When you hear COPD what’s the first thing that comes to your mind ? Lung disease but what kind?
If you have an idea but you’re not yet fully grounded on what COPD is all about, this NCLEX review is for you.
As a nursing student or Internationally Educated Nurse (IEN) preparing to take the NCLEX, it’s essential to have a thorough knowledge and understanding of COPD, then you can apply that knowledge to answer questions on your NCLEX or nursing school exam.
Individuals with COPD are prone to respiratory infections which can cause serious complications (COPD exacerbation or flare-ups) if not treated urgently.
It’s your duty as a nurse to know what COPD is, the risk factors, treatment and how to prevent complications.
What is COPD?
COPD is also known as Chronic Obstructive Pulmonary Disease or Chronic Obstructive Lung Disease (COLD). COPD consists of a group of lung diseases that limits airflow to the lungs.
It’s a chronic lung disease that is progressive. It doesn’t have any cure and can be treated.
It’s also a preventable disease.
COPD is used to refer to two closely related respiratory diseases which are chronic bronchitis and emphysema.
Though they are closely related and tend to occur together, they’re two different disease conditions and need to be studied separately.
What Is Chronic Bronchitis?
Chromic bronchitis is confirmed by the production of a productive cough in 3 months within the space of 2 years. The goblet cells produce excess mucus and inflames the lining of the lungs.
Other diagnostic tests are carried out to rule out pulmonary tuberculosis.
What Is Emphysema?
It’s a chronic lung disease evidenced by abnormal distension of the alveoli. The destruction of the alveoli and the capillary bed takes a long time.
The alveoli is destroyed and can rupture. This causes air to be trapped inside the lungs giving the patient a barrel chest appearance.
The patient hyperventilates, takes short rapid breaths and struggles to breathe.
Note: By the time diagnosis is confirmed, lung damage is irreversible. It’s important to know the risk factors that could lead to COPD and its signs and symptoms.
Clinical Manifestations of COPD
- Cough
- Fatigue
- Dyspnea = shortness or breath
- Coarse crackles and wheezing
- Barrel chest ( emphysema)
- Increased sputum production
- Impaired expiratory airflow
- Use of accessory muscles to breath
- Low-pitched or coarse breath sounds
- Polycythemia= increased RBC production due to chronically low oxygen levels
- ABG values= increased level of alkalosis and decreased level of acidosis.
- Cyanosis= bluish-purple hue to the lips, mouth, earlobes, fingernails
- Clubbing fingers = enlarged fingertips + extremely curved nails
Risk Factors for COPD
- Cigarette smoking
- Air pollution
- Occupation chemicals and dusts
- Genetics
- Respiratory infection
Nursing Interventions for COPD
Assessment
- Monitor vital signs and record
- Monitor patients respiratory function
- Monitor pulse oximetry
- Auscultate lung sounds. Note the respiration rhythm
- Monitor the sputum production and suction mucus if excess suction
- Ensure the patient is placed in a fowler’s or semi- fowler’s to aid breathing
Evaluate
The respiratory function and the ABG values, and the oxygen saturation by pulse oximeter.
Patient Education for COPD
- Teach the patient on the effect of smoking if they are still engaged in it. Formulate a smoking cessation plan with patient.
- Encourage the patient to have small frequent meals and eat balanced and healthy food.
- Encourage the patient to increase fluid intake unless contraindicated.
Medication Therapy for COPD
Mucolytic agent
It’s used to thin and reduce the viscosity of music secretions.
A common mucolytic medication is Acetylcysteine– it works by decreasing the viscosity of the mucus secretions.
Bronchodilator
It helps to ease breathing and dilates the bronchi. It can be taken either as an inhaler or nebulizer.
The 3 most widely used bronchodilators are:
- beta-2 agonists – like salbutamol, salmeterol, albuterol and vilanterol
- anticholinergics – like ipratropium, tiotropium, aclidinium and glycopyrronium
- theophylline
Beta-2 agonists and anticholinergics are available in both short-acting and long-acting forms. Theophylline is only available as an oral tablet in a long-acting form.
Aclidinium
- It’s an anti-chlorogenic drug
- It works as a bronchodilator
- It’s also known as Tudorza Pressair.
- Usually used for long term maintenance of COPD and not used to treat acute episodes.
- Not suitable for cardiac patients.
- It causes irregular heartbeat, dry mouth , tremor , epigastric pain, blurred vision.
Albuterol
- Relaxes the smooth muscles ; promotes bronchodilation.
- Monitor patients with cardiac disease and those who experience seizures.
- Its side effects are cough, tremors, a fast heartbeat and dry mouth.
- Not suitable for patients with cardiac and renal disease.
- Encourage patients to take copious fluid intake unless contraindicated.
Tiotropium
- Acetylcholine contracts smooth muscle in the body.
- Tiotropium works by inhibiting the action of acetylcholine to the receptor site . This stimulates the bronchial smooth muscle to relax; promoting bronchodilation.
- Not suitable for patients with closed- eyed angle glaucoma and renal disease.
Corticosteroid
COPD causes the lungs to flare-up which makes it harder for the patient to breath.
Corticosteroids help to reduce inflammation of the respiratory linings and ease breathing.
Corticosteroids can be used as an adjunct therapy with bronchodilators to reduce flare-ups in the lungs.
IMPORTANT: Teach patients using corticosteroids to rinse their mouth with water after medication administration to prevent oral thrush (candidiasis or oropharyngeal candidiasis).
Common examples of corticosteroids are:
Fluticasone
- It inhibits inflammation by decreasing mast cells, macrophages etc.
- Not suitable for patients with hypersensitivity towards the drugs.
- Not suitable for diabetics and cataract patients.
- Side effects include fatigue, headache, dry eyes, cataract, blurred vision, cough , bronchospasm.
Prednisolone
- Decreases inflammation by suppressing fibroblasts, leukocytes.
- Not suitable for patients with hypertension and glaucoma.
- Not suitable for patients with fungal and viral infections.
- Side effects include myopathy, increased ocular pressure, hypertension, depression, fracture, osteoporosis etc.
Oxygen therapy
- It’s prescribed to COPD patients to subside dyspnea, cyanosis, nasal flaring, use of accessory muscles.
- Normal oxygen saturation level for COPD patients is between 88% – 92%. Anything lower than this will need emergency treatment.
IMPORTANT- COPD PATIENTS MAY LOSE THEIR DRIVE TO BREATHE WITH TOO MUCH OXYGEN. MAINTAIN OXYGEN SATURATION BETWEEN 88-92%
I hope this COPD NCLEX review will help you pass your licensure exams.
Share your knowledge about COPD in the comment section.
Share this post! Check out my pulmonary embolism NCLEX review here.
Sources
Lewis, S. L., Dirksen, S. R., Heitkemper, M. M., Bucher, L., & Camera, I. M. (2020). Lewis’s medical-surgical nursing: Assessment and management of clinical problems (11th ed.). Elsevier.
Saunders, N. K. (2023). Saunders NCLEX-RN Comprehensive Review (7th ed.). Elsevier.
