COPD

Question 1

Stages of COPD

Answer 1

-stage 1 (mild)
-stage 2 (moderate)
-stage 3 (severe)
-stage 4 (very severe or end stage)

Question 2

Pathophysiology

Answer 2

-airways stiff now from prolonged inflammation
-chest hyper-expansion (barrel shaped)
-pt can’t exhale well (retaining CO2) and can’t exchange has well (unable to get enough O2)

Question 3

Risk factors

Answer 3

-cigarette smoking (irritating smoke)
-passive smoking
-occupational: chemicals/dust
-air pollution
-infection: childhood
-genetics: looking at protective factors
-aging

Question 4

Clinical manifestations

Answer 4

-insidious
-copious mucous and chronic cough
-dyspnea on exertion
-hyperventilation and flattened diaphragm
-barrel chest
-tripod, pursed lip breathing
-anorexia, fatigue
-edema
-hypoxemia, hypercapnia
-blue/red skin

Question 5

Cor pulmonale (stage 3 or end stage)

Answer 5

-pulmonary HTN causes heart failure
-dyspnea, lungs sounds clear or with crackles

Question 6

COPD exacerbation

Answer 6

-sudden
-severity of sx worsen
-increase in frequency as disease progresses
-caused by infections or air/environmental sources

Question 7

Exacerbations/acute respiratory insufficiency/failure cause

Answer 7

-failure to seek treatment quickly
-overuse of sedatives may suppress the resp drive

Question 8

Depression/anxiety

Answer 8

-Always air “hungry”
-high life changes as disease progresses

Question 9

Medical management of COPD

Answer 9

-smoking cessation!!
-drug therapy: bronchodilator, corticosteroids, vaccines, antibiotics, mucolytics

Question 10

Medical management of exacerbations

Answer 10

-ID cause if possible
-try to prevent
-hospitalization if indicated and possible ICU
-first line tx is supplemental O2
-rapid assessment

Question 11

Oxygen therapy-short or long term

Answer 11

-combustion: teach no smoking
-CO2 narcosis: loses drive to breathe (decrease o2)
-O2 toxicity: substernal discomfort, paresthesias, dyspnea, restless, fatigue, malaise, hypoxemia, atelectasis
-infection: mostly with heated nubilizer/humidifier
-teach safety

Question 12

Pulmonary rehab (grades 2-4)

Answer 12

-reduce sx
-improve QOL
-increase participation in ADLs
-improve exercise capacity
-decrease SOB
-decrease anxiety/depression

Question 13

Educations

Answer 13

-regular vaccinations
-physical conditioning
-rehab
-breathing exercises
-hydration
-energy conservation
-oxygen at home
-coping measure

Question 14

Airway clearance techniques

Answer 14

-prevent bronchospams!!
-decrease sputum production
-directed or huff coughing
-chest physiotherapy
-airway clearance devices

Question 15

Monitoring/managing potential complications

Answer 15

-resp status
-pulse oximetry
-oxygen PRN
-infection
-pneumothorax

Question 16

ABG @ a glance

Answer 16

-Early: norm or slight decrease pO2 and norm pCO2

-late: low pO2, high-norm or norm PaCO2, low norm pH, high or high norm HCO3

-monitor pt for progression towards worsening acidosis and hypoxemia