COPD III
Chronic Obstructive Pulmonary Disease
Pathophysiology Course
Priority Question Nursing Interventions
An elderly client with worsening COPD presents to the emergency department with
fatigue and altered level of consciousness. Upon assessment the nurse finds O2 Diet:
saturation of 87%, and ABG: pH 7.21, PaCO2 75, and PaO2 55 mm Hg. Which
immediate intervention is best?
• Oral hygiene BEFORE meals to wake up the taste buds!
• Eat small, frequent meals (decreases stomach distention)
1. Apply oxygen 4 LPM via HyperCAPnic (High CO2) = BiPAP
nasal cannula. • HIGH calories & protein
2. Call respiratory for STAT • AVOID eating high amounts of carbohydrates Kaplan
albuterol treatment. • AVOID exercise 1 hour Before/After meals
3. Sit the patient upright and - conserve oxygen for chewing & swallowing
apply Bilevel Positive Airway
Pressure BiPAP • AVOID Gassy Foods
4. Start looking for other jobs • NO carbonated drinks
in cosmetic surgery. • NO high-fiber foods (broccoli, beans)
Fluids:
• Increase fluid intake 8 glasses (2 - 3L/day)
to thin that mucous
Nursing Interventions • AVOID drinking fluids while eating
Infection: 1
Look for the O’s to • Report increase in sputum
know its an opioid: • Fever, Worsening dyspnea
COPD exacerbation Vaccines:
• Pneumococcal every 5 years
NO Opioids: • Flu vaccine every year
• MOrphine Meds: Albuterol if short of breath to vasodilate
the lungs & allow more air flow
HYDROCODONE
• HydrOmorphone OXYCODONE
• HydrOcodone
Side Note for our patients with heavy mucus
• OxycOdone
Our crazy pam &
gs
Bronchitis
NO Benzos:
• Before Bed - Mobilize Secretions
• Diazepam (brand: Valium) • Guaifenesin (Brand: Mucinex)
• Lorazepam (brand: Ativan) • Cool mist humidifier at night to make breathing easier.
ATIVAN
Breathing:
(DIAZEPAM)
Pursed lip breathing
• Inhale: 2 seconds via nose (closed mouth)
• Exhale: 4 seconds with pursed lips
EXAM Question MEMORY TRICK
- 2 nostrils = 2 seconds INhale like smelling a rose
wing a kiss
Huff coughing technique
Correct Order:
1. Sit upright in a chair: feet shoulder
width apart & lean forward
1. Ipratropium 2. Deep slow inhalation through
mouth using diaphragm muscle
2. Hydromorphone 3. Hold breath: 2-3 seconds & then
forcefully exhale
3. Rescue inhaler
4. Repeat HUFF once or twice more
4. Oxygen via nasal
00:02
& avoid from normal coughing
cannula 3 L/min 5. Rest for 5-10 normal breaths & repeat
as needed until secretions clear
5. Diazepam
Chronic Obstructive Pulmonary Disease
Pathophysiology Course
Priority Question Nursing Interventions
An elderly client with worsening COPD presents to the emergency department with
fatigue and altered level of consciousness. Upon assessment the nurse finds O2 Diet:
saturation of 87%, and ABG: pH 7.21, PaCO2 75, and PaO2 55 mm Hg. Which
immediate intervention is best?
• Oral hygiene BEFORE meals to wake up the taste buds!
• Eat small, frequent meals (decreases stomach distention)
1. Apply oxygen 4 LPM via HyperCAPnic (High CO2) = BiPAP
nasal cannula. • HIGH calories & protein
2. Call respiratory for STAT • AVOID eating high amounts of carbohydrates Kaplan
albuterol treatment. • AVOID exercise 1 hour Before/After meals
3. Sit the patient upright and - conserve oxygen for chewing & swallowing
apply Bilevel Positive Airway
Pressure BiPAP • AVOID Gassy Foods
4. Start looking for other jobs • NO carbonated drinks
in cosmetic surgery. • NO high-fiber foods (broccoli, beans)
Fluids:
• Increase fluid intake 8 glasses (2 - 3L/day)
to thin that mucous
Nursing Interventions • AVOID drinking fluids while eating
Infection: 1
Look for the O’s to • Report increase in sputum
know its an opioid: • Fever, Worsening dyspnea
COPD exacerbation Vaccines:
• Pneumococcal every 5 years
NO Opioids: • Flu vaccine every year
• MOrphine Meds: Albuterol if short of breath to vasodilate
the lungs & allow more air flow
HYDROCODONE
• HydrOmorphone OXYCODONE
• HydrOcodone
Side Note for our patients with heavy mucus
• OxycOdone
Our crazy pam &
gs
Bronchitis
NO Benzos:
• Before Bed - Mobilize Secretions
• Diazepam (brand: Valium) • Guaifenesin (Brand: Mucinex)
• Lorazepam (brand: Ativan) • Cool mist humidifier at night to make breathing easier.
ATIVAN
Breathing:
(DIAZEPAM)
Pursed lip breathing
• Inhale: 2 seconds via nose (closed mouth)
• Exhale: 4 seconds with pursed lips
EXAM Question MEMORY TRICK
- 2 nostrils = 2 seconds INhale like smelling a rose
wing a kiss
Huff coughing technique
Correct Order:
1. Sit upright in a chair: feet shoulder
width apart & lean forward
1. Ipratropium 2. Deep slow inhalation through
mouth using diaphragm muscle
2. Hydromorphone 3. Hold breath: 2-3 seconds & then
forcefully exhale
3. Rescue inhaler
4. Repeat HUFF once or twice more
4. Oxygen via nasal
00:02
& avoid from normal coughing
cannula 3 L/min 5. Rest for 5-10 normal breaths & repeat
as needed until secretions clear
5. Diazepam
