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.
The nursing management of COPD takes a wide approach to slow down the disease progression as well as treat the presenting symptoms. Treatment typically includes smoking cessation, supplemental oxygen therapy and medication. In advanced cases, some patients would be good candidates for surgical interventions while others might require palliative care.
In these notes, we’ll be going over the Nursing Management for Patients with COPD, how to reduce the risk of exacerbating COPD and how to treat it with Oxygen Therapy. But before getting into that, make sure that you’ve understood the:
Nursing Management for Patients with COPD: Risk Reduction
As we’ve mentioned in the previous chapters, COPD is a preventable disease (unless acquired through a genetic deficiency). This means that the first step in treating COPD should be to remove or at least minimize the triggering factors of the condition. When it comes to COPD, the number one risk factor contributing towards the worsening of the disease is tobacco smoking.
According to the American Lung Association, roughly 80-90% of COPD cases are caused by cigarette smoking. And further research has shown that smoking cessation slows down the disease progression, improves the patient’s symptoms and reduces the mortality rate. Yet, despite all the awareness, roughly 30-50% of the patients who are diagnosed with moderate to severe COPD continue to smoke even after their diagnosis. And around 65-85% of individuals who make an effort to quit smoking would still be smoking after a year.
However, if you speak to anyone who smokes, these numbers won’t come in shock anymore because they’ll make it very clear that smoking addiction is extremely hard to stop. Still, smoking cessation is our best bet when treating COPD patients and as nurses, we should do our utmost to help them out.
Start by educating your patient about the harmful effects of smoking and its risks concerning COPD. Having a solid understanding of how their life is quite literally in their hands will help them become more aware of the situation give them the motivation to quit.
From there, you can set a “Quit Date” together, and refer them to a smoking cessation program. Once they’ve started the program, they should continue to receive reinforcement through remote online meetings or in-clinic visits. If your patient relapses, make sure to note down the triggers and adjust the plan again to overcome that situation. If you notice that your patient is finding it increasingly difficult to adhere to the smoking cessation program, they can opt to use nicotine replacement therapy such as chewing gums, transdermal patches, lozenges or other forms.
Nursing Management for Patients with COPD: Oxygen Therapy
Arterial Blood Gases (ABGs) have become the standardised test when monitoring the physiological status of a COPD patient. This is because an ABG result provides the exact level of oxygen in the patient’s blood at the given time. Once issued the result will have two important values:
The Partial pressure of oxygen (PaO2) which in normal patients it would range from 75-100 mmHg, and
The Oxygen saturation (SaO2) which normally ranges from 94-100%
In COPD patients however, these values will be much lower, and so we use oxygen therapy to increase these values and bring them as close to the normal ranges as possible. Typically, the medical team would aim for a patient with COPD to have a PaO2 of at least 60mmHg and an SaO2 of at least 90% (Gold, 2019).
Depending on the patient’s desaturation habits, oxygen therapy can be prescribed either a couple of times during the day or it can be continuous. Moreover, the patient’s with advanced COPD whose PaO2 is less than 55mmHg or SaO2 is less than 88% will typically get long-term oxygen therapy. This has been proven to improve quality of life, reduce pulmonary arterial pressure and dyspnoea and improve the patient’s prognosis.
As a nurse, you must regularly observe the patient’s oxygen levels using a pulse oximetry monitor, and check their ABG results. Together, these results will help you and the medical team to keep the patient’s saturation levels within range while using the lowest possible oxygen flow. Now, this factor might seem very small but it’s crucial when caring for patients with COPD.
If too much oxygen is administered the patient could develop a secondary condition known as Hypercapnia (carbon dioxide retention). Moreover, oxygen can be administered through different masks depending on the concentration and flow required. You can read all about the different types of oxygen masks here.
Patients who have a more advanced form of COPD would require additional medical treatment, including the use of Bronchodilators, Corticosteroids or Combined-Therapy. Let’s hop onto The Nursing Management for Patients with Part II – Pharmacology to learn more about it.