3.2 Chronic Respiratory Disorders

Question 1

COPD

Answer 1

• Chronic Obstructive Pulmonary Disease
• Preventable and treatable slowly progressive respiratory disease
• Relates to airway obstruction or airflow obstruction involving airway, pulmonary parenchyma or both
• Not fully reversible

Question 2

COPD

Answer 2

• Third leading cause of death in United States
• Systemic disease resulting from chronic inflammation from damage to airways and damage to parenchyma.
• Chronic Bronchitis and Emphysema

Question 3

Chronic Bronchitis

Answer 3

• Chronic productive cough lasting at least 3 months in 2 consecutive years.
• Airways thicken, diameter narrows
• Mucus may plug airways
• Alveoli damaged (fibrosed) and patient is more susceptible to respiratory infection because of altered alveolar macrophages.

Question 4

Emphysema

Answer 4

• Abnormal permanent enlargement of air spaces to the terminal bronchioles.
• Surface area responsible for gas exchange is destroyed resulting in trapped air and hyperinflation of lungs. (Destruction of alveolar walls)
• Dead space, decreased surface area and hypoxemia
• Increased pulmonary artery pressure which can lead to right side heart enlargement and signs and symptoms of heart failure (Cor Pulmonale)
• Edema, Liver and Spleen Congestion, JVD

Question 5

COPD with Aging

Answer 5

• Accelerated changes of aging such as decrease in function

- Chronic inflammation leads to scarring, narrowing of airways, hypersecretion of mucus

Question 6

COPD Manifestations

Answer 6

• Genetic factors that predispose people to COPD
• Forced exhalation of air due to loss of elastic recoil
• Airway obstruction related to increased mucus, edema, bronchospasm.
• Destroyed lung tissue and inflamed airways
• Hypoxemia and Hypercarbia
• CO2 is around 50 in COPD Patients.

Question 7

COPD Patients

Answer 7

• Rely on decreased oxygen to breath
• Normal respiratory system relies on increased CO2
• ## This is why it is dangerous to supply too much oxygen for COPD Patients. It diminishes their drive to breathe

Question 8

Assessment of COPD

Answer 8

• Health history, risk factors, family history, physical examination

Question 9

Pulmonary Function Tests

Answer 9

• Helps confirm diagnosis of COPD
• Determines z severity, and monitors disease progression
• Spirometry evaluates airflow obstruction
  FEV - Forced Expiratory Volume
  FVC - Forced Vital Capacity

Question 10

FEV (Forced Expiratory Volume)

Answer 10

• FEV 1 (in one second)
  Mild - 80%
  Very Severe - 30%
  Barrell Chest - Primarily with emphysema and chronic hyperinflation of lungs

Question 11

3 Primary Symptoms of COPD

Answer 11

• Chronic Cough
• Sputum Production
• Dyspnea (interferes with everyday eating)
• Patients tend to lean forward and use accessory muscles to breathe.

Question 12

COPD Patients Needs

Answer 12

• They need high calorie, easy to eat food.

Question 13

Treatment for COPD Patients

Answer 13

• Reduce risk of their symptoms
• Major risk factor is environment which is modifiable
• Most important is smoking
• Use of smoking cessation has biggest impact on reducing risk of COPD

Question 14

Treatment for COPD Patients

Answer 14

• Manage exacerbations

- Provide supplemental oxygen, long term use of oxygen has been shown to improve patients quality of life

Question 15

Reduce Risk Factors of COPD

Answer 15

• Promote flu and pneumococcal vaccines
• Prevents infections, viruses, and exacerbations
• Pulmonary Rehab, bronchodilators for short term and steroids for long term.

Question 16

Surgeries

Answer 16

Bullectomy - Bullae are removed (large air spaces)
Lung Volume Reduction - Dead space, tissue is removed
Lung Transplant - Not enough lungs for all COPD Patients

Question 17

Nursing Management

Answer 17

• Assess patient. Review ABG’s Chest X-Ray, Pulmonary Function Test
• Goal is to achieve airway clearance from bronchospasms and sputum
• Medications, physiotherapy, respiratory treatment, increase fluid to thin secretions, teaching them to huff and cough, improve breathing techniques such as using pursed lip breathing (slow and control rate and depth of respirations)
• Improve activity tolerance, pace activities throughout the day.

Question 18

Education

Answer 18

• Use of MDI (Metered Dose Inhaler)
• Use of Acapella (Flutter Device) which loosen mucus in airways.
• ## Percussion on patients back to help loosen mucus

Question 19

Complications of COPD

Answer 19

• Respiratory Insufficiency and failure
• Risk of pneumonia, chronic atelectasis (flattening of alveoli)
• Pneumothorax (air in thorax)

Question 20

Asthma

Answer 20

• Overlap syndrome (both asthma and COPD)
• Coughing, Wheezing, SOB
• Mostly diagnosed as a child
• Inflames and narrows airways and is triggered by something environmental like air quality, exercise or pet dander
• Genetic Condition
• Some improve over time and some completely overcome the disease.
• Hyperresponsive (allergy strongest predisposing factor)

Question 21

COPD

Answer 21

• Diagnosed as an adult (older than 40)
• Lifestyle factors are a big factor
• ## Symptoms milder than asthma but constant and can become progressively worse

Question 22

Asthma (cont)

Answer 22

• Attacks occur at night or early morning.
• Bronchoconstriction that narrows airways, mucosal edema, excessive mucus.
• Increased heart rate
• tachycardia, diaphoresis, chest tightness, central cyanosis around mouth and fingertips,
• Severe sign is hypoxemia

Question 23

Care Plan Asthma

Answer 23

• Prevention of attacks
• Identify Triggers
• Peak flow monitor to measure airflow during expiration
• Figure 24.8 zones of asthma attack flow measurement.
  Green - 80-100% personal best
  Yellow - 60-80%
  Red - Less than 60% (call 911)

Question 24

Terminology

Answer 24

Antagonist - Block effect
Agonist - Produce effect
Adrenergic Amines - Stimulate sympathetic nervous system and activate epinephrine and norepinephrine
Alpha receptors - vascular smooth muscle
Beta Receptors - Bronchioles of lungs, arteries of skeletal muscle

Question 25

Alpha receptors

Answer 25

• Responsible for constriction of blood vessels

Question 26

Beta Receptors

Answer 26

• Dilation of blood vessels

Question 27

Terminology

Answer 27

• Acetylcholine and muscarinic receptors are for parasympathetic nervous system that help slow heart rate and relax muscles.
• Cholinergic is acetylcholine

Question 28

Cholinergic

Answer 28

• ## Drugs that inhibit, enhance, or mimic actions of neurotransmitter acetylcholine are called cholinergic drugs

Question 29

Acetylcholine

Answer 29

• Chief neurotransmitter for parasympathetic nervous system

- Contracts smooth muscles, dilates blood vessels, increases body secretions, slows heart rate.

Question 30

Medication Treatment for Asthma/COPD

Answer 30

• Corticosteroids used for both to decrease
• Antibiotics, mucolytics, and antitussives can help thin mucus and cough up can be used for both
• Quick relief medication can be short acting Beta Adrenergic agonist (albuterol and atrovent)
  inflammation
  Asthma - Leukotriene modifiers (Singulair) used to treat allergies.
  Mast Cell Stabilizers - Prevent release of histamine.

Question 31

COPD Pathophysiology

Answer 31

• COPD accelerates normal lung aging such as vital capacity and forced expiratory volume.
• Airflow limitations are progressive and associated with abnormal inflammation

Question 32

Risk Factors COPD

Answer 32

• Environmental exposure
• Cigarette smoking most important
• Second hand smoke
• Exposure to dust, chemicals, air pollution

Question 33

Clinical Manifestations COPD

Answer 33

• Chronic Cough, Sputum Production, Dyspnea
• Worsen over time
• Dyspnea worse with exercise, and is persistent
• Weight loss common due to dyspnea affecting eating.
• Use of accessory muscles to breathe
• Risk of respiratory insufficiency and infections
• Barrel Chest
• ## Increased CO2 retention, Respiratory Acidosis

Question 34

Diagnostic Tests for COPD

Answer 34

• Spirometry - Evaluate airflow obstruction. Ratio of FEV1 to FVC.
• ABG’s - Especially important in advanced COPD.
• Screening for Alpha1-antitrypsin deficiency. Preformed for patients under 45 with history of COPD.
• Key factors for determining diagnosis is patient history, severity of symptoms, responsiveness to bronchodialators

Question 35

Complications of COPD

Answer 35

• Respiratory insufficiency and Failure
• May need ventilator support
• Pneumonia, chronic atelectasis, pneumothorax, pulmonary arterial hypertension (right side heart failure)

Question 36

Treatment COPD

Answer 36

• Avoid environmental exposure to smoke.

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Question 37

ASTHMA Pathophysiology

Answer 37

• Reversible airway inflammation that leads to long term airway narrowing
• Narrowing due to Broncho restriction, airway edema, airway hyperresponsiveness, airway remodeling.
• ## Caused by mast cells

Question 38

Manifestations Asthma

Answer 38

• Cough, Dyspnea, Wheezing
• Night or Early Morning
• Cough with or without mucus production
• Generalized chest tightness and dyspnea
• Diaphoresis, Tachycardia, hypoxemia, central cyanosis.

Question 39

Asthma Diagnostic Testing

Answer 39

• Improve with bronchodilators
• Pulmonary function normal between exacerbations
• Daily Peak Flow Monitoring is important Measures severity.

Question 40

Complications of Asthma

Answer 40

Status Asthmaticus, Respiratory Failure, Pneumonia, Atelectasis.
Airway obstruction can lead to hypoxemia
- Give fluids
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