Desired Outcome: The patient reports decreasing dyspnea during activity or exercise and rates perceived exertion at 3 or less on a 0-10 scale. Wheezing (frequently heard on forced and unforced expiration). 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. 103 Nursing Best Practice Guideline COPD Clinic & Education Centre Initial Visit Family Physician _____ Marital Status _____ Age ____ Date _____ … Obtain information about current symptoms as well as previous disease manifestations. C. Chronic bronchitis. 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. COPD (Chronic Obstructive Pulmonary Disease) nursing management with interventions and treatment with medications. Antibiotics are beneficial to patients who have increased sputum production, increased sputum purulence, and increased dyspnea. 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. 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. 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. Administer medications (e.g., bronchodilators and inhaled/oral corticosteroids or a combination of these). Mosby. As the disease condition progresses, hypoxemia worsens and hypercapnia may develop. 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. 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. Before you go in and medicate your patient, you should always start off by conducting a Nursing Assessment and establishing your Nursing Goals. See more ideas about copd, chronic obstructive pulmonary disease, copd awareness. Based on your nursing knowledge and the patient’s symptoms, you suspect the patient suffers from what type of COPD? We use cookies to ensure that we give you the best experience on our website. Mild COPD patients may have mild to moderate hypoxemia without hypercapnia. 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). 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. A decrease in breath sounds or presence of adventitious breath sounds may indicate respiratory status change and necessitate prompt intervention. Such a consultation enables a comprehensive nutritional assessment and possible additional therapies, including nutritional counseling related to the disease process. D. Pneumothorax. 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. 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. Inhaled corticosteroids are also often prescribed to reduce airway inflammation. For the identification of exacerbations, several questionnaires exist, with varying degrees of complexity. Health history. Patients may have a predominance of chronic bronchitis or emphysema, and it is often difficult to determine because the conditions usually coexist. The receptionist advised him to … In chronic bronchitis increased bronchovascular markings and cardiomegaly can be seen. If you continue to use this site we will assume that you are happy with it. 3. In addition to this, cigarette smoke-induced loss of cilia also causes decreased mucous clearance and chronic cough. AAT is a serum protein (an α1-protease inhibitor) produced by the liver and normally found in the lungs. Robert Orben Learning Outcomes 1. Arterial blood gas (ABG) analysis: helps to assess the acuteness and severity of disease exacerbation. Pulmonary function studies. COPD heterogeneity: Gender differences in the multidimensional BODE index. The small pulmonary arteries vasoconstriction due to hypoxia. Coarse crackles beginning with inspiration may be heard. To facilitate clearance of retained secretions and increase ease of breathing. Lewis S. M., Dirksen S. R, & Heitkemper M. M, (2014). On assessment, the patient has cyanosis in the lips and edema in the abdomen and legs. Drug Therapy: Drugs are given in a stepwise fashion according to the severity of airflow obstruction. 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. Save my name, email, and website in this browser for the next time I comment. 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. Peripheral airway remodeling: The hallmark feature of COPD is airflow limitation during forced exhalation. Chronic airflow obstruction is the defining feature of COPD; chronic bronchitis without chronic airflow obstruction is not included within COPD. The nurse should obtain a thorough health history from patients with known or potential COPD. B. Deliver humidified oxygen as prescribed, and monitor the patient’s response. Here are some guidance questions to obtain data on the health history of the disease process: How long patients have difficulty breathing? 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. Nursing assessment should include the following. Is there a contraction of abdominal muscles during inspiration? Other irritants include particles from fires used in the home for cooking or heating and workplace exposure to chemical fumes, dust, and particles. 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. 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. 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. Page no 655-660. Elevate head of the bed and provide an over bed table for the patient to lean on. Patient who has symptoms of cough, sputum production, or dyspnea and/or a history of exposure to risk factors for the disease. 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. Diseases commonly exist in COPD ( chronic Obstructive pulmonary disease ( COPD ) Sample Tools assessing! 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