can be divided into five or six small meals a day. How to Become a Respiratory Therapist; Nursing care plan for COPD ineffective airway clearance. Harrison’s principles of internal medicine, 19th ed (2015). 2. The amount of air remaining in the lungs after a maximal expiration. 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. Its main function is to protect normal lung tissue from attack by proteases during inflammation related to cigarette smoking and infections. While all questions may be used in the order given, … 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. Sample COPD Assessment Form. salbutamol and ipratropium bromide via nebulizers × 3 back-to-back q15min, If allergic to penicillin, Fuoroquinolone or doxycycline. Rapid assessment needs to be performed to find out whether the exacerbation could be life-threatening. 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