COPD Flashcards
Clinical Manifestations of COPD
develops slowly chronic intermittent cough sputum production dyspnea with excercise progresses to dyspnea at rest difficulty exhaling frequent respiratory infections chronic fatigue chest tightness prolonged expiratory phase wheezes or crackles - decreased breath sounds barrel chest (increased A-P diameter) pursed lip breathing accessory muscle use bluish-red skin color (polycythemia and cyanosis)
polycythemia
is a disease state in which the hematocrit (the volume percentage of red blood cells in the blood) is elevated
Clinical Manifestations specific to emphysema
Pink puffer
permanent enlargement of air spaces distal to the terminal bronchioles with destruction of their walls
underweight with adequate caloric intake
use of accessory muscles
Clinical Manifestations specific to Chronic Bronchitis
Blue Bloaters
Presence of chronic productive cough for 3 months in 2 consecutive years in patients without other causes of chronic cough
frequent cough (especially in the winter)
foul smelling sputum
increase in A-P diameter
Complications of COPD
Cor pulmonale
COPD exacerbation
Acute respiratory failure
Peptic ulcer disease
Depression / anxiety
Diagnositc Studies for COPD
diagnosis confirmed by spirometry (PFT)
CXR
H and P
6 minute walk
ECG can show RV failure
Typical ABG findings in COPD
Low PaO2
increased PaCO2
decreased pH
Increased bicarbonate level
Global initiatives for COPD
Prevent progression
Relieve symptoms
Prevent/ treat complications
Promote patient participation
Prevent/treat exacerbations
improve quality of life and reduce mortality
Collobarative Care- Drug therapy for COPD
BRONCHODILATORS
Bronchodilators
- relax smooth muscle
- improve ventilation
- decrease dyspnea
- increase FEV1
Bronchodilators used in COPD
- B2 adrenergic agonists
- anticholinergics (atrovent, spiriva)
- Methylxanthines - second line therapy
- inhaled corticosteroids (mod-severe)
methlxanthines for COPD
theophylline
Collaborative care of COPD
Surgery-
- lung volume reduction surgery
- remove diseased lung to enhance performance of remaining lung
Bullectomy
- used for emphysema
- large bullae are resected to improve lung function
Lung Transplantantation
O2 therapy for COPD
used to:
decrease WOB
reduce workload on the heart
Long term O2 therapy in COPD improves:
Survival and prognosis
Exercise tolerance
Cognitive performance;
Sleep
Hematocrit
Pulmonary hypertension
breathing training for COPD
Pursed lip breathing
diaphragmatic breathing
Huff coughing (effective coughing)
Chest physiotherapy
- percussion
- vibration
- postural drainage
Airway clearance
- acapella
- flutter
Treat exacerbations promptly
rules of O2 administration
add humidification
no smoking with Oxygen
1 collaborative care goal for COPD
Improve patient’s quality of life
Health Promotion/Prevention- COPD
Avoid exposure to occupational and environmental pollutants and irritants
Smoking cessation (Most effective intervention)
Awareness of family history of COPD and AAT deficiency
Early diagnosis and treatment of respiratory tract infection
Influenza vaccine and pneumococcal vaccines
Nursing Management - Nutritional therapy-COPD
Consult Nutritionist
Decrease dyspnea and conserve energy:
- Rest at least 30 minutes before eating (no exercising 1 hour before and after eating)
- Use bronchodilator/beta-adrenergic agonists
- Oxygen
- Prepare foods in advance
- Pursed lip breathing
- Small, frequent meals (she said 6 small meals in class)
- Avoid foods that require great deal of chewing
- Avoid gas-forming foods
- High-calorie, high-protein
- Fluids (intake of 3 L/day) should be taken between meals
Nursing Management–Pulmonary rehabilitation–COPD
Increase exercise performance
Reduce dyspnea
Improve quality of life
Activity considerations –COPD
Rest periods
Modify ADLs to conserve energy
Walk 15 to 20 minutes a day at least 3 times/week -
gradual increases
Medication education
Sexual activity–COPD
Plan when breathing is best
Use slow, pursed lip breathing
Refrain after strenuous activity
Do not assume dominant position or prolong foreplay
Promote Sleep–COPD
Nasal saline sprays, decongestants, or nasal steroid inhalers
Psychosocial considerations of COPD
-will need to pull this content from text
us supplemental oxygen with COPD to:
SpO2 goals
PaO2 goals
maintain ADL
Keep O2 sat 90% or greater (on our test we will use 90%)
PaO2 greater than 60mmHg
position for better breathing with COPD
tripod position
Exhale with pulling, pushing, tugging
Monitor the following with COPD
mental status
vital signs
lung sounds
color
Nursing Diagnoses- COPD
Ineffective airway clearance
Impaired gas exchange
Imbalanced nutrition: Less than body requirements
Activity Intolerance
Risk for infection
Anxiety/Depression
Insomnia
Nursing Interventions associated with: Ineffective airway clearance Impaired gas exchange Imbalanced nutrition: Less than body requirements Activity Intolerance Risk for infection Anxiety/Depression Insomnia
find in textbook???
nursing interventions for newly diagnosed COPD –cor pulmonale patient
In class discussion of Cor pulmonale case study
we want to:
–diuresis to remove the excess fluid
–educate the patient on smoking cessation, monitor weights, encourage rehab, medication education
look in textbook for a chart relating to this
anticholinergics used for copd
spiriva, atrovent
“pium”=anticholinergics
