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COPD Exacerbation

select appropriate nursing interventions within the LPN scope of practice, and recognize serious complications.

Competency
Explain care for the client with lower respiratory disorders.

You are an LPN working in a community health clinic on a team of professionals that includes a medical assistant, RN, and nurse practitioner. The clinic is just opening for the day on a day that is particularly hot and humid. A woman runs into the clinic with an older gentleman yelling “he can’t breathe.” The client appears flushed (reddened skin), is unable to speak, and appears very short of breath. The client’s wife tells you that he has “emphysema” and refuses to put the air conditioning on in their home because he is afraid the electric bill will be too high. She also tells you that he ran out of his medications, including his inhalers and prednisone, almost 2 weeks ago. The client has a respiratory rate of 44 and an O2 Sat. of 84% on room air. His blood pressure is 168/100.

Question 1: List two nursing interventions that should be done immediately. (2-3 sentences)

Question 2: What environmental factor(s) do you think contributed to the client’s current situation? (2-3 sentences)

Question 3: What danger could the client face by abruptly stopping prednisone? (5-10 sentences)

Question 4: Explain why compliance is important in managing chronic diseases such as COPD? (5-10 sentences)

Question 5: After this client is stabilized and his breathing improves. What should be addressed with him on his next clinic visit? (5-10 sentences)

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Sample Answer

 

 

Question 1:

  1. Administer high-flow oxygen per nasal cannula or mask according to facility protocol. This increases oxygen availability and improves breathing effort.
  2. Assist the client into a comfortable, upright position. This promotes lung expansion and improves ventilation.

Question 2:

  1. Hot and humid environment: Exacerbates respiratory symptoms in clients with COPD by increasing airway resistance and work of breathing.
  2. Lack of air conditioning: Further contributes to the hot and humid environment, worsening the client’s condition.

Full Answer Section

 

 

 

Question 3:

Abruptly stopping prednisone, a corticosteroid, can lead to serious dangers for a client with COPD:

  • Adrenal insufficiency: Prednisone suppresses the adrenal glands. Abrupt withdrawal can lead to insufficient cortisol production, causing fatigue, weakness, low blood pressure, and even shock.
  • Rebound inflammation: Stopping prednisone can lead to a sudden worsening of inflammation in the airways, causing severe exacerbations and respiratory failure.
  • Increased risk of infection: Prednisone suppresses the immune system. Stopping it can increase susceptibility to infections, further complicating respiratory issues.

Question 4:

Compliance is crucial in managing COPD because:

  • Medications prevent and control symptoms: Inhalers and bronchodilators open airways, while medications like prednisone reduce inflammation. Non-compliance leads to uncontrolled symptoms and worsening of the disease.
  • Prevents exacerbations: Regular medication use reduces the frequency and severity of flare-ups, requiring less emergency care and hospitalization.
  • Improves quality of life: Controlled COPD allows for participation in daily activities and better overall well-being. Non-compliance leads to increased limitations and decreased quality of life.

Question 5:

On the next visit, address:

  • Medication compliance: Discuss barriers to adherence and develop strategies for improved adherence.
  • Financial concerns: Explore low-cost medication options, connect with patient assistance programs, and emphasize the long-term financial benefits of avoiding hospitalizations.
  • Home environment: Discuss the importance of air conditioning for managing COPD and explore cost-effective cooling solutions.
  • Follow-up appointments: Schedule regular visits to monitor symptoms, adjust medications, and provide ongoing education and support.

Disclaimer: This information is for educational purposes only and should not be construed as medical advice. Always consult a healthcare professional for diagnosis and treatment.

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