During the initial assessment, the patient with early-stage COPD is noted to use pursed-lip breathing. What is the primary purpose of this technique?

C) To improve ventilation by keeping airways open

B) To decrease respiratory rate

C) To improve ventilation by keeping airways open

D) To strengthen respiratory muscles

What is the primary purpose of pursed-lip breathing in a patient with COPD?

C) To improve ventilation and ease breathing

A) To increase oxygen saturation

C) To improve ventilation and ease breathing

D) To strengthen respiratory muscles

What is the primary purpose of using an Albuterol inhaler for a patient with COPD?

C) To provide immediate relief from bronchospasm

A) To reduce inflammation in the airways

B) To act as a long-term maintenance therapy

C) To provide immediate relief from bronchospasm

D) To prevent infection in the lungs

A patient with early-stage COPD is being educated on lifestyle modifications to help manage her condition. Which of the following recommendations is most important for the nurse to emphasize?

A) Increase dietary calcium intake

Which intervention is most effective in improving lung function in a patient with COPD?

A) Daily use of bronchodilators

Which of the following interventions would be most appropriate to address the patient's occasional evening wheezing and mild cough?

A) Adjust the timing of her inhaler use

B) Increase her pulmonary rehabilitation sessions to daily

C) Encourage the use of a humidifier at night

D) Recommend over-the-counter cough suppressants

What is the most likely reason for the patient's increased wheezing and persistent mild cough in the evenings?

B) Exposure to environmental allergens

A) Ineffective inhaler technique

B) Exposure to environmental allergens

D) Inadequate medication adherence

What is the primary purpose of adding a short-acting bronchodilator to the patient's COPD management plan?

B) To provide immediate relief of bronchospasm

A) To reduce inflammation in the airways

B) To provide immediate relief of bronchospasm

C) To decrease the production of mucus

D) To prevent respiratory infections

A patient with early-stage COPD reports persistent evening wheezing and mild cough despite avoiding environmental triggers. Which action is most appropriate to address these symptoms?

B) Add a short-acting bronchodilator for use as needed

A) Increase the dosage of her current long-acting bronchodilator

B) Add a short-acting bronchodilator for use as needed

C) Begin a course of oral corticosteroids

D) Discontinue pulmonary rehabilitation exercises

COPD - Nursing Case Study

Pathophysiology

• Primary mechanism: Chronic inflammation in the airways leads to narrowing and damage, causing airflow limitation. This inflammation is often due to long-term exposure to irritants like cigarette smoke.

• Secondary mechanism: Destruction of alveoli (tiny air sacs) reduces surface area for gas exchange, leading to decreased oxygen uptake and carbon dioxide removal. This is primarily seen in emphysema, a type of COPD.

• Key complication: Air trapping and hyperinflation occur as patients struggle to exhale fully, increasing the work of breathing and leading to symptoms like shortness of breath.

Patient Profile

Demographics:

64-year-old female, retired school teacher

History:

• Key past medical history: History of smoking (20 pack-years), mild hypertension

• Current medications: Lisinopril 10 mg daily, Albuterol inhaler as needed

• Allergies: Penicillin

Current Presentation:

• Chief complaint: Occasional shortness of breath

• Key symptoms: Mild, intermittent wheezing and cough, especially in the morning

• Vital signs: Blood pressure 128/82 mmHg, Heart rate 78 bpm, Respiratory rate 18 breaths per minute, Temperature 98.6°F, Oxygen saturation 94% on room air

Section 1

Initial Assessment Findings:

During the initial assessment, the patient presented with stable vital signs, which included a blood pressure of 128/82 mmHg, a heart rate of 78 bpm, a respiratory rate of 18 breaths per minute, and an oxygen saturation of 94% on room air. Upon auscultation of the lungs, mild, intermittent wheezing was noted, particularly in the upper lobes, which aligns with the patient's report of occasional shortness of breath and a morning cough. The wheezing was more pronounced during expiration, which is consistent with the airflow limitation typical in early-stage COPD. The patient also exhibited a mild increase in respiratory effort, demonstrated by slight pursed-lip breathing, a common technique used by patients to help open airways and improve ventilation.

The patient's skin color was noted to be normal, with no signs of cyanosis, indicating that her current oxygenation status was adequate despite the mild pulmonary symptoms. She reported using her Albuterol inhaler occasionally, primarily in the morning, which provided relief from the wheezing and shortness of breath. The patient's history of mild hypertension was well-managed with Lisinopril, and there were no signs of acute distress or exacerbation at the time of assessment. These findings suggest that the patient's COPD is currently stable, yet highlights the need for ongoing monitoring and patient education on effective inhaler use and lifestyle modifications to prevent progression of the disease.

This assessment serves as a foundational basis for further evaluation and planning. The next steps will involve discussing potential lifestyle changes, such as smoking cessation support, and reinforcing the importance of regular follow-up appointments to monitor lung function and adjust treatment as necessary. Additionally, exploring pulmonary rehabilitation options could be beneficial in maintaining her current level of function and preventing future complications.

Section 2

Following the initial assessment, the patient underwent a series of routine diagnostic tests to further evaluate her respiratory status and overall health. Pulmonary function tests (PFTs) were conducted, revealing a mild reduction in FEV1 (Forced Expiratory Volume in the first second) at 70% of the predicted value, confirming the early-stage COPD diagnosis. The FEV1/FVC (Forced Vital Capacity) ratio was calculated at 65%, which is indicative of obstructive lung disease. These results, while consistent with COPD, underscore the importance of ongoing monitoring and highlight the potential for improvement through targeted interventions.

Additionally, a chest X-ray was performed to rule out any acute changes or other underlying conditions. The X-ray showed hyperinflation of the lungs but no signs of pneumonia or significant structural changes, which aligns with the patient's stable COPD status. Basic laboratory tests, including a complete blood count (CBC) and comprehensive metabolic panel (CMP), returned within normal limits, confirming the absence of any acute infection or metabolic disturbances. These findings reinforce the need for lifestyle modifications, such as smoking cessation and regular exercise, to maintain her current health status and prevent disease progression.

The patient was advised to continue using her Albuterol inhaler as needed and to engage in a pulmonary rehabilitation program aimed at improving lung function and overall endurance. Emphasis was placed on the importance of regular follow-up appointments to monitor her lung function and adjust her treatment plan as necessary. Education on recognizing early signs of exacerbation and proper inhaler technique was provided to empower the patient in managing her condition effectively. As the patient embarks on these next steps, the focus will be on maintaining her stability and preventing potential complications.

Section 3

Several weeks after implementing the recommended lifestyle changes and treatment regimen, the patient returned for a follow-up appointment. During this visit, she reported adhering to the smoking cessation plan and participating in a pulmonary rehabilitation program twice a week. She noted improvements in her overall stamina and a slight decrease in shortness of breath during daily activities. Her vital signs were stable, with a blood pressure of 122/78 mmHg, heart rate of 76 beats per minute, respiratory rate of 18 breaths per minute, and oxygen saturation of 96% on room air.

A repeat pulmonary function test was performed, showing a slight improvement in FEV1, now at 74% of the predicted value. This positive change indicates a response to the interventions, reflecting the benefits of regular exercise and smoking cessation on her lung function. The FEV1/FVC ratio remained steady at 65%, reinforcing the early-stage COPD diagnosis but highlighting the potential for further improvement with continued efforts.

Despite these positive developments, the patient expressed concerns about occasional wheezing and mild cough, particularly in the evenings. A detailed review of her inhaler technique revealed improper timing and coordination during use. After receiving a demonstration and practicing the correct technique with her nurse, she gained confidence in her ability to manage her symptoms more effectively. The nurse emphasized the importance of continuing her rehabilitation sessions and maintaining regular follow-up visits to monitor her progress and address any emerging issues promptly. With these steps in place, the patient was encouraged to maintain her current routine, with a focus on further enhancing her lung health and preventing complications.

Section 4

Several weeks later, the patient returned for another follow-up appointment. She reported feeling more energetic and capable during her daily activities, attributing this to her ongoing commitment to the pulmonary rehabilitation program and continued abstinence from smoking. Despite these improvements, she mentioned experiencing increased wheezing and a persistent mild cough in the evenings, which prompted her to seek further evaluation.

During the assessment, her vital signs remained stable with a blood pressure of 120/76 mmHg, heart rate of 74 beats per minute, respiratory rate of 19 breaths per minute, and oxygen saturation of 95% on room air. However, upon auscultation, mild wheezing was noted in the lower lung fields bilaterally, particularly during expiration. A review of her medication regimen and inhaler technique was conducted again, confirming proper use and adherence.

To further investigate the increased wheezing and cough, a chest X-ray was ordered, revealing mild hyperinflation but no signs of acute infection or significant obstruction. Additionally, a sputum culture was performed, which returned negative for bacterial growth. These findings suggested that while the patient was managing her COPD well overall, environmental factors or allergens could be contributing to her evening symptoms. The nurse educated the patient on potential triggers and advised her to keep a symptom diary to help identify any patterns. With this information, the patient was reassured and encouraged to continue her current management plan, with a focus on avoiding potential irritants and maintaining regular follow-up appointments to monitor her progress closely.

Section 5

Several weeks later, the patient returned for another follow-up appointment, reporting that her evening wheezing and mild cough had persisted, despite her efforts to avoid known environmental triggers. She mentioned that she had been consistent with her symptom diary, noting that the symptoms seemed to worsen on days when she spent more time outdoors, particularly when the air quality was poor. Her vital signs remained stable, with a blood pressure of 118/74 mmHg, heart rate of 72 beats per minute, respiratory rate of 18 breaths per minute, and oxygen saturation of 94% on room air.

In response to these continued symptoms, the healthcare team decided to conduct a spirometry test to reassess her lung function and gain further insights into her respiratory status. The spirometry results showed a slight decline in her FEV1/FVC ratio, indicating some degree of airflow limitation, but still within the range expected for early-stage COPD. There were no significant changes from her previous baseline, suggesting that the disease progression was stable. However, the test confirmed the presence of mild airway hyperreactivity, which could explain her increased evening wheezing.

With these new diagnostic results, the nurse collaborated with the patient to adjust her management plan. A short-acting bronchodilator was added to her medication regimen for use as needed, particularly on days when she anticipated exposure to potential irritants. The nurse reinforced the importance of monitoring her symptoms closely and adhering to the newly adjusted treatment plan. The patient was encouraged to continue her pulmonary rehabilitation exercises and to remain vigilant about avoiding poor air quality environments. With a comprehensive approach to managing her COPD, the patient felt reassured and committed to maintaining her health and wellbeing.