Table of Contents:
1. Pathophysiology & Assessment 4. Nutrition
2. Diagnostic Studies 5. Medications
3. Interventions & Teaching 6. Acute Exacerbation
Chronic Obstructive Pulmonary Disease (COPD)
Respiratory
TABLE 1. PATHOPHYSIOLOGY
Chronic Bronchitis (Blue Bloater) Emphysema (Pink Puffer)
PATHOPHYSIOLOGY PATHOPHYSIOLOGY
Inflammation and damage Excess mucus ﹢ Airway Alveolar destruction Loss of elastic recoil Air trapping
inflammation Hypoxemia
FINDINGS FINDINGS
“Blue” from cyanosis and polycythemia anteroposterior (AP) diameter (“barrel chest”)
(compensatory increase in RBC production) and hyperresonance on percussion
y Hypoxia Pulmonary vasoconstriction pulmonary y Can overcome air-trapping with pursed-lip breathing
pressures Right heart failure (cor pulmonale) (“bloater”) (“pink puffer”)
1. Pathophysiology & Assessment 3. Interventions & Teaching
COPD Oxygen
y Chronic airflow limitation y Give only low-flow oxygen to prevent respiratory
#1 risk factor = smoking depression (2-4 L/min or 40% Venturi mask).
y Features of both chronic bronchitis and Titrate to keep pulse oximetry 88-92%.
emphysema (TABLE 1)
Pulmonary hygiene
Manifestations of hypoxemia and air trapping Pursed-lip breathing: Inhale through nose; exhale
y Dyspnea (worse with exertion) (twice as long) through lips without puffing cheeks
y Intercostal muscle use, tripod position (like whistling or blowing bubbles).
y Wheezes, crackles, diminished breath sounds
y Anorexia, weight loss
y Fingernail clubbing
2. Diagnostic Studies
y Spirometry: COPD severity graded by forced
expiratory volume in 1 sec (FEV1) y Huff coughing: Inhale deeply, hold breath 2-3 sec,
ABG: Hypoxemia and chronic, compensated and forcefully exhale by saying “huff” (as if fogging up
respiratory acidosis (pH normal) a mirror). Repeat and cough once you feel mucus.
y Chest X-ray: Lung hyperinflation, flattened diaphragm
Barrel chest and hyperresonance In COPD, the pulse oximetry target for oxygen
are seen with emphysema due therapy is 88-92%.
to air trapping.
© Bootcamp.com 3
1. Pathophysiology & Assessment 4. Nutrition
2. Diagnostic Studies 5. Medications
3. Interventions & Teaching 6. Acute Exacerbation
Chronic Obstructive Pulmonary Disease (COPD)
Respiratory
TABLE 1. PATHOPHYSIOLOGY
Chronic Bronchitis (Blue Bloater) Emphysema (Pink Puffer)
PATHOPHYSIOLOGY PATHOPHYSIOLOGY
Inflammation and damage Excess mucus ﹢ Airway Alveolar destruction Loss of elastic recoil Air trapping
inflammation Hypoxemia
FINDINGS FINDINGS
“Blue” from cyanosis and polycythemia anteroposterior (AP) diameter (“barrel chest”)
(compensatory increase in RBC production) and hyperresonance on percussion
y Hypoxia Pulmonary vasoconstriction pulmonary y Can overcome air-trapping with pursed-lip breathing
pressures Right heart failure (cor pulmonale) (“bloater”) (“pink puffer”)
1. Pathophysiology & Assessment 3. Interventions & Teaching
COPD Oxygen
y Chronic airflow limitation y Give only low-flow oxygen to prevent respiratory
#1 risk factor = smoking depression (2-4 L/min or 40% Venturi mask).
y Features of both chronic bronchitis and Titrate to keep pulse oximetry 88-92%.
emphysema (TABLE 1)
Pulmonary hygiene
Manifestations of hypoxemia and air trapping Pursed-lip breathing: Inhale through nose; exhale
y Dyspnea (worse with exertion) (twice as long) through lips without puffing cheeks
y Intercostal muscle use, tripod position (like whistling or blowing bubbles).
y Wheezes, crackles, diminished breath sounds
y Anorexia, weight loss
y Fingernail clubbing
2. Diagnostic Studies
y Spirometry: COPD severity graded by forced
expiratory volume in 1 sec (FEV1) y Huff coughing: Inhale deeply, hold breath 2-3 sec,
ABG: Hypoxemia and chronic, compensated and forcefully exhale by saying “huff” (as if fogging up
respiratory acidosis (pH normal) a mirror). Repeat and cough once you feel mucus.
y Chest X-ray: Lung hyperinflation, flattened diaphragm
Barrel chest and hyperresonance In COPD, the pulse oximetry target for oxygen
are seen with emphysema due therapy is 88-92%.
to air trapping.
© Bootcamp.com 3
