COPD

Question 1

What is COPD?

Answer 1

Chronic inflammation of the airways, lung parenchyma, and pulmonary blood vessels. The inflammation causes tissue destruction and disrupts defense mechanisms and repair processes of the lungs. This causes gas exchange abnormalities

Question 2

Risk Factors

Answer 2

• Smoking
• Infection- severe recurring respiratory tract infections
• Asthma
• Air pollution
• Aging
• AAT deficiency

Question 3

1) How does COPD obstruct ventilation?

2) What does it cause?

Answer 3

1) Expiration is abnormally slow; Narrow airways; Collapsed airways
2) Mucous in the airways; Edema in the tissues; and Airways being collapsed

Question 4

How does the patient present?

Answer 4

• Difficulty breathing
• Excessive mucous
• Prolonged expiratory time
• Increased AP diameter- Barrel chest
• Hyper resonance

Question 5

S&S of COPD

Answer 5

• Chronic cough that may or may not be productive
• Progressive dyspnea
• Chest heaviness
• Not being able to take a deep breath
• Increased effort to breathe
• Air hunger
• Barrel chest
• Tripod position

Question 6

Complications of COPD

Answer 6

• Pulmonary hypertension
• Cor Pulmonale
• Acute exacerbations
• Respiratory failure
• Infection
• Dysrhythmias

Question 7

1) What is pulmonary hypertension and what does it lead to?

2) Tx

Answer 7

1) It is caused by constriction of pulmonary vessels in response to hypoxia. It eventually causes R sided HF
2) Continuous low flow, long term O2 therapy and anticoagulants

Question 8

What should a nurse inspect a COPD patient for?

Answer 8

• Breathing pattern
• Respiratory rate
• Edema in the feet
• Barrel chest

Question 9

Dx for COPD

Answer 9

• Confirmed through incentive spirometer- FEV1/FVC ratio of less than 70%
• ABGs- respiratory acidosis
• Sputum culture
• Chest X-ray
• Pulmonary function tests

Question 10

1) What does chest X-ray reveal?

2) How does the diaphragm move?

Answer 10

1) Flattened diaphragm and overinflation

2) It doesn’t rise and fall like it should

Question 11

Mild vs. Moderate vs. Severe vs. Very severe COPD

Answer 11

Mild: more than 80%
Moderate: 50%-80%
Severe: 30%-50%
Very severe: less than 30%

Question 12

Nursing Dx for COPD

Answer 12

• Impaired gas exchange
• Ineffective airway clearance
• Altered nutrition
• Activity intolerance

Question 13

Drug therapy for COPD

Answer 13

• Bronchodilators- Relax smooth muscle in the airways and reduces dyspnea
• Corticosteroids- for inflammation
• Oxygen
• Leukotrines
• Anticholinergics- Helps to dry up secretions

Question 14

1) Tx of mild COPD
2) Tx of moderate COPD
3) Tx of severe COPD
4) Tx of pts who don’t respond

Answer 14

1) SABA-albuterol or ipratropium
2) LABA- salmeterol and formeterol
3) ICS and LABA- advair and symbicort
4) Low dose theophylline and ICS

Question 15

Sx therapy for COPD

Answer 15

• Lung volume reduction
• Bronchoscopic lung volume reduction
• Bullectomy

Question 16

1) Tx of hypoxemia
2) What is the goal?
3) How should it be given to the patient?
4) How should therapy be guided?

Answer 16

1) O2 therapy
2) To keep SaO2 greater than 90% or the PaO2 greater than 60mm hg
3) It should be humidified
4) By pulse ox and ABGs

Question 17

Complications of O2 therapy

Answer 17

• Combustion
• CO2 Narcosis
• O2 toxicity
• Infection

Question 18

Health Promotion

Answer 18

• Flu vax yearly because they are susceptible to lung infections
• Stop smoking
• Avoid those who are sick
• Hand hygiene
• Pneumonia vax yearly
• Use a bronchodilator before exercise

Question 19

1) Airway clearance techniques
2) How should these be scheduled?
3) What should be given before CPT?

Answer 19

1) Effective coughing- huff cough; and CPT: postural drainage, percussion, and vibration
2) At least 1 hour before meals or 3 hours after meals
3) A bronchodilator

Question 20

1) What should be done before eating?
2) Diet
3) How should patient eat?

Answer 20

1) Rest for 30mins before and use a bronchodilator
2) High cal High protein
3) In 5-6 small meals a day

Question 21

How can calories be increased?

Answer 21

• Margarine, butter, Mayo, sauces, gravies, and peanut butter
• Use milk to make soups
• Add cheese and choose desserts that contain eggs

Question 22

Acute Exacerbations

1) What signals this?
2) Main causes
3) S&S
4) Drug therapy

Answer 22

1) A change in pts usual status
2) Bacterial and viral infections
3) Increased dyspnea and increased sputum, volume or purulence
4) SABAs and corticosteroids

Question 23

Pursed lip breathing and when is it used?

Answer 23

Prolongs expiration to prevent air trapping

Used in cases of extreme acute dyspnea

Question 24

1) S/E of SABA
2) What should be avoided when giving theophylline?
3) S/E of LABA

Answer 24

1) Tremors and increased HR and BP
2) Antibiotics and cimetidine
3) Can increase glucose levels use cautiously in patients with DM