COPD Flashcards
What is COPD?
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
Risk Factors
- Smoking
- Infection- severe recurring respiratory tract infections
- Asthma
- Air pollution
- Aging
- AAT deficiency
1) How does COPD obstruct ventilation?
2) What does it cause?
1) Expiration is abnormally slow; Narrow airways; Collapsed airways
2) Mucous in the airways; Edema in the tissues; and Airways being collapsed
How does the patient present?
- Difficulty breathing
- Excessive mucous
- Prolonged expiratory time
- Increased AP diameter- Barrel chest
- Hyper resonance
S&S of COPD
- 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
Complications of COPD
- Pulmonary hypertension
- Cor Pulmonale
- Acute exacerbations
- Respiratory failure
- Infection
- Dysrhythmias
1) What is pulmonary hypertension and what does it lead to?
2) Tx
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
What should a nurse inspect a COPD patient for?
- Breathing pattern
- Respiratory rate
- Edema in the feet
- Barrel chest
Dx for COPD
- Confirmed through incentive spirometer- FEV1/FVC ratio of less than 70%
- ABGs- respiratory acidosis
- Sputum culture
- Chest X-ray
- Pulmonary function tests
1) What does chest X-ray reveal?
2) How does the diaphragm move?
1) Flattened diaphragm and overinflation
2) It doesn’t rise and fall like it should
Mild vs. Moderate vs. Severe vs. Very severe COPD
Mild: more than 80%
Moderate: 50%-80%
Severe: 30%-50%
Very severe: less than 30%
Nursing Dx for COPD
- Impaired gas exchange
- Ineffective airway clearance
- Altered nutrition
- Activity intolerance
Drug therapy for COPD
- Bronchodilators- Relax smooth muscle in the airways and reduces dyspnea
- Corticosteroids- for inflammation
- Oxygen
- Leukotrines
- Anticholinergics- Helps to dry up secretions
1) Tx of mild COPD
2) Tx of moderate COPD
3) Tx of severe COPD
4) Tx of pts who don’t respond
1) SABA-albuterol or ipratropium
2) LABA- salmeterol and formeterol
3) ICS and LABA- advair and symbicort
4) Low dose theophylline and ICS
Sx therapy for COPD
- Lung volume reduction
- Bronchoscopic lung volume reduction
- Bullectomy
1) Tx of hypoxemia
2) What is the goal?
3) How should it be given to the patient?
4) How should therapy be guided?
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
Complications of O2 therapy
- Combustion
- CO2 Narcosis
- O2 toxicity
- Infection
Health Promotion
- 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
1) Airway clearance techniques
2) How should these be scheduled?
3) What should be given before CPT?
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
1) What should be done before eating?
2) Diet
3) How should patient eat?
1) Rest for 30mins before and use a bronchodilator
2) High cal High protein
3) In 5-6 small meals a day
How can calories be increased?
- Margarine, butter, Mayo, sauces, gravies, and peanut butter
- Use milk to make soups
- Add cheese and choose desserts that contain eggs
Acute Exacerbations
1) What signals this?
2) Main causes
3) S&S
4) Drug therapy
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
Pursed lip breathing and when is it used?
Prolongs expiration to prevent air trapping
Used in cases of extreme acute dyspnea
1) S/E of SABA
2) What should be avoided when giving theophylline?
3) S/E of LABA
1) Tremors and increased HR and BP
2) Antibiotics and cimetidine
3) Can increase glucose levels use cautiously in patients with DM
