COPD Flashcards
Emphysema
characterized by the irreversible damage to the air sacs in the lungs, leading to their enlargement and reduced elasticity thus making exhalation difficult
Chronic Bronchitis
a persistent inflammation of the bronchial tubes, which carry air to and from the lungs
Effects of smoking on COPD
Most common cause
- Stimulates sympathetic nervous system: HR, BP (vasoconstriction), increase in cardiac workload
- Nicotine: decreases amount of functional HgB, increase platelet aggregation, and further complicates coronary artery disease
Bullae
air spaces in the parenchyma
Take away gas exchange site – takes away functional tissue
Blebs
air spaces adjacent to parenchyma
Take away gas exchange site – takes away functional tissue
Clinical Manifestations of COPD
- Dyspnea
- Chest breathing
- Respiratory Acidosis
- Prolonged expiratory phase
- Wheeze
- Decreased breath sounds
- Bluish-red color of skin
- Underweight
- Fatigue
5 Complications of COPD
- Cor Pulmonale
- Exacerbations
- Acute Respiratory Failure
- Peptic Ulcer Disease
- Depression Anxiety
Explain pathophysiology of cor pulmonale
- hypoxia, acidosis, and hypecapnia are present in COPD
- this leads to polycythemia (increasing blood’s viscosity) and pulmonary vasoconstriction
- this causes pulmonary hypertension, making it difficult for the RV to pump blood through the pulmonary system
- this leads to RV hypertrophy and this RS HF
Define COPD Exacerbation
A sustained worsening of dyspnea, cough or sputum production leading to an increase in the use of maintenance medications and/ or supplementation with additional medications.
What are the signals that someone is experiencing a COPD exacerbation?
Change in usual
- dyspnea
-cough
-sputum
What triggers a COPD exacerbation?
Mainly infection !!
also pollutants
How are COPD exacerbations further classified?
Purulent vs non purulent
What causes acute respiratory failure?
- Caused by
- Exacerbations
- Cor pulmonale
- Discontinuing/changes to bronchodilator or corticosteroid medicatio
What confirms COPD diagnosis?
PFT
FEV 1
Measurement used in PFT
volume of air blown out as hard and fast as possible during the first second of the most forceful exhalation after the greatest full inhalation
FVC
functional vital capacity
total amount of air exhaled during the FEV test
Normal ratio/PFT result
Ratio between FEV1 and FVC should be around 70-80
PaO2 normal value
80-100
PaCO2 normal value
35-45
pH normal value
7.35-7.45
HCO3 normal value
- 22 to 26
Normal COPD ABG results (PaO2, PaCO2, pH, bicarb)
- Low PaO2
- ↑ PaCO2
- ↓ pH (the higher the CO2 the more acidic the blood is)
- ↑ Bicarbonate level found in late stages of COPD
Normal trigger vs COPD trigger to breath
- Hypercapnia is normal trigger to breath
- Hypoxia is COPD trigger to breath – cautious in turning off trigger
How do you preserve the CO2 drive in COPD patients
titrate to lowest effective dosage needed for EACH pt
Ventolin, Atrovent, Combivent are examples of
SABA
SABA MOA
help relax the tight muscles around airways therefore opening them up and making it easier to breathe
Flovent, Pulmicort, Spiriva, Advair, Symbicort are examples of
LABA and combination to CONTROL
Controller COPD medications MOA
- help prevent respiratory symptoms such as wheezing, coughing, and SOB
Key points about nutrition for COPD
- Patients prone to dyspepsia, dyspnea affects intake and tolerance of foods/ meals
- High calorie, protein rich, small frequent meals
Key points about fluids for COPD
- High intake of fluids: 2-3 Liters/ day to loosen secretions
