ATI: Chapter 22: Chronic Obstructive Pulmonary Disease Flashcards
Chronic obstructive pulmonary disease (COPD) encompasses two diseases ________ and _______.
emphysema and chronic bronchitis
Most clients who have emphysema also have ______.
chronic bronchitis
______ is irreversible.
COPD
Emphesema is characterized by the loss of lung elasticity and _______ of lung tissue.
hyperinflation
Emphysema causes destruction of the _______, leading to a decreased surface area for gas exchange, carbon dioxide retention, and respiratory acidosis.
alveoli
Chronic bronchitis is an inflammation of the bronchi and bronchioles due to chronic exposure to ________.
irritants
COPD typically affects middle age to ______.
older adults
With COPD patients promote smoking ________.
cessation.
With COPD patients avoid _______ smoke.
secondhand
With COPD patients use protective equipment, such as a mask, and ensure proper ventilation while working in environments that contain _________ or particles in the air.
carcinogens
With COPD patients influenza and _______ vaccinations are important for all clients who have COPD, but especially older adults.
pneumonia
A risk factor for COPD is _____ age: older adult clients have a decreased pulmonary reserve due to normal lung changes.
advanced
________ is the primary risk factor for the development of COPD.
cigarette smoking
________ deficiency is a risk factor of COPD.
Alpha1-antitrypsin (AAT)
Exposure to ________ is a risk factor for COPD. (air pollution)
environmental factors
Chronic _______ is an expected finding of COPD.
dyspnea
With COPD a physical assessment finding is dyspnea upon _____.
exertion
With COPD a physical assessment finding is a ______ cough that is most severe upon rising in the morning.
productive
With COPD a physical assessment finding is crackles and _______.
wheezes
Hypoexemia is a common finding of _____.
COPD
With COPD a physical assessment finding is rapid and ______ respirations.
shallow
With COPD a physical assessment finding is the use of ________ muscles.
accessory
With COPD a physical assessment finding is a _____ chest or increased chest diameter (with emphysema).
barrel
With COPD a physical assessment finding is _______ on perscussion due to “trapped air” (with emphysema).
hyperresonance
With COPD a physical assessment finding is irregular _______.
breathing pattern
With COPD a physical assessment finding is thin extremities and _______ muscles.
enlarged neck
With COPD a physical assessment finding is dependent edema secondary to _________ failure.
right sided heart
With COPD a physical assessment finding is ______ of fingers and toes (late stages of disease).
clubbing
With COPD a physical assessment finding is pallor and ______ of nail beds and mucous membranes (later stages of the disease).
cyanosis
With COPD a physical assessment finding is decreased ______ saturation levels (expected reference range is 95% to 100%)
oxygen
With COPD a physical assessment finding is in older adults or clients who have dark colored skin, ______ levels can be slightly lower.
oxygen saturation levels
With COPD increased ______ will show on lab tests due to low oxygenation levels.
hematocrit
With COPD use sputum cultures and ______ counts to diagnose acute respiratory infections.
WBC
Arterial blood gases will display hypoxemia (decreased PaO2 less than 80 mm Hg) and _______ (increased PaCO2 greater than 45 mm Hg)
hypercarbia
Serum ______ tests are used to identify COPD.
electrolytes
________ are used for diagnosis, as well as determining the effectiveness of therapy in COPD patients.
Pulmonary Function Tests (PFTs)
Comparisons of forced expiratory volume (FEV) to _______ are used to classify COPD as mild to very severe.
forced vital capacity (FVC)
As COPD advances, the FEV to FVC ratio ________.
decreases
The expected reference range is _____% for FEV to FVC ratio.
100%
For mild COPD, the FEV/FVC ratio is decreased to less than ______%.
70%
As the disease progresses to moderate and severe, the FEV/FVC ratio decreases to less than ______.
50%
A chest x-ray reveals hyperinflation of the ______ and flattened diaphragm in the late stages of emphysema.
alveoli
_______ are often not useful for the diagnosis of early or moderate disease.
chest x-rays
Clients who have COPD usually have oxygen levels less than the expected reference range of ____% to ____%
95% to 100%
Used to assess for deficiency in ____, an enzyme produced by the liver that helps regulate other enzymes (which help break down pollutants) from attacking lung tissue.
AAT (alpha, antitrypsin levels)
Position the client to maximize ventilation for COPD patients in ________.
high Fowlers
Encourage the effective coughing or ______ to remove secretions.
suction
Encourage deep breathing and the use of an ______.
incentive spirometer
Administer breathing treatments and _____ to COPD patients.
meds
Administer _____ as prescribed to COPD patients.
oxygen
Monitor for ______ around the nose and mouth from the oxygen device.
skin breakdown
Promote adequate nutrition because the increased work of breathing increasing the _____ demand.
caloric
Proper nutrition aids in the prevention of ______.
infection
Encourage fluids to promote adequate _____.
hydration
______ decreases energy available for eating, so soft, high-calorie foods should be encouraged.
dyspnea
Monitor _____ and note any changes.
weight
Instruct the client to practice _______ techniques to control dyspneic episodes.
breathing
For diaphragmatic (abdominal) breathing, instruct the client to take breaths deep from the _______.
diaphragm
For diaphragmatic (abdominal) breathing, lie on back with _____.
knees bent
For diaphragmatic (abdominal) breathing, rest a hand over the _______ to create resistance.
abdomen
For diaphragmatic (abdominal) breathing, if the client’s hand _______ upon inhalation and exhalation, the breathing is being performed correctly.
rises and lowers
For pursed-lip breathing, instruct the client to: form the mouth as if preparing to ______.
whistle
For pursed-lip breathing, instruct the client to: take a breath in through the nose and out through the _______.
lips/mouth
For pursed-lip breathing, instruct the client to: not ______ out the cheeks.
puff
For pursed-lip breathing, instruct the client to: take breaths ______ and _______.
deep and slow
Clients who have COPD can need ____ to ____ L/min of oxygen via nasal cannula or up to 40% via Venturi mask.
2 to 4 L/min
Client who have chronically increased _____ levels usually require 1 to 2 L/min of oxygen via nasal cannula.
PaCO2
In COPD, low arterial levels of oxygen serve as the ________ for breathing.
primary drive
Positive expiratory pressure devices assist clients to remove ________.
airway secretions
Patients inhale deeply and _______ through positive expiratory pressure devices
exhales
While exhaling, a ball inside the _________ moves, causing a vibration that results in loosening secretions.
positive expiratory pressure devices
_______ conditioning includes improving pulmonary status by strengthening the condition of the lungs by exercise.
Exercise
The client walks _____ at a self-paced rate until the symptoms of dyspnea occur allowing rest periods and then resuming walking.
daily
The client walks ____ min daily 2 to 3 times weekly.
20 minutes
Determine the client’s physical limitations, and structure activity to include periods of _____.
rest.
Provide rest periods for older adult clients who have _______. Design the room and walkaways with opportunities for relaxation.
dyspnea
Provide support to the client and family. Talk about disease and _____ changes, including home care services such as portable oxygen.
lifestyle
Encourage verbalization of _____.
feelings
Increase fluid intake. Encourage the client to drink ____ to _____ L/day to liquefy mucus.
2 to 3 L/day
Incentive spirometry is used to monitor optimal _______.
lung expansion
_____ the client how to use the incentive spirometer.
Show
Instruct the client to keep a tight ______ seal around mouthpiece and to inhale and hold breath for 3 to 5 seconds. As the client inhales, the needle of the spirometry machine will rise. This promotes _______.
mouth
lung expansion
Short acting beta 2 agonists, such as ______, provide rapid relief.
albuterol
Cholinergic antagonists (anticholinergic medications), such as ______, block the parasympathetic nervous system. This allows for the _____ nervous system effects of increased bronchodilation and decreased pulmonary secretions. These meds are long and are used to prevent bronchospasms.
ipratropium
Methylxanthines, such as ______, relax smooth muscles of the bronchi. These meds require close monitoring of serum medication levels due to narrow ______ ranges. Use only when other treatments are ineffective.
theophylline
therapeutic
Monitor serum levels for toxicity when taking _______. Adverse effects include tachycardia, _____, and diarrhea.
theophylline
nausea
Watch for ____ and tachycardia when taking albuterol.
tremors
Obverse for dry mouth when taking _______.
ipratropium
Encourage the client to suck on hard candies to help moisten dry mouth while taking _____.
ipratropium
Encourage the client to increase _____ intake, report headaches, or blurred vision with bronchodilators (inhalers)
fluid
Monitor ______. Palpitations can occur, which can indicate toxicity of ipratropium.
heart rate
_______ agents decrease airway inflammation.
anti-inflammatory
If ______, such as fluticasone and prednisone, are given systemically, monitor for serious adverse effects (immunosuppression, fluid retention, hyperglycemia, hypokalemia, poor wound healing).
corticosteroids
Leukotriene antagonists, such as montelukast; mast cell stabilizers, such as _____, and monclonal abntiboides, such as omalizumab can be used as anti-inflammatory agents for COPD.
cromolyn
Watch for a decrease in immunity function with the use of _________.
anti-inflammatory agents
Monitor for Hyperglycemia when using _______.
anti-inflammatory agents
Advise the client to report black, tarry stools when using ______.
anti-inflammatory agents
Observe for fluid ______ and weight gain, which is common with anti-inflammatory agents.
retention
Check the _____ and ______ for aphthous lesions (canker sores) when using anti-inflammtory agents.
mouth and throat
_______ can cause anaphylaxis.
omalizumab
Encourage the client to drink plenty of fluids to promote ________.
hydration
Advise the client to use medication to prevent and control ________.
bronchospasms
Encourage the client to take _______ with food.
glucocorticoids
Advise the client to avoid people who have _______.
respiratory infections
Remind the client to use good _______ care.
mouth
Tell the client to use meds as a ______ prevention of COPD symptoms.
phrophylactic
Instruct the client to not discontinue medication _____.
suddenly
______ agents help thin secretions, making them easier for the client to expel.
mucolytic
______ treatments include acetylcysteine and dornase alfa.
nebulizer
_____ is an oral agent that can be taken.
Guaifenesin (mucolytic agents)
A combination of guiafenesin and dextromethorphan also can be taken orally to ______.
loosen secretions
Chest ______ uses percussion and vibration to mobilize secretions.
physiotherapy
Raising the _____ of the bed slightly higher than the head can facilitate optimal drainage and removal of secretions by gravity.
foot
Consult respiratory services for ______, breathing treatments, and suctioning for airway management.
inhalers
Contact nutritional services for weight loss and gain related to medications and ______.
diagnosis
Consult rehabilitative care if the client has prolonged weakness and needs assistance with increasing ________.
activity level
COPD is _____ for older adult clients. Referrals to assistance programs, such as food delivery services, can be indicated.
debilitating
Set up referral services, include _____ services such as portable oxygen.
home care
Encourage the client to eat ______ foods to promote energy.
high calorie
Encourage ____ periods as needed.
rest
Promote ______ to prevent infection.
hand hygiene
Reinforce the importance of _____ meds (inhalers, oral meds) as prescribed.
taking
Promote _____ cessation if needed.
smoking
Encourage immunizations, such as ______ and pneumonia, to decrease the risk of infection.
influenza
Clients should use oxygen as prescribed. Inform other caregivers not to smoke around the ______ due to flammability.
oxygen
Provide support to the client and _____.
family
Respiratory infections result from increase ______ production and poor oxygenation levels.
mucus
Administer oxygen ______.
therapy
Monitor ______ levels.
oxygenation
Administer ______ and other meds.
antibiotics
Advise the client to avoid crowds and people who have ______.
respiratory infections
Air trapping, airway collapse, and stiff ______ lead to increased pulmonary pressures. (right sided heart failure)
alveoli
Blood flow through the lung tissue is difficult with right sided heart failure. This increased workload leads to enlargement and thickening of the ________.
right atrium and ventricle
Manifestations of right sided heart failure as a complication of COPD include:
low oxygenation levels cyanotic lips enlarged tender liver distended neck veins dependent edema
Monitor respiratory status and administer ______ therapy with right sided heart failure (cor pulmonale)
oxygen
Monitor ______ and rhythm with right sided heart failure (cor pulonale).
HR
Administer meds, ______ and diuretics to maintain fluid balance with COPD complication of right sided heart failure (cor pulmonale).
IV fluids
A nurse is providing discharge teaching to a client who has COPD and has a new prescription for albuterol (Proventil). which of the following statements made by the client indicates an understanding of the teaching?
A. “This medication can increase my blood sugar levels.”
B. “This medication can decrease my immune response.”
C. “I can have an increase in my heart rate while taking this medication.”
D. “I can have mouth sores while taking this medication.”
C. “I can have an increase in my heart rate while taking this medication.”
Bronchodialtors such as albuterol can cause tachycardia
A nurse is preparing to administer a new prescription prednisone (Deltasone) to a client who has COPD. Which of the following should the nurse monitor for? (Select all that apply.)
A. Monitor the client for hypokalemia
B. Monitor the client for tachycardia
C. Observe the client for fluid retention
D. Monitor the client for nausea
E. Advise the client to report black, tarry stools
A. Monitor the client for hypokalemia
The nurse should observe for hypokalemia. This is an adverse effect of prednisone.
C. Observe the client for fluid retention
Then nurse should observe for fluid retention. This is an adverse effect of prednisone.
E. Advise the client to report black, tarry stools
The nurse should monitor for black, tarry stools. This is an adverse effect of prednisone.
A nurse is instructing a client on the use of an incentive spirometer. Which of the following statements made by the client indicates an understanding of the teaching?
A. “ I will place the adapter on my finger to read my blood oxygen saturation level.”
B. “I will lie on my back with my knees bent.”
C. “I will rest my hand over my abdomen to create resistance.”
D. “I will take in a deep breath and hold it before exhaling.”
D. “I will take in a deep breath and hold it before exhaling.”
The client who is using the spirometer should take in a deep breath and hold it for 3 to 5 seconds before exhaling. As the client exhales, the needle of the spirometer rises. This promotes lung expansion.
A nurse is discharging a client who has COPD. Upon discharge, the client is concerned that he will never be able to leave his house now that he is on continuous oxygen. Which of the following is an appropriate response by the nurse?
A. “There are portable oxygen delivery systems than you can take with you.”
B. When you go out, you can remove the oxygen and the reapply it when you get home.”
C. “You probably will not be able to go out as much as you used to.”
D. “Home health services will come to you so you will not need to go out.”
A. “There are portable oxygen delivery systems than you can take with you.”
The nurse should inform the client that there are portable oxygen systems that he can use to leave the house. This should alleviate the client’s anxiety.
A nurse is planning to instruct a client on how to perform pursed-lip breathing. Which of the following should the nurse include in the plan of care?
A. Take quick breaths upon inhalation.
B. Place your hand over your stomach
C. Take a deep breath in through your nose
D. Puff your cheeks upon exhalation
C. Take a deep breath through your nose
The client should take a deep breath in through her nose while performing pursed lip breathing. This controls the client’s breathing.
