3.2 Chronic Respiratory Disorders Flashcards
1
Q
COPD
A
- 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
2
Q
COPD
A
- 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
3
Q
Chronic Bronchitis
A
- 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.
4
Q
Emphysema
A
- 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
5
Q
COPD with Aging
A
- Accelerated changes of aging such as decrease in function
- Chronic inflammation leads to scarring, narrowing of airways, hypersecretion of mucus
6
Q
COPD Manifestations
A
- 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.
7
Q
COPD Patients
A
- 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
8
Q
Assessment of COPD
A
- Health history, risk factors, family history, physical examination
9
Q
Pulmonary Function Tests
A
- Helps confirm diagnosis of COPD
- Determines z severity, and monitors disease progression
- Spirometry evaluates airflow obstruction
FEV - Forced Expiratory Volume
FVC - Forced Vital Capacity
10
Q
FEV (Forced Expiratory Volume)
A
- FEV 1 (in one second)
Mild - 80%
Very Severe - 30%
Barrell Chest - Primarily with emphysema and chronic hyperinflation of lungs
11
Q
3 Primary Symptoms of COPD
A
- Chronic Cough
- Sputum Production
- Dyspnea (interferes with everyday eating)
- Patients tend to lean forward and use accessory muscles to breathe.
12
Q
COPD Patients Needs
A
- They need high calorie, easy to eat food.
13
Q
Treatment for COPD Patients
A
- 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
14
Q
Treatment for COPD Patients
A
- Manage exacerbations
- Provide supplemental oxygen, long term use of oxygen has been shown to improve patients quality of life
15
Q
Reduce Risk Factors of COPD
A
- Promote flu and pneumococcal vaccines
- Prevents infections, viruses, and exacerbations
- Pulmonary Rehab, bronchodilators for short term and steroids for long term.
16
Q
Surgeries
A
Bullectomy - Bullae are removed (large air spaces)
Lung Volume Reduction - Dead space, tissue is removed
Lung Transplant - Not enough lungs for all COPD Patients
17
Q
Nursing Management
A
- 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.
18
Q
Education
A
- Use of MDI (Metered Dose Inhaler)
- Use of Acapella (Flutter Device) which loosen mucus in airways.
- ## Percussion on patients back to help loosen mucus
19
Q
Complications of COPD
A
- Respiratory Insufficiency and failure
- Risk of pneumonia, chronic atelectasis (flattening of alveoli)
- Pneumothorax (air in thorax)
20
Q
Asthma
A
- 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)
21
Q
COPD
A
- Diagnosed as an adult (older than 40)
- Lifestyle factors are a big factor
- ## Symptoms milder than asthma but constant and can become progressively worse
22
Q
Asthma (cont)
A
- 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
23
Q
Care Plan Asthma
A
- 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)
24
Q
Terminology
A
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
25
Alpha receptors
- Responsible for constriction of blood vessels
26
Beta Receptors
- Dilation of blood vessels
27
Terminology
- Acetylcholine and muscarinic receptors are for parasympathetic nervous system that help slow heart rate and relax muscles.
- Cholinergic is acetylcholine
28
Cholinergic
- Drugs that inhibit, enhance, or mimic actions of neurotransmitter acetylcholine are called cholinergic drugs
-
29
Acetylcholine
- Chief neurotransmitter for parasympathetic nervous system
| - Contracts smooth muscles, dilates blood vessels, increases body secretions, slows heart rate.
30
Medication Treatment for Asthma/COPD
- 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.
31
COPD Pathophysiology
- COPD accelerates normal lung aging such as vital capacity and forced expiratory volume.
- Airflow limitations are progressive and associated with abnormal inflammation
32
Risk Factors COPD
- Environmental exposure
- Cigarette smoking most important
- Second hand smoke
- Exposure to dust, chemicals, air pollution
33
Clinical Manifestations COPD
- 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
-
34
Diagnostic Tests for COPD
- 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
35
Complications of COPD
- Respiratory insufficiency and Failure
- May need ventilator support
- Pneumonia, chronic atelectasis, pneumothorax, pulmonary arterial hypertension (right side heart failure)
36
Treatment COPD
- Avoid environmental exposure to smoke.
| -
37
ASTHMA Pathophysiology
- 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
-
38
Manifestations Asthma
- Cough, Dyspnea, Wheezing
- Night or Early Morning
- Cough with or without mucus production
- Generalized chest tightness and dyspnea
- Diaphoresis, Tachycardia, hypoxemia, central cyanosis.
39
Asthma Diagnostic Testing
- Improve with bronchodilators
- Pulmonary function normal between exacerbations
- Daily Peak Flow Monitoring is important Measures severity.
40
Complications of Asthma
Status Asthmaticus, Respiratory Failure, Pneumonia, Atelectasis.
Airway obstruction can lead to hypoxemia
- Give fluids
-
