COPD

Question 1

COPD

Answer 1

Smaller airflow limitation not fully reversible (inflammation)

• inability to expire air
• includes: chronic bronchitis and emphysema
• results in hypoxemia, pulmonary HTN, and hypercarpnia

Question 2

Chronic Bronchitis

Answer 2

cough for 3 or months in each of 2 successive yrs

• blue bloater
• dusky to cyanotic
• hypoxia and hypercapnia
• leads to R HF

Question 3

Emphysema

Answer 3

destruction of bronchioles

• pink puffer
• high CO2 retention
• purse lip breathing
• dyspnea

Question 4

COPD Risk Facotrs

Answer 4

• smoking
• occupational
• infection: HIV/tuberculosis
• Genetics: a-antitrypsin
• aging: ephysema

Question 5

COPD Clinical Manifestations

Answer 5

• develops slowly
• cough, sputum, dyspnea
• early: intermittent cough
• fatigue
• tripod position

Question 6

Mild COPD

Answer 6

> 80%

• reduction of RF
• flu vaccine
• SABA

Question 7

Moderate

Answer 7

50-80%

• reduction of RF
• flu vaccine
• SABA & LABA
• rehab

Question 8

Severe

Answer 8

30-50%

• reduction of RF
• flu vaccine
• SABA & LABA
• rehab
• corticosteroids

Question 9

Very Severe

Answer 9

<30%

• reduction of RF
• flu vaccine
• SABA & LABA
• rehab
• corticosteroids
• O2 if respiratory failure

Question 10

COPD Complications

Answer 10

• cor pulmonale
• exacerbations
• acute respiratory failure
• PUD
• Depression/anxiety

Question 11

Cor Pulmonale

Answer 11

• hypertrophy of right side of heart
• result: pulmonary HTN
• leads to: R HF
• dyspnea

Question 12

Exacerbations

Answer 12

• change in dyspnea, cough, sputum
• cause: bacterial/viral infection
• severe: accessory muscles

Question 13

Diagnosis

Answer 13

pulmonary function tests
-chest xray
-spirometry
-history & physical
CAT
6 min walk

Question 14

Spirometry findins

Answer 14

reduced FEV/FVC ratio

increased residual volume

Question 15

ABG findings

Answer 15

low O2
high PaCO2 & pH
high bicarbonate: late stages

Question 16

Interprofessional care

Answer 16

• smoking cessation
• vaccines: flu & pneumonia
• avoid irritants
• T: short acting bronchodilators, corticosteroids, antibiotics, and oxygen

Question 17

Bronchodilators

Answer 17

• relax smooth muscles

- ↓ Dyspnea and ↑ in FEV1

Question 18

Inhaled Corticosteroids

Answer 18

ICS therapy is beneficial for patients with stage 3 (severe) or stage 4 (very severe) COPD
-combine with LABA

Question 19

Antibiotics

Answer 19

• azithromycin

- prevent recurrent exacerbations

Question 20

Phosphodiesterase inhibitor

Answer 20

Roflumilast (Daliresp)

-decrease the frequency of exacerbations in severe COPD

Question 21

Hypoxia Symptoms

Answer 21

Early: RAT
Restlessness
Anxiety
Tachycardia/pnea
Late: BED
Bradycardia
Extreme restlessness
Dyspnea (severe)

Question 22

Respiratory and physical therapy

Answer 22

Breathing retraining; Decreases dyspnea, improves oxygenation, and slows respiratory rate

• pursed lip & abdominal breathing
• effective coughing

Question 23

Chest physiotherapy is indicated for

Answer 23

Excessive, difficult-to-clear bronchial secretions
Retained secretions in artificial airway
Lobular atelectasis from mucous plug

Question 24

Percussion & Vibration

Answer 24

P: Air-cushion impact facilitates movement of thick mucus
V: Facilitates movement of secretions to larger airways