COPD Flashcards
What are the risk factors for COPD?
Cigarette smoking
Occupational chemicals and dust
Air pollution
Infection
Heredity Aging
What is the pathophysiology of COPD? Inflammation
Primary process is inflammation-
- Inhalation of noxious particles
- Mediators released cause damage to lung tissue.
- Airways inflamed
- Parenchyma destroyed
What is the pathophysiology of COPD? Supporting Structures
Supporting structures of lungs are destroyed.
- Air goes in easily, but remains in the lungs.
- Bronchioles tend to collapse.
- Causes barrel-chest look
What are common characteristics of COPD
- Mucus hypersecretion
- Dysfunction of cilia
- Hyperinflation of lungs- Not getting rid of CO2
- Gas exchange abnormalities
What pulmonary vascular changes occur with COPD?
- Blood vessels thicken.
- Surface area for diffusion of O2 decreases
Results in pulmonary hypertension:
Secondary to Increased resistance
COPD
Clinical Manifestations
* Develops slowly
* Diagnosis is considered with
- Cough
- Sputum production
- Dyspnea (Present at rest with advanced disease)
- Exposure to risk factors
COPD
Clinical Manifestations
Continued
* 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
COPD
Physical examination findings
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
COPD
Complications
Cor pulmonale
Exacerbations of COPD
Acute respiratory failure
Depression/anxiety
COPD
Cor Pulmonale
Hypertrophy of right side of heart
Dyspnea
Distended neck veins
Hepatomegaly with right upper quadrant tenderness
Peripheral edema
Weight gain
COPD
Cor Pulmonale Diagnostic Studies
- ECG
- Chest x-ray
- Right-sided cardiac catheterization
- Echocardiogram
- BNP levels
COPD
Exacerbations
- Signaled by change in usual Dyspnea, Cough, Sputum
- Associated with poorer outcomes
- Higher risk for seasonal flu
COPD
Exacerbations Primary Causes
and signs of severity
•Bacterial and viral infections
*Signs of severity
- Use of accessory muscles
- Central cyanosis
COPD
Exacerbations
Treatments
- Short-acting bronchodilators
- Corticosteroids-methopredsiolone- Increased BS, Increased HR & B/P
- Antibiotics
- Supplemental oxygen therapy
COPD
Diagnostic Studies
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
ABG typical findings in later stages of COPD
Low PaO2
↑ PaCO2
↓ pH
↑ Bicarbonate level found in late stages of COPD
COPD
Collaborative Care
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
COPD
Collaborative Care Bronchodilators
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
COPD
Collaborative Care Drug Therapy
•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)
COPD
Collaborative Care
O2 Therapy
*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
COPD
Collaborative Care
•Complications of oxygen therapy
- 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
What does Long-term O2 therapy (LTOT) at home Improve
- Prognosis
- Mental acuity
- Exercise intolerance
- Reduces Pulmonary hypertension
- Periodic reevaluations- May be improving so may need to decrease O2 levels at home
COPD
Respiratory and physical therapy
- 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.
COPD POSTURAL DRAINAGE
- 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
COPD NUTRITIONAL THERAPY
- 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.
COPD Surgical Therapy
- Lung volume reduction surgery- Remove the dead space
- Bullectomy
- Lung transplantation
COPD Nursing Diagnosis
Ineffective airway clearance
Impaired gas exchange
Imbalanced nutrition: Less than body requirements
Risk for infection
Insomnia
COPD
Nursing Management
Planning
*Goals
- Prevention of disease progression
- Ability to perform ADLs
- Relief from symptoms
- No complications related to COPD
COPD
Nursing Management
Nursing Implementation
Health Promotion
*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.
COPD
Nursing Management
Evaluation
*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
