COPD (Chronic Obstructive Pulmonary Disease) nursing management with interventions and treatment with medications. This NCLEX lecture on COPD with help you learn about the management of COPD. Nursing interventions for COPD include: monitoring lung sounds and sputum production, suctioning as needed, monitoring oxygen saturation, maintaining SpO2 88-93% (remember patients with COPD are stimulated to breath due to LOW oxygen levels rather than high carbon dioxide levels), administering breathing treatments as ordered, educating about pursed-lips and diaphragmatic breathing, nutrition needs, vaccinations up-to-date, how to take medications, and side effects of medications. Medications for treatment of COPD depends on the severity of the condition. However, they tend to include as ordered by the physician: Corticosteroids, Phosphodiesterase-4 inhibitors, Methylxanthines, Short-acting and long-acting bronchodilators. Don’t forget to watch part 1 to learn the pathoyphysiology, types of COPD (chronic bronchitis and emphysema), signs and symptoms of COPD, and how it is diagnosed.
Hey everyone it’s sarah thread sterner sori and calm and in this video i’m going to be going over part two of copd where i’m going to be covering the nursing interventions and the medications be sure to check out part one because that video lays the foundation for this video because i discussed the pathophysiology the types of signs and symptoms the complications
And how it is diagnosed and as always over here on the side or in the description below you can access the quiz and the notes that go along with this video so let’s get started first let’s start out talking about the nursing interventions what are you going to do for this patient as the nurse okay number one the most obvious is that you are going to monitor their
Respiratory system which will include listening to those lung sounds what’s going on in there and if they need suction they may need nasotracheal suction you’ll assess their need for that based on their effort of breathing and their oxygen saturation also you’re going to be monitoring that sputum production your patients with chronic bronchitis as we learned in part
One tend to have really unproductive coughs so if ordered you may need to collect a sputum culture because these patients are at risk for developing pneumonia another thing is that you want to monitor that oxygen saturation and keep it between 88 to 93 percent why this number because a lot of people are like 95 to hundreds where we want to keep it well the reason
Is is because how copd patients are stimulated to breathe they are stimulated to breathe due to low oxygen levels and as we learn in the previous video this is what these patients have because of obstructive airflow so they’re stimulated to breathe by low oxygen levels rather than high carbon dioxide levels which is how a person with healthy lungs is stimulated
To breathe whenever their carbon dioxide levels are high it stimulates them to breathe to blow that off but not in this case so we don’t want to give them too much oxygen through a nasal cannula because this will not give their body an incentive to breathe so they could stop breathing causing them to hypo ventilate which in turn is going to increase that carbon
Dioxide even more and become toxic okay so another thing is that we want to administer oxygen as prescribed by the physician usually one to two liters you don’t want to usually go any higher than that monitor their effort of breathing because these patients are at risk with any activity depending on the severity of their copd four episodes of shortness of breath
So you want to teach them about purse lip breathing and dot – chromatic breathing and what are these i would know these four tests how to do it how to teach a patient about them okay let’s talk about pursed lip breathing first and this is a great thing to use whenever your patient is having those disick episodes it usually works even better than putting the oxygen
On them because what it does is it increases the oxygen level it encourages them to breathe out longer so remember the issue with this these patients are retaining a lot of air volume due to what’s going to be going on with their viola sacks and the bronchioles so what they will do is they will breathe in and then blow out through pursed lips like they’re trying
To blow out a birthday candle so it’ll be something like this and this encourages them to breathe out longer to force that air out help slow down that breathing and increase that oxygen level now let’s talk about diaphragmatic breathing this breathing uses the abdominal muscles rather than those accessory muscles for breathing because what has happened is these
Lungs have become hyper inflated it’s pushed the diaphragm rather than having a dome shape and your diaphragm plays a huge role in your ability to breathe effortlessly so what happens whenever you breathe the diaphragm will help when it can try it when it relaxes back up to force that air out so you’re getting all that volume out but here it’s flat and it’s not
Doing their job so your body starts using those accessory muscles to help get that air out of the lungs so um what will what will happen whenever you teach them this is that it will help strengthen that diaphragm it will slow down the breathing rate and make it easier and decrease the energy used to breathe because using those accessory muscles to breathe burns
A lot of calories and that’s why your patients especially ones who have emphysema will have weight loss and you need to encourage them to eat a lot of frequent small meals so how you do that you have the patient lay down you can put a pillow underneath their knees and they will put one hand over their chest and one hand on their abdomen and what they will do is
That with their abdominal muscles they will inhale in move those muscles not moving the chest muscles with abdominal muscles to force that area then they will pursed lip breathe out using the abdominal muscles instead of those accessory muscles and that helps strengthen the diaphragm and discourage the use of those accessory muscles another thing is that you’ll
Be administering breathing treatments as the nurse a lot of times in hospitals respiratory therapy will participate in this as well they give a lot of nebulizer treatments especially those short-acting um médico dilators like albuterol atrovent things like that but as a nurse you will be giving scheduled or as needed inhaler so your role which we’re going to go
Over later in the lecture is to know those category of drugs like long-acting versus short-acting if they’re having an acute episode shortness of breath you want to give a short-acting bronchodilators because it acts fast and those corticosteroid tailors and things like that now let’s talk about the education pieces that you want to provide to your patient who is
Struggling with copd okay the first thing is about nutrition needs especially patients who have the form called emphysema which is your pink puffers because they hyperventilate they breathe rapidly they use those accessory muscles as a call as a compensation mechanism to keep that oxygen where it needs to be so they use a lot of energy doing this so they need to be
Educated to eat high calorie and protein meals and they need to be small but frequent because they don’t want to eat three large meals a day why the anatomy of how your body set up you have your stomach somewhere in this region they already have hyper-inflated lungs and abnormal flattened diaphragm so if they go in eat a lot of food that something’s going to push
Up on those lungs up on that dock room it’s going to cause them difficulty breathing so it’s best for them to eat small but frequent meals that are high and rich in protein also they want to stay hydrated drinking about two to three liters per day unless it’s not contraindicated like the patients with renal failure or heart failure who are on fluid restrictions
And the reason they want to stay hydrated is to keep those mucous secretions thin they don’t want them to be thick because it’s going to block the airway and cause a lot more problems they want to avoid sick people and irritants out in the weather so they need to watch forecasting see if it’s going to be a high alert day for air pollution they need to avoid those
Days because this can trigger copd exacerbation and a lot of patients who have severe copd if they go outside whenever it’s really really hot or humid it smothers them because of the humidity and extreme cold temperatures affect them as well so let them know about that and if your patients smokes educate them on the importance of salt smoking because this can help
Improve the function of the ones and to avoid people who smoke that secondhand smoke is just as bad been smoking themselves also have their vaccinations up today because if they get influenza or anything like that that’s when an attack the lungs this can cause copd exacerbation and it’s really hard for these patients to recover from this and and so they’ll need
To get the flu shot annually and the pneumonia vaccine every five years because they are at risk for developing certain forms of pneumonia and this shot can help prevent that or mild the symptoms okay so let’s look at the medication regimen for patients with copd as the nurse what you need to be familiar with are those group those drug categories that’s going to
Be given in copd the major side effects that you need to watch out for that may be thrown on in clicks and patient education pieces for the most important drugs so to help you remember the typical drugs given in copd remember this new morning chronic pulmonary medications save lungs here we have lung issues these medications along with lifestyle changes and help
The patient have a better quality of life with their breathing so first the c corticosteroids what do corticosteroids do they decrease inflammation and mucus production in the airways because especially with chronic bronchitis those bronchioles are inflamed they’re producing lots of mucus corticosteroids going to help decrease that and help that immune system slow
Down its attacking these are given and give them orally iv inhaled many times and then held ones will be given with a bronchodilator mitt and sometimes there’s combination drugs some drugs you want to be familiar with is prednisone solu-medrol palma core or symbicort simba core is a combination one it is a steroid and it’s a long-acting dilator so side effects of
Corticosteroids we covered this a lot in the endocrine series so if you really want to dive into this and you can check out the endocrine series i have a card should be popping up so you can access that but side effects is easy bruising patient a lot of times you’ll see them the bruises on their arms and their legs their skin will even be really fragile and tear
Easily so be easy with that and they’re at risk for hyperglycemia i have seen this has happened especially your diabetic patients you’ll or even if they’re not diabetic they can increase their sugars really really high so you want to monitor their sugar’s they’re at risk for infection because corticosteroids suppresses the immune system so they need to watch out
For that and avoid those sick people and if they use these over time they’re at risk for osteoporosis okay piece they really need to take away with bronchodilators and copd i mean corticosteroids and copd is um if a patient is prescribed and inhaler that’s a bronchodilator and then inhaler that’s a corticosteroid how which one you’re going to use first it’s very
Important first they want to use the bronchodilator inhaler because what this does is they take it in and opens up those airways it dilates those airways then five minutes later they’re going to use their corticosteroid inhaler because those airways are nice and opened up and that corticosteroid can get in those airways that would have normally been closed off
Because they didn’t use a bronchodilator and it can do its sha so remember that another thing you want to remember after a patient uses their corticosteroid inhaler they need to rinse their mouth another drug use the p4 phosphodiesterase force inhibitors one is called with yuma last and this is used for people with chronic bronchitis and it helps decrease copd
Exacerbation now it’s not a bronchodilator okay what you want to remember about this drug are the side effects of it you want to assess your patients mental status whenever they’re on this because it can increase and the thoughts of suicide ideation so how i remember this because there’s a lot of drugs you have to remember eyes a nursing school i look at the name
And the last part of refu my last is last and last it could be their last day so you want to assess them for thoughts of suicide and rapport that’s with the doctor because this is not a good thing and also they can have weight loss with this so monitor their weight and teach the patient you know if you start having these thoughts please report them and monitor your
Weight okay next methylxanthines a drug and this category is known as the awful and this is many times given orally and it’s a type of bronchodilator so it works by relaxing the smooth muscle opening up those airways and it is used for long-term for patients who have severe copd now remember this about the off limb it has a narrow therapeutic range a lot of times
Test questions like to throw out patients on theophylline you have a dose schedule to give here’s your lab work on theophylline it has a narrow therapeutic range and you want it between 10 to 20 micrograms per milliliters so anything above that’s bad and anything less than that they’re not receiving enough medication now the off link an increase digoxin toxicity so
If you’re on digoxin you’ll want to make sure that there’s auxin levels being monitored and it can decrease the effects of lithium and dilantin okay next s for short acting bronchodilators these relax the smooth muscle of the bronchial tubes and their short acting so they’re great in emergency situations where you’re having some severe shortness of breath going on
Those airways are constricting up is going to go in there open those up so the patient can breathe and when they need quick relief so as the nurse know which ones are short and which ones are long some typical short ones beta-2 agonists albuterol that’s what that is an anticholinergic such as atrovent next the last one l4 long-acting bronchodilators these works the
Same as short but the effects of the medication lasts longer so the patient is going to use them over a period of time they’ll probably be scheduled maybe once or twice a day and just be familiar with which ones are long you have beta-2 agonist like saw metro and then you have anticholinergic like spy revis pairi but that’s a real popular one and what you want to
Remember with this is of course you use the bronchodilators before you use if they’re on corticosteroids that are inhaled so you would use this first open up the airway then use your inhaler of the corticosteroids and some side effects the beta-2 agonists they can cause increased heart rate and you’re an area where chick retention and the anticholinergics can cause
Dry mouth and blurred visions so be on the lookout for that educate your patient about that so that is about the nursing interventions and the medications used in copd don’t forget to watch part 1 and take the nclex review quiz that goes over these lectures and if you like this video please give it a thumbs up and thank you so much for watching and please consider
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Transcribed from video
COPD (Chronic Obstructive Pulmonary Disease) Nursing Interventions Management Treatment NCLEX Part 2 By RegisteredNurseRN
