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z_MEDSURGE: FINAL REVIEW > COPD > Flashcards

COPD Flashcards

1
Q

What is COPD?

A

Pulmonary disease that causes chronic obstruction of airflow from the lungs leading to destruction of the lung tissue resulting in decreased gas exchange, air trapping & high CO2 in the body.

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2
Q

What are the two types of COPD and how does each restrict/obstruct the airflow of respiration?

A
  • Emphysema – Inability to fully exhale due to the loss of elasticity of the alveoli sacs
  • Chronic bronchitis – Limits airflow due to thick, swollen bronchioles and excessive sputum/mucus production
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3
Q

Chronic bronchitis is a _____ problem.

A

Airway

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4
Q

Emphysema is a _____ problem.

A

Alveolar

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5
Q

True or False

COPD tissue damage is irreversible, increases in severity and eventually leads to respiratory failure

A

True

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6
Q

Respiratory distress is the precursor to…

A

Respiratory failure

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7
Q

Which COPD condition results in a barrel chest? Why?

A
  • Emphysema
  • Air gets trapped in the alveoli causing anterior/posterior chest expansion
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8
Q

The main symptom of emphysema is _____.

A

Shortness of breath

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9
Q

The main symptom of chronic bronchitis is _____.

A

Frequent productive cough

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10
Q

What is Cor Pulmonale?

A

abnormal enlargement of the right side of the heart as a result of disease of the lungs or the pulmonary blood vessels.

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11
Q

Why does Cor Pulmonale develop in the COPD patient?

A
  • The heart is working harder to try to get more blood to the lungs and out to the body
  • This results in pulmonary hypertension. The greater the hypertension, the harder the heart needs to work
  • In time this leads to right-heart failure
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12
Q

Describe the pathophysiology of emphysema

A
  • Damage to the Alveoli results in loss of lung elasticity & loss of inflation of lung tissue,
  • Resulting in loss of lung tissue recoil & air trapping
  • Resulting in poor gas exchange
  • Resulting in increase of RBC production
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13
Q

People w/ emphysema are called “Pink puffers”. Explain.

A
  • P – Pink skin & Pursed lipped breathing
    • Pink skin due to increased RBC production
    • Pursed lipped breathing increases internal pressure keeping alveoli from collapsing
  • I – Increased chest (barrel chest)
    • Due to trapped air in alveoli
  • N – No chronic cough (compared to bronchitis)
    • Any cough will be minimal and non-productive
  • K – Keep tripoding
    • Due to labor of breathing
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14
Q

Describe what is happening in chronic bronchitis.

A

Inflammation of the bronchi and excessive mucus production result in a chronic, hacking cough & recurrent infections

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15
Q

People w/ chronic bronchitis are called “Blue bloaters”. Why?

A
  • B – Big and Blue skin
    • Cyanosis due to hypoxia
  • L – Long term “chronic” cough & sputum
    • Due to mucus production
  • U – Unusual lung sounds
    • Crackles and wheezes
  • E – Edema peripherally
    • Due to cor pulmonale
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16
Q

How are people with healthy lungs stimulated to breathe?

A

By high CO2 levels

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17
Q

How are people w/ COPD stimulated to breath?

A

By low O2 levels

18
Q

What are normal O2sat levels for those with COPD?

A

88-93%

19
Q

Why is it dangerous to rise O2sat above 93% for COPD patients?

A
  • Because they are stimulated to breathe by low levels of O2
  • If O2sat is too high, they won’t be stimulated to breathe and will stop doing so
20
Q

True or False

Anemia is a common problem for COPD patients

A

False, the problem is with gas exchange, not with the number of RBCs

21
Q

What does a PaO2 level < 80 indicate?

A

Hypoxemia

22
Q

What is the normal range for PaO2?

A

80-100

23
Q

What does a pH <7.35 and PaCo2 >45 indicate?

A

Respiratory acidosis

24
Q

A PaCo2 level > 45 means the pt is _____.

A

Hypercapnic (retaining CO2)

25
Q

A pt has a PaO2 <80 and PaCO2 >45. What does this indicate and what is the treatment?

A
  • PaO2 <80 and PaCO2 >45 means the patient is Hypoxemic and Hypercapnic
  • Tx = BiPap to bring up O2 level
26
Q

What are the s/s of respiratory failure?

A
  • Mental status changes
  • Decreased LOC
  • Confusion
  • Restlessness
27
Q

An elderly client with worsening COPD presents to the emergency department with fatigue and altered level of consciousness. Upon assessment the nurse finds O2 saturation of 87%, and ABG: pH 7.21, PaCO2 75, and PaO2 55 mm Hg. Which immediate intervention is best?

  1. Apply oxygen 4 LPM via nasal cannula.
  2. Call respiratory for STAT albuterol treatment.
  3. Sit the patient upright and apply Bilevel Positive Airway Pressure BiPAP
  4. Start looking for other jobs in cosmetic surgery.
A

3

28
Q

What are the two types of drugs to NOT use during a COPD exacerbation?

A
  • No Opioids (morphine or any “one”)
  • No Benzos (“pam” or “lam” no Bueno
29
Q

Why should COPD pts have frequent small meals?

A
  • To avoid stomach distention and pressure on the lungs
30
Q

The diet of a COPD pt should be high in _____ and low in _____.

A
  • High Calories and protein
  • Low Carbs and fiber (broccoli, beans)
31
Q

Why is exercise to be avoided for 1hr before and after meals for the COPD pt?

A

To conserve O2 for chewing and swallowing

32
Q

What do we keep in mind re: Fluids for the COPD pt?

A
  • Intake 8 glass (2-3L/day)
  • Avoid fluids while eating (stomach distention)
33
Q

What should the PT report to the HCP?

A
  • s/s of infection
    • increase in sputum
    • fever
    • worsening dyspnea
34
Q

What vaccinations should the COPD pt make sure they get and how often?

A
  • Pneumococcal, every 5yrs
  • Flu, annually
35
Q

For PTs w/ heavy mucus, what should they do at night and why?

A

Mobilize secretions by taking a decongestant and using a cool mist humidifier to make breathing easier

36
Q

What should we teach the COPD PT re: pursed lipped breating?

A
  • Inhale through nose for 2 seconds
  • Exhale through pursed lips for 4 seconds
37
Q

Explain the Huff coughing technique.

A
  1. Sit upright in a chair: feet shoulder width apart & lean forward
  2. Deep slow inhalation through mouth using diaphragm muscle
  3. Hold breath: 2-3 seconds & then forcefully exhale
  4. Repeat HUFF once or twice more & avoid from normal coughing
  5. Rest for 5-10 normal breaths & repeat as needed until secretions clear
38
Q

The COPD PT is at risk for what lung infection?

A

Pneumonia

39
Q

What test is done to test effect of breathing for COPD PTs

A

Spirometry

40
Q

What is the general PT teaching for COPD?

A
  • Nutrition needs
  • Infection exposure avoidance
  • Smoking cessation
  • Vax up to date
  • Breathing techniques (pursed lipped, diaphragmic)
  • Meds: use, sfx

z_MEDSURGE: FINAL REVIEW (15 decks)

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