Pathophysiology of COPD: Heart Failure Respiratory Disorders
Pathophysiology of COPD: Heart Failure Respiratory Disorders
Pathophysiology of COPD: Heart Failure Respiratory Disorders
In the previous review, I covered other respiratory disorders of the respiratory system. So, if you are
studying for NCLEX or your nursing lecture exams be sure to check out that section.
When taking care of a patient with COPD it is very important the nurse knows how to recognize the
typical signs and symptoms seen in this condition, how it is diagnosed, nursing interventions, and
patient education.
Definition: pulmonary disease that causes chronic obstruction of airflow from the lungs
Limited Airflow (due to thick and swollen bronchioles that have become deformed with
excessive sputum production and this narrows the airways)
Inability to fully exhale (due to loss of elasticity of the alveoli sacs from damage and the
sacs start to develop air pockets)
Happens gradually….most people start to notice signs and symptoms middle-aged and
will present with dyspnea with activity they could normally tolerate, recurrent lung
infections, chronic cough etc.
COPD is a term used as a “catch all” for diseases that limit airflow and cause dyspnea.
Types of COPD include:
Pathophysiology of COPD
Normal breathing:
Inhaled oxygen travels down through the trachea which splits at the carina into bronchial tubes
starting with the primary bronchus then into smaller airways called secondary and tertiary bronchi
which divide into bronchioles and the oxygen goes into the alveolar sacs where gas exchange
happens. As the alveoli inflate and deflate with ease, inhaled oxygen attaches to the red blood cells
and carbon dioxide enters the respiratory system to be exhaled.
Also, less oxygen is getting into the blood and more carbon dioxide is staying in the blood. This
leads to low blood levels and high carbon dioxide levels. Patients will have cyanosis due to a
decreased oxygen level. To compensate, the body increases RBC production and cause blood to
shift elsewhere which increases pressure in the pulmonary artery leading to pulmonary
hypertension. Pulmonary hypertension leads to right-sided heart failure (which is why you will start
to see bloating..edema in the abdomen and legs)
In emphysema, the alveoli sacs lose their ability to inflate and deflate due to an inflammatory
response in the body. So, the sac is unable to properly deflate and inflate. Inhaled air starts to get
trapped in the sacs and this causes major hyperinflation of the lungs because the patient is
retaining so much volume.
Hyperinflation causes the diaphragm to flatten. The diaphragm plays a huge role in helping the
patient breathe effortlessly in and out. Therefore, in order to fully exhale, the patient starts to
hyperventilate and use accessory muscles to get the air out now. This leads to the barrel chest
look and during inspect it may be noted there is an INCREASED ANTEROPOSTERIOR
DIAMETER.
The damage in the sacs cause the body to keep high carbon dioxide levels and low blood oxygen
levels. Inhaled oxygen will not be able to enter into the sacs for gas exchange and carbon dioxide
won’t leave the cells to be exhaled.
The body tries to compensate by causing hyperventilation (increasing the respiratory rate…hence
puffer) and the patient will have less hypoxemia “pink complexion” than chronic bronchitis who have
the cyanosis because pink puffers keep their oxygen level just where it needs to be from
hyperventilation.
Remember: Lung Damage
Lack of energy
Nutrition poor (weight loss) due to energy used breathing especially with emphysema
Gases abnormal (high PCO2 >45 and low PO2 <90)..respiratory acidosis
Modification of skin color from pink to cyanosis in lips, mucous membranes, nail beds (“blue
bloaters”)
Gets in the Tripod Position during dyspnea (stands leaning forward while supporting body with
hands on knees or an object)
Extreme dyspnea
In turn over time, people with COPD will be stimulated to breathe due to low oxygen levels
RATHER than high carbon dioxide levels.
Complications of COPD
Heart Disease (remember heart and lungs work together in replenishing the body with
oxygen)…heart failure
Risk for Pneumonia
Spirometry: A test where a patient breathes into a tube that measure how much volume the lungs
can hold during inhalation and how much and fast air volume is exhaled.
Measuring the FVC (Forced Vital Capacity) : a low reading shows restrictive
breathing….it measures the largest amount of air a person exhales after breathing in
deeply in one second.
Forced Expiratory Volume: measures how much air a person can exhale within one
second. A low reading shows the severity of the disease.
Pursed-lip breathing: used for when patient starts to get dyspneic. This
technique increases the oxygen level and encourages them to breath out longer
(remember these patient don’t fully exhale very well). It is similar to like blowing out a
birthday candle.
Nutrition needs: eating high calorie, protein rich meals that are small but frequent and
staying hydrated if not contraindicated….avoid large heavy meals due to compression on
the lungs from the stomach
Avoiding sick people, irritants, hot humid (smothering) or very cold weather
Vaccination up-to-date: annual flu shot and Pneumovax every 5 years because it is very
hard for people with COPD to recover from illnesses
Administering medications: be familiar with groups, side effects, and patient teaching
Corticosteroids: decreases inflammation and mucous production in airway… given: oral, IV, inhaled
and used in combination with bronchodilator like:
Side effects: easy bruising, hyperglycemia, risk of infection, bone problems (long term
use)
Increases risk for digoxin toxicity and decreases the effects of lithium and Dilantin
Phosphodiestrace-4 inhibitors: “Roflumilast” used for people who have chronic bronchitis and it
works by decreasing COPD exacerbation…not a bronchodilator
Side effects: can cause suicidal thoughts (remember the word “last” in the drug’s
name…it could be the patient’s last days if they are not assessed for this side effect) and
can cause weight loss.
Short-acting bronchodilators: relaxes the smooth muscle of the bronchial tubes and are used in
emergency situations where quick relief is needed
Patient education: let them know which drug is short and long-acting, how to use inhaler
and to use bronchodilator inhaler BEFORE steroid inhaler (wait 5 minutes in between)