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PT 571 Cardiopulmonary > 2.3 COPD > Flashcards

2.3 COPD Flashcards

1
Q

Tidal volume

A

normal breathing (in and out)

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2
Q

Vital capacity

A

max amount of air exhaled following max inhalation

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3
Q

Functional residual volume

A

elastic recoil forced of the lungs the chest walls are at equilibrium and no exertion by diaphragm or other respiratory muscles

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4
Q

With COPD FRV increases. T/F

A

True

Breathing in and out at higher FRV

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5
Q

As FRV goes up, VC goes down. T/F

A

True

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6
Q

What is the most common respiratory with acute exacerbations?

A

COPD

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7
Q

85% of chronic dyspnea if caused by:

A 
CHF
MI
Asthma
COPD
ILD
PNA
Psychogenic disorders
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8
Q

COPD

A

Is often missed or misdiagnosed due to S&S! People begin to limit activities so they don’t get these effects…

Worsening of SOB
Phlegm-Producing cough and episodes of wheezing

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9
Q

Paroxysmal atrial is may be normally seen post-op. T/F

A

True

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10
Q

When is oxygen recommended for a patient?

A

PaO2 <60, SaO2 90%
not enough oxygen perfusing brain and system!

People may be adapted to live in lower levels…88% if hx, look at S&S!

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11
Q

Ideally what do we want our pt’s SaO2 to be?

A

92%

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12
Q

What is the PaO2, SaO2 rule?

A

40mmHg, 70%
50, 80%
60, 90%

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13
Q

If someone is at 88% SaO2 with CHF, do we like that?

A

No…perfusion problem getting to the bloodstream

Has pulmonary edema! They’re not live normally an and is in a hypoxemic state!!

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14
Q

If someone is at 88% (a little short 92%) SaO2 with COPD and lives there…

A

Talk to medical team where they want them. Check S&S.

May live in this state if they’re used to it chronically…

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15
Q

When someone is 79% am I concerned?

A

YES

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16
Q

Tachypnea with high RR caused by:

A

1) Increased respiratory drive (response to amount of increase CO2/ drop pH levels)
2) Impaired ventilatory mechanics (not using diaphragm, flattened chest, airways restricted due to mucus or hyperinflated, morphological changes!

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17
Q

Pulmonary Etiology?

A

Increase:
More accessory muscles
SBP
RR

Decrease:
SaO2

Normal BNP

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18
Q

Cardiac Etiology?

A

Increase:
RR
BNP

Decrease:
Less accessory muscle
SBP

Normal SaO2

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19
Q

Chart review:

A 
General PMH
Medications?
Family hx?
Social?
Smoking?
Drug or alcohol?
Susceptible to infection? Think about prior hospital stay...
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20
Q

Key Subjective:

A

Confirm CC is SOB/Dyspnea
New problem or an exacerbation or chronic condition
Precipitated the problem
What makes you feel more/less breathless?
Inhalers/nebulizers more than normal?
Previous similar episodes?

Check cognitive status due to hypoxemia!

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21
Q

Chest x-ray is performed to r/o

A

heart or lungs!

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22
Q

What do pulmonary tests tell us?

A

Overview of function of the lungs…
FEV1 - used to only look at this…

We look at FVC and FEV1!

FEV1/FVC NORMAL IS 75%
Tells you their severity of disease, but doesn’t tells you your patient’s activity tolerance/SOB.

<70% is COPD

Doesn’t tell you entire picture!!!

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23
Q

What stays relatively normal throughout progression of diseases?

A

Tidal volume, the last thing that changes as disease progression

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24
Q

When would you not treat a patient w/ COPD?

A

If they are hypoxic! <80% SaO2… Talk to team if their giving him oxygen and doing ABGs… Wait for new lab values.

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25
Q

Non-rebreather mask

A

Let’s you breath out but not in. Supposed to deliver 100% FiO2, but doesn’t due to seal on face. About 70%…

26
Q

Nasal canola can deliver up to how many liters?

A

6L

27
Q

What are physical clues that suggests emphysema?

A

Subcutaneous emphysema

Leaning forward w/ UE’s in closed chain (max accessory muscle use)

28
Q

What are some observations seen in COPD pts?

A 
Stridor
Accessory muscles
Sit upright (better than supine b/c V/Q matching is better)
Expiratory wheeze
Inability to speak in whole sentences
29
Q

Can COPD patients have chest pain?

A

Yes, but differentiate if it’s muscular from breathing or cardiac!!

30
Q

Hypothesis of Key Impairments:

A 
Poor breathing mechanics
Poor oxygen transportation
Aerobic reconditioning
Respiratory muscle weakness and fatigue
Decreased functional strength/power
Decreased functional mobility
31
Q

With COPD you want to help them successfully breathe so during Objectives you should perform Interventions as well! T/F

A

True

32
Q

COPD

A

Induced SOB
Anxiety, panic attacks
Increased SOB and anxiety
Reduced activity, fatigue

33
Q

Treatments for COPD

A

Pursed-lip breathing

Deep breathing

34
Q

If a patient is 88-90% what should be our treatment?

A

Breathing exercises! Don’t panic and call the nurse.

35
Q

Pursed-lip breathing

A

Breathing out gently through pursed lips
Delay closure of small airways through PEP
Longer expiration slowing RR
Decrease work of ventilatory pump
Decrease anxiety
Apply to functional activities
Minimizing dynamic hyperinflation w/ exercise

36
Q

Deep breathing: D2 pattern ventilation

A

Inspiration:
Trunk extension
Shoulder flexion, abduction, ER
Looking up

Expiration:
Trunk flexion
Shoulder extension, adduction, IR
Looking down

37
Q

Peak expiratory flow rate

A

Gives you info about expiratory flow
Outpatient

or
PEFR meter
FEV meter

38
Q

The taller you are the higher the PEFR (L/min)

A

True

39
Q

Associated degree of obstruction w/ FEV1

A

Little or no obstruction: FEV1>2.0 L to normal

Mild to Mod: FEV1 1.0-2.0 L

Severe: FEV1 <1.0 L

40
Q

Staging of COPD (FEV1), The American Thoracic Society

Predicts mortality/progression

A

Stage 1: FEV1 50-79% predicted

Stage 2: FEV1 35-49% predicted

Stage 3: FEV1 <35% predicted

41
Q

GOLD

A

Stages the disease based on presentation of cough, SOB, clinical signs, looks more into limitations and FEV1 too

What medical intervention is appropriate included as well!

42
Q

Stages of GOLD: 1

A

Smoker’s cough, little or no SOB, no clinical signs of COPD, FEV1 >80% predicted

43
Q

Stages of GOLD: 2

A

SOB on exertion, sputum-producing cough, some clinical signs of COPD, FEV1 50-80% predicted

44
Q

Stages of GOLD: 3

A

SOB on mild exertion, FEV1 30-50% predicted

45
Q

Stages of GOLD: 4

A

SOB on mild exertion, R HF, cyanosis, FEV1 <30% (50% chance of dying within 2 years)

46
Q

New index: BODE

A

Looks at function of the patient, more than just FEV1, predicts prognosis, outcomes, and chances/incidence of re-hospitalization.

47
Q

BODE: (4 variables)

A

1) BMI
2) Airway Obstruction (FEV1)
3) Dyspnea (Medical Research Council dyspnea score)
4) Exercise capacity (6MWT)

48
Q

(BODE) MMRC Index score and approximate 4-year survival rate

A

0-2: 80% survival
3-4 67% survival
5-6: 57% survival
7-10: 18% survival

49
Q

RT

A

Consider timing after RT to help patient be more successful!

50
Q

Diaphragmatic breathing

A

Comfortable position, drawing awareness to abdominal wall, plating for abdominal excursion during inspiration at tidal volume.

Sidelying, semi-fowler, supine, sitting, standing, walking, stairs

51
Q

4 steps of a cough:

A

1) adequate inspiration
2) glottal closure
3) building up intrathoracic and intraabdominal pressure
4) Glottal opening and expulsion

52
Q

Assisted cough technique

A

Utilize firm pillow, towel roll, or hands to splint for self-assisted cough
*Exaggerate with arms overhead

53
Q

Huff assessment

A

Forced exhalation w/o maximal effort, that can be utilized to mobilize secretions from peripheral airways

Inhale, hold 2-3s, breathe out slowly and forcefully
(fogging mirror)

54
Q

Effective huffing

A

Mouth open, O-shaped to keep glottis open, sigh

Crackles heard, excess present

55
Q

Ineffective huffing

A

Mouth half or almost closed, mouth shaped for E sound, hissing/blowing

56
Q

Promote posterior pelvic tilt

A

facilitates diaphragmatic breathing

*towel under ischial tuberosities

57
Q

Minimize anterior pelvic tilt

A

Avoid excessive opening of the anterior chest which leads to upper chest breathing and restricts diaphragmatic excursion

58
Q

Repatterining technique: sniff activation

A

simple and effective method of teaching diaphragmatic breathing, act of sniffing
progression - focus on slow inhalation holding the breath in, and slow exhalation through pursed-lip… then decrease pursed-lip

59
Q

Facilitation Techniques: Lateral costal breathing, Segmental breathing

A

Facilitates diaphragmatic excursion and may be done bilaterally, or unilaterally

*Gently apply pressure against ribs during inspiration, and/or quick stretch before inspiration and continue to give pressure during inspiration

60
Q

Facilitation Techniques: Upper chest inhibiting

A

inhibits the upper chest to help pt recruit diaphragm during inhalation
*LAST option

61
Q

Facilitation Techniques: Thoracic mobilization

A

if mobility of thoracic is restricted, helps patient move through breathing pattern if they can’t control it

  • Towel roll vertically on TS, improves anterior chest wall mobility
  • Sidelying improves lateral chest wall mobility
  • Add D2 for mobility

PT 571 Cardiopulmonary (7 decks)

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