Non-pharmacotherapeutic interventions
Education
Specific
educational interventions, such as self-management programs, diet and smoking
cessation counseling, have been shown to reduce health resource utilization related
to management of acute exacerbations. Dietitian recommendation includes
adequate hydration, high-protein, and high-calorie. Components of COPD education also include
effective inhaler technique, early recognition and treatment of acute
exacerbations, identification of community resources and end-of-life care
issues (DE O’Donnell et al., 2008).
Smoking
cessation
COPD is
preventable. Smoking cessation is the single most effective intervention to
reduce the risk of developing COPD and the only intervention that has been
shown to slow the rate of lung function decline (DE O’Donnell et al., 2008; Ferrara, 2011).
Vaccinations
Vaccinations
prevent acute exacerbations of COPD (AECOPD). Individuals with COPD infected
with influenza are at significant risk of requiring hospitalization. Respiratory
tract infections are extremely dangerous to this population. COPD patients
should receive the annual influenza vaccines, and a pneumococcal vaccine also
is highly recommended (DE O’Donnell et al., 2008; Ferrara, 2011).
Pulmonary
rehabilitation
Clinically
stable patients who remain dyspneic and limited in their exercise capacity
despite optimal pharmacotherapy should be referred for supervised pulmonary
rehabilitation. Pulmonary rehabilitation significantly improves dyspnea,
exercise endurance, quality of life and risk of hospitalizations following AECOPD
(DE O’Donnell et al., 2008; Ferrara, 2011).
Diaphragmatic breathing exercises,activity as tolerated, muscle stretch gymnastics, chest
physiotherapy and walking
are the most beneficial components of pulmonary rehabilitation (Higginson,
2010).
Independent Nursing Care
- Assess for signs and symptoms of COPD.
- Encourage verbalization of feeling, concerns, and fears.
- Explain all tests and procedures to the patient using clear, simple explanations.
- Help the patient identify coping strategies that have worked in the past and support the use of these strategies.
- Help the patient identify factors that exaggerate symptoms of COPD.
- Provide care in a calm and reassuring manner.
- Provide quiet time, and decrease environmental stimulation.
- Teach stress-reduction and relaxation techniques.
- Use therapeutic communication skills to develop a trusting relationship with the patient.
(Decramer et al., 2008; Gullick & Stainton, 2008)
Collaborative Nursing Care
- Prevent complications & progression
- Reduce frequency & severity of exacerbations
- Alleviate breathlessness & other resp. symptoms
- Improve exercise tolerance & ADL
- Treat exacerbations & complications
- Promote patient comfort & active participation
- Improve quality of life, end of life decisions
- Refer the patient to a smoking-cessation program, as appropriate.
- Drug therapy: bronchodilators & anticholinergic agents, theophylline
- Oxygen therapy
- Surgical therapy
- Pulmonary rehabilitation
- Nutritional therapy
- Administer nebulizer treatments.
- Provide mechanical ventilation, as indicated.
- Obtain arterial blood gas levels.
- Acknowledgement and acceptance of patients’ self-report of present level of dyspnea
- Secretion clearance strategies
- Non-invasive and invasive ventilation modalities
- Energy conserving strategies
- Relaxation techniques
- Breathing retraining strategies
(Decramer et al., 2008; Gullick & Stainton, 2008)
