COPD Flashcards
What is COPD? Is it reversible? What two disease processes do most patients overlap? What other disease may COPD exist with?
- progressive airway limitation or obstruction
- not fully reversible
- most patients overlap emphysema and chronic bronchitis
- COPD may exist with asthma
COPD Pathophysiology
- 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
How is Chronic bronchitis diagnosed?
Cough and sputum for at least 3 months in each of two consecutive years
Chronic bronchitis issues
- inflammation: increased mucus production, thicker bronchial walls
- mucus plugging: reduced ciliary function
- damaged/fibrosis adjacent alveoli
- increased susceptibility to respiratory infection
What is emphysema?
Slow progression of wall destruction of overextended alveoli
Emphysema issues
- 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
Emphysema —> ventilation/perfusion mismatch leading to….(6)
- chronic hypoxemia
- hypercapnia
- polycythemia (increased RBCs)
- right sided HF: episodic to chronic
- peripheral edema
- central cyanosis and respiratory failure
COPD Risk factors
- 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
COPD S/S (15)
- 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)
Primary symptoms of emphysema (3)
- wheezing
- barrel chest
- accessory muscle use
Chronic bronchitis primary symptoms
- sputum
- productive cough
Right sided heart failure (cor pulmonale) S/S (9)
- 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
How does cor pulmonale cause edema?
-chronic low O2 —> chronic pulmonary resistance —> pulmonary HTN —> increased right-side cardiac work load —> resulting peripheral edema
COPD ASSESSMENT
- history and physical
- spirometry
- ABGs
- chest x-ray
- alpha1-antitrypsin if the patient is below 45 or has a family hx
What do you withhold from a patient 6-12 hours before pulmonary function tests?
Bronchodilators —> if a pt has taken these it may not give an accurate result due to lungs being more open
What percentage of FEV1/FVC means that someone has COPD?
<70%
Main complications of COPD (2)
- respiratory insufficiency and failure: Chronic or acute
- PNA, chronic atelectasis
COPD symptom reduction for stable disease
- relief of dyspnea
- increased respiratory flow rate
- decreased sputum
- normal ABGs
- improved chest X-ray
Smoking cessation
- set quit date
- refer to program
- frequent follow up
- individualized reinforcement
- nicotine replacement therapy ‘
- antidepressants —> buproprion SR, nortyptiline
- nicotine acetylcholine receptor partial agonist: Vareniciline
What is the COPD collaborative management goal?
Improve oxygenation: ventilation and diffusion
Bronchodilators (what they do, improvement in prognosis? pt education)
- reduce airway obstruction, improve ventilation
- no improvement in prognosis
- patient ed on deliver method
3 examples of bronchodilators
- beta2-adrenergic —> salmeterol, terbutaline
- anticholinergic/ antimuscarinic agents —> ipatropium
- combination short-acting beta2-adrenergic agonist and anticholinergic agent —>__ol/__opium
Corticosteroids (what they do, do they change prognosis? how long does the treatment last?)
- reduce inflammation, improve ventilation
- no change in prognosis; may reduce exacerbation
- short term treatment for symptom improvement
Example of corticosteroids
-inhaled form (combination): advair (salmeterol/fluticasone), symbicort (for otero/budenoside)
Other meds for therapy
- antibiotics for infection; no prophylaxis
- alpha1-antitrypsin augmentation therapy
- mucolytic agents
- vasodilator
- vaccines (prevent respiratory infections)
COPD Exacerbation
- address cause if identified —> infection, air pollution
- optimization of bronchodilator
- antibiotics, corticosteroids, O2 therapy, respiratory treatments PRN
What to do for severe COPD (chronic bronchitis) to reduce risk of exacerbation?
PO daily roflumilast for decreased risk of exacerbation and frequency of exacerbation
Hospital admission for COPD (symptoms, what to do first, meds)
Symptoms —> dyspnea, confusion, respiratory muscle fatigue, paradoxical chest movements
- O2 and rapid assessment
- short acting inhaled bronchodilator, corticosteroids, antibiotics for bacterial infections
COPD and Oxygen therapy GOLD 2018 guidelines
- 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
Oxygen therapy for COPD patients (in COPD patients with chronic hypercapnia what is Hg more attracted to? High flow O2 decreases ___?
- COPD patients with chronic hypercapnia —> Hg more attracted to CO2 than O2
- high flow O2 decreases hypoxia pulmonary vasoconstriction
BEST PRACTICE FOR O2 THERAPY W/ COPD PATIENTS
- O2 flow PRN to maintain SaO2 greater than or equal to 90%
- recheck need in 60-90 days
COPD Surgical interventions
- bullectomy —> remove Bullae from lungs
- bronchoscope lung volume reduction —> collapse areas of emphysema destroyed tissue
- lung transplant
COPD newer approaches (triple therapy)
- long-acting beta agonist (salmeterol)
- long-acting muscarinic antagonist (tiotropium)
- inhaled corticosteroid
What do inhaled corticosteroids increase the risk of? What needs to be checked prior to prescription?
- increases risk of PNA
- eosinophil count must be evaluated prior to prescription
Pulmonary rehabilitation
- 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
What is skills training in pulmonary rehab?
- breathing exercises —> diaphragmatic, pursed-lip
- activity pacing
- participation in self-care activities
Pursed lip breathing
- 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
COPD nursing management
- airway clearance
- directed coughing: huff coughing
- chest physiotherapy: postural drainage
- increased fluids
- NS/water aerosol mist
- vaccination: flu and PNA
What is huff coughing?
-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.
