Registered Nurses Role in COPD Care


 
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Introduction

Chronic Obstructive Pulmonary Disease (COPD) denotes a group of lung diseases marked by severe block in the airways and difficulty in breathing. Chronic Bronchitis and Emphysema are the two most common conditions in COPD. Chronic bronchitis is the inflammation of the lining of the bronchial tubes.

Chronic bronchitis is defined by the occurrence of severe productive cough for at least three months in a calendar year and for two consecutive years. Chronic bronchitis causes an increase in number of the goblet cells known as hyperplasia and increase in size of the mucous glands known as hypertrophy (McIvor et.al, 2011).

COPD patients in advanced stages primarily due to chronic bronchitis are commonly referred to as Blue Bloaters. They exhibit a bluish color on the skin and lips known as cyanosis with hypoxia and fluid retention. Emphysema is a condition marked by severe damage to alveoli and bronchioles.

Emphysema is characterized by inflammation of the alveoli, enlargement of the air spaces and damage to the airspace walls. This reduces the oxygen exchange and elasticity causing lung collapse. Although, damage to the lungs from COPD is irreversible, prompt nurse interventions can control symptoms and exacerbations.

Challenges

COPD has been a neglected respiratory condition in spite of being one of the most common causes of hospital admission (Kaufman, 2013).

The management of the disease poses considerable challenges. The side effects of the available pharmacological treatments, poor patient adherence to the treatment guidelines brings nurse’s role to the forefront in the management of COPD (Spencer and Hanania, 2013).

COPD carries substantial morbidity and mortality risks. Patients with inadequate COPD care are prone to frequent exacerbations that demand emergency interventions. Frequent exacerbations lead to retardation and degeneration in lung function.

Further, Chronic obstructive pulmonary disease (COPD) and asthma are common chronic diseases of the respiratory tract.

Differentiating chronic obstructive pulmonary disease from asthma poses diagnostic challenges.

A misdiagnosis of COPD or asthma can lead to inadequate care and exacerbations of the disease (Kuebler et.al, 2008).

Nurse Interventions

Forced Expiratory Volume in 1s (FEV (1)) has been the gold standard for the nurse’s diagnosis, classification, and follow-up in patients with COPD.

The limitations of Forced Expiratory Volume in 1s have lead to evaluation of better noninvasive modalities using Quantitative computed tomography (Van Tho et.al, 2012).

Further, bronchoscopic interventions to reduce lung volume in patients with emphysema have facilitated the duplication of positive outcomes of lung volume reduction surgery without significant morbidity (Kim et.al, 2009).

Major respiratory nurse pharmacological interventions for the treatment of acute COPD exacerbations include short-acting bronchodilators, oral corticosteroids and antibiotics. Supplementary oxygen and ventilator support when deemed necessary improves treatment outcomes.

Nurse care includes risk-reduction measures like smoking cessation, influenza and pneumonia vaccinations, pulmonary rehabilitation, self-management support and follow-up care (Garvey and Ortiz, 2012).

Safety evaluation studies have validated the safety and validity of various nurse interventions. This includes alpha (1) antitrypsin, prophylactic antibiotic therapy, anticholinergics by inhalation, beta (2) agonists by inhalation, corticosteroids by oral and inhalation route, theophylline, nutritional supplementation, mucolytics therapy, oxygen therapy including long-term domiciliary oxygen therapy, peripheral muscle strength training, general physical activity enhancement, inspiratory muscle training, psychosocial and pharmacological interventions for smoking cessation and pulmonary rehabilitation (McIvor et.al, 2011).

Noninvasive positive pressure ventilation is a recent alternative to intubation in critically ill patients with respiratory insufficiency or poor gas exchange who may require flexible bronchoscopy for diagnostic or therapeutic purposes.

This ventilatory technique decreases the risk of bronchoscopy-related complications in patients with refractory hypoxemia, postoperative respiratory distress, severe emphysema, obstructive sleep apnea, and obesity hypoventilation syndrome.

Further, the intervention facilitates the bronchoscopic examination of patients with severe dyspnea due to expiratory central airway collapse (Murgu et.al, 2011).

Recent research on nurse interventions for patients requiring non-invasive ventilation for acute respiratory failure due to COPD has shown that nurse care is pivotal for such challenging treatment outcomes.

NIV nurse care includes achieving non-invasive adaptation, ensuring effective ventilation and responding to patients' perceptions of non-invasive ventilation (Sorensen et.al, 2013).

Key Factors in COPD Nurse Care

A Delphi study report conducted across fifteen countries to select process and outcome indicators that are relevant to study the quality of care pathways for patients hospitalized with exacerbations of chronic obstructive pulmonary disease has identified oxygen therapy, pulmonary rehabilitation and patient education as key process indicators.

Patient understanding of the therapy and self-management have been identified as key outcome indicators. A focus on these indicators will improve nurse care for COPD patients (Lodewijckx et.al, 2013).

Recent studies to test a theoretically and empirically supported model of the relationships among truncal obesity, disease severity as indicated by carbon monoxide diffusing capacity [DLCO]), dyspnea, functional capacity as represented by a six minute walk test distance with chronic obstructive pulmonary disease has shown that truncal obesity does not affect functional performance directly, but affect it indirectly through dyspnea taking us to the conclusion that the effectiveness of pulmonary rehabilitation can be enhanced when nurses consider weight reduction as a factor for better treatment outcomes for overweight and obese COPD patients (Ade-Oshifogun, 2012).

Anxiety is a common comorbidity in COPD that often escapes the attention of caregivers. Identifying anxiety in COPD patients is a challenge because of the overlap in the symptoms of anxiety and those of COPD compounded by the side-effects of medication. Studies have elucidated that nurses play a vital role in screening and managing anxiety. Nurse care and patient education is vital to prevent episodes of panic in COPD patients (Willgoss et.al, 2011).

Conclusion

Chronic obstructive pulmonary disease is one of the main causes of morbidity and mortality worldwide. Registered Nurses play a key role in the accurate diagnosis, initiation of appropriate interventions, effective discharge planning, and post-discharge care and in the development of patient education protocols.

References

•Ade-Oshifogun JB. Model of functional performance in obese elderly people with chronic obstructive pulmonary disease. J Nurs Scholarsh. 2012 Sep; 44(3):232-41.

•Bunker JM, Reddel HK, Dennis SM, Middleton S, Van Schayck C, Crockett AJ, Hasan I, Hermiz O, Vagholkar S, Marks GB, and Zwar NA.A pragmatic cluster randomized controlled trial of early intervention for chronic obstructive pulmonary disease by practice nurse-general practitioner teams: Study Protocol. Implement Sci. 2012 Sep 7; 7:83.

•Casey D, Murphy K, Cooney A, Mee L. Developing a structured education programme for clients with COPD. Br J Community Nurs. 2011 May; 16(5):231-7.

•Garvey C, Ortiz G. Exacerbations of chronic obstructive pulmonary disease. Open Nurs J. 2012; 6:13-9.

•Kaufman G. Chronic obstructive pulmonary disease: diagnosis and management. Nurs Stand. 2013 Jan 23-29; 27(21):53-7, 60-2.

•Kim V, Steiner RM. Interventional treatment options for advanced emphysema: imaging manifestations. J Thorac Imaging. 2009 Aug; 24(3):195-205.

•Kuebler KK, Buchsel PC, Balkstra CR. Differentiating chronic obstructive pulmonary disease from asthma. J Am Acad Nurse Pract. 2008 Sep; 20(9):445-54.

•Lodewijckx C, Sermeus W, Panella M, Deneckere S, Leigheb F, Troosters T, Boto PA, Mendes RV, and Decramer M, Vanhaecht K. Quality indicators for in-hospital management of exacerbation of chronic obstructive pulmonary disease: results of an international Delphi study. J Adv Nurs. 2013 Feb; 69(2):348-62.

•McIvor RA, Tunks M, Todd DC. Copd. Clin Evid (Online). 2011 Jun 6; 2011. Pii: 1502.

•Murgu SD, Pecson J, Colt HG. Flexible bronchoscopy assisted by noninvasive positive pressure ventilation. Crit Care Nurse. 2011 Jun; 31(3):70-6.

•Scullion JE, Holmes S. Palliative care in patients with chronic obstructive pulmonary disease. Nurs Older People. 2011 May; 23(4):32-9.

•Sørensen D, Frederiksen K, and Grøfte T, Lomborg K. Practical wisdom: A qualitative study of the care and management of non-invasive ventilation patients by experienced intensive care nurses. Intensive Crit Care Nurs. 2013 Jun; 29(3):174-81.

•Spencer P, Hanania NA. Optimizing safety of COPD treatments: role of the nurse practitioner. J Multidiscip Healthc. 2013; 6:53-63.

•Van Tho N, Wada H, Ogawa E, Nakano Y. Recent findings in chronic obstructive pulmonary disease by using quantitative computed tomography. Respir Investig. 2012 Sep; 50(3):78-87.

•Willgoss T, Yohannes A, Goldbart J, Fatoye F.COPD and anxiety: its impact on patients' lives. Nurs Times. 2011 Apr 19-May 2; 107(15-16):16-9.


 
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Articles in this issue:

Masthead

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    Editor-in Chief:
    Kirsten Nicole

    Editorial Staff:
    Kirsten Nicole
    Stan Kenyon
    Robyn Bowman
    Kimberly McNabb
    Lisa Gordon
    Stephanie Robinson

    Contributors:
    Kirsten Nicole
    Stan Kenyon
    Liz Di Bernardo
    Cris Lobato
    Elisa Howard
    Susan Cramer

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