Medical Surgical COPD #3

Question

The nurse begins the hospital shift by assessing a client with a diagnosis of exacerbation of chronic obstructive pulmonary disease (COPD). The nurse expects to document which findings? Select all that apply.

Answers

  1. Hypercapnia
    • Rationale:

      This answer is correct because hypercapnia is a clinical manifestation associated with COPD. Due to inelastic alveoli, CO2 will not be exhaled as readily and will accumulate leading to hypercapnia.

  2. Increased vital capacity on pulmonary function studies
    • Rationale:

      This answer is not correct because COPD clients would exhibit decreased vital capacity on pulmonary function tests; not increased vital capacity. Because of inelastic alveoli, the amount of air that may be exhaled after a full inhalation is decreased in clients with COPD.

  3. Oxygen desaturation when ambulating with physical therapy
    • Rationale:

      This answer is correct because activity of any kind will lead to hypoxemia in clients with COPD. Activity intolerance, especially during an acute exacerbation is a common manifestation in COPD clients.

  4. Hematuria
    • Rationale:

      This answer is not correct because hematuria or blood in the urine is not associated with a diagnosis of COPD. Clients with COPD will display many different expected clinical manifestations. Emphysema causes a loss of elasticity within the alveoli leading to the retention of CO2 and hypercapnia.

  5. Pursed-lip breathing
    • Rationale:

      This answer is correct because pursed-lip breathing is associated with acute exacerbation of COPD. Pursed-lip breathing is a method to increase pressure within the alveoli, therefore opening the airways during exhalation to improve ventilation.

Overview

The focus of this question is being able to recognize expected findings in a client experiencing an acute exacerbation of COPD. An understanding of the pathophysiology of COPD and its associated expected manifestations are necessary in order to answer this question correctly.

Explanation

Learning Outcomes

Clients with COPD will display many different expected clinical manifestations. Emphysema causes a loss of elasticity within the alveoli leading to the retention of CO2 and hypercapnia. Another common finding in clients with emphysema is a barrel chest caused by air trapping. COPD clients will often use pursed-lip breathing in an effort to fully ventilate by increasing the pressure within the lungs during exhalation. Oxygen desaturation with activity is also common due to destructive changes within the alveoli making gas exchange difficult.

Test Taking Tip

Common manifestations of COPD include hypercapnia, oxygen desaturation with exercise, use of accessory muscles for respirations, dyspnea, hyperinflated chest on x-ray, decreased vital capacity (not increased as in option B), barrel chest (increased AP:Lateral diameter), and clubbing.

Video Rationale