Advanced Age ( Older adults have a decreased pulmonary reserve due to lung changes)

Cigarette Smoking

Alpha 1- Antitrypsin (AAT) deficiency

Exposure to environmental factors ( air pollution)

Sputum Cultures

WBC counts

Arterial Blood Gases (ABGs)

• Hypoxemia ( decreased PAO2, less than 80 mm Hg)

• Hypercarbia (increased PACO2, greater than 45 mm hg)

Blood Electrolytes

Dyspnea upon exertion

Severe cough ( in the morning when you first wake up)

Hypoxemia

Crackles & Wheezes

Rapid & shallow respirations

Use of accessory muscles

Barrel Chest or increased chest diameter (w/ Emphysema)

Hyperresonance on percussion deu to " trapped air" ( w/ Emphysema)

Irregular breathing pattern

Thin extremities & enlarged neck muscles

dependent edema secondary to R sided HF

Clubbing of fingers & toes ( late stages)

Pallor & cyanosis of nail beds & mucous membranes ( late stages)

Decreased O2 levels ( ERR is 95-100%)

In older adults or clients who have DARK COLORED SKIN, O2 levels can be slightly lower

Pulmonary function tests

Chest x-ray

• reveals hyperinflation of alveoli and flattened diaphragm in the late stages of emphysema

• often not useful for the diagnosis of early or moderate disease

Alpha1, antitrypsin levels

• used to assess for deficiency in AAT, an enzyme produced by the liver that helps regulate other enzymes (which help break down pollutants) from attacking lung tissue

COPD encompasses two diseases ( Emphysema & Chronic Bronchitis). Most who have Emphysema will also have Chronic Bronchitis

COPD is irreversible

Usually affects MIDDLE age - OLDER adults

Chronic Bronchitis

• Inflammation of the bronchi & bronchioles due to chronic exposure to irritants.

Emphysema

• the loss of lung elasticity & hyperinflation of lung tissue

• Causes: Destruction of Alveoli, leading to decreased surface area for gas exchange, carbon dioxide retention, and respiratory acidosis

high-fowlers position

encourage effective coughing, or suction to remove secretions

encourage deep breathing and use of an incentive spiromenter

admin breathing treatments and medications

admin oxygen as prescribed

• clients who have COPD can need 2 to 4 L/min of oxygen via nasal cannula or up to 40% via Venturi mask

• clients who have chronically increased PaCO2 levels usually require 1 to 2 L/min of oxygen via nasal cannula

• monitor for skin breakdown around the nose and mouth from the oxygen device

promote adequate nutrition

monitor weight and note any changes

instruct the client to practice breathing techniques to control dyspneic episodes

• instruct the client to: take deep breaths from the diaphragm, lie on back with knees bent, rest a hand over the abdomen to create resistance inhalation and exhalation, the breathing is being performed correctly

• Pursed lip breathing: form the mouth as if preparing to whistle, take a breath in through the nose and mouth through the lips/mouth, not puff the cheeks, take breaths deep and slow

  
  

Respiratory Infection

• avoid crowds and people who have respiratory infections

• obtain pneumonia and influenza immunizations

Right-sided heart failure

• monitor respiratory status and administer oxygen therapy

• monitor for GI disturbances (nausea, anorexia)

• monitor HR and rhythm

• admin meds as prescribed

• admin IV fluids and diuretics to maintain fluid balance

Bronchodilators

Nursing Actions:

• monitor for toxicity when taking theophylline

• watch for tremors and tachycardia when taking abuterol

• observe for dry mouth when taking ipratropium

Client education:

• suck on hard candies to help moisten dry mouth while taking ipratropium

• increase fluid intake, report headaches, or blurred vision

• monitor HR

Anti-inflammatory agents

• Nursing Actions:

  • watch for decrease in immunity function

  • monitor for delayed wound healing

  • monitor for hyperglycemia

  • observe for fluid retention and weight gain

• Client education:

  • fluids

  • report black tarry stools

  • do not discontinue medication suddenly

  • mouth care

Mucolytic agents

• Therapeutic procedures:

  • chest physiotherapy

  • raising the foot of the bed slightly higher than the head can facilitate optimal drainage and removal of secretions by gravity

Incentive Spirometer: Monitors optimal lung expansion (inhale & hold breath for 3-5 secs)

• O2 level is 88-92% ( moderate - severe COPD)

Bronchodilators ( Inhalers):

• Short-Acting Beta 2 Agonists: Albuterol provides RAPID relief

• Cholinergic Antagonists " Anticholinergic meds" : Ipratropium blocks the Parasympathetic Nervous System) (*LONG acting & PREVENT bronchospasm*)

• Methylxanthines (Theophylline): relaxes the smooth muscles of the bronchi ( closely monitor blood medication levels due to narrow therapeutic ranges & ONLY use when tx are INEFFECTIVE)

Breathing Techniques

• Positive Expiratory Pressure Device:

• 1) Assist client to remove airway secretions

• 2) Client inhales deeply & exhales through device

• 3) While exhaling, a ball inside moves which causes a vibration that loosens secretions

Exercise Conditioning

• Improves pulmonary status by strengthening the condition of the lungs

• Walks at a self paced rate until dyspnea occurs then stops to rest. Once dyspnea resolves client resumes.

• Walks 20 min daily , 2-3 x weekly

• Provide rest periods for older adults ( have room & always for relaxation)

• Increase fluid intake (2-3 L/day to liquify mucus)