Chronic Obstructive Pulmonary Disease Flashcards
Obstructive Lung Disease is classified by what?
Airway obstruction that is worse with expiration (breathing out)
what are the common obstructive disorders?
- Asthma
- Emphysema also known as COPD
- Chronic Bronchitis
COPD/ Emphysema description: (5)
- Airflow limitation not fully reversible
- generally progressive
- abnormal inflammatory response of lungs to noxious(harmful,poisionus) particles or gases
- symptoms occur in middle adult years
- incidence increases with age
what is emphysema a direct result of?
years of smoking, middle aged and elderly is majority affected.
Chronic Bronchitis
“ blue bloater”
- airway flow problem
- color is dusky to cyanotic
- recurrent cough and increased sputum production
- hypoxia ( 02 to tissues)
- Hypercapnia (increased co2)
- respiratory acidosis
- increased hemoglobin
- increased respiratory rate
- extertional dyspnea
- increased incidence in SMOKERS
- digital clubbing
- cardiac enlargement
- use of accessory muscles to breathe
- leads to right side heart failure
- Bilateral pedal edema
- increased JVD: jugular vein distention
Clinical Signs and symptoms of chronic bronchitis contiued:
dyspnea and tachypnea
weight gain due to edema or weight loss due to difficulty eating and increased metabolic rate
wheezing
prolonged expiratory time
Rhonchi
pulmonary hypertension
What are the risk factors (something that predisposes you) of chronic bronchitis : 6
- Cigarette Smoking
- exposure to irratants
- genetic predisposition
- exposure to organic or inorganic dust
- exposures to noxious or poisonous gases
- respiratory tract infection
How to diagnose Chronic Bronchitis?
Presence of cough and sputum production for at least 3 months for most days of the year, for 2 consecutive years.
Lab and diagnostic testing for chronic bronchitis:
- chest xray
- PFT (Pulmonary function testing)
- ABG
- Sputum
- EKG
- CBC: Increase hemoglobin
what is Chronic Bronchitis?
Lung damage and inflammation in the large airways
what is the treatment for Chronic Bronchitis? 10
- Stop smoking
- avoid air pollutants
- antibiotics
- bronchodialators: albuterol, terbutaline, avair(combination one)
- Adequate hydration
- chest physiotherapy: an airway clearance technique to drain lungs.
- Nebulizer treatments
- Corticosteriods (Pulmicort, Fluticasone, Azmacort, Prednisone)
- diuretic
- oxygen therapy
What do we teach the patient, when talking about how to control their chronic bronchitis?
- Instruct on the benefirs of not smoking or being around second-hand smoke
- importance of early medical treatment at the first sign and symptoms of getting sick
- might have to sleep semi-fowlers (30degrees)
- instruct them on importance of oxygen if they are prescribed
What does discharge planning consist of for chronic bronchitis?
- consider pulmonary rehab
- psychosocial consideration (mental health)
- Use of Bronchodialator 1st
- Case Management for oxygen, medication, home health
- importance of flu and pnuemonia vaccine
Emphysema:
“PINK PUFFER”:
- increased co2 retention (PINK)
- minimal cyanosis
- pursed lip breathing
- dyspnea
- hyperrenesonance on chest percussion ( lung sound, low pitch)
- orthopneic
- barrel chested: due to air trapping
- prolonged exipratory time
- speaks in short jurky sentances
- anxious
- use of accessory muscles to breath
- thin appearance
Clinical s/s of emphysema continued:
- tachypnea
- grunting
- decreased breath sounds
- clubbing of fingers and toes
- decreased chest expansion (lungs flat)
- chronic cough with or without sputum
- LOC changes due to too much c02
- harder for them to inflate their lungs
Risk factors of emphysema? 7
- cigarette smoking, main cause active and passive
- occupational chemicals and dust
- air pollution
- infection
- hereditary
- aging
- genetic susceptibilites
Lab and diagnostic testing for emphysema:
spirometry is the most common and the way to diagnose emphysema.
- chest xray
-PFT
-arterial blood gases
-later stages= low pao2, higher paco2, lower ph, high bicarb level
- complete blood count, increased hgb in later stages
-ekg
what is the treatment for emphysema? 12
best way for them to sit is tripod
avoid smoke and pollution
bronchodialator
antibiotics
flu vaccine
pnuemonia vaccine
adequate hydration
o2 therapy for hypoxia
mucolitics
corticosteriods
lung transplant
diuretics for edema
Antitrypsin deficiency acounts for what percent of emphysema and what is it?
accounts for 3% it is an autosomal recessive disorder
patient teaching for emphysema?
-experience many losses
-activity consideration
-pulmonary rehab
- sexual activites
-sleep
-psychosocial considertions
-nutritional considerations
-pursed lip breathing (2 count in 4 count out)
- instruct on benefits of not smoking or being around 2nd hand smoke
- importance to early medical treatment and first signs of sickness
-may sleep in semi-fowlers
- instruct on 02 importance
nursing diagnosis for emphysema?
ineffective airway cleareance
impaired gas exchange
imbalanced nutrition less than body requirements
risk for infection
insomnia
discharge planning for pt with emphysema?
consider pulmonary rehab
psychosocial consideration
bronchodialator first
case management for 02, meds, and home health
importance of flu and pnuemonia
bronchodialators
non labeled use for both chronic bronchitis and emphysema:
short acting BD such as albuterol
teach them about inhaler: two inhalations as needed, one minute between the two. then if using corticosteriod inhaler after wait 5 mins before administering.
bronchodialator AE: 10
tachycardia
palpiitations
chest pain
tremors
HA
diziness
nervousness
report s/s hypokalemia
afib
call hcp if requiring more than frequent use of medication
