COPD Flashcards
What is COPD? divided into what 2 things?
Chronic Obstructive Pulmonary Disease
Chronic = Not going away, Not getting better
Not reversible
-Includes Emphysema and Chronic Bronchitis
describe the patho of emphysema?
Increased proteases breakdown elastin causing damage to alveoli and small airways
- ->Loss of elasticity in lungs
- ->Hyperinflation of lungs
- ->Collapsed small airway
- -> Alveoli drop in number, some become large and flabby
=Reduced gas exchange
What is air trapping? what does it lead to?
Elastic recoil dysfunction
- ->Hyperinflation of lungs causes flattening of diaphragm
- ->Use of accessory muscles to breathe
- ->Increased work of breathing (actually uses more oxygen)
what does air trapping result in?
- Air hunger
- Uncoordinated breathing pattern
- Needs additional oxygen due to demand from work of breathing
what is chronic bronchitis? most common cause?
Inflammation of the bronchi and bronchioles: Caused by irritants
- Most common cause is smoking
- Irritant causes inflammation, vasodilation, mucosal edema, congestion and bronchospasm
- Increased mucous production –> Infection
=Results in: Impaired Airflow & gas exchange
(smaller lumen + build up of gas unexchanged)
what is alpha 1 antitrypsin deficiency? how do you get it?
Risk factor for COPD
- AAT inhibits excessive protease activity (so that protease doesn’t cause airway damage)
- Having low levels of AAT (or no AAT) may allow the lungs to become damaged.
- This allows neutrophil elastase (normally kept at bay by AAT) to destroy lung tissue, causing lung disease
AAT gene is recessive
- If one allele is affected and the other is normal- Carrier-
- If both alleles are affected – Disease (young age)
signs of COPD
Impaired Gas Exchange
- ->Decreased PaO2 in blood
- ->Increased PaCO2 in blood
- Hypoxemia (low oxygen in tissue level)
- Acidosis
- Respiratory Infections
- Respiratory Failure
- Dysrhythmias
- Cor Pulmonale (right sided heart failure)
sxs of COPD
SHOB Breathing Problems Wheezing Coughing Mucous Production Increase Orthopnea Sexual Activity Decrease Basic ADL’s Difficulty Progression of symptoms Changes in weight Decrease
risk for copd
Age (older) Gender (females more at risk) Occupational History Family History History of Smoking (Pack Year)
general appearance of someone with COPD
Neglect of basic hygiene Weight distribution: Enlarged Neck Muscles, Thin Arms Position : Orthopneic/ Tripod Barrel Chest Fatigue
COPD respiratory assessment
-Increased Breathing Rate
-Breathing Pattern: Shallow, Uncoordinated
-Use of accessory muscles
-Retractions
-Clubbing
-ANXIETY
-Adventitious breath sounds (may be normal)
Wheezing
Rhonchi
Diminished
cardiac assessment copd?
Edema Pallor Cyanosis Tachycardia Arrhythmias
pink puffer=
emphysema
blue bloaters =
chronic bronchitis
labs for copd?
-ABG’s
-Establish Baseline
-“CO2 Retainers” : compensatory metabolic
alkalosis
-PaO2 low, PaCO2 high, HCO3 high
(compensatory)
-Sputum Cultures
-WBC Count
-Serum Alpha1 Antitrypsin
-H & H - create more RBC to carry more /o2
-Electrolytes
COPD ABG
- “CO2 Retainers” : compensatory metabolic alkalosis
- PaO2 low, PaCO2 high, HCO3 high
-Chronic respiratory acidosis is compensating metabolically
what is gold classification? what tool are we using to determine the results?
- At Risk, Mild, Moderate, Severe, Very Severe (I, II, III, IV)
- Forced Expiratory Volume (Airflow in first second of exhale) determines classification
- as you get worse, the FEV gets less
diagnostics for copd
- Lung Volume & Airflow Rates
- Able to distinguish Obstructive Disease from Restrictive Disease
- Vital Capacity (Max. amount of air that can be exhaled after a full inspiration)
- *Residual Volume (Air Trapping)
- Total Lung Capacity (Max amount of air that your lungs can hold)
- chest x ray
I: Milds
80% normal lung function
II: Moderate
50-80% lung function
III: Severe
30-50% lung function, typically involved severe restraint of respirations, tininess of breath and frequent COPD exacerbations
IV: Very Severe
<30% lung function
Interventions for COPD
- Maintain airway
- Assess
- Oxygen
- Breathing techniques
- Positioning
- Exercise conditioning
- Effective coughing
- Suctioning
- Hydration
- Vibratory Positive Pressure Device (flutter valve)
- Adherence to pharmacology regimen
- Monitor patient’s breathing and disease progression
2 types of breathing technique for COPD
Diaphragmatic breathing: place hand over abdomen as resistance- encourage engaging muscle
Pursed lip breathing: creates resistance to help push air out (emphysema)
positioning for COPD
upright
in a chair
”Hypoxic Drive to Breath”
- Normal drive to breath controlled by CO2 changes
- COPD loses CO2 drive and gets O2 drive
- Hypoxic drive to breath controlled by O2 levels
- Change in threshold: Maintain SpO2 at 88-92%
ex: if on 15 L @ 94% turn them down to get to 92%
- Know your patient’s home O2 level- try to keep them there
- Know your patient’s baseline ABG
-Positive Pressure Ventilation-
9expands alveoli to increase ventilation (BIPAP)
exercise conditioning for copd?
May be formal or informal
Start slow, rest periods and slowly increase overtime (as tolerated)
May require use of oxygen
2-3 X’s per week
goal: keeps muscles strong to help with breathing
suctioning for copd?
Only as needed
Nasotracheal Suctioning
Hydration for copd?
2-3 L per day
Humidity
Vibratory Positive Pressure Devices
Flutter Valve: Helps to remove secretions
anxiety management for copd?
Positioning Breathing techniques Support groups Therapeutic communication ***** Rest Anti-anxiety medication
nutrition for copd?
Increased protein and calorie needs
High calorie
High Protein
Malnutrition can worsen disease Small & frequent meals Food selection Pre-medicate before meals- give albuterol before meals
Care Coordination
Home health care Oxygen Equipment Understanding long term health challenges & management Goal setting- palliative care
normal ranges for ABG
pH: 7.35-7.45.
(PaO2): 80 to 100 mmHg.
(PaCO2): 35-45 mmHg.
Bicarbonate (HCO3): 22-26 mEq/L.
ROME
High CO2= acidosis
High Bicarb = alkalosis
