Hi, I'm Cathy with Level Up RN. In this video, I am going to talk about COPD and at the end of the
video, I'll give you guys a little quiz to test your knowledge of some of the key concepts I'll
be covering in this video. So chronic obstructive pulmonary disease is a combination of two
conditions. It's a combination of emphysema and chronic bronchitis, and these two things together
lead to airway obstruction and COPD is irreversible. So this is differentiated from
asthma, which we talked about in my previous video, which is reversible and intermittent.
With COPD, it is irreversible. So let's talk about the pathophysiology. So with emphysema,
we have destruction of the alveoli in the lungs, and this leads to decreased lung elasticity.
It also causes hyperinflation and air trapping in the lungs. With bronchitis, we have inflammation
of the airways and hypersecretion of mucus. So these two changes together lead to
hypoventilation, hypoxemia, and hypercapnia, which is the retention of carbon dioxide in the lungs.
So in terms of risk factors, smoking is the big one, smoking is the number one risk factor
for COPD. Other risk factors include air pollution and occupational chemicals or dust. In terms of
the signs and symptoms of COPD, your patient will likely present with a cough, you may see them have
excess sputum, when you listen to their lungs, they may have crackles and wheezes, and then
when you percuss their chest, you may hear hyper resonance. So that is due to that trapped air.
Other signs and symptoms include a barrel chest, use of accessory muscles when they're breathing,
clubbing, which is kind of enlargement of the tips of the finger with like spoon-shaped
nails. In addition, they may have cyanosis
and rapid, shallow respirations. And then in order to breathe more effectively, you may see them
in a tripod position, so this is like where they're kind of leaning over a table like this,
and it just makes it easier for them to breathe because of that dyspnea associated with COPD.
Let's now talk about the diagnosis of COPD. So a patient with COPD will have a decreased oxygen
saturation, or SpO2. So normally we would expect patients to have an SpO2 between 95 and 100%,
with COPD, they will have a much lower SpO2, like in the low 90s, and that is expected for a patient
with this condition. Also, if we run an arterial blood gas, we'll find an increase in PaCO2 and a
decrease in PaO2. And then other tools we can use to diagnose COPD include pulmonary function tests,
as well as a chest x-ray. Medications that can be used with COPD include bronchodilators,
anticholinergics, corticosteroids, mucolytics, and oxygen therapy as well. In terms of nursing care,
you're going to want to place the patient in an upright position because it's easier
for them to breathe that way, you're going to administer oxygen as ordered by the provider,
and you're going to monitor for complications, which can include right-sided heart failure.
There's a lot of teaching you need to do with your patient as well. So, first of all, if your patient
is a smoker, we need to strongly encourage them to stop smoking. We want to teach them effective
breathing techniques to help relieve their dyspnea, so this includes abdominal and pursed-lip
breathing. We also want to teach effective coughing and how to use an incentive spirometer.
And I see patients sometimes trying to blow into their incentive spirometer at the hospital,
so you've got to teach them to suck in, right? So you breathe in with an incentive spirometer,
so there's breathe in and incentive spirometer. And they should do this 10 times an hour while
they're awake. And then in terms of their diet, we want to encourage them to consume small,
frequent meals, increase their fluid intake, and also increase their calories and protein intake.
And then we also want to teach them oxygen safety if they're going to need to go home with oxygen
therapy. So they should hang a no smoking sign at their door, they need to wear cotton clothing
and have cotton bedding, that type of thing. All right. Time for a quiz. I have three
questions. First question, COPD includes which two conditions?
If you said emphysema and chronic bronchitis, you are correct. Question number two,
what is the number one risk factor for COPD? The answer is smoking. Question number three,
when you percuss the lungs of your patient with COPD, what do you expect to hear?
The answer is hyper resonance, and that is due to the trapped air that we have with COPD.
Hope this video has been helpful and hopefully you enjoyed that quiz as well.
I'll see you soon on another video.