COPD Flashcards
is a preventable and treatable slowly progressive respiratory disease of airflow obstruction involving the airways, pulmonary parenchyma, or both.
COPD
3rd leading cause of death worldwide accounting for 3.23 million deaths in 2019
COPD
Presence of chronic productive cough for 3 months in each of 2 consecutive years in a patient in whom other causes of chronic cough have been excluded
Chronic Bronchitis
An abnormal permanent enlargement of the air spaces distal to the terminal bronchioles, accompanied by destruction of their walls and without obvious fibrosis
Emphysema
Risk factors of COPD
-Cigarette smoking
-Occupational chemicals and dusts
-Air pollution
-Infection
-Genetics
-Aging
An autosomal recessive disorder that may affect the lungs or liver.
a-Antitrypsin (AAT) Deficiency
Purpose of AAT (a-Antitrypsin Deficiency)
AAT protects normal lung tissue from attack by proteases during inflammation related to smoking and infection
Clinical Manifestations of COPD (Early)
-Chronic intermittent cough (Earliest sign)
-Dyspnea on exertion
-Inability to deep breathe
-Heaviness on chest
-Gasping
-Increased effort to breath
-Air hunger
-Rationalization (defense mechanism)
Clinical Manifestations of COPD (Late)
-Dyspnea at rest
-Use of accessory muscles
-Wheezing
-Chest Tightness
Clinical Manifestations of COPD (Advanced)
-Fatigue
-Weight loss
-Anorexia
-Barrel Chest
-Pursed-lip breathing
-Tripod Positioning
-Cor pulmonale
Classification of GOLD 1 is
Mild
Classification of GOLD 2 is
Moderate
Classification of GOLD 3 is
Severe
Classification of GOLD 4
Very severe
Medical Management of COPD
-Smoking cessation
-Drug therapy (Bronchodilators, as ordered)
Bronchodilators for Mild COPD
Use short-acting bronchodilators
Bronchodilators for Moderate COPD
Used long acting bronchodilators
Nusing care of patient taking LABA + ICS Combo
-Have the patient to rinse the mouth after using the inhaler because this will help to decrease systemic absorption and decrease GI upset and nausea.
-Monitor the patient for any sign if respiratory infection.
Bronchodilators for severe COPD
Rofumilast (Daliresp)
Used to decrease the frequency of exacerbations
Rofumilast (Daliresp)
Medical Management for COPD
-Oxygen Therapy
Best method of mask for COPD is
Venturi Mask
Administers precise, high-flow rates of oxygen
Venturi Mask
Tobacco Rregulation Act
RA 9211
is a chronic, irreversible dilation of the bronchi and bronchioles that results from destruction of muscles and elastic connective tissue.
Bronchiectasis
Bronchiectasis Risk Factors
-Recurrent respiratory infections
-Cystic fibrosis
-Rhematic and other systemic diseases
-Tuberculosis
-Immunodeficiency disorders
Clinical Manifestations of Bronchiectasis
-Chronic Cough (negative for PTB)
-Sputum Production
-Hemoptysis
-Clubbing of fingers
-History of repeated infections
Surgical removal of a segment of a lobe
Segmental resection
Surgical removal of a lobe
Lobectomy
Surgical removal of an entire lung
Pneumonectomy
Segmental resection and Lobectomy Position
Position in semi-fowlers or on UNAFFECTED SIDE
Pneumonectomy Position
Position in semi-fowlers or on
AFFECTED SIDE
Is a heterogenous disease, usually characterized by chronic airway inflammation which causes airway hyperresponsiveness, mucosal edema, and mucus production9
Asthma
The two distinct disease processes is :
-Chronic Bronchitis
-Emphysema
A generalized term in which person is thin, breathing fast and is pink
Pink Puffers
A generalized term referring to a person who is blue and overweight
Blue boater
Enzyme inhibitor that protects the lung parenchyma from injury.
alpha-antitrypsin
Meaning of FEV
Forced Expiratory Volume
How we classify COPD?
Level of Severity
Drug of Choice for short-acting bronchodilators in COPD
Salbutamol- ipratropium (Pulmodual, Duoneb)
Long Acting Bronchodilators drugs:
Salmeterol (as monotherapy)
Formoterol (as monotherapy)
Drugs for long-acting anticholinergic
Tiotropium (Spiriva)
Rofumilast classifications
Phosphodiesterase inhibitor
Nursing care of patients on oxygen therapy
-Assess need for adjustments in 02 flow rate
-Evaluate response to 02 therapy
-Monitor patient for signs of adverse effects of 02 therapy
-In many cases, choose the optimal 02 delivery device (nasal cannula, simple face mask)
Nursing Management for COPD
-Administer medication and oxygen therapy, as ordered
-Instruct patient to eliminate, if not reduce, pulmonary irritants
-Instruct patient to perform “directed coughing” or “huff” coughing
-Facilitate chest physiotherapy
-Encourage increased fluid intake
-Provide bland aerosol mist
-Encouraged pursed-lip breathing
-Encourage patient to pace activities throughout the day or use supportive devices to decrease energy expenditures
Coughing that consists of a slow, maximal inspiration followed by breath-holding for several seconds and then two or three coughs.
Directed coughing
Consists of one or two forced exhalations (huffs) from low to medium lung volumes with the glottis open
Huff coughing
Steps in chest physiotherapy
- Positioning
- Vibration
- Coughing
Medical Management of Bronchiectasis
-Chest Physiotherapy
-Smoking cessation
-Antibiotic therapy, as ordered
-Bronchodilator, as ordered
-Mucolytic, as ordered
Nursing Care of Patients undergoing Lung Surgery
-Preoperative preparations
-Obtain an infection free tracheobronchial tree
-Chest physiotherapy
-Antibiotic therapy, as ordered
-Direct suctioning through bronchoscope (collaborative)
-Segmental resection and Lobectomy
The purpose of positioning the patient in Semi-Fowlers on Unaffected side
To allow expansion of affected lung
The purpose of positioning the patient in Semi-Fowles turned on Affected side
To promote lung expansion and prevent flooding of the remaining lung expansion and prevent flooding of the remaining lung with blood from the affected part
It is a largely reversible, unlike COPD
Asthma
Risk factors and Triggers of Asthma
-Genetics
-Immune response
-Allergens
-Exercise
-Air pollutants
-Occupational factors
-Respiratory tract infection
-Nose and sinus problems
-Drugs (NSAIDS, Beta Blockers and ACE inhibitors)
-GERD
-Psychologic Factors
The genetic predisposition to develop an allergic response to common allergens (IgE- mediated
Atopy
A newborn baby’s immune system must be educated so it will function properly during infancy and the rest of life
Hygiene hypothesis
Asthma that is induced or exacerbated during physical exertion
Exercised-induced asthma
Clinical Manifestations of Asthma
-Cough
-Tachypnea
-Dyspnea
-Wheezing
-Diaphoresis
-Tachycardia
-Widened pulse pressure
-Central cyanosis (Late)
Symptoms occur fewer than 2x per week
Mild Intermittent
Symptoms occur 3-6 times per week
Mild Persistent
Symptoms occur daily
Moderate Persistent
Symptoms occur continuously
Severe Persistent
Emergency Medical Management
O- Oxygen
S-Salbutamol (Nebulize)
H- Hydrocortisone
I- Ipratropium
T- Theophylline
Medical Management of Asthma
-Management is based on the Global Initiative for Asthma (GINA)
Goals of GINA:
-Decrease asthma morbidity and mortality
-Improve management of asthma worldwide
Goals of Asthma Treatment:
Achieve and maintain control of the disease
Medication of choice for relief of acute symptoms of EIA
Salbutamol (Ventolin)
Salbutamol is a
Short-acting Beta2-adrenergic Agonist (SABA)
Relaxes smooth muscles thereby promoting bronchodilation
Salbutamol (Ventolin)
Inhibits muscarinic cholinergic receptors and reduce intrinsic vagal tone of the airway
Ipratropium (Atrovent)
Given if the patient cannot tolerate SABA
Ipratropium (Atrovent)
Ipratropium is a
Anticholinergic
Is a plastic container with a mouthpiece or mask at one end, and space to insert an inhaler at the other.
Space device
Device used for inhaled corticosteroids
Spacer
Mast cell stabilizer
Cromolyn sodium
Indications of Cromolyn Sodium
-Alternative for corticosteroids
-Prophylaxis for EIA
-Prevents attacks in unavoidable exposure to known triggers
Mild to moderate bronchodilator
Theophylline
Relief of night time symptoms
Theophylline
Theophylline is a
LABA (Long Acting Beta Agonist)
Theophylline Toxicity:
STARV
S-sweating
T-Tachycardia
A-Anxiety
R-Restlessness
V-Vomiting
Acts either by interfering with leukotriene synthesis or by blocking the receptors where leukotrienes exert their action
Montelukast (Singulair)
Montelukast (Singulair) is a
Leukotriene inhibitor
May be used as alternative to ICS for mild persistent asthma
Montelukast (Singulair)
Binds to circulating IgE, preventing it from binding to receptors on mast cells
Omalizumab (Xolair)
Indication of Omalizumab (Xolair)
Used for patients with allergies and severe persistent asthma
Nursing Management of Asthma
-Monitor respiratory rate, depth, and effort
-Auscultate breath sounds
-Note the declining level of awareness or consciousness
-Note skin color, temperature, and moisture.
-Encourage and assist with deep-breathing exercises, turning, and coughing. Suction as necessary
-Provide airway adjunct as indicated. Place in semi-fowlers position
Rapid onset, severe, and persistent asthma that does not respond to conventional therapy and occurs with little or no warning
Status Asthmaticus
Risk Factors of Status Asthmaticus
-Infection
-Anxiety
-Nebulizer abuse
-Dehydration
-Increased adrenergic blockage
-Non-specific irritants
-Hypersensitivity to medications
Clinical Manifestations of Status Asthmaticus
-Same with asthma but does not respond to conventional treatment
-Disappearance of wheezing- indicates total obstruction of airway and an impending sign of respiratory failure
Medical Management of Status Asthmaticus
-High-flow supplemental oxygen, as ordered
-Use partial or non-breather mask
-SABA, as ordered
-Systemic corticosteroids, as ordered
-IV fluids, as ordered (for hydration)
-Magnesium sulfate IV infusion, as ordered
Nursing Care of Patient on Partial or Non-Rebreather Masks
-O2 flows into reservoir bag and mask during inhalation.
-This bag allows patient to rebreathe about first third of exhaled air (rich in O2) in conjunction with flowing O2.
-O2 flow rate must be sufficient keep bag from collapsing during inspiration to avoid CO2 build-up
-If deflation occurs, increase liter flow to keep bag inflated.
-Mask should fit snugly
-With non-rebreather masks, make sure valves are open during expiration and closed during inhalation to prevent drastic decrease in FiO2
Which of the following must be ordered for quick relief of bronchospasm in the medical management of Status Asthmaticus?
a. SABA c. Montelukast
B. LABA d. Theophylline
SABA
Side effects of Magnesium Sulfate IV infusion
-Facial warmth
-Flushing
-Tingling
-Nausea
-Central nervous depression
-Respiratory depression
-Hypotension
