Question

He is recovering well and hopes to have his chest tube out soon. He receives a phone call from his daughter that his wife is being admitted with COPD exacerbation. He tells you that his wife is 72 years old and this is her 3rd time being admitted this year for the same problem. The daughter describes that she had to bring her in as she became extremely anxious and SOB despite wearing her oxygen as ordered.

1. Discuss briefly your understanding of the pathophysiology of COPD as it relates to this patients’ manifestations. Use the reference article posted in the folder as well as your text.

2. What would you anticipate to be potential complications of COPD exacerbation? How would complications be avoided and treated?

3. Describe the anticipated nursing and medical management of patients with COPD including goals of care. Make a list using bullets.

4. Discuss what you know about oxygen therapy, indications, concerns, and discharge teaching needed. Describe how oxygen would be titrated up when patients continue to de-sat.

Answer 1

1, COPD exacerbation is a pulmonary disease that causes airflow block and breathing problem that leads to lung damage. inflammation of lungs due to infection or irritants due to air pollution, smoking, seasonal allergens, pneumonia cause COPD. it causes panic symptoms when the patient has to breathe difficulty patient gets stress it makes the breathing problem worse.
2, complications of COPD include depression, heart problems, lung cancer, high blood pressure in the lungs. treatment includes antibiotics and inhalers, steroids, it can be prevented through avoiding lung irritants, large crowd, drinking more fluids will be helpful to loosen the mucous and get flu shot to avoid lung infection, regular lung checkup, taking healthy diet and enough rest, avoiding smoking and following hand washing and using sanitizers for hands to avoid spreading germs.
3, the goal of care for COPD include
- avoid secondary complications
-Improve the quality of care
-Reduce the respiratory symptoms
Nursing management;
-advice patient to avoid smoking and allergens and involve the patient in smoking cessation
-dietary supplements and a well-balanced diet help for lungs to meet nutritional needs.
- Educate the patient about symptoms of COPD.
-Teach breathing and coughing exercise
-Pulmonary rehabilitation improves the quality of patient life
-Support the family and patient to manage the symptoms
Medial management:
-bronchodilators for every 2 to 3 hours
-Beta-blockers and anticholinergics for pulmonary muscle relaxations
- Glucocorticoids inhalers
-Oxygen therapy for long term o2 therapy and improve lung capacity
-antibiotic therapy and vaccination therapy to prevent infection
4, Oxygen therapy improves hemodynamics, lung capacity, mental status, and exercise endurance. when a patient with exacerbation oxygen therapy improves patient conditions. ABG evaluated before oxygenation. o2 therapy should be regulated to avoid acidosis and maintain the co2 level. o2 sat should be 88 - 92% with o2 2 l/min. during exacerbation of COPD provide 24% of o2 through the face mask to maintain >90% o2 saturation. after o2 initiation check ABG every 60minutes. check ABG at room air before discharge. if the patient with low po2 need for long term o2 therapy and need 4 to 6 weeks followup for LTOT assessment. For LTOT use it needs only 15 hours a day o2 for the patient including overnight.
when patients experience hypoxemia patient needs high oxygen flow system for o2 delivery using reservoir mask, provide 10 to 15l/min for initial management and maintain 94-98% o2 saturation.  
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