COPD Flashcards
COPD results from…
repeated exposure to respiratory irritants that begin to damage the structures of the respiratory system
Damage to the large and small airways cause…
increased mucus production, causing arrest in cilia action
Increased mucus production leads to…
excessive fluid accumulates with lung mucosal cells or edema
Edema leads to…
narrowing of airway passages which leads to airflow limitation
Airflow limitation
- air trapping
2. hyperinflation of the lungs
air trapping
decreased airflow with exhalation
bronchitis
inflammation of the mucous membranes of the bronchial tubes
chronic bronchitis
- disorder of excessive bronchial mucous secretion
- productive cough for 3 or more months in 2 consecutive years
Major risk factor for chronic bronchitis
smoking
emphysema
destruction of the walls of the alveoli resulting with enlargement of abnormal air spaces
What deficiency is there with emphysema?
a1-antitrypsin
a1-antitrypsin
enzyme that normally inhibits the activity of proteolytic enzymes and destruction in the lungs
Describe progression of emphysema
- inflammatory cells collect in distal airway lead to destruction of elastic fibers in the respiratory bronchioles and alveolar ducts
- which causes alveoli and air spaces to enlarge with loss of corresponding portions of pulmonary capillary beds
- which leads to surface area of alveolar-capillary diffusion is reduced which affects gas exchange
Risk factors for COPD
- smoking (greatest)
- frequent exposure to smoke
- long term exposure to chemical irritants in workplace or hobby
- asthma
Short term exposure to smoke or irritants
normally does not pose risk for COPD
The key to preventing COPD
not engaging in behaviors that have been linked with etiology of disease
Prevention Methods for COPD
- not smoke or quit
- decrease exposure to secondhand smoke
- decrease occupational respiratory irritants
- decrease air pollutants
Culture that has a higher risk of developing COPD
Hispanic population due to acculturation, education levels, alcohol, and substance abuse
Clinical manifestations of COPD
varies from simple chronic bronchitis without disability to chronic respiratory failure and severe disability
FEV1
forced expiratory volume in 1 second measure by spirometer
How to measure severity of COPD
FEV1 and symptom manifestations determine the level of COPD
Clinical manifestations typically…
absent or minor early in the disease
Initial symptoms of COPD
-chronic cough and sputum production
initial symptoms tend to begin….
long before changes in pulmonary function
When do patients typically seek medical help for COPD symptoms?
after 10 yrs of initial symptoms
When does dyspnea occur initially?
Dyspnea initially occurs on extreme exertion and progresses over time
Manifestations of chronic bronchitis
- cough with copious amounts of thick, tenacious sputum
- cyanosis
- evidence of right-sided heart failure
- adventitious lung sounds
evidence of right-sided heart failure
- distended neck veins
- edema
- liver engorgement
- enlarged heart
adventitious lung sounds
- loud rhonchi
- possible wheezes
Manifestations of emphysema
- dyspnea (1st symptom)
- cough is minimal or absent
- barrel chest
- client is usually thin
- tachypneic
- uses accessory muscles
- tripod position
- pursed-lip breathing
tripod position
- used with emphysema patients
- sitting and leaning forward
pursed-lip breathing
prolong expiratory phase in an effort to promote more alveolar emptying while maintaining open alveoli
prolonged impairment of gas exchange as a result of COPD leads to…
cardiac dysfunction
cardiac function
heart having to work harder to provide oxygen through the bloodstream
earliest manifestations
chest pain and HTN
caloric demand increases as…
the effort to breathe increases
Eating becomes more difficult with…
tachypnea
Increase in caloric demand with decreased caloric intake often occurs…
in latter stages of COPD resulting in weight loss and possible anemia
Anxiety due to periods of dyspnea occurs
with exacerbations in moderate and severe COPD
Severe COPD leads to
impairment of other body systems due to insufficient airflow further restricting quality of life
Stages of COPD
- Mild
- Moderate
- Severe
- Very Severe
Stage 1: Mild
- usually chronic cough and sputum production
- mild airflow limitation
- FEV1 > 80% predicted
Stage 2: Moderate
-usually worsen symptoms with SOB on exertion
Stage 3: Severe
-worsen symptoms w/ noticeable SOB
Stage 4: Very Severe
-severe symptoms
Spirometry
common office test used to assess how well your lungs work by measuring how much air you inhale, how much you inhale, and how quickly you exhale
Serum alpha1-antitrypsin levels
screen for deficiency if:
- fam hx
- early COPD onset
- female
- does not smoke
Normal serum alpha1-antitrypsin levels
80-260 mg/dL
fasting not require
alpha1-antitrypsin
protects the lungs from injury
CBC w/ WBC differential
shows increased RBC and hematocrit
polycythemia
increased # of blood cells
increased WBC and increased % of immature WBCs indicate…
bacterial infection
ABGs
Arterial blood gas
-evaluate gas exchange especially during acute COPD exacerbations
emphysema pts
- mild hypoxemia
- normal or low carbon dioxide tension
- respiratory may be present as a result of increased RR
chronic bronchitis & airway obstruction pts
- marked hypoxemia and hypercapnia with respiratory acidosis
- SpO2 decreased because of marked hypoxemia
chest x-ray result for emphysema
small white patches indicative of hyperinflated alveolar sacs filled with secretions that are common in emphysema
chest x-ray result for more advanced bronchitis
long fields with larger areas of white, indicating secretions
chest x-ray may show flattening of the diaphragm because of…
hyperinflation and evidence of pulmonary infection if present
Ventilation Perfusion Scanning
- determine extent lung tissue is ventilated but not perfused
- determine extent lung tissue is perfused but not adequately ventilated
- radiosotope injected or inhaled to illustrate areas of shunting and absent capillaries
Pulse Oximetry
- monitored to assess the need for supplemental oxygen
- often less than 95% due to marked airway obstruction and hypoxemia
- used to monitor oxygen saturation of the blood
Exhaled Carbon Dioxide
ETCO2
-may be measured to evaluate alveolar ventilation
Normal value for exhaled carbon dioxide
35-45mmHg
When would exhaled carbon dioxide levels be elevated?
when ventilation is inadequate and decreased when pulmonary perfusion is impaired
ETCO2 monitoring leads to
reduced frequency of ABGs
Periodic exacerbations
period of increased symptoms:
- dyspnea and cough
- sputum from lungs
- decline in activity
- lead to change in meds
- lung tissues have progressive destructive changes
Possible causes of periodic exacerbations
- respiratory infection
- air pollution
- temp change
- unknown cause
Oxygen management goals
- slow disease progression
- ease symptoms
- improve health status and exercise tolerance
- prevent and treat exacerbations and complications
- reduce mortality risk
Pharmacologic Therapy for COPD
- immunizations
- broad spectrum antibiotics
- bronchodilators
- statins
Non-pharmacologic Therapy for COPD
- postural drainage
- pulmonary rehab
- dietary measures
- herbal teas
- acupuncture
- guided imagery
- surgical interventions
immunizations for COPD
- pneumococcal vaccine
- pneumococcal revaccination if 65 or older and previous vaccine was 5+ yrs ago
- yearly flu vaccine
broad spectrum antibiotics
- for infections with patients with purulent sputum with dyspnea
- exacerbations 4+ per year
Bronchodilators
- improve airflow
- reduce air trapping
- relax bronchial smooth muscle
- widen airway
albuterol
short acting
ipratropium bromide
longer duration
-anticholinergic agent by MDI
salmeterol
long acting
-beta 2 agonist, can be given with a corticosteroid (fluticasone) to reduce risks of cardiac side effects
theophylline (oral)
-weak bronchodilator with a narrow TR
statins
new research shows significant improvement for the client with COPD
statins are associated with a decrease in…
all-cause mortality as well as a reduction in the rate of respiratory-related emergency care
In addition to targeting systemic inflammation…
statins may also target airway inflammation
What medications are not recommended for COPD patients
- cough suppressants: usually ineffective
- sedatives: generally avoided, may cause secretion retention, decreased respirations
postural drainage
drainage by gravity of secretions from various lung segments
secretions that remain in the lungs or respiratory airways…
promote bacterial growth and subsequent infection
before postural drainage…
bronchodilator or nebulizer therapy to loosen secretions
sequence for postural drainage
- positioning
- percussion
- vibration
- removal of secretions by coughing or suction
how long does the patient hold each position in the postural drainage
10-15 minutes
-may be shorter in the beginning and gradually increases to 10-15 minutes
after postural drainage
- listen to lungs
- compare findings to baseline
- document amount
- document color
- document character
Pulmonary Rehab
- assessment
- exercise training
- aerobic exercise program
- nutrition counseling
- smoking cessation
- education
- hydration with humidifiers
aerobic exercise program
- improves exercise tolerance
- enhance ability to perform ADLs
- prevent deterioration of physical condition
education for pulmonary rehab
-avoid exposure to other airways irritants and allergens
how long is pulmonary rehab performed?
at least 6 wks
What does pulmonary rehab achieve?
- reduces dyspnea and fatigue
- improve exercise tolerance
- improve quality of life
- benefit patients at all disease stages
dietary measures
- reduce dairy products and salt to reduce production and thin secretions
- need protein and calcium
- diet high in fat and low carbs
enteral formulas for dietary measures
- high calorie
- modified carb and fat
- helps reduce diet-induced carbon dioxide production
what beverage relieves chest congestion
hot herbal teas with peppermint
hypnotherapy
insufficient evidence of effectiveness
bullectomy
reduces dyspnea and allows re-expansion of compressed lung region
bullae
enlarged alveolar air spaces, do not contribute to gas exchange, compress lung tissue
lung reduction surgery
removes nonfunctional lung areas with hyperinflation
-improves survival > 50 months
lung transplant
single and bilateral transplants
-increases survival 75 % to 2 yrs
Nursing plan of care
- client will adapt breathing patterns to meet oxygenation demands adequately
- client will experience ease of respirations with the use of positioning and pursed-lip breathing
- client will maintain patent airway, allowing adequate oxygenation
- client will maintain SpO2 levels >90%
- client will tolerate activity levels, allowing completion of ADLs
Priorities for nursing
- focused on promoting oxygenation
- airway clearance
- effective breathing patterns
5 R’s for smoking cessation
- Relevance to quit
- Risks of using tobacco
- Rewards of quitting
- Roadblocks to quitting
- Repetition with each new encounter with the patient
STAR
S: set a date within 2 wks
T: tell fam, friends, coworkers
A: anticipate challenges to quit especially in first few weeks
R: remove all tobacco products
Evaluation/Outcomes
- pt consistently maintained SpO2 >90%
- pt modified ADLs to reduce fatigue related to activity intolerance
- pt demonstrated appropriate use of medications
When to initiate long term oxygen therapy
severe and progressive hypoxemia
goal of oxygen therapy
SpO2 > 90% (varies per patient)
Different ways to administer oxygen therapy
intermittently, at night, or continuously
giving too much oxygen to COPD patients…
takes away the drive to breathe
-max 2 L/min
drive to breathe for healthy patients
occurs with hypercapnia
drive to breathe for COPD patients
low O2 levels
hypercapnia
interferes with body’s ability to respond to increased COPD
Types of inhaler
- MDI
- MDI with spacer
- DPI
- SMI
DPI
dry powder
close mouth tightly around mouth piece of the inhaler and inhale rapidly
spacer/holding inhaler
-recommended for young children and corticosteroid
In the mouth inhaler not recommended for…
corticosteroid
