Teaching for a client with chronic obstructive pulmonary disease (COPD) should include which of the following topics?
A. How to have his wife learn to listen to his lungs with a stethoscope from Wal-Mart.
B. How to increase his oxygen therapy.
C. How to treat respiratory infections without going to the physician.
D. How to recognize the signs of an impending respiratory infection.
Correct Answer: D. How to recognize the signs of an impending respiratory infection.
Respiratory infection in clients with a respiratory disorder can be fatal. It’s important that the client understands how to recognize the signs and symptoms of an impending respiratory infection. Acute exacerbation of COPD is an acute worsening of respiratory symptoms. Assessing severity is often based on the model developed by Anthonisen and colleagues which classifies severity by the presence of worsening dyspnea, sputum volume, and purulence. Mild exacerbations are defined by the presence of 1 of these symptoms in addition to one of the following: increased wheezing, increased cough, fever without another cause, upper respiratory infection within 5 days, or an increase in heart rate or respiratory rate from the patient’s baseline.
Option A: It isn’t appropriate for the wife to listen to his lung sounds, besides, you can’t purchase stethoscopes from Wal-Mart. COPD will typically present in adulthood and often during the winter months. Patients usually present with complaints of chronic and progressive dyspnea, cough, and sputum production. Patients may also have wheezing and chest tightness.
Option B: Hospitalized patients often require oxygen and bronchodilator therapy in the form of a SABA with or without a SAMA. Oxygen therapy can range from a nasal cannula to mechanical ventilation depending on the severity of the exacerbation. Pulmonary rehabilitation plays a large role in improving outcomes. Rehabilitation has been shown to improve the quality of life, dyspnea, and exercise capacity in patients with COPD.
Option C: If the client has signs and symptoms of an infection, he should contact his physician at once. Moderate and severe exacerbations are defined by the presence of 2 or all 3 of the symptoms respectively. Patients may have acute respiratory failure and physical findings of hypoxemia and hypercapnia. Arterial blood gas analysis, chest imaging, and pulse oximetry are indicated.
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