COPD Flashcards
Protein that is deficient when a person develops COPD genetically
Alpha antitrypsin
What is airflow obstruction usually due to with COPD, especially chronic bronchitis?
Mucous Hypersecretion
Mucosal edema
Bronchospasm
How is COPD diagnosed?
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
What are expected ABG findings for later stages of COPD?
Low PaO2
Increased PaCO2
Decreased pH (high acidity)
increased bicarbonate level (b/c kidneys eventually help compensate)
What happens with longstanding COPD progression?
*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)
What does pulmonary HTN lead to?
*Cor Pulmonale
(Hypertrophy of right side of heart)
*Which eventually causes right-sided heart failure
S/S of Cor Pulmonale
*Dyspnea, possible lung crackles
*Distended neck veins
Hepatomegaly with RUQ tenderness
*Peripheral edema
*Weight gain (from edema)
Diagnostic studies for Cor Pulmonale
Chest X-ray
*Echocardiogram (US of heart)
Multigated acquisition (MUGA) scan (To evaluate heart fx)
*BNP levels (ventricles release BNP when they’re overloaded)
What drug class are SABAS from?
B2 Adrenergic agonists
Example of SABAS
Albuterol (proventil HFA, Ventolin HFA)
Use of SABAS
Onset and duration
Acute bronchospasm
Onset of action in minutes and duration of 4 to 8 hrs
How do SABAS work?
Prevent release of inflammatory mediators from mast cells
Side effects of SABAS
Tremors
Anxiety
Tachycardia
Palpitations
(Not for long term use)
Drug class of LABAS
B2 Adrenergic agonists
Examples of LABAs
Salmeterol (Severent)
Formoterol (Foradil)
Use of LABAS
Bronchodilation
Decrease need for SABAs
Class of SAMAS & LAMAS
Anticholinergics
Example of SAMA
Ipratropium (Atroventt HFA)
Example of LAMA
Tiotropium (Spiriva)
Action of SAMAS and LAMAs
Bronchodilators muscles around bronchi (b/c irritated lungs can result in constricted muscles around bronchi)
Side effects of SAMAS and LAMAS
Bladder pain
Difficulty urinating
Dark urine
Cough
Dyspnea
Chest tightness
Wheezing
Anticholinergics are contraindicated for which two conditions?
BPH
Glaucoma
How do Methylxanthines work?
Bronchodilator class that alleviated early phase of attacks but has little effect on bronchial hyperresponsiveness
Example of methylxanthines
Theophylline
Nursing consideration when administering theophylline
Narrow margin of safety, need to monitor serum levels
Drug therapy for pts with COPD FEV1 < 60%
LABA
ICS (inhaled corticosteroids)
Example of inhaled corticosteroids
Fluticasone/Salmeterol (Advair)
Function of inhaled corticosteroids (ICS)
Reduce bronchial hyperresponsiveness
Decrease mucous production
(Inhaled form - long term control)
Nursing considerations when administering ICS
Fixed schedule
Side effects can be reduced by using a spacer or by rinsing mouth after each use
Antibiotic that may be prescribed for a COPD pt to take daily
Azithromycin (Zithromax)
(Anti-inflammatory/immune effect)
Phosphodiesterase inhibitor that may be prescribed for pts with COPD
Roflumilast (Daliresp)
(Suppresses cytokine release/anti inflammatory action)
Mainstay of COPD treatment
Bronchodilators
Acceptable O2 sat for COPD patient
88-92%
Acceptable PaO2 for pt with COPD
> 60 mm Hg
Best O2 delivery system for pts with COPD
Low flow is most common
*But Venturi mask is more precise so better for COPD pts
Why is a pt with COPD likely to be malnourished?
Increased inflammatory mediators
Increased metabolic rate
Lack of appetite
