Now, here's another really important point. I want you to have these 4 complications in mind.
When we talk about the worst case scenario when a patient has COPD, these are 4 of the
worst case scenarios that you'll see. With chronic obstructive pulmonary disease, the patient
is going to have pulmonary hypertension. That means the arterial blood pressure in the
pulmonary arteries is going to be extra high. So remember arteries take blood away from the
heart so those pulmonary arteries are coming from the right atrium, tricuspid valve, right
ventricle. Then those pulmonary arteries are taking blood over to the lungs. When that is
elevated, that's going to really mess up the rest of the system. Cor pulmonale means cor
means heart, pulmonale means lungs so that means the heart's in trouble and it's the lungs'
fault. Remember that pulmonary hypertension we just talked about. Well, when that is elevated
arterial pressures, now the right side of the heart is having to work extra extra hard because
all the blood pressure in the lungs is elevated. So it's having to really overcompensate to take
that blood that comes from right atrium, tricuspid, right ventricle over to the lungs. Now this
workload is significantly increased. So the right ventricle will do the same thing that the left
ventricle does when the systemic blood pressure is high. Now the right ventricle, because the
blood pressure in the lung is high, it will start to get bigger to try to compensate. Initially,
that's helpful but if this goes on too long that right wall is going to get thick and just as
ineffective as the left ventricle does when you have systemic high blood pressure. So, cor
pulmonale means right-sided heart failure because of the lung, meaning the lung pressures
were elevated. Now when I have right-sided pressure, everything is going to back up. Right?
So right ventricle, up to the tricuspid, right atrium out through the rest of the body. So if a
patient has specifically right-sided congestive heart failure, they're going to feel like their
liver is going to get kind of bloaty and yucky and they're not going to feel good when they
eat, you're going to have issues with jugular vein distension. This one will look really big and
bounding. You're also going to have edema, peripheral edema will be noted. So, think of
everything backing up on the right side, jugular vein distension, liver is going to get kind of
full, you're going to end up with feeling not good afterwards and we have some real issues
with the blood supply and the liver and you're going to have pulmonary edema. Those are all
signs of cor pulmonale. So make sure you pause for just a second and if I ask you the question
"Why does COPD cause right-sided heart failure?" See if you can talk through the answer.
Okay, welcome back. Good job thinking through that answer on your own. Now the last 2, a
little bit similar, they're going to have recurrent respiratory infections and they are at
increased risk for chronic respiratory failure. Remember respiratory failure is you're not able
to supply the body with enough oxygen that it needs or even get rid of enough carbon dioxide.
So, neither one is a good deal. So, all excellent nurses know these are 4 possible late stage
complications of COPD. Be on the lookout for the signs and symptoms of these late stage