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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
vital capacity
TV + IRV + ERV
26
total lung capacity
Vital Capacity + Residual Volume
27
prep for bronchoscopy
``` NPO 8 hrs. prior (may vary) for risk for aspiration Consent form (conscious sedation) ```
28
post bronchoscopy
NPO until return of gag esp if received Versed | Assess resp. effort/rate
29
Thoracocentesis: Insertion of needle into pleural space (between parietal & visceral pleura) to:
Remove fluid (from cancer or infection) Instill meds Facilitate breathing
30
COPD
Lower airway disorder resulting in irreversible changes that are chronic and progressive Includes: Emphysema and Chronic Bronchitis
31
asthma
unlike emphysema and bronchitis, is a condition of intermittent, reversible airflow obstruction
32
etiology of chronic bronchitis
Inhalation of physical or chemical irritants, with cigarette smoking most common Also implicated: pollutants, chronic resp. infections, genetic predisposition
33
patho chronic bronchitis
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
cor pulmonale
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
assessment findings chronic bronchitis
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
diagnostic results COPD
Chronic Hypercapnia (CO2) Chronic hypoxia PFTs: Increased Residual Volume, Decreased Forced Expiratory Volume- cant get CO2 out (air trapping)
37
emphysema patho
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
emphysema assessment findings
Dyspnea on exertion (DOE) that progresses to dyspnea at rest Cyanosis around lips Clubbing of fingers
39
emphysema diagnostics
ABGS normal until late (compensated resp. acidosis in late stages) Decreased Forced Expiratory Flow and Volume
40
characteristics of chronic bronchitis
1. Barrel Chest 2. Stout, stocky appearance 3. Cyanosis 4. Persistent cough 5. copious sputum
41
characteristics of emphysema
1. Cachectic 2. Accessory Muscle use 3. Tachypnea, hyperventilation 4. Skin pink 5. SOB 6. Exertional dyspnea DOE 7. Hyper-resonance
42
common nursing diagnoses for chronic bronchitis and emyphsema
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
medical management for chronic bronchitis and emphysema
``` 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
COPD medications (classes)
``` bronchodilators anticholinergics MDI anti-inflmmatory (corticosteroids) leukotriene inhibitors ```
45
bronchodilators
(Sympathomimetics/ß2 agonists) | Stimulate beta2 receptors in lungs to cause smooth muscle relaxation with bronchodilation
46
examples of bronchodilators
- 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
anticholinergics
Block choinergic receptors located in large airways, producing bronchodilation Fewer side effects than that Beta2 agonists
48
MDI metered dose inhaler
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
anti-inflammatory meds (corticosteroids)
- 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
examples of anti-inflammatory meds (corticosteroids)
``` Inhaled examples: -Azmacort (triamcinolone acetonide)-MDI -Flovent (fluticasone proprionate)- MDI, DPI (dry powder inhaler) Other examples: -Decadron (dexamethasone) -Methylprednisolone (Prednisone) -Hydrocortisone (Cortisone) ```
51
leukotriene inhibitors
Also referred to as Leukasts: constrict airways secondary to inflammation Less effective than steroids
52
exaplmes of leukotriene inhibitors
Example: Singulair (montelukast)

chronic (17 decks)

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