COPD Flashcards
cause obstruction of the airways, usually through a combo of bronchoconstriction and inflammation.
ie. asthma, bronchitis (chronic or acute) and emphysema
COPD; chronic obstructive pulmonary disease
COPD is used to describe a specific progressive disorder that slowly alters the structures of the respiratory system over time, irreversibly affecting lung function.
-periodic exacerbations, respiratory infection, with increased symptoms of dyspnea and sputum (mucus or mucopurulent matter expectorated from the lungs) production.
-airways and lung parenchyma do not return to normal.
-present progressive destructive changes
-Not Curable, but managed. Usually includes both chronic bronchitis and emphysema.
-narrowing of sm. bronchioles
Leads to impaired gas exchange.
Chronic obstructive pulmonary disease
repeated exposure to repiratory irritants that begin to damage the structures with in the lungs.
-damage to small and large airways cause increase mucous production.
Causing arrest in cilia action.
-excessive amounts of fluid accumulate with the lung mucosal cells, causing edema.
-resulting in airflow limitation.
-air trapping
-hyperinflation, leading to Bronchitis; (inflammation of the mucous membranes of the bronchial tubes)
Pathophysiology and Etiology
inflammation of the mucous membranes of the bronchial tubes
Bronchitis
disorder of excessive bronchial mucous secretions; productive cough. -lasts 3 or more months -cigarette smoking leading contibutor -Inhaled irritants; vasodilation, congestion, and edema of the bronchial mucosa `Goblet cells increase by size and # `mucous glands enlarge `thick mucous produced `impaired ability to clear
persistant airway edema, excessive mucous production, and impaired airway clearance.
Chronic bronchitis
Lilly; Cont. inflammation and low grade infection of the bronchi
destruction of the walls of the alveoli, with resulting enlargement of abnormal air spaces.
- inflammatory cells, surface area for alveolar-capillary diffusion is reduced, affecting air exchange.
- Elastic recoil is lost, reducing Vol. air
- cigarette smoking strong indicator
with loss of interstitial membranes and airway support tissue, resulting in Airway collapse and loss of alveolar surface area for gas exchange.
Emphysema
Lilly; cond. in which the air spaces enlarge as a result of the destruction of the alveolar walls
Not smoking, smoking cessation.
decrease exposure to 2nd hand smoke
occupational irritants, air pollutants
Prevention
Smoking #1
Occupational exposure to irritants
asthma suffers
9/11 victims
Risk Factors with COPD
forced expiratory volume in 1 second; is the amount of air that can be exhaled in 1 sec as measured by a spirometer
-reading and symptom manifestation
determinants in COPD severity
FEV1
Absent; minor
chronic could sputum production
no SOB
Early stages
chronic productive cough
dyspnea
excerise intolerance
“smokers cough”
Symptoms; finally seeking help from physician
cough copious, thick, tenacious sputum, cyanosis evidence of right sided heart failure; ie. distended neck veins, edema, liver enlargement and an enlarged heart. -Low Rhonchi; possibly wheezing;
Manifestations of Chronic Bronchitits
Insidious onset Dyspnea; 1st symptom (initially only with exerction) progresses to even at rest. Cough minimal or absent Airtrapping; hyperinflation increases anterposterior chest; barrel chest thin, tachypneic tripod position, (sitting, leaning forward) -pursed-lip breathing;
Emphysema
prolongs the expiratory phase; promotes more alveolar emptying
-exhaling through a narrow opening between lips
pursed-lip breathing
prolonged impairment of gas exchange is a result of COPD eventually results in
Cardiac dysfunction
chest pain
hypertension
heart having to work harder to provide oxygen through the bloodstream
Cardiac dysfunction
makes breathing difficult to eat.
Tachycardia
- PT
- Nutrionists
- pharmacists
- family members
- counselors
Collaborate with
PFT; pulmonary function testing
-extent and progression of COPD
Ventilation; Perfusion scanning. VQ mismatch, extent to which lung tissue is ventilated but not perfused (dead space) or not adequately ventilated.
Radiosotope injected or inhaled to illustrate areas of shunting and absent capillaries
Serum a1-antitrypsin levels 1% deficency with fam hx 80-260 mg/dL
ABG;s evaluate gas exchange
pulse Oximetry; O2 sat %
Exhaled CO2; evaluate alveolar ventilation; 35-45 mmHG
CBC’s with WBC diff. shows increase in WBC’s, shows RBC’s and Hct (chronic hypoxia)
Chest Xray; sm patches indicatie of the hyperinflated alveolar sacs filled with secretions; common in emphysema.
flattened diaphragm; barrel chest in chronic bronchitis; and possible infection.
**lung transplant; no other treatment avail.
-Pharm therapy
Diagnostic Tests
used for severe and progressive hypoxemia. O2 therapy improves exercise tolerance, mental functioning and quality of life with advanced COPD.
O2 therapy
PVD
Percussion, Vibration, and Postural Drainage
dependent nursing functions.
percussions; clapping, forceful striking of the skin with cupped hands.
vibrations; vigorous quiverings produced by hands placed flat against chest wall. Used after percussion to increase turbulence of the exhaled air. loosens thick secretions
postural drainage; drainage by gravity of secretions
lower lobes need most 2-3x/day and before bedtime
Avoid before and after meals; exhausting. Check Vitals
PVD; Percussion, Vibrations, and Postural drainage; Nursing Action
Postioning Percussion Vibration Removal of Secretions/coughing or suctioning -Each. position 10-15 mins.
Sequence of Postural Drainage treatment
hydration effective coughing percussion postural drainage coughing suppressants usually ineffective sedatives are avoided
Pulmonary hygiene measures:
Air
way clearance is a high priority
-promote o2, monitoring and promoting airway clearance and effective breathing patterns.
-Assess respiratory status q 1-2 hr. rate & pattern
-Monitor ABG’s
-Daily weights, I & O’s, assess mucous and skin turgor
-expectorate (expel or spit out) fluid overload
-Encourage fluids (2000-2500 ml/day)
-Place in Fowlers, high-Fowlers or orthopneic (head & arms supported over table)
-Assist in coughing/breathing exercises
-Tripod
-Provide tissues/wastebasket
-Refer to respiratory therapist
-Perform PVD’s
-Admin Bronchodilator meds
Nursing Interventions for: Ineffective Breathing pattern
helps keep airways open by maintaining positive pressure, and abdominal breathing improves lung expansion.
Relaxation techniques reduce anxiety and it effects on the RR.
Pursed-lipped breathing
Promote Balanced Nutrition;
increase breathing and increase metabolic demands and more calories are required.
-Assess nutritional status
-Observe & document food intake
-Monitor Lab values; serum albumin and electrolytes
-Consult dietitian;
-increase protein, and decrease fat without excess carbs minimize CO2 production during metabolism;
(Carbs metabolized to for CO2 and H20)
-Seated or high fowlers position for meals; promote lung expansion decreases dyspnea
Assist with food choices. encourage family to bring in food from home.
Keep snacks @ bedside
Provide mouthcare ac meals
Consult with Dr. if oral intake a problem
-eat small frequent meals of protein; eat slowly foods not hot
-provide dietary education on right meals/food to eat
Nursing Interventions for Imbalanced nutrition; less than body requirements
helps to maintain open airways by maintaining positive pressure longer during expiration. Exhale 2x longer than inhale
Inhale through nose with mouth closed and exhale slowly through pursed lips
pursed lip breathing
conserves energy by using large muscles (more efficient) of inspiration. hands on chest and belly. hands go up and down on belly
Diaphragmatic breathing
after brochodilator treatment. Inhale deeply and hold breath briefly and then cough.
Controlled cough
inhale deeply while leaning forward. exhale with huff; helps to keep airways open while mobilize secretions
huff cough
-produce bonchodilation stimulate the beta sites to relax the bronchial smooth muscle.
-improves hyperinflation, dyspnea, and exercise capacity
-Inhaled (preferred site), oral, sub q or IV
Mistakes
fail to shake device before inhaling
inhale through nose, too soon, upside down, dont hold breath for right amount of time; 5-10 secs)
Beta Agonists 2 works on lungs
small airways; destruction of the walls of the alveoli, collapse cycle of inflammation and repair, scar tissue; lose elasticity
pathophysiology of emphysema
Positioning; tripod;
HOB; chair; arm rest opens diaphragm
diaphramatic breathing (from belly); pursed lip breathing (longer expiration alveoli open easier to breath)
antianxiety meds, low stimulation in room
measures to try to improve oxygentation
fights infection
antibiotics
reduce secrections
anticholinergics
reduce inflammation; make you thirsty; increase fluids
corticosteriods
open airways, relax smooth muscle
bronchodilators
tremors; stimulants
anxiety; tachycardia
2 common side effects of bronchodilators
smoking cessation infection control activity and exercise immunizations fluid requirements (2000-2500 ml/day); not around meal time when to seek medical attention home O2 therapy pulmonary hygiene tripod positioning percussion postural drainage treatment
Educational topics to explore with COPD patient
relax bronchial smooth muscle.
Used to treat bronchospasms
-contraindicated with uncontrolled HTN, and increases stroke risk
-adverse effects are insomnia, restlessness, anorexia, hyperglycemia, tremors, headache
bronchodilators
stimulate beta adrenergic receptors which results in relaxation and dilation of the bronchioles, but also peripheral vasoconstriction and decreased DBP
Beta Adrenergic agonists
Aformoterol (Brovana);
Formoterol (Foradil, Perforomist)
Salmeterol (Serevent)
Long acting (LABA) Beta 2; inhalation
Albuterol (Ventolin, Proventil) Inhale & PO
Levalbuterol (Xopenex)
Pirbuterol (Maxair)
Turbutaline (Brethine)
Short acting inhalation
Beta,2
Metaproterenol (Alupent)
Short acting
Beta 1 & 2, inhalation and PO
blocks Acetycholine, and bronchoconstriction, resulting in bronchodilation.
- used for bronchospasm assoc. with chronic bronchitis and emphysema.
- contraindicated with peanut/peanut oil, Soybeans, and legume allergies.
- Adverse effects are dry mouth and throat, nasal congestion, palpitations, gi distress, headache, coughing and anxiety.
Anticholinergics
Ipratropium (Atrovent); MDI 2 puffs 4x/day
-oldest and most commonly used anticholinergic.
Pharmacologically very similar to atropine
Side effects: cough and dry mouth (hydrate!)
blurred vision,
headache,
eye pain,
palpatations
tremors
Anticholinergics
Tiotropium (Spiriva)
-admin once/day
Anticholinergics
Combivent (MDI) and DuoNeb (Inhalation)
Beta2/Anticholinergic Combination med
smooth muscle relaxant;
-Most commonly used is
Theophylline; 400-600 mg/daily in divided doses
Also, Aminophylline
CNS stimulant-+inotrope (increases force of contraction)
+chronotrope (increases HR)
~Contraindicated with patients who have uncontrolled cardiac dysrhythmias, seizure disorders, hyperthyroidism, and peptic ulcers. Can cause tachycardia and palpitations
therapeutic range is 10-20 mcg/ml, but 5-15 mcg/ml is recommended
Overdose is treated with charcoal
Limit (stay away from) caffeine intake with this drug! tremors and tachycardia.
Xanthine derivitives-smooth muscle relaxant
Phosphodiesterase; 4 inhibitors; prevent cough and excess mucus, as well as decreasing frequency of COPD exacerbations.
ex. Daliresp
~Adverse effects are N/V, headache, insomnia, dizziness, weight loss and psychiatric symptoms
Non-Bronchodilators
Antiinflammatory that enhances beta agonists.
`Methylprednisolone (Prednisone PO)
(Solumedrol IV 40-125 mg/once to 3x daily)
Budesonide (Pulmicort inhalation)
Fluticsone (Flovent inhalation 50-100 mcg BID)
Possible Adverse effects: Inhalation, pharyngeal irritation, coughing, dry mouth, and candidiasis (thrush)
IV-adrenal insufficiency, increased susceptibility to infection, insomnia, nervousness, Seizures, and with long term use osteoporosis
Corticosteriods
