COPD

Question 1

Emphysema

Answer 1

loss of lung elesticity & hyperinflation of lung tissue that leads to decrease surface area for gas exchange -> CO2 retention -> respiratory acidosis

• Abnormal distention of air spaces beyond the terminal bronchioles with destruction of the walls of the alveoli
• hypoxia results

Question 2

Chronic bronchitis

Answer 2

inflammation of the bronchi & bronchioles due to chronic exposure to irritants

Question 3

Typical posture of a person with COPD?

Answer 3

tripod

Question 4

Pulmonary Emphysema :Pink Puffer”

Answer 4

• increase CO2 retention (pink)
• no cyanosis
• Purse lip breathing
• dyspnea
• ineffective cough
• hyperresonance on chest percussion
• orthopneic
• Barrel chest
• Exertional Dyspnea
• prolonged expiratory time
• Speaks in short jerky sentences
• anxious
• use of accessory muscles to breathe
• thin appearance
• leads to right sided heart failure

Question 5

Chronic Bronchitis

Answer 5

• cough & sputum production for 3 months in each of 2 consecutive years
• ciliary function is reduced, bronchial walls thicken, bronchial airways narrow, & mucous may plug airways
• chronic mucus hypersecretion causes lung function decline, exacerbations, & infections
• Most patients will have elements of both emphysema & chronic bronchitis

Question 6

Chronic Bronchitis “Blue Bloater”

Answer 6

• airway flow problem
• color dusky to cyanotic
• recurrent cough & increased sputum production
• hypoxia
• hypercapnia
• respiratory acidosis
• increased Hgb
• increased respiratory rate
• exertional dyspnea
• increased incidence in smokers
• digital clubbing
• cardiac enlargment
• use of accessory muscles to breathe
• leads to right-sided heart failure: bilateral pedal edema, increased JVD

Question 7

Bronchodilators

Answer 7

• ventolin (albuterol): beta 2-agonists for rapid relief (rescue)
• Atrovent: an anticholinergic increase bronchodilation & decrease pulmonary secretions
• Theo-dur: relaxes smooth muscles of the bronchi

Question 8

Nursing Management of COPD

Answer 8

• promote smoking cessation
• Medications, assisting with ADLs, oxygen therapy, teaching strategies
• Pursed-lip breathing: helps slow exhalation & prevent collapse of the small airways; allows more air to be exhaled & decreased hyperinflation
• Diaphragmatic breathing
• Cooling fan, relaxation techniques, exercise training; positioning

Question 9

Managing Impaired Gas exchange

Answer 9

• monitor for hypoxemia: pulse oximetry, ABGs, O2

- Oxygen prescription: teaching & safety

Question 10

Managing cough & ineffective airway clearance

Answer 10

• eliminate pulmonary irritants
• cough effectively
• postural drainage, acepella (vibration)

Question 11

Improving Exercise Tolerance

Answer 11

• early mobilization after acute exacerbation
• bed & chair exercises: strength training
• acitivity alternating with rest
• walking aids, PT, OT, pulmonary rehab

Question 12

Promotion Nutrition

Answer 12

• assess nutritional status, treat underlying cause, stabilize weight & body compostiton, supplements
• timing of bronchodilators before meals; small & frequent meals
• dietician referral

Question 13

Pneumothorax

Answer 13

from ruptured bullaue

• sudden sharp & abrupt chest pain
• severe SOA, chest asymmetry
• Bullae are enlarged airspaces that grow & take up space in chest cavity; compress areas of healthier lung & impair gas exchange; surgical excision
• respiratory failure: severe COPD & hypercapnia