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Med Surg > COPD > Flashcards

COPD Flashcards

1
Q

Protein that is deficient when a person develops COPD genetically

A

Alpha antitrypsin

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2
Q

What is airflow obstruction usually due to with COPD, especially chronic bronchitis?

A

Mucous Hypersecretion
Mucosal edema
Bronchospasm

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3
Q

How is COPD diagnosed?

A

Confirmed by spirometry (pulmonary fx test)
- FEV1 (forced expiratory vol in 1 sec) / forced vital capacity (whole amt they can forcefully exhale) ratio = <70%
- chest X-ray
- sputum culture and sensitivity if infection suspected
- ABGs
- COPD assessment test (CAT) - impact on ADLs

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4
Q

What are expected ABG findings for later stages of COPD?

A

Low PaO2
Increased PaCO2
Decreased pH (high acidity)
increased bicarbonate level (b/c kidneys eventually help compensate)

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5
Q

What happens with longstanding COPD progression?

A

*Pulmonary vascular changes:
- small pulmonary arteries constrict
- blood vessels thicken
= *pressure in pulmonary circulation increases

Results in *PULMONARY HYPERTENSION

(COPD often coexists with *CV diseases)

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6
Q

What does pulmonary HTN lead to?

A

*Cor Pulmonale
(Hypertrophy of right side of heart)
*Which eventually causes right-sided heart failure

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7
Q

S/S of Cor Pulmonale

A

*Dyspnea, possible lung crackles
*Distended neck veins
Hepatomegaly with RUQ tenderness
*Peripheral edema
*Weight gain (from edema)

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8
Q

Diagnostic studies for Cor Pulmonale

A

Chest X-ray
*Echocardiogram (US of heart)
Multigated acquisition (MUGA) scan (To evaluate heart fx)
*BNP levels (ventricles release BNP when they’re overloaded)

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9
Q

What drug class are SABAS from?

A

B2 Adrenergic agonists

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10
Q

Example of SABAS

A

Albuterol (proventil HFA, Ventolin HFA)

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11
Q

Use of SABAS
Onset and duration

A

Acute bronchospasm
Onset of action in minutes and duration of 4 to 8 hrs

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12
Q

How do SABAS work?

A

Prevent release of inflammatory mediators from mast cells

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13
Q

Side effects of SABAS

A

Tremors
Anxiety
Tachycardia
Palpitations
(Not for long term use)

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14
Q

Drug class of LABAS

A

B2 Adrenergic agonists

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15
Q

Examples of LABAs

A

Salmeterol (Severent)
Formoterol (Foradil)

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16
Q

Use of LABAS

A

Bronchodilation
Decrease need for SABAs

17
Q

Class of SAMAS & LAMAS

A

Anticholinergics

18
Q

Example of SAMA

A

Ipratropium (Atroventt HFA)

19
Q

Example of LAMA

A

Tiotropium (Spiriva)

20
Q

Action of SAMAS and LAMAs

A

Bronchodilators muscles around bronchi (b/c irritated lungs can result in constricted muscles around bronchi)

21
Q

Side effects of SAMAS and LAMAS

A

Bladder pain
Difficulty urinating
Dark urine
Cough
Dyspnea
Chest tightness
Wheezing

22
Q

Anticholinergics are contraindicated for which two conditions?

A

BPH
Glaucoma

23
Q

How do Methylxanthines work?

A

Bronchodilator class that alleviated early phase of attacks but has little effect on bronchial hyperresponsiveness

24
Q

Example of methylxanthines

A

Theophylline

25
Q

Nursing consideration when administering theophylline

A

Narrow margin of safety, need to monitor serum levels

26
Q

Drug therapy for pts with COPD FEV1 < 60%

A

LABA
ICS (inhaled corticosteroids)

27
Q

Example of inhaled corticosteroids

A

Fluticasone/Salmeterol (Advair)

28
Q

Function of inhaled corticosteroids (ICS)

A

Reduce bronchial hyperresponsiveness
Decrease mucous production
(Inhaled form - long term control)

29
Q

Nursing considerations when administering ICS

A

Fixed schedule
Side effects can be reduced by using a spacer or by rinsing mouth after each use

30
Q

Antibiotic that may be prescribed for a COPD pt to take daily

A

Azithromycin (Zithromax)
(Anti-inflammatory/immune effect)

31
Q

Phosphodiesterase inhibitor that may be prescribed for pts with COPD

A

Roflumilast (Daliresp)
(Suppresses cytokine release/anti inflammatory action)

32
Q

Mainstay of COPD treatment

A

Bronchodilators

33
Q

Acceptable O2 sat for COPD patient

A

88-92%

34
Q

Acceptable PaO2 for pt with COPD

A

> 60 mm Hg

35
Q

Best O2 delivery system for pts with COPD

A

Low flow is most common
*But Venturi mask is more precise so better for COPD pts

36
Q

Why is a pt with COPD likely to be malnourished?

A

Increased inflammatory mediators
Increased metabolic rate
Lack of appetite

Med Surg (12 decks)

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