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medical surgical respiratory > COPD > Flashcards

COPD Flashcards

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USMLE® Step 1 flashcards
1
Q

What are the risk factors for COPD?

A

Cigarette smoking

Occupational chemicals and dust

Air pollution

Infection

Heredity Aging

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2
Q

What is the pathophysiology of COPD? Inflammation

A

Primary process is inflammation-

  • Inhalation of noxious particles
  • Mediators released cause damage to lung tissue.
  • Airways inflamed
  • Parenchyma destroyed
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3
Q

What is the pathophysiology of COPD? Supporting Structures

A

Supporting structures of lungs are destroyed.

  • Air goes in easily, but remains in the lungs.
  • Bronchioles tend to collapse.
  • Causes barrel-chest look
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4
Q

What are common characteristics of COPD

A
  • Mucus hypersecretion
  • Dysfunction of cilia
  • Hyperinflation of lungs- Not getting rid of CO2
  • Gas exchange abnormalities
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5
Q

What pulmonary vascular changes occur with COPD?

A
  • Blood vessels thicken.
  • Surface area for diffusion of O2 decreases

Results in pulmonary hypertension:

Secondary to Increased resistance

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6
Q

COPD
Clinical Manifestations

A

* Develops slowly

* Diagnosis is considered with

  • Cough
  • Sputum production
  • Dyspnea (Present at rest with advanced disease)
  • Exposure to risk factors
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7
Q

COPD
Clinical Manifestations

Continued

A

* Causes chest breathing

•Use of accessory and intercostal muscles

•Inefficient breathing

* May experience chest tightness with activity

* Bluish-red color of skin

* Polycythemia and cyanosis-

•Lack of oxygen causes increased production of RBC and increases viscosity of blood causing pulmonary edema

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8
Q

COPD
Physical examination findings

A

Prolonged expiratory phase

Wheezes

Decreased breath sounds

↑ Anterior-posterior diameter (barrel chest)

Tripod position

Pursed lip breathing- Teach your patients breathe through nose slowly out through lips. Causes bronchioles to stay open longer

Chronic Fatigue- secondary to improper exchange of O2 and CO2

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9
Q

COPD
Complications

A

Cor pulmonale

Exacerbations of COPD

Acute respiratory failure

Depression/anxiety

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10
Q

COPD
Cor Pulmonale

A

Hypertrophy of right side of heart

Dyspnea

Distended neck veins

Hepatomegaly with right upper quadrant tenderness

Peripheral edema

Weight gain

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11
Q

COPD
Cor Pulmonale Diagnostic Studies

A
  • ECG
  • Chest x-ray
  • Right-sided cardiac catheterization
  • Echocardiogram
  • BNP levels
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12
Q

COPD
Exacerbations

A
  • Signaled by change in usual Dyspnea, Cough, Sputum
  • Associated with poorer outcomes
  • Higher risk for seasonal flu
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13
Q

COPD
Exacerbations Primary Causes

and signs of severity

A

•Bacterial and viral infections

*Signs of severity

  • Use of accessory muscles
  • Central cyanosis
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14
Q

COPD
Exacerbations

Treatments

A
  • Short-acting bronchodilators
  • Corticosteroids-methopredsiolone- Increased BS, Increased HR & B/P
  • Antibiotics
  • Supplemental oxygen therapy
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15
Q

COPD
Diagnostic Studies

A

Diagnosis confirmed by spirometry- Give bronchodilator then test and measure results before and after. Want it below 70.

  • Chest x-ray
  • History and physical examination are also important in the diagnostic workup. Bad habits and work exposure.
  • COPD Assessment Test (CAT)
  • 6-minute walk test to determine O2 desaturation in the blood with exercise
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16
Q

ABG typical findings in later stages of COPD

A

Low PaO2

↑ PaCO2

↓ pH

↑ Bicarbonate level found in late stages of COPD

17
Q

COPD
Collaborative Care

A

Evaluate for environmental or occupational irritants

Determine ways to control or avoid

Influenza virus vaccine

Pneumococcal vaccine (Pneumovax)

Exacerbations treated promptly

Educated to be treated promptly

Smoking Cessation

18
Q

COPD
Collaborative Care Bronchodilators

A

Commonly used bronchodilators

β2-Adrenergic agonists-Albuterol-Short term. Long term Advair (Steroid ones)

Anticholinergics

Methylxanthines-Only use in extreme circumstances. Inteferes with LOT OF MEDICATIONS. Increases HR and B/P

19
Q

COPD
Collaborative Care Drug Therapy

A

•Long-acting anticholinergic

*Tiotropium (Spiriva)

•Inhaled corticosteroid therapy

*Used for moderate to severe cases-Advair is usually drug of choice

•Antibiotic therapy

*Azithromycin (Zithromax)

•Phosphodiesterase inhibitor

*Roflumilast (Daliresp)

•Combivent Respimat (ipratropium and albuterol)

20
Q

COPD
Collaborative Care

O2 Therapy

A

*O2 therapy is used to

  • Keep O2 saturation > 90% during rest, sleep, and exertion, or
  • PaO2 greater than 60 mm Hg.
  • O2 delivery systems are high or low flow
  • Humidification
  • Used because O2 has a drying effect on the mucosa- Especially if on anticoagulation
21
Q

COPD
Collaborative Care

•Complications of oxygen therapy

A
  • Combustion
  • CO2 narcosis- Altered mentation secondary to increased CO2.
  • O2 toxicity- Prolonged exposure to high O2. For N/C no more than 4L. Or will develop Pulmonary edema. PaO2 >60% for 24 hours =toxicity
  • Absorption atelectasis- With high concentration of O2 its absorbd by the blood and the aveloi collapse causing lung to collapse.
  • Infection- High chances of bacterial pseudomanas secondary to warm humidifier use

***At the peripheral chemoreceptors and the central chemoreceptors in the medulla monitor the CO2 Levels. When levels increase it demands the body to breathe to blow off extra CO2. With chronic CO2 increase the budy adjusts and quits trying to blow it off

22
Q

What does Long-term O2 therapy (LTOT) at home Improve

A
  • Prognosis
  • Mental acuity
  • Exercise intolerance
  • Reduces Pulmonary hypertension
  • Periodic reevaluations- May be improving so may need to decrease O2 levels at home
23
Q

COPD

Respiratory and physical therapy

A
  • Breathing retraining (Pursed lip breathing)
  • Effective coughing
  • Chest physiotherapy

*Percussion- Cup with hand and break down mucous on chest or back

Vibration- Vest that helps to break up

Postural drainage- Helps with gravity. Position depending on where the mucous is to allow it to drain.

24
Q

COPD POSTURAL DRAINAGE

A
  • Gravity assists in bronchial drainage.
  • Techniques are individualized according to patient’s pulmonary condition and response to initial treatment.
  • Commonly ordered 2 to 4 times per day
25
Q

COPD NUTRITIONAL THERAPY

A
  • Weight loss and malnutrition are common.
  • Decrease dyspnea and conserve energy before eating
  • Supplemental O2 may be helpful.
  • Eat five to six small meals to avoid bloating.
  • High-calorie, high-protein diet is recommended.
  • Fluids (intake of 3 L/day) should be taken between meals. If CHF DO NOT fluid overload.
26
Q

COPD Surgical Therapy

A
  • Lung volume reduction surgery- Remove the dead space
  • Bullectomy
  • Lung transplantation
27
Q

COPD Nursing Diagnosis

A

Ineffective airway clearance

Impaired gas exchange

Imbalanced nutrition: Less than body requirements

Risk for infection

Insomnia

28
Q

COPD

Nursing Management
Planning

A

*Goals

  • Prevention of disease progression
  • Ability to perform ADLs
  • Relief from symptoms
  • No complications related to COPD
29
Q

COPD

Nursing Management
Nursing Implementation

Health Promotion

A

*Health Promotion

  • Abstain from /stop smoking.
  • Avoid or control exposure to occupational and environmental pollutants and irritants.
  • Early diagnosis and treatment of respiratory tract infection
  • Awareness of family history of COPD

Acute Intervention

Ambulatory and Home Care

Pulmonary rehabilitation

Activity considerations

•Modify ADLs to conserve energy.

•Walk 15 to 20 minutes a day at least
3 times a week with gradual increases.

òAdequate rest should be allowed.

30
Q

COPD

Nursing Management
Evaluation

A

*Expected Outcomes

  • Normal breath sounds
  • Effective coughing
  • Return of PaO2 to normal range for patient
  • Improved mental status

*Expected Outcomes

  • Maintenance of normal body weight
  • Normal serum protein levels
  • Feeling of being rested
  • Improvement in sleep pattern
  • Awareness of need to seek medical attention
  • Behaviors minimizing risk of infection
  • No infection
31
Q
A

medical surgical respiratory (10 decks)

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