Chronic Obstructive Pulmonary Disease (COPD) is a progressive lung disease that causes airflow limitation and breathing difficulties due to chronic airway inflammation and alveolar damage. COPD primarily includes emphysema and chronic bronchitis.
This guide covers:
- Pathophysiology
- Causes and risk factors
- Signs and symptoms
- Lab value interpretation
- Complications
- Nursing care and patient teaching
- NCLEX-style priority actions
Pathophysiology
COPD causes chronic destruction of the lungs, resulting in:
- Decreased gas exchange
- Air trapping in the alveoli
- Hypercapnia (high CO₂ in the body)
- Hypoxemia (low O₂ levels)
Memory Trick:
C = Chronic air trapping
C = CO₂ high
Causes & Risk Factors
Main Causes:
- Smoking (most common)
- Occupational exposure (e.g., car mechanics, industrial workers)
Risk Factor NCLEX Tip:
Long-term smoking (>30 years) significantly increases COPD risk.
Types of COPD
Emphysema ("Pink Puffer")
- Pink skin & pursed-lip breathing
- Increased chest ("barrel chest")
- No chronic cough (minimal mucus)
- Keep tripod position to ease breathing
Patho: Loss of alveolar elasticity → lung hyperinflation → air trapping.
Chronic Bronchitis ("Blue Bloater")
- Big & blue skin (cyanosis)
- Long-term chronic cough & sputum
- Unusual lung sounds (crackles, wheezes)
- Edema (peripheral) from cor pulmonale
Patho: Chronic bronchial inflammation → excessive mucus production → airflow obstruction.
Expected O₂ Saturation
For COPD patients, 88–93% SpO₂ is normal. Over-oxygenating can reduce respiratory drive.
Key Lab Values in COPD
Arterial Blood Gas (ABG) Patterns:
- Low PaO₂ (<80 mmHg) → Hypoxemia
- High PaCO₂ (>45 mmHg) → Hypercapnia
- pH < 7.35 → Respiratory acidosis
Memory Trick:
COPD = CO₂ Prisoned → Carbon Dioxide → Carbon diACID (acidosis).
Deadly Complication: Respiratory Failure
Hypoxemic Respiratory Failure = Low O₂
Hypercapnic Respiratory Failure = High CO₂
Priority Intervention: Apply BiPAP for hypercapnia.
NCLEX Tip:
Monitor mental status changes — early signs of worsening CO₂ retention include:
- Restlessness
- Confusion
- Decreased level of consciousness
Nursing Care for COPD Exacerbations
Avoid:
- Opioids (e.g., morphine, hydromorphone, oxycodone)
- Benzodiazepines (e.g., diazepam, lorazepam) — can cause respiratory depression
If in tripod position with severe dyspnea:
- Use BiPAP
- Administer rescue inhalers (Albuterol)
- Oxygen via nasal cannula if needed, but maintain target saturation
Patient Teaching & Lifestyle Management
Dietary Recommendations:
- Perform oral hygiene before meals
- Eat small, frequent meals to avoid stomach distention
- High-calorie, high-protein diet
- Avoid large amounts of carbs (increase CO₂ production)
- Avoid high-fiber gas-producing foods (broccoli, beans)
- Avoid carbonated drinks
Fluids:
- Increase fluids to 2–3 L/day (unless contraindicated) to thin mucus
- Avoid drinking fluids with meals
Infection Prevention:
- Annual flu vaccine
- Pneumococcal vaccine every 5 years
- Report increased sputum, fever, or worsening dyspnea immediately
Breathing Techniques for COPD
Pursed-Lip Breathing:
- Inhale for 2 seconds through the nose
- Exhale for 4 seconds through pursed lips
- Prevents airway collapse and improves oxygen exchange
Huff Coughing Technique:
- Sit upright with feet flat
- Take a deep breath through the mouth
- Hold for 2–3 seconds
- Forcefully exhale while saying “huff”
- Repeat 1–2 times, then normal breaths
Bronchitis-Specific Nursing Tips
- Mobilize secretions before bed
- Use guaifenesin for mucus thinning
- Cool mist humidifier for easier breathing
NCLEX & HESI Priority Tips
- For hypercapnia (high CO₂): BiPAP is first-line
- For O₂ sat 88–93%: Normal for COPD — don’t over-oxygenate
- For COPD exacerbation: Avoid opioids and sedatives
- Always monitor ABG changes closely
Summary Table – COPD Nursing Care
| Category | Key Points |
|---|---|
| Causes | Smoking, occupational hazards |
| Types | Emphysema (Pink Puffer), Chronic Bronchitis (Blue Bloater) |
| Normal SpO₂ | 88–93% |
| ABG | Low PaO₂, High PaCO₂, Low pH |
| Priority | BiPAP for hypercapnia |
| Diet | High calorie/protein, low carbs, small meals |
| Breathing | Pursed-lip, Huff coughing |
| Avoid | Opioids, benzodiazepines |
| Vaccines | Flu annually, Pneumococcal every 5 years |
Frequently Asked Questions (FAQs)
Q1. Why is high oxygen dangerous in COPD?
It can suppress the hypoxic drive to breathe, worsening CO₂ retention.
Q2. Can COPD be cured?
No, but symptoms can be managed with medications, oxygen therapy, and lifestyle changes.
Q3. What is the difference between emphysema and chronic bronchitis?
Emphysema damages alveoli causing hyperinflation; chronic bronchitis causes airway inflammation and mucus overproduction.
Q4. Why use pursed-lip breathing?
It prolongs exhalation, prevents airway collapse, and improves gas exchange.
