CHRONIC PULMONARY DISEASE Flashcards
CHRONIC OBSTRUCTIVE PULMONARY DISEASE AND ASSOCIATED RESPIRATORY DISEASES
- COPD IS A SLOWLY PROGRESSIVE RESPIRATORY DISEASE OF AIRFLOW OBSTRUCTION
— INVOLVING THE AIRWAYS, PULMONARY PARENCHYMA, OR BOTH
PATHOPHYSIOLOGY OF COPD
- AIRFLOW LIMITATION IS PROGRESSIVE, ASSOCIATED WITH ABNORMAL INFLAMMATORY RESPONSE TO NOXIOUS PARTICLES OR GASES
- CHRONIC INFLAMMATION DAMAGES TISSUE
- SCAR TISSUE IN AIRWAYS RESULTS IN NARROWING
- SCAR TISSUE IN THE PARENCHYMA DECREASES ELASTIC RECOIL (COMPLIANCE)
- SCAR TISSUE IN PULMONARY VASCULATURE CAUSES THICKENED VESSEL LINING AND HYPERTROPHY OF SMOOTH
CHRONIC BRONCHITIS
- COUGH AND SPUTUM PRODUCTION FOR AT LEAST 3 MONTHS IN EACH OF 2 CONSECUTIVE YEARS
- CILIARY FUNCTION IS REDUCED, BRONCHIAL WALLS THICKEN, BRONCHIAL AIRWAYS NARROW, AND MUCOUS MAY PLUG AIRWAYS
- ALVEOLI BECOME DAMAGED, FIBROSED, AND ALVEOLAR MACROPHAGE FUNCTION DIMINISHES
- THE PATIENT IS MORE SUSCEPTIBLE TO RESPIRATORY INFECTIONS
PATHOPHYSIOLOGY OF CHRONIC BRONCHITIS
EMPHYSEMA
- ABNORMAL DISTENTION OF AIR SPACES BEYOND THE TERMINAL BRONCHIOLES WITH DESTRUCTION OF THE WALLS OF THE ALVEOLI
- DECREASED ALVEOLAR SURFACE AREA INCREASES IN “DEAD SPACE,” IMPAIRED OXYGEN DIFFUSION
- HYPOXEMIA RESULTS
- INCREASED PULMONARY ARTERY PRESSURE MAY CAUSE RIGHT-SIDED HEART FAILURE (COR PULMONALE)
- CHANGES IN ALVEOLAR STRUCTURE
NORMAL CHEST VS. BARREL-SHAPED CHEST
TYPICAL POSTURE OF A PERSON WITH COPD
WHAT IS THE PRIMARY CLINICAL SYMPTOM OF EMPHYSEMA?
D. WHEEZING
ASSESSMENT AND DIAGNOSIS OF COPD
- HEALTH HISTORY
- PULMONARY FUNCTION TESTS
— SPIROMETRY - ARTERIAL BLOOD GAS
- CHEST X-RAY
COMPLICATIONS OF COPD
- RESPIRATORY INSUFFICIENCY AND FAILURE
- PNEUMONIA
- CHRONIC ATELECTASIS
- PNEUMOTHORAX
- COR PULMONALE
COPD MEDICAL MANAGEMENT
- PROMOTE SMOKING CESSATION
- REDUCING RISK FACTORS
- MANAGING EXACERBATIONS
- PROVIDING SUPPLEMENTAL OXYGEN THERAPY
- PNEUMOCOCCAL VACCINE
- INFLUENZA VACCINE
- PULMONARY REHABILITATION
COPD SURGICAL MANAGEMENT
- BULLECTOMY
- LUNG VOLUME REDUCTION
- LUNG TRANSPLANT
MEDICATIONS TO TREAT COPD
- BRONCHODILATORS, MDIs
- BETA-ADRENERGIC AGONISTS
— Albuterol - MUSCARINIC ANTAGONISTS (ANTICHOLINERGICS)
— Ipratropium bromide - COMBINATION AGENTS
— combivent/ Methylxanthine??
— Theophylline - CORTICOSTEROIDS
- ANTIBIOTICS
- MUCOLYTICS:
— acetylcysteine - ANTITUSSIVES
COPD NURSING MANAGEMENT
- OBTAIN HISTORY
- REVIEW OF DIAGNOSTIC TESTS
- ACHIEVING AIRWAY CLEARANCE
- IMPROVING BREATHING PATTERN
- IMPROVING ACTIVITY TOLERANCE
- MDI PATIENT EDUCATION
Which statement by the client with chronic obstructive pulmonary disease (COPD) indicates the need for additional follow-up instruction?
- B. “I don’t need to get the flu shot.”
For relief of hypoxemia in the newly admitted client with chronic obstructive pulmonary disease (COPD), what does the client most likely need?
- A. Oxygen flow rate of 1 to 2 L/min via nasal cannula
Your client has been diagnosed with chronic bronchitis and started on a mucolytic. What is the rationale for ordering a mucolytic for this client?
- D.Mucolytics thin secretions, making them easier to expectorate.
ASTHMA
- CHRONIC INFLAMMATORY DISEASE OF THE AIRWAYS THAT CAUSES HYPERRESPONSIVENESS, MUCOSAL EDEMA, AND MUCUS PRODUCTION
- INFLAMMATION LEADS TO COUGH, CHEST TIGHTNESS, WHEEZING, AND DYSPNEA (FIG. 24-6)
- ASTHMA IS LARGELY REVERSIBLE; SPONTANEOUSLY OR WITH TREATMENT
- ALLERGY IS THE STRONGEST PREDISPOSING FACTOR
ASTHMA CLINICAL MANIFESTATIONS
- COUGH, DYSPNEA, WHEEZING
- EXACERBATIONS
- COUGH, PRODUCTIVE OR NOT
- GENERALIZED WHEEZING
- CHEST TIGHTNESS AND DYSPNEA
- DIAPHORESIS
- TACHYCARDIA
- HYPOXEMIA AND CENTRAL CYANOSIS
MEDICATIONS MANAGEMENT FOR ASTHMA
- QUICK-RELIEF MEDICATIONS
— BETA2-ADRENERGIC AGONISTS
— ANTICHOLINERGICS - LONG-ACTING MEDICATIONS
— CORTICOSTEROIDS
— LONG-ACTING BETA2-ADRENERGIC AGONISTS
— LEUKOTRIENE MODIFIERS
—- montelukast
ASTHMA PATIENT TEACHING
- HOW TO IDENTIFY AND AVOID TRIGGERS
- PROPER INHALATION TECHNIQUES
- HOW TO PERFORM PEAK FLOW MONITORING
- HOW TO IMPLEMENT AN ACTION PLAN
- WHEN AND HOW TO SEEK ASSISTANCE
USING A PEAK FLOW METER
CLINICAL MANIFESTATIONS OF COPD
THREE PRIMARY SYMPTOMS
- CHRONIC COUGH
- SPUTUM PRODUCTION
- DYSPNEA
WEIGHT LOSS DUE TO DYSPNEA
“BARREL CHEST”
