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.