chronic pulmonary disease Flashcards
Pulmonary function tests
What pt does
Tidal volume
Residual
FEV1
Normal results
What it diagnosis
Pt exhales as hard/fast and as long as possible into spirometer
Tidal volume: volume of air with each breath (inhale+exhale)
Residual: amount of air left in lungs
FEV1: amount of air exhaled in 1 sec of FVC
Normal results: 80-120% of expected value
Used in diagnosis of respiratory conditons
COPD ***
Chronic bronchitis:
Inflammation/↑mucus secretion
Risk of infection
Emphysema:
Airspaces are distended
Dead space in lungs
COPD s/s***
Cardinal signs:
Chronic cough, sputum production, dyspnea
Barrel chest
Hypoxia
Hypercapnia
Polycythemia
Advanced copd: fatigue, weight loss, anorexia
COPD diagnositic testing***
Spirometry:
given bronchodilator and FEV1 tested pre/post to see change
ABGs while hospitalized:
may find:
chronic elevated co2, bicarb
low ph
COPD complications
acute exacerbation
what you see and what causes it
classic s/s
tx ***
acute exacerbation (flare up):
worse s/s
cause by infections
classic s/s: ↑cough, sputum production, dyspnea
*only need 2 of 3
tx: bronchodilatores, IV steroids, abx, pursed lipbreathin
COPD complication
pulmonary htn and corpulmonale ***
high pulmonary vascular pressure causes right sided HF
COPD management ***
meds: bronchodilators, steroids
oxygen therapy
surgeries
pulmonary rehab
nutrition
breathing exercises (pursed lip breathing)
COPD management: oxygen therapy ***
goal: >90%
only as much O2 to kep >90%
normal drive to breath is co2 but these pts are o2
OXYGEN ADMIN ***
nasal cannula (low flow)
*if pt needs low oxygen concentration (1-6L/min)
simple face mask (low flow)
*short periods (transport) 6-12L/min
nonrebreather
highconcentration (100%) open oxygen until bad inflated
venturi mask: can dial in oxygen
tracheostomy collar or t-piece
surgical management: COPD ***
bullectomy-removal of large bullae:
*contribute to dead space or lung compression
lung transplant
lung colume reduction surgery
COPD drug therapy ***
short/long acting bronchodilators
inhaled steriods
(not used alone in copd, give bronchodilator first)
combination inhalers
oral/iv steroids during exacerbation
Asthma ***
inflammatory process: bronchial hyperractivtity
triggers/risk factors:
allergens
infections
excercise, stress, GERD
asthma s/s ***
wheezing (not an indicator of severity)
cough
dyspnea
silent chest (cant hear airflow)
accessory muscle use
↑WOB
asthma complications
status asthmaticus (meds not helping)
what is going on
s/s
tx ***
medical emergency:
bronchospasm that are unresponsive to brochodilators and corticosteroids
s/s: chest tightness, ↑SOB, may be unable to speak
tx: mechanical ventilations
sedatives
IV magnesium (relax muscles)
asthma action plan-self care
what to use to determine tx
teach client
when to call doctor ***
use peak flow meter readings to determine tx
teach:
how to use inhaler and peak flow
monitor pollution index
know allergens and triggers
when to call doctor:
if things dont get better after taking meds
peak flow meter
green: 80-100
yellow: 50-79
red: less than 50
ashma drug therpy
step up therapy ***
short acting bronchodilators
steriods: PO, IV, inhaled
(give first before bronchodilator bc issue is inflammation, in COPD you do bronchodilation first)
leukotiene modifiers:
montelukast (singulair) ↓inflammatory response
long acting bronchodilators:
never without an inhaled steroid in asthma pts
bronchodilators : B2 adrenergic agonists ***
short acting beta agonist (SABA):
albuterol:
emergency inhaler or nebulizer
SE: tachycardia, nervousness, palpitations, tremors
long acting beta agonist (LABA):
Salmeterol: (not for acute symptoms)
SE: HA, dry mouth, tremors
bronchodilators: anticholinergics (muscarinic agonist) ***
short acting: Ipratropium (Atrovent) nebulizer or inhaler
SAMA
SE:
dye mouth
cough
bad taste
usually combined with aluterol for ned
Long acting: tiotropium (Spiriva) inhaler
LAMA
not for actue symptoms
steroids
control inflammation ***
inhaled, IV, PO
inhalers
fluticasone (Flovent) or budesonide (Pulmicort)
*SE: oral thrush
IV corticosteroids
methylprednisolone (solumedrol)
*for acute exacerbation
PO
prednisone
*long term use: endocrine issues(crushins)
leukotriene modifiers ***
control leukotrienes
long term tx
*montelukast (skingulair)
*suicidal effects
*for asthma
Methylxanthines ***
aminophyline: IV
Theophyline: PO
bronchodilator
assess for toxicity:
*N/V, seizures, insomnia
