Asthma & COPD Flashcards
What is the first thing you should do if your pt is having trouble oxygenating?
- raise HOB
- turn up / apply O2
What is asthma?
What can happen with repeated attacks?
- chronic condition with intermittent and reversible obstruction of airway d/t inflammation and hypersensitivity
- repeated attacks can lead to permanent damage to airway = enlarged epithelial cells and changes in bronchiole smooth muscle
Describe inflammation and hypersensitivity in relation to asthma?
- inflammation occurs in the lumen causing obstruction inside the airway
- hypersensitivity causes constriction of bronchial smooth muscle narrowing the outside of the airway (=bronchospasm)
What are the 4 hallmark sx of asthma?
- wheezing
- SOB / dyspnea
- chest tightness
- coughing
What are some s/s of an acute asthma attack?
- audible wheeze
- inc RR
- use of accessory muscle
- prolonged exhalation : d/t air trapping
- hypoxemia –> hypoxia
What should the normal PaO2 range be for someone who is diagnosed as having asthma, but has no other lung problems?
80 - 100 : may be below this during an attack
How does the PaCO2 change throughout the course of an asthma attack?
- Early : CO2 will be low –> still able to blow it off with inc in RR
- late : CO2 will be high –> can no longer effectively blow off CO2
What test is used to determine the severity of an acute asthma attack?
What test is used to diagnose it?
- Acute : ABG
- Dx : pulmonary function test
What is the criteria to be dx with asthma from a pulmonary function test?
- FEV 15-20% below normal
- 12% inc in FEV after administration of bronchodilator
- methacholine : test for hypersensitivity –> induces bronchospasm
What are 4 interventions that can be used for a pt with asthma?
- personal asthma action plan
- edu
- drug therapy : knowing when to use what drug
- lifestyle modification
What is included in a personal asthma action plan?
- empowerment
- goals : inc sx free pds, and reduce severity of attacks
- self assessment : triggers, timing, sx, and reaction to meds
- medication adjustment s
- when to call the provider
- when to call 911
How is a peak flow meter used to determine tx for an asthma pt?
How do you establish baseline?
- Baseline : 2-3 weeks measure BID when sx are well controlled to establish a PR
- should continue to measure BID
- if peak flow is 80-100% of PR : ur good
- if peak flow is 50-80% of PR : take rescue med and recheck
- if peak flow is < 50% of PR : take rescue med and call 911
What are 9 common triggers of asthma
- cold air
- dry air
- NSAIDS & ASA
- beta blockers
- small air particles
- exercise
- upper resp illness
- MSG
- stress
What types of medications are used to tx asthma?
- control therapy : take everyday –> LABA, cholinergic antagonist, corticosteroid
- rescue meds : SABA, to tx/prop
When is an asthma attack considered an emergency?
- < 50% of PR with peak flow
- at 50-80% of PR with peak flow but not responding to meds
- cyanosis
- nasal flaring
- retractions
- trouble talking/walking d/t inc work to breathe
What is status asthmaticus?
- medical emergency
- asthma attack not responding to tx
- can lead to pneumothorax –> resp arrest –> cardiac arrest
- severe labored breathing with use of accessory muscles
- distended neck veins
What is done for tx of status asthmaticus?
- raise HOB
- O2
- start and IV
- bronchodilators : ned
- IV steroids
- Epi
- fluids
- may require intubation
What is emphysema?
What does it cx?
- emphysema : inc proteases that breakdown elastin in the lungs which causes damage to alveoli and small airways
- cx : hyperinflation and air trapping –> reduced gas exchange and inc work to breathe
What is air trapping?
when there is a residual volume in the lungs –> cannot exhale completely
If a pt who is 22 yo and reports no current or previous use of cigarets or vaping but is dx with COPD, what do you suspect is the cause?
- alpha 1 antitrypsin deficiency
- the lack the enzyme that controls protease activity –> inc breakdown of elastic
What is chronic bronchitis?
What is it cx by?
What is it characterized by?
- chronic bronchitis : inflammation of the bronchi and bronchioles
- cx by : irritants
- characteristics : mucosal edema, congestion, bronchospasms, inc mucus production
Pts with COPD what impaired gas exchange, you would expect __ (high/low) PaO2 and ___ (high/low) PaCO2
- low PaO2
- high PaCO2
Why is it important to assess ability to preform ADLs and note general appearance in a pt who has COPD?
changes (dec ability) to preform ADLs may indicate disease progression
Cor pulmonale is more closely associated with ___ (CB/Em), and is cx by ___
- chronic bronchitis
- inc pressure in the lung and artery d/t congestion
A person who experiences significant unintentional weight loss most likely has ___ (CB/Em). The weight loss is explain by __
- emphysema
- there is a large inc in metabolic demand in order to breathe
What psychosocial aspects would it be important to address in a pt with COPD?
- anxiety
- fear of future
- expenses
- social support
- smoking cessation
A pt with well managed COPD most likely has a baseline ABG with what general trends (high/low) : pH PaO2 PaCO2 HCO3
What value would change indicating an acute exacerbation?
- pH : normal 7.35-7.45
- PaO2 : low
- PaCO2 : high
- HCO3 : high
- an acute exacerbation would be indicated by a change in pH
Why is it important to collect sputum cultures on a pt who has COPD and is being tx for a resp infection?
- they are treated very often therefore it is best to get a culture so a narrow antibiotics can be used (if appropriate) to help reduce resistance
Why would and H&H be high for a COPD pt?
their body is trying to compensate for dec perfusion by making more RBCs
What test is used to dx COPD
pulmonary function test : at risk and FEV???
A COPD pt is beginning exercise conditioning, what points should the nurse include in pt edu?
- start slow and incorporate rest pds –> inc activity over time
- may req inc O2
- try to exercise 2-3 x / wk
When should you suction a pt who has COPD (generally)?
only if needed –> very painful for pt
What time of day would a pt with chronic bronchitis be able to cough most effectively?
What should also be considered with effective coughing (esp after surgery)
- in AM : mucus builds up over night
- after hot shower
- after hot beverage
- should also consider pain management
Why is pursed lip breathing effective?
creates pressure to help push the air out of the lungs
What is diaphragmatic breathing and how is it helpful
- apply pressure with hand over abd
- allow pt to engage abd muscles to help breathe
What is the drive to breathe in COPD pts?
How does this effect their O2 therapy?
What is our goal for O2 therapy?
- drive : hypoxia = O2
- alter O2 tx to keep their SpO2 b/t 88-92% or <95% (they still need O2)
- goal is to get them to their home O2 level
What type of diet should a person with COPD be on?
- low card
- high calorie high protein
- small frequent meals
- premed
What is involved in the coordination of care for a COPD pt?
- home health
- O2
- equipment
- understanding long term health challenges and management
- goal setting
