Running head: DOCC: COPD TYPICAL PATIENT DESCRIPTION AND

DOCC: COPD Typical Patient Description and Assessment Guide

Monique Ramirez
University of Arizona
Clinical Systems Leadership Immersion
NURS 660
Mary Oconnell

DOCC: COPD TYPICAL PATIENT DESCRIPTION AND

DOCC: COPD Typical Patient Description and Assessment Guide

COPD is the limitation of airflow into the lungs due to inflammation as a response to
irritation such as smoke. The disease is usually progressive and not fully reversible (Pauwels,
Buist, Calverley, Jenkins, & Hurd, 2001, p. 1257). Emphysema and asthma are the most
common kinds of COPD with a combination of small airway disease and parenchymal
destruction (Global Initiative for Chronic Obstructive Lung Disease [GOLD], 2010, p. 2). The
noxious agents causes inflammation and leads to structural changes in the lung parenchyma. This
further damages the loose alveolar attachment to the small airways and disrupts lung recoil and
causes air trapping (GOLD, 2010, p. 2). Emphysema is characterized by impaired gas exchange
and manifests symptoms of decreased oxygen such as shortness of breath (GOLD, 2010, p. 3).
Chronic bronchitis is the presence of cough and sputum production over three months during two
consecutive years (GOLD, 2010, p. 3). The irritation and inflammation effect the proximal
airways, peripheral airways, lung parenchyma, and pulmonary vasculature. This induces changes
that cause mucus hypersecretion, airflow limitation, air trapping, gas exchange abnormalities,
and pulmonary hypertension (GOLD, 2010, p. 24). The most common symptoms patients present
with is shortness of breath, productive cough, and depending on the severity, some may have
lower extremity edema as pulmonary hypertension develops.
COPD diagnosis can be considered in anyone over the age of 40 years with symptoms of
dyspnea that is progressive, worsens with exercise, persistent, and intermittent cough that may be
unproductive or chronic sputum production. In the past mostly men were diagnosed with COPD,
however women have an increase incidence of smoking in high income countries and are at
higher risk for indoor air pollution such as solid fuel for cooking and heating therefore making
the gender diagnosis almost equal (World Health Organization, 2013). Any history of tobacco

DOCC: COPD TYPICAL PATIENT DESCRIPTION AND

smoke, occupational dusts, chemicals, or smoke from home cooking and heating fuels are risk
factors for COPD (GOLD, 2010, p. 33). Diagnosis is confirmed by spirometry with a
postbronchodilator FEV1/FVC < 0.70. Spirometry results confirms airflow limitation that may
not be reversible (GOLD, 2010, p. 33). Anyone with the above mentioned symptoms and risk
factors should be assessed for COPD. Spirometry is the standard for confirming diagnosis. When
speaking healthcare providers that care for COPD patients, they mention symptoms such as
cyanosis of mucous membranes and oxygen dependence does not develop until the later stages of
COPD, therefore screening for medical history is important to detect COPD in early stages
before lung function worsens (H. Shah, personal communication, October 5, 2014)
Some systemic factors associated with COPD diagnosis includes cachexia, skeletal
muscle wasting, osteoporosis, depression, anemia, and increased risk of cardiovascular disease
(GOLD, 2010, p. 28). Systemic and lung inflammation, hypoxia, hypercapnic acidosis,
endothelial and vessel wall abnormalities, and polycythemia are all potential pathogenic
mechanism for the cardiovascular disease in COPD patients (Choudhury, Rabinovich, &
MacNee, 2014, p. 104). In cardiology, coronary artery disease and COPD share the most
common risk factor of smoking, therefore its not uncommon to see both disease processes in
one patient (K. Lotun, personal communication, October 3, 2014). Skeletal muscle wasting is
due to the reduced exercise capacity, inflammation, hypoxemia, corticosteroids, inadequate
nutrition, and oxidative stress (Choudhury et al., 2014, p. 107). Osteoporosis can be contributed
to the use of steroid and inflammatory process (Choudhury et al., 2014, p. 110). Poor nutritional
intake during exacerbations, increased metabolic rate with abnormal breathing dynamics, Beta2agonists, and systemic inflammation explains the resulting cachexia in these patients (Choudhury
et al., 2014, p. 112). Because COPD is a chronic inflammatory multisystem disease, anemia is

DOCC: COPD TYPICAL PATIENT DESCRIPTION AND

not uncommon is this population (Choudhury et al., 2014, p. 113). Depression may be diagnosed
due to the inability to be physically active, poor nutritional and health status, and smoking habits
(Choudhury et al., 2014, p. 117).
Comprehensive Assessment Guide
i. General survey: Most people have symptoms but do not seek a medical professional
until complaints of shortness of breath interferes with daily activities and lung function worsens
acutely by a respiratory tract infection. Some may not experience cough or sputum production
(GOLD, 2010, p. 33). In general shortness of breath will be seen either at rest or with activity.
The patient may appear anxious because of the lack of oxygen.
ii. Neurological: Some cognitive dysfunction may be seen such as perception, memory,
and motor functions that may be related to hypoxemia, smoking, and vascular disease caused by
inflammation (Dodd, Getov, & Jones, 2010). Assessing the patients memory and noting any
changes is an important assessment finding.
iii. Cardiac: In advanced stages, pulmonary hypertension can lead to ankle and leg edema
(GOLD, 2010, p. 33).
iv. Respiratory: COPD population may have pursed lipped breathing to help decrease air
trapping. Breathing will also be shallow at a rate of over twenty breaths per minute (GOLD,
2010, p. 33). Auscultation findings may include reduced breath sounds, wheezing, and crackles
(GOLD, 2010, p. 36). Medical history questions should include questions of previous exposures
to risk factors such as smoking, occupational, or environmental exposures (GOLD, 2010, p. 35).
v. Gastrointestinal: Because of medication therapy, the incidence of GERD is a common
comorbidity and factor associated with exacerbations in this population (Kim et al., 2013, p. 8).

DOCC: COPD TYPICAL PATIENT DESCRIPTION AND

vi. Musculoskeletal: Chest wall abnormalities called a barrel-shaped chest may be

present with a protruding abdomen due to hyperinflation (GOLD, 2010, p. 35). Patients may also
have a lower BMI and decreased muscle tone.
vii. Genitourinary: None seen with COPD.
viii. Integumentary: Cyanosis or blue discoloration of the mucosal membranes may be
present due to decreased oxygenated blood levels (GOLD, 2010, p. 35). The decreased oxygen
may also increase capillary refill to over 3 seconds and cause clubbing the fingers and toes.
Oxygen saturations may be also be low when vitals are taken.
ix. Symptom Assessment: The most common symptoms in COPD are shortness of breath,
cough, sputum production, and depending of stage of COPD wheezing and chest tightness can
also be seen. Weight loss and anorexia is are important part of assessment since they can identify
other signs of disease, such as tuberculosis or bronchial tumors (GOLD, 2010, p. 35). Edema
assessment is vital as it can be the only symptomatic pointer to the development of pulmonary
hypertension (GOLD, 2010, p. 35).
x. Psychological: Screening for anxiety and depression is important since high levels of
anxiety are associated with poor outcomes (GOLD, 2010, p. 35). Because of the lack of oxygen
in these patient, they may seem anxious for air.
xi. Social: The shortness of breath and severity of symptoms can affect the social life of
many patients. Activities may be avoided to prevent shortness of breath, therefore limitations on
social participation is common and can affect daily activities and work (GOLD, 2010, p. 90).
xii. Spiritual: Because COPD has a poor prognosis and patients are faced with activity
limitations, social isolation, and poor quality of life, patients often require physical and
emotional support (Gardiner et al., 2009, p. 163). Assessing spirituality and coping mechanism to

DOCC: COPD TYPICAL PATIENT DESCRIPTION AND

relieve anxiety and depression is essential to the spiritual health as it reflects in their overall
mental state.
Key Assessment Data
Assessment should include risk factors in the patients and family history. Questions such
as exposure, past medical history of asthma, allergies, sinusitis, nasal polyps, respiratory
infections as a child, or other respiratory disease should be asked (GOLD, 2010, p. 35). History
of symptom patterns, exacerbations, associated comorbidities such as heart disease, osteoporosis,
and musculoskeletal disorders should be assessed (GOLD, 2010, p. 35). An evaluation of
symptom severity and how they affect current quality of life, activity, work, family, depression,
and anxiety along with adequate family and social support in necessary (GOLD, 2010, p. 35). If
the patient currently smokes, assessment of willingness to stop smoking can determine if the
patient is willing to decrease risk factors. Including smoking cessation education and resources
should be available to the patient.
The most common risk factor associated with COPD is the use of tobacco. Other agents
such as occupational dusts and chemicals, indoor and outdoor air pollutants are less common risk
factors. Smoking cessation is the single most cost effective intervention for the prevention of
COPD (GOLD, 2010, p. 42). Utilizing all available resources for promoting smoking cessation
and education are key health promotion intervention for COPD. Although studies have not
shown education to improve exercise performance or lung function, it has improved skills, the
ability to cope with COPD, and improved the individuals health status (GOLD, 2010, p. 48).
Education, resources, and adequate time on smoking cessation can maintain a 25% long-term
quit rate and can improve patient response to exacerbations (GOLD, 2010, p. 48). Education
should be tailored to the needs of the patient.

DOCC: COPD TYPICAL PATIENT DESCRIPTION AND

Summary
A typical COPD patient will have signs and symptoms of impaired oxygen delivery. This
would include shortness of breath during increased oxygen demand, decreased tolerance to
physical activity, capillary refill greater than 3 seconds, clubbed fingers and toes, and cyanosis of
mucous membranes. In severe cases patient may be oxygen dependent and have lower extremity
edema. The chronic inflammatory process and irritation will cause mucus production in the lungs
which the body will try to expel by inducing cough. The mucus production in the lungs will
cause the crackles and wheezing upon auscultation. The constant damage and lung repair further
damages the alveolar sacs and causes air trapping. In an effort to expel the oxygen that is
trapped, pursed lipped breathing will be seen as the body develops mechanism to eliminate the
excess air. The barrel chest develops as the lungs further inflate in a response to air trapping. As
symptoms worsens, it negatively affects quality of life, ability to remain physically active, and
social health. Further decline in health status causes anxiety and depression. Oxygen dependency
and dependency on others can make the anxiety and depression worse. COPD is a vicious cycle.
One bad habit can initiate a cascade of events that leads to poor prognosis and places patients at
risk for multiple comorbidities and deceases life expectancy.

DOCC: COPD TYPICAL PATIENT DESCRIPTION AND

References
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http://dx.doi.org/http://dx.doi.org/10.1016/j.ccm.2013.10.007
Dodd, J. W., Getov, S. V., & Jones, P. W. (2010, April 1). Cognitive function in COPD.
European Respiratory Journal, 35(4), 913-922.
http://dx.doi.org/10.1183/09031936.00125109
Gardiner, C., Gott, M., Payne, S., Small, N., Barnes, S., Halpin, D., ... Seamark, D. (2009,
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Association between chronic obstructive pulmonary disease and gastroesophageal reflux
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DOCC: COPD TYPICAL PATIENT DESCRIPTION AND

World Health Organization (2013). Chronic obstructive pulmonary disease (COPD). Retrieved
from http://www.who.int/mediacentre/factsheets/fs315/en/