COPD

Question 1

What is lost in COPD?

Answer 1

alveolar tissue

Question 2

Is COPD reversible

Answer 2

no

Question 3

COPD presents with progressive airflow ____.

Answer 3

obstruction

Question 4

With bronchiloar and alveolar destruction, what is lost?

Answer 4

Pulmonary elastic recoil

Question 5

What is the main risk factor for COPD?

Answer 5

inhalation of toxic chemicals from cigarettes

Question 6

What is a risk factor for COPD that is r/t childhood?

Answer 6

Low birth weight & alpha1-antitrypsin deficiency

Question 7

What work environments contribute to COPD?

Answer 7

coal mining, gold mining, and textile b/c of exposure to dust and chemicals

Question 8

What normally maintains the airways in an open position?

Answer 8

elasticity of the lung parenchyma

Question 9

COPD ___ the rigidity of the bronchilaor wall.

Answer 9

decreases

Question 10

B/c COPD decreases the rigidity of bronchiolar walls, the lungs are more likely to do what?

Answer 10

collapse during exhalation

Question 11

Increased gas flow in narrowed bronchioli leads to a ____ pressure. What does this cause?

Answer 11

decreased

airway collapse

Question 12

Increased pulmonary secretions with COPD causes what 2 things:

Answer 12

active bronchospasm

obstruction

Question 13

Air sacs will ____ in size with COPD

Answer 13

enlarge

Question 14

What eventually develops with COPD

Answer 14

emphysema

Question 15

COPD destroys lung ____

Answer 15

parenchyma

Question 16

the 3 main s/s of COPD

Answer 16

DOE or at rest
chronic cough
chronic sputum production

Question 17

As expiratory flow obstruction increases in severe COPD, RR ____ and a ____ expiratory time are evident.

Answer 17

increases

prolonged

Question 18

BS are ____ in COPD

Answer 18

decreased

Question 19

What adventitious BS is common in OCPD

Answer 19

expiratory wheezes

Question 20

What is needed to definitively dx COPD?

Answer 20

Spirometry

Question 21

What is PFT result in COPD

Answer 21

decrease FEV1:FVC ratio

Question 22

An FEV1:FVC ratio <___ of predicated that is not _____ confirms COPD dx.

Answer 22

70%

reversible w/ bronchodilators

Question 23

COPD - FRC

Answer 23

increased

Question 24

COPD - TLC

Answer 24

increased

Question 25

CXray is senstive test for COPD T/F

Answer 25

false

Question 26

When will ABGs show COPD?

Answer 26

w/ severe dx

Question 27

The PaO2 in a pt with COPD usually does not decrease until the FEV1 is <____

Answer 27

50%

Question 28

What are two therapeutic interventions that may alter history of COPD?

Answer 28

smoking cessation | long-term O2 admin

Question 29

Home O2 therapy is recommended if PaO2 is <___ in COPD patients

Answer 29

55

Question 30

For COPD, home O2 therapy is recommended if Hct is ____

Answer 30

above 55%

Question 31

For COPD, home o2 is recommended if there is evidence of what disease?

Answer 31

cor pulmonale

Question 32

For COPD, the goal of O2 is to achieve a PaO2 of ___

Answer 32

>60

Question 33

What 3 drug clasess are often used in combination for COPD?

Answer 33

long acting B2 agonist inhaled corticosteroid Long-acting anticholinergic

Question 34

During COPD exacerbations what 3 meds might be necessary?

Answer 34

Abx Systemic corticosteroids Theophylline

Question 35

Exacerbations of COPD are always infective. T/F

Answer 35

False - can be noninfective or infective

Question 36

Diuretics can cause ____ depletion

Answer 36

chloride

Question 37

Chloride depletion can cause what ABG

Answer 37

hypochloremic metabolic acidosis

Question 38

Diuretic-induced chloride depletion may produce a hypochloremic metabolic alkalosis that _____ the ventilatory drive and may aggravate chronic carbon dioxide retention.

Answer 38

depresses

Question 39

Further pulmonary evaluation is indicated with hypoxemia at ___

Answer 39

RA

Question 40

Further pulmonary evaluation is indicated with a bicarb of ___

Answer 40

>33

Question 41

Further pulmonary evaluation is indicated with a PCO ____

Answer 41

>50

Question 42

Further pulmonary evaluation is indicated with a history of _____

Answer 42

respiratory failure

Question 43

Further pulmonary evaluation is indicated with severe _____

Answer 43

SOB attributed to dx

Question 44

Further pulmonary evaluation is indicated with a planned _____ procedure

Answer 44

pneumonectomy

Question 45

Further pulmonary evaluation is indicated with difficulty in assessing _____ by just clinical signs

Answer 45

pulmonary function

Question 46

Further pulmonary evaluation is indicated with need to determine resposne to ?

Answer 46

bronchodilation

Question 47

Further pulmonary evaluation is indicated with supstected ____

Answer 47

PHTN

Question 48

Encourage smoking cessation for _____

Answer 48

6 weeks

Question 49

Intraoperative suggestions for COPD

Answer 49

minimally invasive techniques regional shorter surgeries

Question 50

COPD - avoid surgical procedures likley to last longer than ______

Answer 50

3 hours

Question 51

Poor nutritional statue w/ a low ______ <3.5 is a powerful predictor of post op pulmonary complications in COPD

Answer 51

albumin

Question 52

COPD - regional anesthesia is suitable for operations that do not invade ___ or are performed on ____.

Answer 52

peritoneum; extremities

Question 53

COPD - Use of regional anesthetic techniques that produce sensory anesthesia above ___ is not recommended.

Answer 53

T6

Question 54

In COPD a high block can impair ventilatory functions requiring active ____.

Answer 54

exhalation

Question 55

In COPD, active exhalation can affect ERV, PEFR, and _____

Answer 55

max minute ventilation.

Question 56

Emergence from anesthesia with inhaled agents is ____ in COPD patients.

Answer 56

prolonged significantly

Question 57

Why is inhaled emergence prolonged in COPD patients?

Answer 57

Air trapping also traps the agent as they try to flood out of the various body compartments into the lungs

Question 58

At ETT bypassess most of the natural airway ___ system

Answer 58

humidification

Question 59

T/F: patients with copd are at a decreased risk of lung injry

Answer 59

false -increase risk

Question 60

The goal of mechanical ventilation in COPD patients is to prevent _____ and avoid ____.

Answer 60

development of auto-PEEP; | dynamic hyperinflation of lungs

Question 61

When does auto-PEEP occur?

Answer 61

Positive pressure ventilation is applied and insufficient expiratory time is allowed

Question 62

Auto Peep increases ______

Answer 62

intrathoracic pressure

Question 63

Auto peep impeded ______ return

Answer 63

venous

Question 64

With auto peep, the elevated intrathoracic pressure is transmited where?

Answer 64

to the pulmonary artery

Question 65

What capnography signs indicate air-trapping in COPD patients that are mechanically ventilated?

Answer 65

CO2 concentration does not plateau but is still upsloping at the time of the next breath.

Question 66

An upsloping ETCO2 in COPD indicates what?

Answer 66

there is still admixture of air from dead space reducing the ETCO2