COPD

Question 2

What is COPD?

Answer 2

Chronic Obstructive Pulmonary Disease (COPD) is a progressive, chronic inflammatory lung disease characterized by airflow limitation that is not fully reversible.

The inflammation causes slowly an obstruction to bronchioles and thereby a pulmonary emphysema.

Question 3

What are the main symptoms of COPD?

Answer 3

Chronic cough, sputum production (especially in the morning), dyspnea (shortness of breath), wheezing, chest tightness, decreased exercise tolerance, fatigue due to poor oxygenation, frequent respiratory infections, weight loss, and decreased Spo2 % levels (increased risk for Co2-retention).

Question 4

What are examples of COPD?

Answer 4

emphysema and chronic bronchitis.

Question 5

What are the stages of COPD according to GOLD Criteria?

Answer 5

Stages include:
- Mild (Stage I): FEV1 ≥80%, may have no symptoms, winded with moderate exercise or walking upstairs.

• Moderate (Stage II): FEV1 50–79%, frequent stops to catch breath, coughing, wheezing and breathlessness.
• Severe (Stage III): FEV1 30–49%, shortness of breath worsens, frequent flare-ups or exacerbations that leads to hospitalization. Worsening symptoms.
• Very Severe (Stage IV): FEV1 <30% or <50% with respiratory failure, Low oxygen level, constant shortness of breath. Flare ups and exacerbation, can be life threatening.

Question 6

What is the pathophysiology of Emphysema?

Answer 6

Emphysema develops when the alveoli are destroyed, causing them to merge into one large air sac, leading to decreased surface area for gas exchange and air trapping.

Since it doesn’t absorb oxygen as well as healthy alveoli, the blood gets less oxygen.

Emphysema also causes the lungs to stretch out, losing their elasticity. As a result, air remains trapped in the lungs, making breathing difficult.

Alveoli are destroyed, leading to fewer, larger air sacs

Decreased surface area for gas exchange

Air trapping and hyperinflation

Loss of lung elasticity

Question 7

What are the clinical presentations of Emphysema?

Answer 7

‘pink puffers’ (normal oxygen levels, pursed-lip breathing), severe dyspnea, barrel chest from difficulty exhaling, leading to air trapping., weight loss, and decline in functional ability.

Question 8

What is the pathophysiology of Chronic Bronchitis?

Answer 8

The condition causes inflammation in the lining of bronchial tubes, which are responsible for carrying air to and from the alveoli. Chronic bronchitis damages the cilia (the hair-like fibers lining the bronchial tubes), which help eliminate mucus.

As a result, it becomes more challenging to remove mucus, making you cough more and obstructs the airflow. That’s why people with chronic bronchitis develop mucus that stays for an extended period, sometimes up to two years. Other symptoms of chronic bronchitis are shortness of breath and coughing.

Inflammation of the bronchi

Increased mucus production and thickening of airway walls

Ciliary dysfunction

Airflow obstruction

Question 9

What are the clinical presentations of Chronic Bronchitis?

Answer 9

‘blue bloaters’ (low oxygen levels, cyanosis, fluid retention), persistent productive cough with thick mucus esp in morning, and edema.

Question 10

What is the primary cause of COPD?

Answer 10

Smoking is the primary cause of COPD.

Question 11

What are other risk factors for COPD?

Answer 11

Long-term exposure to air pollutants, second-hand smoke, indoor cooking fuels, occupational exposure to dust, fumes, and chemicals from workplace, genetic predisposition (Alpha-1 antitrypsin deficiency) a rare genetic disorder that can cause COPD even in nonsmokers, and respiratory infections.

Question 12

What are the main risk factors for emphysema?

Answer 12

Long-term smoking, genetic deficiency (Alpha-1 antitrypsin), and chronic respiratory infections.

Question 13

What are the main risk factors for chronic bronchitis?

Answer 13

Smoking, recurrent respiratory infections, air pollution, and occupational irritants.

Question 14

What are the pharmacological treatments for COPD?

Answer 14

Bronchodilators (e.g., albuterol, salmeterol) - Relax airway muscles, inhaled corticosteroids (e.g., fluticasone) - Reduce airway inflammation, combination inhalers, oral corticosteroids (short-term), and antibiotics for infections.

Question 15

What are the non-pharmacological interventions for COPD?

Answer 15

Smoking cessation, pulmonary rehabilitation, exercise training, education, and breathing techniques to improve quality of life, oxygen therapy (if SpO2 <88%), PAP at night in cases of sleep apnea and COPD or CPAP or BiPAP CPAP or BiPAP can be consider in palliative phase of the disease for ventilation support, Lung Transplantation. Lung transplantation is a viable option for definitive surgical treatment of end-stage emphysema, Surgery: Bullectomy

Question 16

What is bullectomy?

Answer 16

Bullectomy is a surgical option for select patients with bullous emphysema and can help reduce dyspnea and improve lung function.

Question 17

What is lung volume reduction surgery?

Answer 17

Lung Volume Reduction Surgery. Lung volume reduction surgery is a palliative surgery in patients with homogenous disease or disease that is focused in one area and not widespread throughout the lungs.

Question 18

What surgical options are available for COPD?

Answer 18

Bullectomy, lung volume reduction surgery, and lung transplantation.

Question 19

What are the long-term treatments for COPD?

Answer 19

Maintenance bronchodilators, inhaled corticosteroids, two long-acting β2-agonists in the same inhaler, and lifestyle modifications.

Question 20

What are the short-term treatments for COPD?

Answer 20

Rescue inhalers (SABAs) and oral corticosteroids during exacerbations.

Question 21

What is CPAP?

Answer 21

Continuous Positive Airway Pressure (CPAP) is a device that pressurizes the air to a higher level than the air in the room,- delivering constant air pressure to - keep airways open, especially during sleep. - It prevents alveolar collapse and - improves oxygenation. Used in sleep apnea and acute exacerbations of COPD.

Question 22

What is BiPAP? It’s Functions?

Answer 22

Bilevel Positive Airway Pressure (BiPAP) provides two levels of pressure: higher during inhalation (IPAP) and lower during exhalation (EPAP). It supports both breathing in and out and enhances ventilation in severe COPD.

Question 23

What are the main aims for treating COPD?

Answer 23

To relieve symptoms, improve exercise tolerance and quality of life, prevent disease progression and exacerbations, and reduce mortality.

Question 24

What are the prevention strategies for COPD?

Answer 24

smoking cessation, avoiding occupational/environmental irritants, vaccinations (influenza, pneumococcal), early treatment of respiratory infections, and regular follow-ups with a healthcare provider.

Question 25

What are the symptoms and clinical presentation of COPD?

Answer 25

Symptoms of COPD include cough, dyspnea, and sputum. A history of smoking or pollutant exposure is common, and physical signs may include barrel chest, wheezing, and prolonged expiration.

Question 26

What are the necessary examinations for diagnosing COPD?

Answer 26

Spirometry (FEV1/FVC <70%), chest X-ray or CT scan, arterial blood gas (ABG), sputum cultures, alpha-1 antitrypsin testing, Blood chemistry: alpha1-antitrypsin is measured to verify deficiency and diagnosis of primary emphysema. Complete blood count (CBC) and differential - Increased hemoglobin (advanced emphysema), increased eosinophils (asthma). Electrocardiogram (ECG) - Right axis deviation, peaked P waves (severe asthma); atrial dysrhythmias (bronchitis), tall, peaked P waves in leads II, III, AVF (bronchitis, emphysema); vertical QRS axis (emphysema).

Question 28

What to do in emergency response for COPD?

Answer 28

Assess airway, breathing, SpO2 Administer SABA (e.g., salbutamol) Provide supplemental oxygen Initiate corticosteroids and antibiotics if indicated Position patient upright.

Question 29

What should be assessed in a nursing assessment for COPD?

Answer 29

Assess patient’s exposure to risk factors, past and present medical history, signs and symptoms of COPD and their severity, patient’s knowledge of the disease, vital signs, breath sounds and pattern, respiratory rate and rhythm, lung sounds, SpO2 monitoring, skin color, and use of accessory muscles.

Question 30

What are some nursing interventions for COPD patients?

Answer 30

Administer medications as prescribed, educate on inhaler use, position for optimal breathing, encourage fluid intake and coughing, and teach breathing techniques.

Question 31

Nursing interventions

Answer 31

Administer medications as prescribed (bronchodilators and corticosteroids) stay alert for potential side effects. Educate on inhaler use. Positioning for optimal breathing (high fowler position) Encourage fluid intake and coughing Pursed lip breathing. Pursed lip breathing helps slow expiration, prevents collapse of small airways, and control the rate and depth of respiration. Diaphragmatic breathing. Diaphragmatic breathing reduces respiratory rate, increases alveolar ventilation, and sometimes helps expel as much air as possible during expiration. Inspiratory muscle training. This may help improve the breathing pattern. Monitor cognitive changes. The nurse should monitor for cognitive changes such as personality and behavior changes and memory impairment. Monitor pulse oximetry values. Pulse oximetry values are used to assess the patient’s need for oxygen and administer supplemental oxygen as prescribed. Prevent infection. The nurse should encourage the patient to be immunized against influenza and S. pneumonia because the patient is prone to respiratory infection.

Question 32

What is pursed lip breathing?

Answer 32

Pursed lip breathing helps slow expiration, prevents collapse of small airways, and control the rate and depth of respiration.

Question 33

What is diaphragmatic breathing?

Answer 33

Diaphragmatic breathing reduces respiratory rate, increases alveolar ventilation, and sometimes helps expel as much air as possible during expiration.

Question 34

Why is pulse oximetry important in COPD management?

Answer 34

Pulse oximetry values are used to assess the patient’s need for oxygen and administer supplemental oxygen as prescribed.

Question 35

What are key points in patient education for COPD?

Answer 35

Proper inhaler technique, PEP blow guidance, peer support - rehabilitation groups especially for physical exercise, importance of medication adherence, smoking cessation, recognizing symptoms of exacerbation, energy conservation techniques, Manage daily activities. Daily activities must be paced throughout the day and support devices can be also used to decrease energy expenditure. Exercise training. Exercise training can help strengthen muscles of the upper and lower extremities and improve exercise tolerance and endurance.

Question 36

What are common symptoms of COPD exacerbation?

Answer 36

Increased dyspnea, increased sputum volume or purulence, wheezing, chest tightness, fever, fatigue, functional capacity due to poor ventilation, and sleep difficulties.

Question 37

What treatments are indicated for COPD exacerbation?

Answer 37

Sputum sample, Chest X-ray if pneumonia is suspected, Blood samples (CBC, CRP, Krea and electrolytes), Medicines (Bronchodilators, inhaled corticosteroid, antibiotics), Oxygen supply carefully, remember the risk of CO2- retention… nasal prongs, Sometimes invasive or non-invasive (CPAP, BiPaP) ventilation is needed. Prophylaxis of vein thrombosis

Question 38

What nursing considerations are important during COPD exacerbation management?

Answer 38

Monitor ABGs and vitals, assess skin color, auscultate heart and lungs, assess breathing, ensure medication compliance, patient positioning, prevent infections, follow ups and encourage vaccination (influenza and pneumococcal)

Question 39

Management of the exacerbation of COPD

Answer 39

SABA use Corticosteroids and antibiotics Increased oxygen (with caution due to CO2 retention)