Question

Julie is a 52-year-old female who has come to a local walk-in clinic to discuss her COPD and specifically the problem she is having with exacerbations and time ‘off sick’. She is a heavy smoker, and her progressively deteriorating lung function suggests that she has moderate COPD, although she also has a history of childhood asthma, and had allergic rhinitis as a teenager.

She has a sedentary office job and, although she is breathless on exertion, this generally does not interfere with her lifestyle. The relatively frequent exacerbations are more troublesome. They are usually triggered by an upper respiratory infection and can take a couple of weeks to recover. She has had three exacerbations this winter, and as a result her employer is not happy with her sickness absence record and has asked her to seek advice from her general practitioner.

Julie is on a short-acting β2-agonist, although she rarely uses it except during exacerbations. In the past, she has used an inhaled steroid, but stopped that some time ago as she was not convinced it was helping.

While auscultating Julie’s lungs, the nurse hears expiratory wheezes throughout. Her vital signs are as follows: blood pressure 110/82; pulse 116; respiratory rate 39; oxygen saturation on room air is 88%. Recent spirometry showed a typical COPD flow-volume loop, although she had some reversibility (250 ml and 20%) with a post-bronchodilator FEV1 of 60% predicted.

3. What is the highest priority nursing treatment for Julie? Explain your answer

Answer 1

COPD should be considered in any person with an exposure to risk factors such as cigarettes or environmental or occupational pollutants and or chronic cough or dyspnea The FEV1 establishes the diagnosis of COPD, and the severity of obstruction determines the stage of COPD. As the severity of COPD increases, exacerbrations of COPD are associated with poorer outcomes. Exacerbrations of COPD maybe treated at home or in the hospital immediate care unit or intensive care unit. Medications used to decrease aireay resistance during exacerbrations of COPD are bronchodilators and oral systemic corticosteroids. If a patient has clinical signs of sirway infection, antibiotic treatment is usually used. Supplementsl oxygen therapy titrated by ABG measurement maybe used. Attempts are made to use noninvasive mechanical methods . Chest physiotherapy and postural drainage, breathing exercises and retraining is found to be effective. Cessation of smoking in all stages of COPD is the single most effective and cost-effective intervention to reduce the risk of developing COPD and stop the progression of disease.