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Nursing G140 Exam #1 (MS) > COPD > Flashcards

COPD Flashcards

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1
Q

What is COPD? Is it reversible? What two disease processes do most patients overlap? What other disease may COPD exist with?

A
  • progressive airway limitation or obstruction
  • not fully reversible
  • most patients overlap emphysema and chronic bronchitis
  • COPD may exist with asthma
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2
Q

COPD Pathophysiology

A
  • lungs abnormal inflammatory response to particles/gases
  • Chronic inflammation + body’s repair attempt: airways change with scar tissue and narrowing —> mucus hypersecretion, thickening of peripheral airway, fibrosis, exudate; scare tissue formation: narrowing airway lumen; alveolar wall destruction: decreased gas exchange; thickening of pulmonary vessels: pulmonary hypertension
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3
Q

How is Chronic bronchitis diagnosed?

A

Cough and sputum for at least 3 months in each of two consecutive years

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4
Q

Chronic bronchitis issues

A
  • inflammation: increased mucus production, thicker bronchial walls
  • mucus plugging: reduced ciliary function
  • damaged/fibrosis adjacent alveoli
  • increased susceptibility to respiratory infection
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5
Q

What is emphysema?

A

Slow progression of wall destruction of overextended alveoli

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6
Q

Emphysema issues

A
  • decreased surface contact with pulmonary capillaries: hypoxemia
  • impaired CO2 elimination: hypercapnea and respiratory acidosis
  • decreased size capillary bed, increased resistance to pulmonary airflow (less flexible air sacs)
  • Chronic pulmonary hypertension: right-sided HF= cor pulmonale
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7
Q

Emphysema —> ventilation/perfusion mismatch leading to….(6)

A
  • chronic hypoxemia
  • hypercapnia
  • polycythemia (increased RBCs)
  • right sided HF: episodic to chronic
  • peripheral edema
  • central cyanosis and respiratory failure
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8
Q

COPD Risk factors

A
  • smoking and second hand smoke
  • e-cig smoking for those who never smoked regular cig —> 75% increased risk
  • occupational exposure
  • air pollution: indoor or outdoor
  • increased age
  • alpha1-antitrypsin deficiency leading to lung destruction
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9
Q

COPD S/S (15)

A
  • easily fatigued
  • frequent respiratory infections
  • use of accessory muscles to breathe
  • orthopneic
  • cor pulmonale (late in disease)
  • thin in appearance
  • wheezing
  • pursed-lip breathing
  • chronic cough
  • barrel chest
  • dyspnea
  • prolonged exploratory time
  • bronchitis- increased sputum
  • digital clubbing (late sign)
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10
Q

Primary symptoms of emphysema (3)

A
  • wheezing
  • barrel chest
  • accessory muscle use
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11
Q

Chronic bronchitis primary symptoms

A
  • sputum

- productive cough

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12
Q

Right sided heart failure (cor pulmonale) S/S (9)

A
  • fatigue
  • increased peripheral venous pressure
  • ascites
  • enlarged spleen and liver
  • may be secondary to chronic pulmonary problems
  • distended jugular veins
  • anorexia and complaints of GI distress
  • weight gain
  • dependent edema
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13
Q

How does cor pulmonale cause edema?

A

-chronic low O2 —> chronic pulmonary resistance —> pulmonary HTN —> increased right-side cardiac work load —> resulting peripheral edema

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14
Q

COPD ASSESSMENT

A
  • history and physical
  • spirometry
  • ABGs
  • chest x-ray
  • alpha1-antitrypsin if the patient is below 45 or has a family hx
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15
Q

What do you withhold from a patient 6-12 hours before pulmonary function tests?

A

Bronchodilators —> if a pt has taken these it may not give an accurate result due to lungs being more open

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16
Q

What percentage of FEV1/FVC means that someone has COPD?

A

<70%

17
Q

Main complications of COPD (2)

A
  • respiratory insufficiency and failure: Chronic or acute

- PNA, chronic atelectasis

18
Q

COPD symptom reduction for stable disease

A
  • relief of dyspnea
  • increased respiratory flow rate
  • decreased sputum
  • normal ABGs
  • improved chest X-ray
19
Q

Smoking cessation

A
  • set quit date
  • refer to program
  • frequent follow up
  • individualized reinforcement
  • nicotine replacement therapy ‘
  • antidepressants —> buproprion SR, nortyptiline
  • nicotine acetylcholine receptor partial agonist: Vareniciline
20
Q

What is the COPD collaborative management goal?

A

Improve oxygenation: ventilation and diffusion

21
Q

Bronchodilators (what they do, improvement in prognosis? pt education)

A
  • reduce airway obstruction, improve ventilation
  • no improvement in prognosis
  • patient ed on deliver method
22
Q

3 examples of bronchodilators

A
  • beta2-adrenergic —> salmeterol, terbutaline
  • anticholinergic/ antimuscarinic agents —> ipatropium
  • combination short-acting beta2-adrenergic agonist and anticholinergic agent —>__ol/__opium
23
Q

Corticosteroids (what they do, do they change prognosis? how long does the treatment last?)

A
  • reduce inflammation, improve ventilation
  • no change in prognosis; may reduce exacerbation
  • short term treatment for symptom improvement
24
Q

Example of corticosteroids

A

-inhaled form (combination): advair (salmeterol/fluticasone), symbicort (for otero/budenoside)

25
Q

Other meds for therapy

A
  • antibiotics for infection; no prophylaxis
  • alpha1-antitrypsin augmentation therapy
  • mucolytic agents
  • vasodilator
  • vaccines (prevent respiratory infections)
26
Q

COPD Exacerbation

A
  • address cause if identified —> infection, air pollution
  • optimization of bronchodilator
  • antibiotics, corticosteroids, O2 therapy, respiratory treatments PRN
27
Q

What to do for severe COPD (chronic bronchitis) to reduce risk of exacerbation?

A

PO daily roflumilast for decreased risk of exacerbation and frequency of exacerbation

28
Q

Hospital admission for COPD (symptoms, what to do first, meds)

A

Symptoms —> dyspnea, confusion, respiratory muscle fatigue, paradoxical chest movements

  • O2 and rapid assessment
  • short acting inhaled bronchodilator, corticosteroids, antibiotics for bacterial infections
29
Q

COPD and Oxygen therapy GOLD 2018 guidelines

A
  • short term PRN for SaO2 greater than or equal 90%
  • long term therapy for PaO2 55 mmHg or SaO2 < 88%; PaO2 55-60 mmHg with CHF or Hct > 55%

-O2 intermittent therapy —> desaturation r/t ADL, exercise, sleep

30
Q

Oxygen therapy for COPD patients (in COPD patients with chronic hypercapnia what is Hg more attracted to? High flow O2 decreases ___?

A
  • COPD patients with chronic hypercapnia —> Hg more attracted to CO2 than O2
  • high flow O2 decreases hypoxia pulmonary vasoconstriction
31
Q

BEST PRACTICE FOR O2 THERAPY W/ COPD PATIENTS

A
  • O2 flow PRN to maintain SaO2 greater than or equal to 90%

- recheck need in 60-90 days

32
Q

COPD Surgical interventions

A
  • bullectomy —> remove Bullae from lungs
  • bronchoscope lung volume reduction —> collapse areas of emphysema destroyed tissue
  • lung transplant
33
Q

COPD newer approaches (triple therapy)

A
  • long-acting beta agonist (salmeterol)
  • long-acting muscarinic antagonist (tiotropium)
  • inhaled corticosteroid
34
Q

What do inhaled corticosteroids increase the risk of? What needs to be checked prior to prescription?

A
  • increases risk of PNA

- eosinophil count must be evaluated prior to prescription

35
Q

Pulmonary rehabilitation

A
  • multidisciplinary at least 6 weeks (longer more effective)
  • assessment and patient/fam education
  • smoking cessation
  • physical reconditioning, nutritional counseling
  • psychological support: coping mechanisms
  • skills training
36
Q

What is skills training in pulmonary rehab?

A
  • breathing exercises —> diaphragmatic, pursed-lip
  • activity pacing
  • participation in self-care activities
37
Q

Pursed lip breathing

A
  • no puffing of cheeks
  • no open mouth during exhalation
  • sit up right and relax
  • breath in through nose for 2 seconds
  • slowly exhale with pursed lips for 4 seconds
38
Q

COPD nursing management

A
  • airway clearance
  • directed coughing: huff coughing
  • chest physiotherapy: postural drainage
  • increased fluids
  • NS/water aerosol mist
  • vaccination: flu and PNA
39
Q

What is huff coughing?

A

-sit up straight with chin slightly tilted forward and mouth open. Take a slow deep breath to fill lungs 3/4 full. Hold breath for two to three seconds and exhale forcefully or slowly to move mucus.

Nursing G140 Exam #1 (MS) (5 decks)

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