Chronic Obstructive Pulmonary Disorder (COPD) is a preventable chronic inflammatory pulmonary illness that obstructs the airflow in the lungs. For the majority of the cases, COPD presents with three main symptoms: A chronic cough, sputum production and dyspnoea. And roughly 80-90% of the patients suffering from COPD would have been or still are tobacco smokers.
However, even though most patients with COPD would have similar symptoms, their needs would be different. In the sense, that not all patients would be affected the same way, some might struggle with shortness of breath only on exercise while others might have it while eating. This means that an in-depth nursing assessment for COPD patients is crucial to tailor your nursing care plan according to the patient’s needs.
In these notes, we’ll be going over the Nursing Assessment for Patients with COPD, as well as the medical tests required to determine the severity and secondary complications of COPD. But before getting into that, make sure that you’ve understood the:
Nursing Assessment for COPD Patients: Health History
Given that COPD is a progressive illness, it’s important to take a step back and actually understand when it started, and what triggered it. Start off by introducing yourself to the patient, and find a private area to initiate the assessment. Once the patient is comfortable, you can start off by asking about their exposure to risk factors. Specific questions about the type, intensity and duration of exposure will give you a clear indication of what triggered the condition. You might want to ask:
Whether the patient smokes, is around second-hand smoke or has environmental pollutants at work/home
How often are they exposed to the irritant? How long have they been exposed to it?
Do they have a history of hospitalizations for respiratory problems?
Next up, you should ask your patient about their past medical history specifically about any previous respiratory conditions, including allergies, asthma, sinus infections or nasal polyps. This should also include their closest family relatives, so note down the patient’s family history in relation to respiratory illnesses.
Once you’ve established a good understanding of the patient’s background you can move on to assess the current situation and how the COPD symptoms are affecting your patient’s life. Ask your patient when they can first recall experiencing any respiratory-related symptoms, if they’ve noticed a pattern of symptom development and whether they occur only during exercise or at rest as well. You might want to ask:
Which symptoms do they notice first?
Does the shortness of breath become worse when exercising?
How much exercise can they tolerate?
Are they experiencing any pain, and if so where? Is the pain interfering with their daily routine?
Have they noticed any changes in their eating and sleeping routines?
Lastly, you should ask questions to understand the patient’s knowledge and current management about the condition as well as their social and familial support system.
Once you’ve obtained a thorough medical history, you can move on to the physical assessment to get a better understanding of the patient’s physiological status.
Nursing Assessment for COPD Patients: Physical Assessment
Start off by taking a quick look at your patient’s position, both when sitting and standing. In most cases, patients with COPD would rest their hands onto their knees to support their breathing. Next up, you can take their hands and check:
Pulse
Oxygen Saturation
Clubbing of fingers
Record everything onto the patient’s file and move on to assessing their Respirations:
Are the respirations forced?
Can the patient finish off a sentence in one breath?
Are they contracting their abdominal muscles, or using their shoulders during inhalation?
Is the expiration time prolonged?
Can you note any unusual breath sounds? (Wheezing/ Crackles)
Most patients will present with a Cough, if you note that it’s productive you should also assess their Sputum in terms of colour, amount and consistency.
Along with the physical assessment, there’s a series of tests that the patient will be asked to perform. These tests will determine the severity of the disease and guide the medical team when selecting the treatment.
Nursing Assessment for COPD Patients: Medical Tests
Pulmonary Function Studies will confirm the diagnosis, its severity and monitor the disease progression.
Spirometry evaluates the level of airflow obstruction and the reversibility of obstruction after the use of bronchodilators.
Arterial Blood Gases check the baseline oxygenation and gas exchange.
Chest X-ray will exclude any alternative diagnoses.
Screening for alpha1-antitrypsin deficiency will highlight any genetic deficiencies.
Summary of the Nursing Assessment for Patients with COPD:
1. Health History
Assess the exposure to risk factors, past medical and family history, the presenting symptoms and how they interfere with the patient’s life.
2. Physical Assessment
Assess the patient’s general physiology (Pulse, SpO2). Check the patient’s respiratory patterns, cough and sputum.
3. Medical Tests
Pulmonary function tests, Spirometry, ABGs, Chest X-ray, Alpha1-Antitrypsin test.
If you have any questions send them over on my Instagram @Miriana.Nurse
References
Hinkle, Janice. Brunner & Suddarth’s Textbook of Medical-Surgical Nursing . Wolters Kluwer Health. Kindle Edition.