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hey everyone it's sarah thread sterner
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sori and calm and in this video I'm
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going to be going over part two of copd
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where I'm going to be covering the
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nursing interventions and the
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medications be sure to check out part
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one because that video lays the
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foundation for this video because I
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discussed the pathophysiology the types
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of signs and symptoms the complications
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and how it is diagnosed and as always
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over here on the side or in the
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description below you can access the
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quiz and the notes that go along with
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this video so let's get started first
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let's start out talking about the
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nursing interventions what are you going
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to do for this patient as the nurse okay
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number one the most obvious is that you
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are going to monitor their respiratory
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system which will include listening to
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those lung sounds what's going on in
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there and if they need suction they may
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need nasotracheal suction you'll assess
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their need for that based on their
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effort of breathing and their oxygen
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saturation also you're going to be
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monitoring that sputum production your
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patients with chronic bronchitis as we
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learned in part one tend to have really
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unproductive coughs so if ordered you
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may need to collect a sputum culture
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because these patients are at risk for
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developing pneumonia another thing is
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that you want to monitor that oxygen
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saturation and keep it between 88 to 93
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percent why this number because a lot of
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people are like 95 to hundreds where we
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want to keep it well the reason is is
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because how COPD patients are stimulated
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to breathe they are stimulated to
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breathe due to low oxygen levels and as
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we learn in the previous video this is
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what these patients have because of
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obstructive airflow so they're
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stimulated to breathe by low oxygen
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levels rather than high carbon dioxide
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levels which is how a person with
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healthy lungs is stimulated to breathe
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whenever their carbon dioxide levels are
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high
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it stimulates them to breathe to blow
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that off but not in this case so we
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don't want to give them too much oxygen
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through a nasal cannula because this
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will not give their body an incentive to
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breathe so they could stop breathing
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causing them to hypo ventilate which in
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turn is going to increase that carbon
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dioxide even more and become toxic okay
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so another thing is that we want to
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administer oxygen as prescribed by the
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physician usually one to two liters you
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don't want to usually go any higher than
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that monitor their effort of breathing
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because these patients are at risk with
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any activity depending on the severity
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of their COPD four episodes of shortness
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of breath so you want to teach them
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about purse lip breathing and dot -
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chromatic breathing and what are these I
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would know these four tests how to do it
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how to teach a patient about them okay
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let's talk about pursed lip breathing
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first and this is a great thing to use
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whenever your patient is having those
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disick episodes it usually works even
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better than putting the oxygen on them
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because what it does is it increases the
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oxygen level it encourages them to
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breathe out longer so remember the issue
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with this these patients are retaining a
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lot of air volume due to what's going to
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be going on with their viola sacks and
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the bronchioles so what they will do is
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they will breathe in and then blow out
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through pursed lips like they're trying
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to blow out a birthday candle so it'll
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be something like this and this
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encourages them to breathe out longer to
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force that air out help slow down that
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breathing and increase that oxygen level
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now let's talk about diaphragmatic
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breathing this breathing uses the
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abdominal muscles rather than those
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accessory muscles for breathing because
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what has happened is these lungs have
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become hyper inflated it's pushed the
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diaphragm
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rather than having a dome shape and your
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diaphragm plays a huge role in your
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ability to breathe effortlessly so what
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happens whenever you breathe the
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diaphragm will help when it can try it
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when it relaxes back up to force that
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air out so you're getting all that
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volume out but here it's flat and it's
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not doing their job so your body starts
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using those accessory muscles to help
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get that air out of the lungs so um what
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will what will happen whenever you teach
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them this is that it will help
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strengthen that diaphragm it will slow
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down the breathing rate and make it
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easier and decrease the energy used to
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breathe because using those accessory
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muscles to breathe burns a lot of
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calories and that's why your patients
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especially ones who have emphysema will
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have weight loss and you need to
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encourage them to eat a lot of frequent
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small meals so how you do that you have
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the patient lay down you can put a
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pillow underneath their knees and they
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will put one hand over their chest and
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one hand on their abdomen and what they
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will do is that with their abdominal
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muscles they will inhale in move those
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muscles not moving the chest muscles
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with abdominal muscles to force that
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area then they will pursed lip breathe
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out using the abdominal muscles instead
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of those accessory muscles and that
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helps strengthen the diaphragm and
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discourage the use of those accessory
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muscles another thing is that you'll be
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administering breathing treatments as
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the nurse a lot of times in hospitals
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respiratory therapy will participate in
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this as well they give a lot of
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nebulizer treatments especially those
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short-acting
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um médico dilators like albuterol
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atrovent
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things like that but as a nurse you will
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be giving scheduled or as needed inhaler
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so your role which we're going to go
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over later in the lecture is to know
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those category of drugs like long-acting
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versus short-acting if they're having an
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acute episode shortness of breath you
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want to give a short-acting
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bronchodilators because it acts fast and
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those corticosteroid
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tailors and things like that now let's
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talk about the education pieces that you
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want to provide to your patient who is
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struggling with COPD okay the first
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thing is about nutrition needs
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especially patients who have the form
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called emphysema which is your pink
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puffers because they hyperventilate they
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breathe rapidly they use those accessory
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muscles as a call as a compensation
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mechanism to keep that oxygen where it
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needs to be so they use a lot of energy
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doing this so they need to be educated
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to eat high calorie and protein meals
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and they need to be small but frequent
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because they don't want to eat three
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large meals a day why the anatomy of how
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your body set up you have your stomach
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somewhere in this region they already
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have hyper-inflated lungs and abnormal
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flattened diaphragm so if they go in eat
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a lot of food that something's going to
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push up on those lungs up on that dock
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room it's going to cause them difficulty
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breathing so it's best for them to eat
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small but frequent meals that are high
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and rich in protein also they want to
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stay hydrated drinking about two to
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three liters per day unless it's not
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contraindicated like the patients with
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renal failure or heart failure who are
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on fluid restrictions and the reason
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they want to stay hydrated is to keep
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those mucous secretions thin they don't
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want them to be thick because it's going
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to block the airway and cause a lot more
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problems they want to avoid sick people
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and irritants out in the weather so they
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need to watch forecasting see if it's
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going to be a high alert day for air
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pollution they need to avoid those days
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because this can trigger COPD
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exacerbation and a lot of patients who
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have severe COPD if they go outside
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whenever it's really really hot or humid
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it smothers them because of the humidity
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and extreme cold temperatures affect
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them as well so let them know about that
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and if your patients smokes educate them
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on the importance of salt smoking
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because this can help improve the
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function of the ones
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and to avoid people who smoke that
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secondhand smoke is just as bad been
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smoking themselves also have their
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vaccinations up today because if they
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get influenza or anything like that
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that's when an attack the lungs
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this can cause COPD exacerbation and
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it's really hard for these patients to
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recover from this and and so they'll
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need to get the flu shot annually and
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the pneumonia vaccine every five years
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because they are at risk for developing
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certain forms of pneumonia and this shot
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can help prevent that or mild the
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symptoms okay so let's look at the
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medication regimen for patients with
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COPD as the nurse what you need to be
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familiar with are those group those drug
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categories that's going to be given in
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COPD the major side effects that you
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need to watch out for that may be thrown
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on in clicks and patient education
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pieces for the most important drugs so
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to help you remember the typical drugs
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given in COPD remember this new morning
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chronic pulmonary medications save lungs
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here we have lung issues these
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medications along with lifestyle changes
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and help the patient have a better
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quality of life with their breathing
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so first the C corticosteroids
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what do corticosteroids do they decrease
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inflammation and mucus production in the
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Airways because especially with chronic
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bronchitis those bronchioles are
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inflamed they're producing lots of mucus
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corticosteroids going to help decrease
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that and help that immune system slow
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down its attacking these are given and
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give them orally IV inhaled many times
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and then held ones will be given with a
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bronchodilator mitt and sometimes
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there's combination drugs some drugs you
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want to be familiar with is prednisone
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solu-medrol palma core or symbicort
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simba core is a combination one it is a
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steroid and it's a long-acting
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dilator so side effects of
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corticosteroids we covered this a lot in
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the endocrine series so if you really
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want to dive into this and you can check
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out the endocrine series I have a card
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should be popping up so you can access
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that but side effects is easy bruising
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patient a lot of times you'll see them
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the bruises on their arms and their legs
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their skin will even be really fragile
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and tear easily so be easy with that and
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they're at risk for hyperglycemia I have
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seen this has happened especially your
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diabetic patients you'll or even if
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they're not diabetic they can increase
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their sugars really really high so you
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want to monitor their Sugar's they're at
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risk for infection because
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corticosteroids suppresses the immune
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system so they need to watch out for
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that and avoid those sick people and if
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they use these over time they're at risk
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for osteoporosis okay
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piece they really need to take away with
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bronchodilators and COPD
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I mean corticosteroids and COPD is um if
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a patient is prescribed and inhaler
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that's a bronchodilator and then inhaler
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that's a corticosteroid how which one
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you're going to use first it's very
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important first they want to use the
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bronchodilator inhaler because what this
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does is they take it in and opens up
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those Airways it dilates those Airways
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then five minutes later they're going to
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use their corticosteroid inhaler because
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those Airways are nice and opened up and
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that corticosteroid can get in those
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Airways that would have normally been
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closed off because they didn't use a
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bronchodilator
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and it can do its SHA so remember that
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another thing you want to remember after
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a patient uses their corticosteroid
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inhaler they need to rinse their mouth
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another drug use the p4
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phosphodiesterase force inhibitors one
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is called with Yuma last and this is
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used for people with chronic bronchitis
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and it helps decrease COPD exacerbation
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now it's not a bronchodilator
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okay what you want to remember about
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this drug are the side effects of it
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you want to assess your patients mental
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status whenever they're on this because
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it can increase and the thoughts of
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suicide ideation so how I remember this
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because there's a lot of drugs you have
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to remember eyes a nursing school I look
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at the name and the last part of refu my
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last is last and last it could be their
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last day so you want to assess them for
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thoughts of suicide and rapport that's
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with the doctor because this is not a
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good thing and also they can have weight
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loss with this so monitor their weight
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and teach the patient you know if you
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start having these thoughts please
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report them and monitor your weight okay
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next methylxanthines a drug and this
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category is known as the awful and this
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is many times given orally and it's a
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type of bronchodilator so it works by
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relaxing the smooth muscle opening up
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those Airways and it is used for
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long-term for patients who have severe
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COPD now remember this about the off
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limb it has a narrow therapeutic range a
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lot of times test questions like to
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throw out patients on theophylline you
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have a dose schedule to give here's your
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lab work on theophylline it has a narrow
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therapeutic range and you want it
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between 10 to 20 micrograms per
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milliliters so anything above that's bad
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and anything less than that they're not
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receiving enough medication now the off
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link an increase digoxin toxicity so if
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you're on digoxin you'll want to make
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sure that there's auxin levels being
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monitored and it can decrease the
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effects of lithium and dilantin
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okay next s for short acting
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bronchodilators these relax the smooth
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muscle of the bronchial tubes and their
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short acting so they're great in
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emergency situations where you're having
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some severe shortness of breath going on
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those Airways are constricting up is
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going to go in there open those up so
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the patient can breathe and when they
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need quick relief so as the nurse know
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which ones are short and which ones are
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long some typical short ones
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beta-2 agonists albuterol that's what
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that is
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an anticholinergic such as atrovent
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next the last one l4 long-acting
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bronchodilators these works the same as
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short but the effects of the medication
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lasts longer so the patient is going to
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use them over a period of time they'll
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probably be scheduled maybe once or
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twice a day and just be familiar with
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which ones are long you have beta-2
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agonist like saw metro and then you have
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anticholinergic like spy Revis pairi but
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that's a real popular one and what you
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want to remember with this is of course
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you use the bronchodilators before you
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use if they're on corticosteroids that
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are inhaled so you would use this first
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open up the airway then use your inhaler
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of the corticosteroids and some side
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effects the beta-2 agonists they can
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cause increased heart rate and you're an
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area where chick retention and the
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anticholinergics can cause dry mouth and
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blurred visions so be on the lookout for
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that educate your patient about that so
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that is about the nursing interventions
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and the medications used in COPD don't
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forget to watch part 1 and take the
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NCLEX review quiz that goes over these
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lectures and if you like this video
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please give it a thumbs up and thank you
00:16:15
so much for watching and please consider
00:16:17
subscribing to this YouTube channel
