COPD

Question 1

chronic lung disease…

Answer 1

bronchitis and pulmonary emphysema (COPD)

asthma

Question 2

intermittent disease

reversible airflow obstruction and wheezing

Answer 2

asthma

Question 3

characterized by bronchospasm and dyspnea

• damage to lung is NOT reversible and increases in severity
• compensation occurs over time, ABGs altered

Answer 3

COPD

Question 4

as COPD worsens…

Answer 4

• amount of O2 in blood decreases (hypoxemia)

- amount of CO2 in blood increases (hypercapnia)

Question 5

worsened COPD causes…

Answer 5

• *chronic respiratory acidosis
• increased arterial carbon dioxide (PaCO2)
• results in kidneys retaining bicarb as compensates

Question 6

if advanced emphysema….

Answer 6

d/t alveoli being affected

hypercarbia is a problem

Question 7

how is cough and comfort facilitated in COPD pt

Answer 7

semi or high fowlers (lessens pressure on abdomen)

Question 8

why can gastric distention occur in COPD pt

Answer 8

elevated diaphragm and inhibits full lung expansion

Question 9

describe chronic bronchitis

Answer 9

• *blue bloaters
• daily productive cough for more than 3 months (at least 2 yrs)
• characterized by excess mucus secretion within bronchial tubes, inflammation leading to cough and difficulty breathing

Question 10

describe s/s of chronic bronchitis

Answer 10

• overweight and cyanotic
• elevated hemoglobin
• peripheral edema
• rhonchi, wheezing, crackles
• blue lips, face, mucus, nail beds
• right HF
• distended neck veins

Question 11

describe emphysema

Answer 11

• *pink puffer
• permanent enlargement and destruction of airspaces distal to the terminal bronchiole
• characterized by long term, progressive SOB d/t overinflation of alveoli (skin appears pink)

Question 12

increased work to breathe in emphysema pt….

Answer 12

causes increased O2 consumption

Question 13

what does an xray indicate in emphysema

Answer 13

hyperinflation with flattened diaphragm

Question 14

describe s/s of emphysema

Answer 14

• older and thin
• severe dyspnea
• quiet chest/breath sounds
• *barrel chest
• pursed lip breathers

Question 15

nursing interventions for COPD (same for bronchitis and emphysema)

Answer 15

• lowest FiO2 (1-2 L), prevent CO2 retention
• monitor for s/s fluid overload
• maintain paO2 55-60
• tripod position
• administer bronchodilators and anti-inflammatory

Question 16

overinflation of lungs causes what

Answer 16

• rib cage to remain partially expanded, appears barrel chest like
• pt works harder to breathe BUT amount of O2 taken in is not adequate enough

Question 17

inadequate arterial oxygenation is manifested by

Answer 17

• cyanosis
• slow cap refill
• clubbing of fingernails (chronic and late sign)

Question 18

cells of body depend on…

Answer 18

O2 to carry out their functions

Question 19

this occurs with insufficient oxygenation

Answer 19

chronic bronchitis

leads to general cyanosis and R HF

Question 20

other COPD interventions

Answer 20

• teach to sit upright and bend forward
• teach diaphragmatic and pursed lip breathing
• administer O2 at 1-2 L by nasal cannula
• pace activity and conserve energy
• small, frequent meals (increase calories and protein)
• fluid intake 3 L a day (between meals not with them)
• smoking cessation

Question 21

COPD dietary methods

Answer 21

• increased Mg and Ca (role in muscle contraction and relaxation)
• monitor Mg and Phos. role r/t bone mineral density
• if a smoker, may need vitamin C

Question 22

because eating consumes energy…

Answer 22

-may need mechanical soft diets (needed as eating takes necessary energy needed for breathing)

Question 23

exposure to tobacco smoke….

Answer 23

primary cause of COPD in US

Question 24

if cyanotic and lethargic…

Answer 24

bad oxygenation

Question 25

if O2 is running at >4 L….

Answer 25

must bubble through water solution so it is humidified

Question 26

if 1-4 L O2 is running….

Answer 26

in mask or nares, pharynx provides adequate humidfication