Goals for Acute COPD Exacerbation – COPD Nursing Care in ER

00:00 So let's start with the definition again. COPD exacerbation.

00:05 Now, the Global Initiative for Chronic Obstructive Lung Disease that's called the GOLD guidelines, this is how they define a COPD exacerbation.

00:13 It's an acute worsening of respiratory symptoms that result in additional therapy.

00:20 Okay, so you went back and you made that list.

00:23 So based on this definition, acute worsening of respiratory symptoms, what do we know about Mrs. Taylor that is worsening of her symptoms? Just sitting in a chair, she's short of breath, right? She has this headache which could be a sign of elevated CO2.

00:43 And her sputum has turned a darker color and she's not acting herself.

00:49 All of those would add up to tell so this is a worsening of respiratory symptoms and her daughter was right on point to bring in her for care.

00:58 Okay, now I want you to switch roles.

01:00 Now, I want you to start thinking like an ER nurse.

01:03 So Mrs. Taylor's daughter takes her to ER.

01:06 Now, sometimes we call ER as emergency rooms, sometimes we call them trauma emergency centers.

01:12 They technically mean the same thing and you'll hear us use these terms interchangeably.

01:17 So here are our goals. No matter what the diagnosis is, always ABC.

01:22 Assess the medical stability of every patient's airway, breathing, and circulation.

01:29 Particularly airway and breathing are gonna be a big deal because of her diagnosis of COPD and what we've learned that she's struggling with that.

01:36 Now, we're gonna make sure that we treat that low blood oxygen and the high CO2 if she has it.

01:43 Often if a patient's COPD has progressed, they have low oxygen and they have that elevated CO2.

01:50 Now we're kinda watching that because if she's complaining of headaches that definitely could be the cause of the headache.

01:56 Now we're gonna provide ventilator support to help her including medications that would bronchodilate, et cetera.

02:02 So there's a lot of bullet points on this slide.

02:05 I don't want this to go by you so think as an ER nurse, my top priorities, maintain stability of ABC.

02:12 Then I'm gonna look at what her oxygen and carbon dioxide levels are in the blood.

02:17 We're gonna do the ventilatory support interventions to help that resolve.

02:22 So we're probably gonna give her oxygen as we need to to make sure that she has an adequate tissue perfusion.

02:28 Probably gonna start an IV and lab work but for sure we'll do lab work.

02:33 And we're gonna get their patient ready to either go home or be admitted.

02:38 So that's what your goal is. Ready to go. You're the ER nurse.

02:42 You know for a COPD patient who's experiencing an exacerbation, maintain stability of ABCs, treat that low blood oxygen or high CO2, whatever we're dealing with, provide ventilatory support, oxygen is needed, definitely gonna draw a lab work, likely ABGs and other labs.

03:00 And we're gonna get the patient ready, collaborating with the health care provider.

03:04 Can we determine can they go safely home or do they need to be admitted to the hospital because keep in mind, that's what the emergency center's job is.

03:14 Get a patient in, stabilize them, and make the determination what's a safe discharge plan.

03:19 Is home safe or will they be better off with observation or treatments inside the hospital.