COPD

Question 1

Nursing interventions to reduce dyspnea in patient with COPD?

Answer 1

Pursed lip breathing to prolong exhalation, prevent airway collapse, and reduce feelings of breathlessness.

Question 2

Primary aspect of respiratory assessment?

Answer 2

Auscultation during inhalation and exhalation (its first because of ABCs).

Question 3

Primary factor in chronic inflammatory response in COPD?

Answer 3

Driven by activation of neutrophils and macrophages, which release enzymes and inflammatory mediators contributing to tissue damage.

Question 4

Characteristics of respiratory acidosis with metabolic compensation?

Answer 4

pH on acidic side, elevated PaCO2, increased bicarbonate reflect body’s metabolic compensation to normalize pH, and paO2 reflects impaired gas exchange.

Question 5

2 types of COPD?

Answer 5

Emphysema and chronic bronchitis

Question 6

What is emphysema?

Answer 6

Destructive problem of lung elastic tissues that reduces its ability to recoil after stretching which leads to hyperinflation of lungs. Results in dyspnea and reduced gas exchange.

Question 7

Primary and secondary emphysema?

Answer 7

P- linked to decrease in enzyme alpha1-antitrypsin
S- due to cigarette smoke as main cause, sometimes long term exposure to air pollution

Question 8

What is COPD?

Answer 8

Collection of lower airway disorders that interfere with airflow/gas exchange.

Question 9

What is chronic bronchitis?

Answer 9

Long term Inflammation of bronchitis/bronchioles characterized by increase in mucus/chronic cough. Bronchioles walls thicken/mucus builds up leading to reduced air flow. Causes- inspired irritants like cig smoke.

Question 10

Causes of COPD?

Answer 10

Smoking (most cases), environmental exposures (high levels of fumes, fossil fuels, coal mining, chemical industries), infection, heredity (antitrypsin deficiency), and aging

Question 11

What are blebs and bullae?

Answer 11

Blebs- small air filled blister that form on surface of lungs when alveoli are weak/burst
Bullae- air filled tissues that cause loss of elastic recoil and collapse, they result from multiple destroyed alveoli and make gas exchange worse

Question 12

Defining features of COPD?

Answer 12

Airflow obstruction, mucous hyper secretion, bronchus spasms, hyperinflation of lungs

Question 13

Physical exam findings for COPD?

Answer 13

Prolonged exhalation, wheezes, decreased breath sounds, barrel chest (increase in anterior-posterior diameter), blue-red colour of skin, tripod position (compensates to get air into lungs), and trouble with ALDS/exercise. They can also be underweight, have chronic fatigue, accessory muscle use, and have a thin appearance.

Question 14

What is cor pulmonale?

Answer 14

Right side HF caused by COPD. Airway collapse and lung tissue pressure is increased/blood vessels narrow which makes blood flow difficult. Right heart chambers will thicken because of the work needed to pump the blood into the lungs/need to overcome pressure. Causes HF

Question 15

S+S of cor pulmonale?

Answer 15

Hypoxia, hypoxemia, fatigue, increasing dyspnea, enlarged liver, cyanotic lips, distended neck veins, warm/cyanotic hands and feet, and bounding pulses.

Question 16

3 complications from COPD?

Answer 16

Exacerbations, cor pulmonale, and acute respiratory failure.

Question 17

Exacerbations of COPD?

Answer 17

Causes by infection mostly, and air pollution. Signalled by change in the usual (dyspnea, cough, sputum)

Question 18

Acute respiratory failure?

Answer 18

Causes by exacerbation of COPD and they get really sick. They look blue, resps go up, and sats go down. Infection makes symptoms worse by increasing inflammation and mucus.

Question 19

Diagnostic tests for COPD?

Answer 19

PFT, sputum C+S (to check infection), ECG (check for Right side HF), chest x rays (hyper-inflation), ABG values, echocardiogram, and spirometry.

Question 20

Pulmonary function test?

Answer 20

FEV1 is volume of air blown out as hard/fast as possible during 1st second of most forceful exhalation. COPD classified from mild to very severe based on PFT.

Question 21

ABG normal values? Values expected for COPD?

Answer 21

PaO2: 80-100
pH: 7.35-7.45
PaCO2: 35-45
Bicarbonate: 22-26
SaO2: 95-100
Low PaO2, decreased pH (acidic), increased PaCO2, and increased bicarbonate in late stages.

Question 22

Respiratory acidosis, alkalosis and metabolic acidosis/alkalosis description and S+S?

Answer 22

RAc- retention of CO2 (increased), pH decreased, bicarbonate increased (causes hypoxia, decreased BP, dizzy, dyspnea, and muscle weakness)

RAl- excretion of CO2 (decreased), pH increased, causes seizures/lethargy/tachycardia/nausea/vomit/N&T

MAc- pH low, bicarbonate low (throw up)

MAl- pH increased (basic), increase in bicarbonate, excessive renal loss (poop too much)

Question 23

True or false: Pt with COPD have higher rates of depression/panic disorder

Answer 23

True. It’s r/t feelings of not being able to breathe, loss of function, fear of death, and exhaustion.

Question 24

What to monitor in COPD?

Answer 24

Impaired gas exchange, ineffective airway clearance (mucous), imbalanced nutrition (less than body requires), disturbed sleep, increase anxiety, and risk for infection.

Question 25

O2 therapy for COPD?

Answer 25

Give low flow, prevent over oxygenating, sit between 88-92%

Question 26

Interventions for COPD?

Answer 26

Practice purse lip breathing, coughing (before meals, when rising in morning, before bed), exercise conditioning, hydrate (2L/day), deep breathing, elevate HOB, and medications.

Question 27

Medications for COPD?

Answer 27

Steroids (for exacerbations), bronchodilators (to relax muscles around airways and open them up), anti-inflammatories, antibiotics (respiratory infections)

Question 28

Nutrition for COPD patients?

Answer 28

Pt are prone to dyspepsia. Food should be high calorie/protein rich. Eat small frequent meals through the day (avoid dry food and caffeine containing drinks).

Question 29

How does smoking affect our lungs?

Answer 29

Cigarette smoke triggered increased synthesis of protease enzymes (destroy and eliminate particles inhaled). This can damage the alveoli and small airways by breaking down elastin. Over time the alveolar space will loose their elastic recoil and collapse.