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COEXISTING > COPD > Flashcards

COPD Flashcards

1
Q

what is COPD

A

airway outflow obstruction 2/2 chronic bronchitis or emphysema

  • obstruction is generally progressive
  • may be accompanied by hyperreactivity
  • may be partially reversible
  • damage to lung parenchyma occurs

= deterioration in the elastic recoil of the lungs; early small airway collapse
= enlargement of air spaces, fibrosis, increased mucus production

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2
Q

chronic bronchitis

A

obstruction of the small airways

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3
Q

emphysema

A

enlargement of air sacs

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4
Q

COPD vs. asthma

A

obstruction in COPD is not reversible or not completely reversible w/ bronchodilators (as opposed to asthma)

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5
Q

risk factors for COPD

A
  • cigarette smoking/2nd hand smoke
  • industrial exposure
  • ambient air pollution
  • alpha1 antitrypsin deficiency (only known genetic abnormality, but accounts for <1% of cases)
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6
Q

anatomical changes in COPD

A
  1. enlargement of bronchial mucus glands
  2. mononuclear inflammation
  3. emphysema
  4. bronchoconstriction
  5. pulmonary fibrosis
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7
Q

s/s COPD

A
  • chronic productive cough
  • progressive exercise limitation
    (bronchitis = cough, emphysema = dyspnea)
  • orthopnea
  • sputum discoloration
  • wheezing
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8
Q

PFT results of COPD

A
  • decreased FEV1/FVC ratio
  • decreased FEF 25-75%
  • increased RV & noraml to increased FRC & TLC
  • scooped expiratory curve on flow/volume loop
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9
Q

CXR results in COPD

A

hyperinflation
flat diaphragm
vertical cardiac silhouette

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10
Q

ABG results in COPD

A 
chronic bronchitic (blue bloaters)
- PaO2 <60mmHg &amp; PaCO>45mmHg

emphysema (pink puffers)
- PaO2>60mmHg & PaCO2 usually normal

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11
Q

s/s emphysema

A 
thin
anxious, purse lips
accessory muscles
dyspnea
scant secretions
markedly diminished breath sounds
RHF w/ pulm infection
hyperinflation on CXR
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12
Q

s/s bronchitis

A 
overweight
cyanosis/dusky appearance
cough
copious secretions
diminished breath sounds
RHF/cor pulmonae
increased bronchovascular markings on CXR
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13
Q

goal of COPD treatment

A

relieve the symptoms

slow the progression

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14
Q

treatment of COPD (chronic tx)

A

smoking cessation
supplemental O2 to PaO2 60-80 (NC at home)

home O2 is indicated for PaO2<55 or hct >55 or cor pulmonale

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15
Q

preop assessment of COPD patients

A 
exercise intolerance
chronic cough
dyspnea
breath sounds
prolonged exhalation
smoking
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16
Q

preop optimization of COPD patients

A

smoking cessation
bronchodilation
eliminate infection
hydration

17
Q

preop smoking cessation guidelines

A

12-24hrs = carboxyhgb drops to near-normal levels

2-6 weeks = improved ciliary function (normalization of immune system takes at least 6 weeks)

4-8 weeks = reduction in postop pulmonary complications

BEST stop smoking 2months preop

18
Q

smoking & surgery

A

smoking = decreased ciliary motility, increased sputum production, decreased immune function, increased airway reactivity

  • increased postop morbidity
  • 2-6x risk of postop PNA
  • impaired wound healing
19
Q

PDE inhibitors & COPD

A

inhibit breakdown of 3,5 cAMP = bronchodilation

20
Q

cromolyn

A

mast cell stabilization & inhibition of histamine release = bronchoconstriction prophylaxis

21
Q

preop education for COPD patients

A
  1. counsel re: postop complications (atelectasis, hypercapnea, hypoxemia, secretion retention, bronchospasm)
  2. explain need for postop mech ventilation
  3. education re: splinting & IS
22
Q

COPD patient: induction

A
  • consider regional (
23
Q

COPD patient: ventilator settings

A 
Tv 6-8mL/kg: keep PIP<40
rr 6-10
allow sufficient I:E ratio
avoid barotrauma (autoPEEP)
consider baseline PaCO2
-rapid correction to normal may result in metabolic alkalosis
24
Q

COPD patient: emergence

A

postop respiratory status = priority

  • adequate pain control (good deep breathing & coughing)
  • consider prolonged mechanical ventilation
25
Q

how long does it take the FRC to recover on a normal healthy patient

A

5-7 days

26
Q

nitrous oxide in COPD patients?

A

may decrease dose required of volatiles
BUT
limits the concentration of O2 that can be administered
diffusion into airspaces = bullae rupture & pneumothorax

27
Q

extubation of COPD patients postop

A

w/ preop FEV1/FVC <50% or preop PaCO2 >50 –> postop mechanical ventilation is likely
- this is not a complication, this is an expected result of anesthesia/surgery in those w/ mod-severe COPD!

28
Q

goals of postop mechanical ventilation

A

PaO2 60-100

PaCO2 to maintain pH 7.35-7.45

COEXISTING (10 decks)

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