COPD Exacerbation for Progressive Care Certified Nurse (PCCN)

COPD Exacerbation

Definition/Etiology:

• Definition – Chronic Obstructive Pulmonary Disease
  • COPD = Airways +_ Alveoli
  • Inflammation of airway – chronic bronchitis
  • Destruction of Alveoli – emphysema
    • Most patients have both
    • Diagnosis = productive cough >3 months each year
    • Where asthma is intermittent – NOT COPD MAJOR difference between COPD and Asthma

• Etiology –
  • Age > 45 years old
  • Smoking 70%
  • Acute Exacerbation
    • RTI or Pneumonia
    • Heart Failure

Pathophysiology:

• Inflammation process
• Mucus production
• Obstruction of airways
• Air is trapped in the alveoli
• Leads to Hypoxemia and retention of CO2

Noticing: Assessment & Recognizing Cues:

• Exacerbation = ACUTE WORSENING
• Subjective Cues
  • Increased SOB on excursion 
  • Worsening Cough
  • Purulent Sputum
  • Weight Loss
  • Family history
• Objective Cues
  • Barrel Chest
    • Accessory Muscles
  • Clubbing fingers
    • Poor tissue Perfusion
  • Lungs
    • Pursed lipped breathing
    • Cough
    • Ex Wheezing
    • Diminished

Interpreting: Analyzing & Planning:

• Labs
  • Blood Gas 
    • High C02 >45 (Hypercapnia)
  • Sputum Culture – Look for infection
• Diagnostics
  • CXR 
    • Flattening of the diaphragm
    • Increased size of the chest
  • Peak Flow 
    • Blow hard and fast in meter
    • Peak flow meters measure your peak expiratory flow rate (PEFR), a number that correlates with how open the lung’s airways are; as asthma worsens and the airways narrow.
    • DOES NOT IMPROVE AFTER BRONCHODILATOR

Responding: Patient Interventions & Taking Action:

• ABCs 
  • 88-92% Great Goal
    • CO2 dependent – be careful
    • O2 Nasal Cannula/Venturi Mask for 15 hours a day -daunting task
• Pharmacological 
  • Inhaled Bronchodilators
    • Short Acting – Albuterol
  • Oral/IV Steroids –  Prednisone
  • Antibiotics – Azithromycin 
• Interventions Non-Pharmacological
  • High-Fowler’s Positioning
  • Chest Physiotherapy
• Adjunct Medical Therapy
  • Pulmonary
    • RT

Reflecting: Evaluating Patient Outcomes:

• Oxygenation & Gas Exchange
  • 02 Sat & Pulmonary Function Test
• Symptom Management
  • Bring patient back to baseline
• Patient Education 
  • Avoid triggers they can control

Linchpins (Key Points):

• Notice – Activity Intolerance
• Interpret – CXR
• Respond – Meds & Physiotherapy
• Reflect – Patient’s Oxygenation, Gas Exchange and Comfort