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A&E Test 2 > COPD > Flashcards

COPD Flashcards

1
Q

Oxygenation Requires 2 Things

A
  1. Ventilation

2. Perfusion

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2
Q

Chronic Bronchitis

A

Chronic Inflammation of the bronchi and the bronchioles causing vasodilation, congestion, mucosal edema (excess mucous production).
Overall the inflammation makes the airway lumen much smaller! Trouble breathing in and out!

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3
Q

Emphysema

A

Loss of E-lasticity and abnormal permanent enlargement of the alveoli. this also decreases the surface area for the exchange of gases. Trouble breathing out!

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4
Q

An obstruction can be mechanical or functional, but they both have what impact on the body?

A

-Retain CO2 making the body acidotic

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5
Q

What is the relationship between emphysema and chronic bronchitis?

A
  • Many PT will have symptoms of both, a combination. A PT with COPD might have the flabby alveoli and the mucous
  • Both caused by smoking!
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6
Q

Cigarette Smoking- 6 consequences due to one main thing

A

Increase in proteases

  1. decrease ciliary activity
  2. possible loss of ciliated cells (protective cells)
  3. cellurar hyperplasia
  4. Reduction in airway diameter
  5. increased difficulty in clearing secretions
  6. production of mucous
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7
Q

Proteases

A
  • enzymes which scavenge things from the lungs and function to protect our lungs.
  • RMR this is an enzyme and enzymes come from cells, when more cells are being destroyed more and more proteases are being released and they are eating more things up, including the lung itself!
  • they work adaptively meaning and increase in destruction triggers more proteases.
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8
Q

How does nicotine connect to the sympathetic nervous system

A

-it stimulates the SNS causing:
1. increased Heart Rate
2. Increased Blood Pressure
3. Peripheral Vasoconstriction
OVERALL INCREASED CARDIC WORKLOAD

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9
Q

Wheezing vs Stridor

A

wheezing- narrowing of the lower airways

stridor- obstruction in the upper airway

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10
Q

What to ask during assessment?

A

risk factors

  1. age-higher risk with older people
  2. gender- women and men are slowly equalizing
  3. occupational hazards
  4. family history
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11
Q

Physical Assessment 7 things to note

A
  1. abnormal breath sounds- wheezing or crackles
  2. Barrel Chest
  3. clubbing of the fingernails
  4. cyanosis- late sign
  5. Dyspnea- SUBJECTIVE ACCOUNT OF HOW SHORT OF BREATH A PERSON IS
  6. trippod position
  7. weight loss
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12
Q

Why do people with emphysema have weight loss?

A
  1. they have marked dyspnea- hard to eat

2. they have increased energy expenditure because they are breathing more and using energy to breath

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13
Q

2 causes of clubbing fingernails

A

RARE

  • could be idiopathic
  • chronic hypoxia causing vasodilation and enlargement of the fingernails. so if someone is a smoker and they have this it is usually due to this reason and not an idiopathic cause.
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14
Q

Dyspnea- How do you assess it?

A
  • Ask the PT to tell how, indicate on the line how bad it is.
  • Objective assessment includes observing the use of accessory muscles, hyperventilation
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15
Q

Orthopneic and Tripod Positions

A
  • leaning forward maximizes the thoracic cavity and decreases the resistance.
  • compensatory mechanism
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16
Q

Blue Bloater Symptoms

A
  • chronic bronchitis
  • cant get O2 in or CO2 out
  • coughing alot
  • fat
  • cyanotic
  • ronchi and wheezing
  • alot of yellow/green sputum
  • peripheral edema
  • 3 months for at least 2 years
  • elevated hemoglobin
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17
Q

Pink Puffer Symptoms

A
  • emphysema
  • skinny
  • alot of dyspnea
  • older
  • quiet chest- could lead to pneumo-thorax
  • hyper-inflated chest seen in X-ray
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18
Q

common lab tests done

A
  1. ABG
  2. CBC
  3. Sputum analysis
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19
Q

ABG

A
  • pH: 7.35-7.45
  • CO2- BASIC 35-45 ACDIC
  • HCO3- ACID 22- 26 BASIC
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20
Q

Hypercarbia

A
  • also called hypercapnia
  • acidosis
  • low pH
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21
Q

polycythemia

A

increase in RBC to help carry oxygenate throughout the body

this increases blood viscosity which increases heart’s workload and increases risk for blood clot

22
Q

Alpha 1 AntiTrypsin

A
  • gene that causes emphysema in young people

- this gene increases the levels of protease which leads to tissue damage

23
Q

sputum testing

A

-to check for respiratory infection which these PT are more likely to get bc mucous is a good breeding ground for bacteria

24
Q

How do you check for oxygenation saturation

A

-pulse ox. the oxygen saturation only tells you how much oxygen binds to hemoglobin but this does not tell you how much blood or hemoglobin is in the blood. so check for normal hemoglobin levels.
For COP patients know their baseline.

25
Q

diagnostic tests

A
  1. Chest X-Ray
  2. Patient’s presentation
  3. Pulmonary Function Test
26
Q

Chest X -Ray

A
  • Is not useful for early or moderate stages but useful to determine late stage disease.
  • in late stages the diaphragm is more inflated
27
Q

Patient Presentation Evaluation

A

-Productive cough lasting for more then 3 months for 2 years

28
Q

Pulmonary Function Test

A
  • use a spirometer to test the lung volumes and can help detect lung disease
29
Q

What is spirometry

A

means to assess lung function by measuring total volume of air the patient can hold and expel after a maximal inhalation

30
Q

vital capacity

A

volume a non-forced exhale

31
Q

Residual volume

A

air left in the lungs after a max expiration

32
Q

TLC- Total lung Capacity

A

total amount of air in the lungs after taking the deepest breath possible

33
Q

FEV1 - forced expiratory volume in one second

A

-volume of air expired in 1 second

34
Q

FVC- Forced vital capacity

A

total air that can be forced out

35
Q

FEV1 / FVC Ratio

A
  • fraction of air exhaled in 1 second / total volume exhaled
36
Q

what things will influence your predicted normal values for FEV1 / FVC

A

age
height
sex
ethnic origin

37
Q

what are the normal ranges

A

– greater then or equal to 80% for both FEV1 , FVC, and Ratio

38
Q

COPD Spirometry Reading

A

-typical findings when they are reduced to lower then 70% and they have an increased RV

39
Q

complications of COPD

A
  • hypoxemia
  • acidosis
  • respiratory infections
  • cor pulmonale
  • cardiac dysrrythmias
40
Q

Cor Pulmonale - why does it happen and what is it

A

right sided heart failure, occurs often in COPD patients because the lungs are not oxygenating the blood correctly so the right side of the heart hypertrophies and works very hard to pump blood through into the lungs.

41
Q

Clinical Manifesations of Cor Pulmonale

A
  • alot of dyspnea
  • fatigue
  • distended neck veins
  • dependent edema
  • enlarged and tender liver
42
Q

5 priority nursing diagnoses

A
  1. hypoxemia
  2. weight loss
  3. anxiety
  4. activity intolerance
  5. risk for infection
43
Q

why is hypoxemia a priority nursing diagnoses

A 
reduced airway size
too much mucus
airway obstruction
diaphragm flattening 
loss  of elasticity
could all lead to low levels of oxygen in the blood and high levels of CO2
44
Q

why is weight loss a concern

A
  • hard for them to breath- use more energy
  • hard to eat bc of dyspnea
  • excessive secretions
45
Q

drug management therapies 3 types

A
  • bronchodilators - reduce airway resistance and hyperinflation and reduce dyspnea
  • anti-inflammatory steroids
  • inhalers
46
Q

oxygen therapy for COPD

A

-LOW FLOW
-central chemoreceptors which normally run based on CO2 are damaged because of chronically high CO2 levels so they began running on an hypoxia meaning really low levels of O2 will trigger the need to breath
-2-4 liters a minute MAX IS 4 LITERS A MIN
-give using nasal cannula or 40% on a venturi mask
-humidify as needed
-GOAL PaCO2 for COPD- 60-65% Normal Goal is 80-100%
Saturation of Oxygen- 90% around

47
Q

chronic O2 management at home

A
  • improves the health of the PT
  • helps better neuropsychologic function
  • increased exercise intolerance
  • reduced pulmonary hypertension
48
Q

positioning for a PT with COPD

A

-raise the head of the bed

49
Q

Exercise for PT with COPD

A
  • encourage PT to remain as active as possible
50
Q

Respiratory Therapy

A
  • pursed lip breathing technique - has a longer expiratory phase which helps prevent the bronchiolar collapse and air trapping
  • diaphragmatic breathing- focuses on using diaphragm instead of accessory muscles to breath which helps slow RR and achieve maximum inhalations and makes the diaphragm stronger
51
Q

Nutrition and Hydration management

A
  • bc they have a hard time eating and breathing they might not be getting all the nutrients that they need
  • Avoid high CARB diets to prevent the increase in CO2 load
  • take dietary supplements
  • eat smaller meals more frequently - 5-6 small meals
  • fluids - intake normal 2-3 Liters of water to help liquify the mucus
52
Q

preventing infections in individuals with COPD

A
  • teach them to avoid large crowds
  • get a pneumonia vaccine
  • yearly influenza vaccine

A&E Test 2 (2 decks)

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