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COPD Flashcards

1
Q

ventilation

A

movement of air in and out of the lungs

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2
Q

perfusion

A

exchange of oxygen and carbon dioxide at alveolar-capillary level

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3
Q

Ventilation/perfusion must be matched so that

A

adequate O2 and CO2 exchange can occur

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4
Q

examples of v/q mismatches

A

Pneumonia: ventilation problem

P.E.: (pulmonary embolism-clot) perfusion problem

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5
Q

respiratory control center is located in the

A

medulla oblongata

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6
Q

central chemoreceptors COPD

A

Found near the medulla

Are stimulated by an increase in CO2 or a decrease in pH

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7
Q

peripheral chemoreceptors

A

Located in the carotids and aortic arch

Are stimulated by an increase in CO2, a decrease in pH, or by hypoxia

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8
Q

respiratory assessment diagnostics

A 
Percutaneous Biox (Pulse Oximetry) Capnography
X-Ray
CT Scan – Helical / Spiral 
MRI: Magnetic Resonance Imaging
V/Q scan
Sputum 
ABG
PFT
Bronchoscopy
Thoracentesis
Lung Biopsy
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9
Q

pulse oximetry COPD

A

Measures: oxygen saturation
Non invasive
False results: Increased bilirubin, Dark nail polish/fake nails
CO poisoning

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10
Q

capnography COPD

A

Measures: exhaled CO2
Normal pCO2: 35-45
Non invasive
Usually in ventilated patients

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11
Q

purpose of CXR COPD

A

Detect alterations
Determine position of tubes, catheters (chest tube, PICC line, endotracheal tube, ports)
Evaluate progress of disease, etc. (pneumonias)

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12
Q

CT scan helical/spiral

A

3D scan

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13
Q

MRI

A

Preparation: no metals, remove jewelry
Contraindication: any form of metal that cannot be removed

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14
Q

V/Q scan or lung scan

A

Inhalation or IV injection of radiopaque iodine to detect alterations in patterns of ventilation or perfusion; blank spaces indicates (ventilation) blockage in the airways, (perfusion) blood clot
V/Q mismatch ventilation but not perfusion
V: ventilation Q: perfusion (IV)

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15
Q

C&S for COPD

A

Gram-stain results 24 hours; Culture results 72 hours

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16
Q

AFB acid fast bacillus

A

For TB

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17
Q

purpose of cytology

A

Identify abnormal cells (usually malignancies)

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18
Q

Collection of 1st sputum in AM is best

A

this is when it is Most concentrated

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19
Q

purpose of ABGs

A

Identify acid-base imbalances
Identify hypoxia
Drawn from radial or femoral artery

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20
Q

purpose of pulmonary function tests (PFT)

A

Assess functional capacity of the lungs; helps evaluate pulmonary disease and response to treatments; volume, force

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21
Q

tidal volume

A

(Normal male: 400-500 cc): volume inspired or expired during spontaneous breath

22
Q

inspiratory reserve volume (IRV)

A

volume that can be inspired at the end of normal inspiration

23
Q

Expiratory reserve volume (ERV)

A

volume that can be expired at the end of normal expiration

24
Q

residual volume (RV)

A

volume of air remaining in lungs after maximal expiration

25
Q

vital capacity

A

TV + IRV + ERV

26
Q

total lung capacity

A

Vital Capacity + Residual Volume

27
Q

prep for bronchoscopy

A 
NPO 8 hrs. prior (may vary) for risk for aspiration 
Consent form (conscious sedation)
28
Q

post bronchoscopy

A

NPO until return of gag esp if received Versed

Assess resp. effort/rate

29
Q

Thoracocentesis: Insertion of needle into pleural space (between parietal & visceral pleura) to:

A

Remove fluid (from cancer or infection)
Instill meds
Facilitate breathing

30
Q

COPD

A

Lower airway disorder resulting in irreversible changes that are chronic and progressive
Includes: Emphysema and Chronic Bronchitis

31
Q

asthma

A

unlike emphysema and bronchitis, is a condition of intermittent, reversible airflow obstruction

32
Q

etiology of chronic bronchitis

A

Inhalation of physical or chemical irritants, with cigarette smoking most common
Also implicated: pollutants, chronic resp. infections, genetic predisposition

33
Q

patho chronic bronchitis

A
  1. Inflammation
  2. hyperplasia of mucus-producing glands
  3. excessive mucus production
  4. decreased ciliary action
  5. Airway obstruction
  6. Hypoxia, hypercapnea, resp acidosis
  7. PaO2 dec, PaCO2 inc
  8. polycythemia
  9. “blue bloater”
34
Q

cor pulmonale

A

Rt. Sided cardiac hypertrophy as the heart pumps against increased pulmonary vascular resistance; backflow into the vena cava and the periphery/tissues causing edema

35
Q

assessment findings chronic bronchitis

A

Early: Productive cough on awakening (smoker’s cough)
Dyspnea, wheezing
Decreased activity (often subconscious)
Cyanosis (“Blue Bloater”) or dusky color
Distended neck veins due to backflow of the rt sided failure
Increased edema due to backflow of the rt sided failure
Appear stout or overweight
Late: Right sided cardiac failure and respiratory failure

36
Q

diagnostic results COPD

A

Chronic Hypercapnia (CO2)
Chronic hypoxia
PFTs: Increased Residual Volume, Decreased Forced Expiratory Volume- cant get CO2 out (air trapping)

37
Q

emphysema patho

A
  1. Alveolar walls destroyed
  2. “Air trapping” in alveolar spaces
  3. Increased dead spaces
  4. Hyperventilation
  5. Increased work of breathing
  6. Weight loss
  7. PaO2, PaCO2 Normal/Low
  8. “Pink puffer”
38
Q

emphysema assessment findings

A

Dyspnea on exertion (DOE) that progresses to dyspnea at rest
Cyanosis around lips
Clubbing of fingers

39
Q

emphysema diagnostics

A

ABGS normal until late (compensated resp. acidosis in late stages)
Decreased Forced Expiratory Flow and Volume

40
Q

characteristics of chronic bronchitis

A
  1. Barrel Chest
  2. Stout, stocky appearance
  3. Cyanosis
  4. Persistent cough
  5. copious sputum
41
Q

characteristics of emphysema

A
  1. Cachectic
  2. Accessory Muscle use
  3. Tachypnea, hyperventilation
  4. Skin pink
  5. SOB
  6. Exertional dyspnea DOE
  7. Hyper-resonance
42
Q

common nursing diagnoses for chronic bronchitis and emyphsema

A
  1. Impaired gas exchange
  2. Ineffective airway clearance
  3. Anxiety
  4. Activity Intolerance
  5. Imbalanced Nutrition – less than body requirements
  6. Risk of Infection
  7. Decisional conflict r/t smoking cessation
  8. Interrupted family process
  9. Sexual dysfunction
  10. Disturbed sleep pattern
43
Q

medical management for chronic bronchitis and emphysema

A 
improve ventilation (CPAP, meds)
remove secretions (pulmonary hygiene)
slow progression (aerobic and breathing exercises)
prevent complications (treat edema- digoxin, diuretics)
promote health maintenance (stop smoking, nutrition, avoid allergens, oxygen therapy)
44
Q

COPD medications (classes)

A 
bronchodilators
anticholinergics
MDI
anti-inflmmatory (corticosteroids)
leukotriene inhibitors
45
Q

bronchodilators

A

(Sympathomimetics/ß2 agonists)

Stimulate beta2 receptors in lungs to cause smooth muscle relaxation with bronchodilation

46
Q

examples of bronchodilators

A
  • Albuterol (Proventil) – inhaler
  • Salmeterol (Serevent)-long acting (for long term control; never used alone or as a 1st choice agent) due to increased severity of asthma attacks
  • Metaproterenol (Alupent) - inhaler
47
Q

anticholinergics

A

Block choinergic receptors located in large airways, producing bronchodilation
Fewer side effects than that Beta2 agonists

48
Q

MDI metered dose inhaler

A

Clean Mouth piece after use
Spacer allows large drops to land on walls of spacer as opposed to mouth & vocal chords, while smaller drops disperse more fully into deeper airways

49
Q

anti-inflammatory meds (corticosteroids)

A
  • Reserved for severe cases
  • Given IV, po, or by inhalation
  • Use with spacer for inhalation (reduce drug disposition in oropharynx increasing risk of candidiasis)
50
Q

examples of anti-inflammatory meds (corticosteroids)

A 
Inhaled examples:
-Azmacort (triamcinolone acetonide)-MDI
-Flovent (fluticasone proprionate)- MDI, DPI (dry powder inhaler) 
Other examples:
-Decadron (dexamethasone) 
-Methylprednisolone (Prednisone)
-Hydrocortisone (Cortisone)
51
Q

leukotriene inhibitors

A

Also referred to as Leukasts: constrict airways secondary to inflammation
Less effective than steroids

52
Q

exaplmes of leukotriene inhibitors

A

Example: Singulair (montelukast)

chronic (17 decks)

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