COPD

Question 1

• diseases that cause obstruction of the airways, usually through a combination of bronchoconstriction and inflammation
• includes asthma, acute or chronic bronchitis, emphysema

Answer 1

obstructive pulmonary diseases

Question 2

• a specific progressive disorder that slowly alters the structures of the respiratory system over time, irreversibly affecting lung function
• periodic exacerbations, often related to respiratory infection, with increased symptoms of dyspnea and sputum
• not curable
• typically includes components of both emphysema and bronchitis
• results from repeated exposure to irritants

Answer 2

Chronic Obstructive Pulmonary Disease (COPD)

Question 3

• condition related to COPD

- excessive bronchial mucous secretion

Answer 3

bronchitis

Question 4

• condition related to COPD

- destruction of the walls of the alveoli

Answer 4

emphysema

Question 5

what is the cause of COPD?

Answer 5

repeated exposure to irritants that begin to damage the structures in the lungs

Question 6

what happens in COPD when there is damage to the small and large airway passages?

Answer 6

• increase in mucous production
• arrest in cilia action
• fluid accumulates and causes edema
• edema cases air trapping > hyperinflation of lungs

Question 7

• disorder of excessive bronchial mucous secretions
• characterized by productive cough lasting 3+ months in 2 consecutive years
• narrowed airways and excess secretions obstruct airflow
• expiration is affected first, then inspiration
• recurrent infection is common
• cigarette smoking is strongly implicated

Answer 7

chronic bronchitis

Question 8

• disorder characterized by the destruction of the walls of the alveoli, with resulting enlargement of abnormal air spaces
• wall destruction causes alveolar spaces to enlarge, causing loss of portions of the capillary bed
• surface area for alveolar-capillary diffusion is reduced (affecting gas exchange)
• cigarette smoking is strongly implicated

Answer 8

emphysema

Question 9

what condition often exists as a comorbid disease with COPD?

Answer 9

asthma

Question 10

• progressive, nonreversible process of airway narrowing and loss of supporting tissue
• includes chronic bronchitis with persistent airway edema, excess mucous production and impaired airway clearance
• includes emphysema with loss of interstitial membranes and airway support tissue, resulting in airway collapse and loss of alveolar surface area for gas exchange
• small airway disease with bronchoconstriction

Answer 10

COPD

Question 11

what are the risk factors for COPD?

Answer 11

• smoking (80% of cases)

- short term exposure to high levels of irritating substances

Question 12

what increases as the effort to breathe increases?

Answer 12

caloric demand

Question 13

NOTE

classification of COPD by severity (BOB p1270)

Answer 13

stage 1: mild (usually chronic cough, sputum production, mild airflow limitation)
stage 2: moderate (SOB on exertion, worse symptoms than stage 1)
stage 3: severe (worse symptoms, with noticeable SOB)
stage 4: very severe (severe symptoms, respiratory failure or clinical signs of right heart failure)

Question 14

what are some diagnostic tests for COPD?

Answer 14

• PFT
• V-Q scanning
• serum alpha1-antitrypsin levels
• ABG
• pulse oximetry
• exhaled CO2
• CBC with WBC differential
• CXR

Question 15

COPD test:
-performed to establish diagnosis and evaluate progression of COPD
-based on calculated norms for individual based on age, height, sex, weight
-

Answer 15

Pulmonary Function Testing (PFT)

Question 16

COPD test:

• screening that may be performed to determine the extent to which lung tissue is ventilated but not perfused or perfused but inadequately ventilated
• radioisotope is injected or inhaled to illustrate areas of shunting or absent capillaries

Answer 16

Ventilation Perfusion Scanning (V-Q scanning)

Question 17

COPD test:

• screen for deficiency
• normal adult level range from 80 to 260 mg/dL

Answer 17

serum alpha1 antitrypsin levels

Question 18

COPD test:

-values used to evaluate gas exchange, particularly during acute exacerbations

Answer 18

Arterial Blood Gases (ABGs)

Question 19

COPD test:

• method of monitoring oxygen saturation of the blood
• marked airway obstruction and hypoxemia often cause levels of less than 95%

Answer 19

Pulse Oximetry

Question 20

COPD test:

• measurement to evaluate alveolar ventilation
• elevated when ventilation is inadequate and decreased when pulmonary perfusion is impaired

Answer 20

Exhaled Carbon Dioxide

Question 21

COPD test:

• blood test to detail the kinds and numbers of blood cells in your body
• addition of WBC can indicate infection, allergic reaction or toxic reaction

Answer 21

Complete Blood Count with White Blood Cell Differential

Question 22

COPD test:

• test that will show small white patches indicative of hyperinflated alveolar sacs filled with secretions that are common in emphysema
• advanced chronic bronchitis will show larger white area
• may show flattening of the diaphragm

Answer 22

Chest X-ray (CXR)

Question 23

what immunizations are recommended for COPD patients?

Answer 23

• pneumococcal pneumonia vaccine

- yearly flu vaccine

Question 24

NOTE

antibiotics

Answer 24

• broad spectrum may be prescribed if infection is suspected
• clients with purulent sputum and increased dyspnea (but no other signs of infection) may benefit from antibiotics
• prophylactic antibiotics may be ordered for clients who have more than 4 exacerbations a year

Question 25

what does PVD stand for?

Answer 25

postural, vibration, and postural drainage

Question 26

• forceful striking of the skin with cupped hands

- over congested areas can mechanically dislodge tenacious secretions from bronchial walls

Answer 26

percussion

Question 27

• series of vigorous quiverings produced by hands that are laid flat against the clients chest wall
• used after percussion to increase the turbulence of exhaled air and thus loosen thick secretions

Answer 27

vibrations

Question 28

• drainage by gravity of secretions from various lung segments
• wide variety of positions may be necessary to drain secretions
• assess client’s vital prior to this

Answer 28

postural drainage

Question 29

what is the order of steps for PVD therapy?

Answer 29

position > percussion > vibration > removal of secretions by coughing/suctioning

Question 30

why might heart sounds be difficult to hear in a patient who has COPD?

Answer 30

a barrel chest may make heart sounds more difficult to auscultate