Which is an intervention for a patient with chronic obstructive pulmonary disease?

RRB Nsg. Superintendent-20 July 2019 (Shift-1)

Medical & Surgical Nursing

Easy

Appeared in: RRB Nsg. Superintendent-20 July 2019 (Shift-1)

Explanation

Pursed-lip breathing is a key self-management technique taught to patients with COPD to control dyspnea.
It works by creating positive end-expiratory pressure (PEEP), which splints the airways open during exhalation.
This prolonged exhalation helps to empty trapped air from the lungs, reducing hyperinflation and improving gas exchange.
By slowing the respiratory rate, it also helps reduce the work of breathing and can alleviate feelings of panic associated with breathlessness.

Option A: Chronic systemic (oral) steroid therapy is not recommended for the routine management of stable COPD due to an unfavorable risk-benefit ratio, with significant side effects like osteoporosis and muscle weakness.
Option B: A high-carbohydrate diet increases carbon dioxide (CO₂) production through metabolism, which adds to the respiratory burden of a patient who already has difficulty exhaling CO₂.
Option C: High-flow oxygen can suppress the hypoxic respiratory drive in patients with chronic CO₂ retention, potentially leading to respiratory depression and failure (CO₂ narcosis).

Visual 1: Diagram: A step-by-step illustration showing a patient performing pursed-lip breathing (inhaling through the nose, exhaling slowly through pursed lips).
Visual 2: Flowchart: A decision tree for oxygen therapy in COPD, showing when to use low-flow versus high-flow systems and the target saturation levels.

Clinical Relevance

Nursing practice connection: Use the key finding related to Nursing Interventions for Chronic Obstructive Pulmonary Disease (COPD) to guide bedside assessment, documentation, and the next nursing action.
Patient education is a critical nursing role in COPD management. Teaching techniques like pursed-lip breathing empowers patients to manage their symptoms and improves their quality of life.
Oxygen is a medication, and its administration requires careful assessment and monitoring. Incorrectly administering high-flow oxygen to a COPD patient with CO₂ retention is a major patient safety risk.
What if? If the patient had acute hypoxemic respiratory failure without a history of COPD, high-flow oxygen would be a primary intervention to correct severe hypoxemia quickly.

How to Approach the Question

First, identify the core of the question: it asks for a standard, recommended intervention for a patient with chronic, stable COPD.
Recall the pathophysiology of COPD: it's a disease characterized by airflow limitation, air trapping, and difficulty with exhalation, often leading to CO₂ retention.
Evaluate each option based on this pathophysiology.
Option A (Chronic steroids): Think about long-term vs. short-term use. Chronic systemic steroids have major side effects, making them unsuitable for long-term management.
Option B (High-carb diet): Consider the metabolic byproducts. Carbs produce the most CO₂, which is exactly what COPD patients struggle to eliminate.
Option C (High-flow O₂): Remember the concept of hypoxic drive. For some COPD patients, high oxygen levels can turn off their stimulus to breathe.

Concept Tested & Keywords

Concept Tested: Nursing Interventions for Chronic Obstructive Pulmonary Disease (COPD)
Stem keywords: intervention, patient, chronic obstructive pulmonary disease, COPD
Lead-in keywords: Which is
Negative lead-in flag: false

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