Occupational Therapy for COPD in Acute Care / Acute Rehab / SNF / Home Health

Background

  • Chronic Obstructive Pulmonary Disease (COPD) is an umbrella term used to describe progressive lung diseases including emphysema, chronic bronchitis, and refractory (non-reversible) asthma.
  • Therapeutic air exchange cannot occur
  • Breathing becomes more difficult
  • Results in decreased ability to participate in ADLs, IADLs, etc.
  • Can cause the heart to become enlarged
  • Can cause hypertension
  • Can cause cognitive impairment
  • Possible psychosocial (anxiety & depression) involvement

Vital Signs

  • Beware of the dangers of over-supplementing oxygen.
  • In patients with COPD, “titrate their oxygen” and aim for an oxygen saturation target of 88-92%.
    • Provides adequate tissue oxygenation while avoiding the complication of hyperoxic hypercapnia by giving the minimum amount of oxygen needed to stay above severe hypoxemia.
    • Giving patients with COPD lots to oxygen tells their breathing mechanism that they have a lot of oxygen and they should slow their breathing. They retain COand their body gets worse.
  • Normal oxygen saturation does not rule out respiratory failure.
    Do not rely on the oxygen saturation to warn you of impending respiratory failure.
    • Hemoglobin may remain saturated with oxygen despite hypoventilation causing rising levels of carbon dioxide.
    • The oxygen saturation may not fall below 90% until the patient is already in serious trouble, especially if the patient is on supplemental oxygen.
    • Respiratory rate, pCO2, and level of consciousness should all be assessed routinely.
    • At a minimum, it is also necessary to record the respiratory rate, and if they are having supplemental oxygen.

Oxygen Delivery Methods for OTs

  • Room Air
  • Nasal Cannula (most common) – with or without a humidifier
  • High Flow Nasal Cannula (HFNC)
    • HFNC allows for high flow due to air being heated and humidified.
    • Isn’t just a standard nasal cannula cranked up to very high flow rates.
    • Takes gas and can heat it to 37oC with a 100% relative humidity.
    • Can decrease airway inflammation, maintain mucociliary function, improve mucous clearance and reduce the caloric expenditure in acute respiratory failure.
    • In patients with acute respiratory failure, the percentage of gas we rebreathe gets larger, and as a result, we can rebreathe larger amounts of carbon dioxide as we draw our breaths from a mixed reservoir from our upper airway.
    • HFNC gives a continuous flow of fresh gas at high flow rates replacing or washing out the patient’s pharyngeal dead-space (the old gas low in oxygen and high in CO2). Each breath that the patient now re-breathes will be washed out of carbon dioxide and replaced with oxygen-rich gas improving breathing efficiency.
    • Cons: cannot be hooked up to portable tank to mobilize patient due to high flow rate
  • Oxygen Mask
  • CPAP & BiPAP

Breathing Techniques

  1. Pursed lip breathing
  2. Diagram breathing
  3. Pacing (stop, rest, continue)

Interventions

  • Stress management
  • Therapeutic breathing
  • Pacing/Planning/Prioritizing/Positioning
  • Energy conservation
  • Oxygen safety, contraindications, and use
  • Body mechanics

Tips

  • Carry a portable pocket-sized pulse oximeter to use in a tight squeeze.
  • Use extension tubing if possible.
  • Double-check oxygen tank level prior to mobilizing.
  • Ensure nasal cannula is fitted incorrect orientation (prongs facing DOWNWARD and towards the patient), often patients may re-don them incorrectly.
  • To facilitate breathing, position patient upright in bed in fowler’s instead of supine.

Sources:

https://www.copdfoundation.org

https://journals.lww.com/em-news/Fulltext/2011/02000/Titrated_Oxygen_Better_than_High_Flow_for_Patients.3.aspx

https://acphospitalist.org/archives/2009/12/tech.htm

rebelem.com/high-flow-nasal-cannula-hfnc-part-1-how-it-works/

 

Jeff is a licensed occupational therapist and lead content creator for OT Dude. He covers all things occupational therapy as well as other topics including healthcare, wellness, mental health, technology, science, sociology, and philosophy. Buy me a Coffee on Venmo.