Editing Medical-Surgical Nursing (section)

=== Chronic Obstructive Pulmonary Disease ===

Chronic obstructive pulmonary disease encompasses emphysema, in which alveolar walls are destroyed and air trapping occurs, and chronic bronchitis, in which airway inflammation and mucus production dominate. Findings include a prolonged expiratory phase, barrel chest, use of accessory muscles, wheezes and diminished breath sounds, chronic productive cough, clubbing, and weight loss.

Nursing interventions: teach pursed-lip breathing to prevent airway collapse on exhalation, diaphragmatic breathing, tripod positioning, energy conservation, adequate hydration to thin secretions, small frequent high-calorie meals because eating is tiring and a full stomach worsens dyspnea, and smoking cessation, which is the only intervention that slows disease progression.

Nursing application: many patients with advanced disease are chronic carbon dioxide retainers. Oxygen is titrated to the lowest effective flow, commonly targeting an oxygen saturation of about eighty-eight to ninety-two percent, because excessive oxygen can worsen ventilation-perfusion mismatch and blunt respiratory drive. Oxygen is never withheld from a hypoxemic patient, but it is given deliberately and monitored.