Chronic obstructive pulmonary disorder (COPD) is an umbrella term that is used to describe several respiratory conditions, including emphysema and chronic bronchitis. Cor pulmonale refers to a complication of COPD. The damage to the lungs eventually leads to blood pressure in the pulmonary artery. The increased pressure in the pulmonary artery eventually causes enlargement and failure of the right ventricle.
COPD normally is the result of chronic damage to the lungs. Smoking is one of the most common causes of COPD. The alveoli are the sacs in the lungs were gas exchange between oxygen and carbon dioxide occurs. Repeated damage to the lungs leads to the destruction of the alveoli. The alveoli become distended and trapped air. In chronic bronchitis, continued damage to the respiratory tree results in chronic inflammation of the bronchi, the two tubes that bring air from the trachea to the lungs. Due to the chronic inflammation, the individual has trouble exhaling air. Both forms of COPD result in chronic dyspnea, or shortness of breath. Many individuals with COPD require the use of low-flow oxygen to help them breathe. The increased levels of carbon dioxide that occur in the body result in the body switching to the hypoxic drive as a breathing stimulus. The hypoxic drive forces the individual to breathe only when oxygen levels are low. For this reason, individuals with COPD should not be given high flow oxygen (AAOS, 2019).
Cor pulmonale refers to right-sided heart failure. Most cases of heart failure are left-sided. When the right side fails, it is normally due to the left side failing first. However, with cor pulmonale, the continued pressure in the pulmonary artery exerts too much ‘back’ pressure on the right ventricle. The right ventricle pumps blood to the lungs through the pulmonary artery. When the pressure is increased, the right ventricle must work harder. Eventually, the right ventricle struggles against this pressure, and failure develops (Sayami, Baral, Shrestha, & Karki, 2019).
References
AAOS. (2019). Advanced emergency. Boston: Jones and Bartlett Publishers.
Sayami, M., Baral, S., Shrestha, R., & Karki, D. B. (2019). Prevalence of Chronic Cor Pulmonale in Chronic Obstructive Pulmonary Disease Patients in a Teaching Hospital in Nepal. Journal of Institute of Medicine Nepal, 41(1), 15-19.
EXAMPLE OF LAB
| Lab/Diagnostic Test | Rationale for Abnormal | Relevant Nursing Care |
| WBC | The patient’s respiratory infection indicates elevated WBCs. | Patient should continue to take antibiotics and closely monitor WBC labs to ensure infection does not intensify. |
| RBC | Lung disease can cause the body to produce too many RBCs due to the low O2 levels. | Assess patient for fatigue, pallor, dyspnea on exertion, tachycardia, HA-headache |
Patient’s LABS:
- Glucose (blood) 195 mg/dL Normal: 65-100 mg/dL
- Cholesterol, Total (Blood) 224 mg/dL Normal: <200 mg/dL
- Very Low Density Lipoprotein (VLDL) 52 mg/dL Normal: <30 mg/dL
- Low Density Lipoprotein (LDL) 122 mg/dL Normal: <130 mg/dL
- High Density Lipoprotein (HDL) 42 mg/dL Normal 35-85 mg/dL
- Triglycerides (blood) 300 mg/dL Normal 10-190 mg/dL
Patient Urinalysis
- specific gravity 1.027
- pH 7.0
- protein negative
- bilirubin negative
- glucose negative
- ketones negative
- occult blood negative
- RBCs/HPF 0
- WBCs/HPF 0
- bacteria negative
- no epithelial cells
- casts none
Urinalysis Normal Value:
Color clear yellow to amber
Appearance clear to faintly hazy
Specific gravity 1.003-1.030
pH 4.5-8.0
Protein negative
Bilirubin negative
Glucose negative
Ketones negative
Occult blood negative
RBCs/HPF 0-3
WBCs/HPF 0-4
Bacteria negative on a spun specimen
