COPD Flashcards
pulmonary disease that causes chronic obstruction of airflow from the lungs
COPD
Key points for COPD
Limited Airflow (due to thick and swollen bronchioles that have become deformed with excessive sputum production and this narrows the airways)
Inability to fully exhale (due to loss of elasticity of the alveoli sacs from damage and the sacs start to develop air pockets)
Irreversible once developed…cases vary among people from mild to severe…managed with lifestyle changes and medications.
Happens gradually….most people start to notice signs and symptoms middle-aged and will present with dyspnea with activity they could normally tolerate, recurrent lung infections, chronic cough etc.
COPD is a term used as a “______” for diseases that limit airflow and cause dyspnea.
catch all
What is the most common cause of COPD?
Tends to be environmental from harmful irritants that have been breathed into lungs
signs & symptoms tend to happen gradually and most people start to notice them at middle age
dyspnea with activity, chronic cough, recurrent lung infections
Emphysema “_________ puffers”
Chronic bronchitis “________bloaters”
pink (due to cyanosis & edema); blue
Why does Chronic bronchitis cause the diaphragm, which is normally dome shaped to flatten?
Over time, more and more air volume added to the lungs leads to hyperinflation of the lungs. This pushes down on the diaphragm and leads to flattening.
not enough oxygen getting in and retaining that carbon dioxide - this describes _______________
COPD
Normal breathing:
Inhaled oxygen travels down through the trachea which splits at the _________ into bronchial tubes starting with the primary bronchus then into smaller airways called secondary and tertiary bronchi which divide into bronchioles and the oxygen goes into the __________ sacs where gas exchange happens. As the alveoli inflate and deflate with ease, inhaled oxygen attaches to the __________ cells and carbon dioxide enters the respiratory system to be _____________.
carina; alveolar; red blood cells; exhaled
Those with chronic bronchitis are referred to as _________________. Why is this ?
blue bloaters
The name “blue bloaters” is due to cyanosis from “hypoxia” and bloating from edema AND increase in lung volume. The bloating is from the effects of the lung disease on the heart which causes right-sided heart failure.
What happens in chronic bronchitis?
Why does hyperinflation occur? How does the body attempt to compensate ?
Why does heart failure happen?
In chronic bronchitis, the bronchioles become damaged that leads them to be thick and swollen and deformed. This is accompanied by more sputum production. This limits the ability of the person being able to completely exhale the air taken in. So, when they take another breath in, it will increase the air volume even more (because they have retained air from the previous breath), and this leads to hyperinflation.
Also, less oxygen is getting into the blood and more carbon dioxide is staying in the blood. This leads to low blood levels and high carbon dioxide levels. Patients will have cyanosis due to a decreased oxygen level. To compensate, the body increases RBC production and cause blood to shift elsewhere which increases pressure in the pulmonary artery leading to pulmonary hypertension. Pulmonary hypertension leads to right-sided heart failure (which is why you will start to see bloating..edema in the abdomen and legs)
Those with emphysema are referred to as ______________. Why is this ?
pink puffers
The name comes from hyperventilation (puffing to breathe) and pink complexion (they maintain a relatively normal oxygen level due to rapid breathing) rather than cyanosis as in chronic bronchitis.
In emphysema, the alveoli sacs lose their ability to inflate and deflate due to an inflammatory response in the body. So, the sac is unable to properly deflate and inflate. Inhaled air starts to get trapped in the sacs and this causes major hyperinflation of the lungs because the patient is retaining so much volume.
Hyperinflation causes the diaphragm to flatten. The diaphragm plays a huge role in helping the patient breathe effortlessly in and out. Therefore, in order to fully exhale, the patient starts to hyperventilate and use accessory muscles to get the air out now. This leads to the barrel chest look and during inspect it may be noted there is an INCREASED ANTEROPOSTERIOR DIAMETER.
The damage in the sacs cause the body to keep high carbon dioxide levels and low blood oxygen levels. Inhaled oxygen will not be able to enter into the sacs for gas exchange and carbon dioxide won’t leave the cells to be exhaled.
The body tries to compensate by causing hyperventilation (increasing the respiratory rate…hence puffer) and the patient will have less hypoxemia “pink complexion” than chronic bronchitis who have the cyanosis because pink puffers keep their oxygen level just where it needs to be from hyperventilation.
S/S of COPD
LUNG DAMAGE Mnemonic
Remember: Lung Damage
Lack of energy
Unable to tolerate activity (shortness of breath)
Nutrition poor (weight loss) due to energy used breathing especially with emphysema
Gases abnormal (high PCO2 >45 and low PO2 <90)..respiratory acidosis
Dry or productive cough constant (productive with chronic bronchitis)
Accessory muscle usage during breathing, Abnormal lung sounds: diminished, coarse crackles (chronic bronchitis) or wheezing
Modification of skin color from pink to cyanosis in lips, mucous membranes, nail beds (“blue bloaters”)
Anteroposterior diameter increased (barrel chest)….emphysema “pink puffers”
Gets in the Tripod Position during dyspnea (stands leaning forward while supporting body with hands on knees or an object)
Extreme dyspnea
In turn over time, people with COPD will be stimulated to breathe due to low __________ levels RATHER than high _____________levels.
oxygen; carbon dioxide
Complications of COPD
Heart Disease (remember heart and lungs work together in replenishing the body with oxygen)…heart failure
Pneumothorax (spontaneous due to forming of air sacs)
Risk for Pneumonia
Cancer (especially lung)
How is COPD diagnosed ?
Spirometry: A test where a patient breathes into a tube that measure how much volume the lungs can hold during inhalation and how much and fast air volume is exhaled.
Measuring the FVC (Forced Vital Capacity): a low reading shows restrictive breathing….it measures the largest amount of air a person exhales after breathing in deeply in one second.
Forced Expiratory Volume: measures how much air a person can exhale within one second. A low reading shows the severity of the disease.
the bronchioles become damaged that leads them to be thick and swollen and deformed. This is accompanied by more sputum production.
Emphysema or Chronic Bronchitis
Chronic Bronchitis
Forced expiratory volume
measures how much air a person can exhale during a forced breath. The amount of air exhaled may be measured during the first (FEV1), second (FEV2), and/or third seconds (FEV3) of the forced breath.
Forced vital capacity (FVC) is the total amount of air exhaled during the FEV test.
the alveoli sacs lose their ability to inflate and deflate due to an inflammatory response in the body. So, the sac is unable to properly deflate and inflate.
Emphysema or Chronic Bronchitis
Chronic Bronchitis
NURSING INTERVENTIONS FOR COPD PATIENT
listen to ________ (may need suction) and sputum production…obtain a culture if ordered…at risk for pneumonia
monitor ______- production
Monitor ____ saturation - keep it between 88-93%
Monitor effort of breathing and teach about ___________ and _______ breathing
Administer _________treatments as needed
lung sounds; sputum; pursed-lip; diaphragmatic; breathing
how are COPD patients stimulated to breathe?
Low oxygen levels rather than high carbon dioxide levels (which is the normal)
We don’t want to give them too much oxygen because it will stop their incentive to breathe. Give them too much O2 it will stop their breathing leading to hypoventilation and toxic buildup of CO2
Given oxygen as prescribed in low amounts 1-2 liters
patient education for COPD
Nutrition needs: eating high calorie, protein rich meals that are small but frequent and staying hydrated if not contraindicated….avoid large heavy meals due to compression on the lungs from the stomach
Avoiding sick people, irritants, hot humid (smothering) or very cold weather
Stop smoking or being around people who smoke
Vaccination up-to-date: annual flu shot and Pneumovax every 5 years because it is very hard for people with COPD to recover from illnesses
Pursed lip and diaphragmatic breathing techniques
Administering medications: be familiar with groups, side effects, and patient teaching
COPD- If they are given too much oxygen it will reduce their need to breathe…causing ______________ and carbon dioxide levels will increase to toxic levels.
hypoventilation
Medication regime for COPD
Chronic Pulmonary Medications Save Lungs
Corticosteroids
Phosphodiestrace-4 inhibitors:
Methylxanthines
Long-acting Bronchodilators
what do corticosteroids do?
How are they given?
Give some examples
What are some side effects ?
decreases inflammation and mucous production in airway
given: oral, IV, inhaled and used in combination with bronchodilator like:
Symbicort: combination of steroid and long acting bronchodilator
Other corticosteroids: Prednisone, Solu-medrol, Pulmicort
Side effects: easy bruising, hyperglycemia, risk of infection (because corticosteroids suppress the immune system), bone problems such as osteoporosis (long term use)
Patient education: rinse mouth after using inhaled corticosteroids…can develop thrush, use corticosteroid inhaler AFTER using bronchodilator inhaler
What do Phosphodiestrace-4 inhibitors do ?
What side effect should we look out for?
“Roflumilast” used for people who have chronic bronchitis and it works by decreasing COPD exacerbation…not a bronchodilator
Side effects: can cause suicidal thoughts (remember the word “last” in the drug’s name…it could be the patient’s last days if they are not assessed for this side effect) and can cause weight loss.
What do Methylxanthines do ?
Give an example
What should we remember about it ?
Theophylline (most commonly given orally) type of bronchodilator used long term in patients who have severe COPD
Remember: Narrow therapeutic range of 10 to 20 mcg/mL
Increases risk for digoxin toxicity and decreases the effects of lithium and Dilantin
What to remember about bronchodilators ?
Know which ones are short acting and which ones are long acting
Short-acting bronchodilators: relaxes the smooth muscle of the bronchial tubes and are used in emergency situations where quick relief is needed
Albuterol (beta 2 agonist) and Atrovent (anticholinergic)
Long-acting Bronchodilators: relaxes the smooth muscle of the bronchial tubes (same as short-acting bronchodilators BUT their effects last longer) used over a longer period of time….taken once or twice a day
Beta 2 agonist: salmeterol, anticholinergics: Spiriva
Patient education: let them know which drug is short and long-acting, how to use inhaler and to use bronchodilator inhaler BEFORE steroid inhaler (wait 5 minutes in between)
WHY? TO OPEN UP THE AIRWAYS SO THE STEROID CAN GET IN THERE AND DO ITS JOB
Side effects of beta 2 agonist: increased heart rate, urinary retention
Side effects of anticholinergic: dry mouth, blurred vision
This breathing technique uses abdominal muscles for breathing rather than accessory muscles
Diaphragmatic Breathing
helps make diaphragm stronger which is weak
slows down breathing rate to allow breathing to be easier
decreases energy used to breathe
used along with pursued breathing technique
used for when patient starts to get dyspneic. This technique increases the oxygen level and encourages them to breath out longer (remember these patient don’t fully exhale very well). It is similar to like blowing out a birthday candle.
Pursed Lip breathing
In which order should we use bronchodilators and corticosteroids ?
BRONCHODILATOR FIRST IN ORDER TO OPEN UP THE AIRWAYS SO THE STEROID CAN GET IN THERE AND DO ITS JOB
