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

NHM MP Staff Nurse - 2015

Medical & Surgical Nursing

Medium

Appeared in: NHM MP Staff Nurse - 2015

Explanation

Pursed-lip breathing is a non-pharmacological technique taught to patients with COPD to manage dyspnea.
It works by slowing the respiratory rate and prolonging the expiratory phase, which helps empty trapped air from the lungs.
This action creates positive pressure in the airways, preventing premature airway collapse during exhalation.
By improving ventilation and reducing air trapping, it helps decrease the work of breathing and improves carbon dioxide removal.

Option B: Long-term systemic steroid therapy is avoided in stable COPD due to severe side effects like osteoporosis, muscle weakness, and hyperglycemia.
Option C: High-flow oxygen can suppress the hypoxic respiratory drive in patients with chronic CO2 retention, leading to hypoventilation and worsening hypercapnia.
Option D: Carbohydrate metabolism produces a higher amount of carbon dioxide compared to fat and protein, which increases the respiratory workload for a patient who already has difficulty exhaling CO2.

Clinical Relevance

Nursing practice connection: Use the key finding related to Management of 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 control their symptoms and reduce anxiety.
Nurses must ensure oxygen safety, titrating oxygen to the prescribed target saturation (typically 88-92%) and educating patients and families on the dangers of using high flow rates without medical orders.
Nutritional counseling is vital. Nurses should encourage small, frequent, nutrient-dense meals that are higher in protein and fat and lower in simple carbohydrates to reduce CO2 production and prevent weight loss.

How to Approach the Question

First, identify the core concept of the question, which is the standard, safe management of a patient with chronic COPD.
Evaluate each option based on the pathophysiology of COPD. Key problems in COPD include air trapping, difficulty exhaling CO2, and potential for a hypoxic respiratory drive.
Analyze Option A (Pursed-lip breathing): This is a breathing technique. Does it help with air trapping? Yes, by keeping airways open longer during exhalation. This is a positive, safe intervention.
Analyze Option B (Chronic steroid therapy): Consider the risks vs. benefits of long-term medication. Chronic systemic steroids have major side effects, making them unsuitable for long-term maintenance.
Analyze Option C (High flow oxygen): Recall the concept of hypoxic drive. In some COPD patients, high O2 can be dangerous. Therefore, this is generally contraindicated.
Analyze Option D (High Carbohydrate diet): Think about metabolism. Carbs produce more CO2 than fats. Since COPD patients struggle to clear CO2, increasing its production is not a helpful intervention.

Concept Tested & Keywords

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E6 Medicine Davidson Principles Practice 24e p. 597-599

E6 Nursing Brunner Adult Health 3SA Vol 1 Part 2 p. 40-42