COPD

Question 1

How Cardiac and Pulmonary Systems work together

Answer 1

They are interdependent. If no oxygen delivered to bloodstream, heart would stop functioning. And, if heart stops pumping, lungs would cease functioning from lack of blood supply. ALL body tissues rely on cardiopulmonary system for nutrients!

Question 2

Respiratory System Functions

Answer 2

Supplies oxygen to the blood and removes waste products (mostly CO2) from blood. Oxygen transports across alveolus to capillary network, exchanging for CO2, which is exhaled.

Question 3

Tracheotomy

Answer 3

Small incision made into trachea to allow air to pass freely into the lungs. Used when trachea or pharynx become blocked.

Question 4

Major Structures of Respiratory System

Answer 4

Pulmonary Tree:

Trachea > 2 Bronchi > Bronchioles > Alveolar Ducts > Alveolar Sacs

Question 5

Muscles active during INSPIRATION

Answer 5

Musculature of the thorax. Inspiration: Diaphragm, intercostals (maintain rib alignment), scalenes (elevate rib cage). May also recruit neck and collarbone muscles to assist when musculature is impaired.

Question 6

Muscles active during EXPIRATION

Answer 6

Passive relaxation of inspiratory musculature. If forced expiration, abdominals are actively contracted to squeeze diaphragm upward.

Question 7

Diaphragm Function

Answer 7

Provides muscle power for breathing in (inspiration). Contracts and domes downward when stimulated, which enlarges volume of thorax and causes drop in pressure in the lungs relative to air in the environment. Air then enters lungs to equalize pressure.

Question 8

How Autonomic and Sympathetic Nervous Systems work together for breathing

Answer 8

Autonomic has control over involuntary breathing. With anxiety or increased activity, sympathetic will automatically increase the depth/rate of inspiration. Breathing also has a volitional component (ie: controlling breathing when swimming).

Question 9

Area of Brain Responsible for Breathing

Answer 9

Pons, medulla and other parts of the brain provide central control of breathing. Adjust response due to input from receptors in lungs, aorta, and carotid artery.

Question 10

5 Chronic Lung Diseases (list)

Answer 10

1) COPD
2) Sarcoidosis
3) Asthma
4) Idiopathic Pulmonary Fibrosis
5) Cystic Fibrosis

Question 11

COPD

Answer 11

Chronic, progressive and insidious lung disease. Includes emphysema and chronic bronchitis; alveoli are damaged/clogged. Air sacs lose their elasticity, become floppy, damaged and enlarged not allowing oxygen to escape easily. Air can become trapped in the lungs.

Question 12

Sarcoidosis

Answer 12

Chronic lung disease. Growth of inflammatory cells in lungs.

Question 13

Asthma

Answer 13

Chronic lung disease. Irritability of bronchotracheal tree; typically episodic; narrowing of airways.

Question 14

Idiopathic Pulmonary Fibrosis

Answer 14

Chronic lung disease. Most common, progressive ILD (interstitial lung disease) causing scarring of lungs/impaired function. Unknown cause.

Question 15

Cystic Fibrosis

Answer 15

Chronic lung disease. Genetic, progressive disease causing thick, sticky mucus to build up in lungs, leading to life-threatening infections.

Question 16

2 Primary Medical Conditions included in COPD

Answer 16

1) CHRONIC BRONCHITIS: Bronchial airways become inflamed, leading to increased mucus production, cough, airway obstruction. Smoking major contributor. Prone to URIs.
2) EMPHYSEMA: Alveoli are gradually damaged. Smoking leading cause, but airborne irritants can contribute. SOB on exertion, up to dyspnea at rest as disease progresses.

Question 17

Dyspnea

Answer 17

Shortness of breath.

Question 18

How COPD is Medically Managed

Answer 18

• Most take meds daily
• Anti-inflammatory agents (steroids or cromolyn sodium), bronchodilators (albuterol or theophylline), and expectorants (iodides or guaifenesin)
• Pneumococcal and flu vaccines recommended
• Oxygen therapy at specific flow rate (Turning up oxygen does NOT help! Can result in retention of CO2 and failure of right side of heart!)
• May wean from ventilator to oxygen after initial acute respiratory distress
• Ventilators assist in inspiration but DO NOT increase healthy alveolar sacs/slow progress of COPD! May be used in acute exacerbations caused by pneumonia, flu, CHF.

Question 19

Pulmonary Rehabilitation (PR)

Answer 19

Multidisciplinary program for tx tailored to COPD pt. Psych, physical, emotional probs addressed. Nurses, resp/phys/occ therapists, psychologists, and others involved. Improves dyspnea, reduces hospital days, utilizes medical services efficaciously.

Question 20

5 Barriers to Engaging in Occupations with COPD

Answer 20

1) Uncertainty about Disease Progression
2) Attributing Cause to External Factors
3) Progressing Restriction in Activity and Isolation
4) Anxiety and Depression (most strongly linked to decreased exercise capacity and SOB)
5) Passive Acceptance

Question 21

5 Intervention Techniques for COPD (list)

Answer 21

1) Dyspnea Control Postures
2) Pursed-Lip Breathing (PLB)
3) DIaphragmatic Breathing
4) Relaxation
5) Other Tx/Considerations (ie: percussion/vibration, environmental factors, dyspnea control techniques)

Question 22

Dyspnea Control Postures

Answer 22

Intervention for COPD. Use of postures that reduce breathlessness. Seated=bend fwd slightly supporting on forearms. Standing=lean fwd propping on counter/shopping cart.

Question 23

Pursed-Lip Breathing (PLB)

Answer 23

Intervention for COPD. Prevent tightened airways by providing resistance to expiration. Improves air movement, releases trapped air, keeps airways open. Use for bending, lifting, stairs. (Relax neck/shoulders; Inhale through nose for 2-count; Purse lips; Exhale slowly for 4-count.)

Question 24

Diaphragmatic Breathing

Answer 24

Intervention for COPD. Increased use of diaphragm to improve chest volume. Learn by placing small book at base of sternum as visual cue, lie supine and inhale slowly to raise book. Exhale through pursed lips to drop book.

Question 25

Relaxation (technique)

Answer 25

Intervention for COPD. Progressive muscle relaxation w/breathing exercises can decrease anxiety and control SOB. One technique: tense muscles (sequence like face, neck, shoulders) while slowly inhaling, then relax muscles while exhaling twice as slowly through pursed lips.

Question 26

Additional Considerations for COPD Intervention

Answer 26

• PT for chest expansion/increased chest flexiblity
• Percussion/vibration and postural drainage to loosen secretions in lungs
• Consider environmental factors (humidity, pollution, temp., etc.)
• Dyspnea Control Techniques with Activity Progression (graded activity)

Question 27

Causes of COPD

Answer 27

• 2nd hand smoke
• Air pollution
• Dust/workplace fumes
• Biomass exposure (eg wood smoke)
• Uncommon genetic condition called alpha1-antitrypsin deficiency

Question 28

Things that Worsen COPD

Answer 28

• Influenza
• Pneumonia
• KEEP VACCINATIONS UP TO DATE!

Question 29

Symptoms of COPD Worsening

Answer 29

• SOB
• Wheezing
• Chest tightness
• Ongoing (chronic) cough
• Difficulty with routine activities (due to difficulty breathing)
• Fatigue
• Weight and/or Muscle loss

Question 30

COPD Statistics

Answer 30

• 3rd leading cause of death in US
• 16 million Americans have it
• Predominantly diagnosed in >40, both sexes
• More common in men, but more women die from COPD

Question 31

Self-Management of COPD

Answer 31

• Consult doc early
• Seek diagnosis and intervention strategies
• Quit smoking
* Pulmonary rehab
• Healthy diet/exercise
* Maintain positive outlook

Question 32

Patient and Family Education for COPD

Answer 32

Should include:
• Energy conservation
• Management of symptoms
• Disease process
• Risk factors