COPD Nursing Management: Complete NCLEX Review

Emphysema vs Chronic Bronchitis

• Emphysema ("Pink Puffer"): Destruction of alveolar walls → air trapping. Barrel chest, dyspnea, thin, pursed-lip breathing, minimal cough
• Chronic Bronchitis ("Blue Bloater"): Excessive mucus production → airway obstruction. Productive cough ≥3 months/year for 2 years, cyanosis, edema

Assessment

• Decreased breath sounds, prolonged expiration, wheezing
• Use of accessory muscles, tripod position
• ABGs: chronic respiratory acidosis with metabolic compensation
• Pulmonary function tests: decreased FEV1/FVC ratio

Medications

• Bronchodilators: Albuterol (rescue), ipratropium, tiotropium
• Inhaled corticosteroids: Fluticasone - rinse mouth after use to prevent thrush
• Use bronchodilator FIRST, then corticosteroid (5 min between)

Oxygen Therapy

• Low-flow: 1-2 L/min via nasal cannula
• Target SpO2: 88-92% (avoid suppressing hypoxic drive)
• High-flow oxygen can cause respiratory depression in COPD

Patient Teaching

• Pursed-lip breathing: inhale through nose, exhale slowly through pursed lips
• Diaphragmatic breathing, energy conservation techniques
• Annual flu vaccine, pneumococcal vaccine
• Smoking cessation is the ONLY intervention that slows disease progression

Study at Respiratory Disorders cheat sheet and Respiratory Nursing deep dive.