COPD Flashcards
COPD encompasses
Emphysema & Bronchitis
What does smoking do?
hyperplasia (increased number of cells)
ii. Lost or decreased ciliary activity
iii. Abnormal distal dilation and destruction of alveolar walls
iv. Chronic, enhanced inflammation results in remodeling
Passive smoking
i. Decreased pulmonary function
ii. Increased respiratory symptoms
iii. Increased risk of lung and nasal sinus cancer
COPD risk factors
a. Infection
b. Severe, recurring respiratory infections in childhood
c. HIV
d. Tuberculosis
e. Asthma
f. Air pollution
g. Occupational dusts and chemicals
h. Aging
i. Genetics
Defining feature of COPD
airflow limitation not fully reversible during forced exhalation
Air flow limitation due to:
i. Loss of elastic recoil
ii. Airflow obstruction due to mucous hypersecretion, mucosal edema, and bronchospasm
Main characteristic of COPD
inability to expire air “air trapping” barrel chest
COPD patho
Excess mucus production and cough
Pulmonary vascular changes
d. Results in pulmonary hypertension resulting in right ventricular hypertrophy which results in right heart failure
Diagnosis is considered with:
i. Chronic cough (intermittent—first symptom)
ii. Sputum production
iii. Dyspnea; occurs with exertion and progressive
iv. Exposure to risk factors
1. Smoke, occupational dust
Diagnostics
a. Hypoxemia PaO2 < 60 mmHg; SaO2< 88 %
b. Hypercapnia PaCO2 > 45 mmHg
Increased RBC (body think they need more oxygen)
e. Bluish-red color of skin—polycythemia and cyanosis
Complications:
Pulmonary HTN Cor pulmonale (R sided ♡ failure)
Acute exacerbation symptoms
- Increased dyspnea, increased sputum volume, increased sputum purulence
- Malaise, insomnia, fatigue, depression, confusion, decreased exercise tolerance, wheezing, fever
Hospitalized for complications
i. Acute exacerbations
ii. Acute respiratory failure
iii. Pneumonia
iv. HF
- Removes diseased tissue so healthy tissue works better
2. Diaphragm can return to normal shape
Lung volume reduction surgery (LVRS)
COPD therapies
i. Oxygen therapy (considered a medication)
ii. O2 therapy is used to treat hypoxemia
Keep O2 sat @
88-92%, during rest/sleep/exertion
PaO2 >60
O2 admin what flow?
low flow
Complications of O2 therapy
Combustion
CO2 narcosis
O2 toxicity
Infection
CO2 narcosis what is it?
- CO2 no longer stimulus to breathe
2. DEVELOP A TOLERANCE TO HIGHER CO2 LEVELS-TRICKS BRAIN TO NOT TAKE DEEP BREATHES BC BODY THINGS I HAVE ENOUGH OXYGEN
Respiratory Care
Breathing retraining
Airway clearance techniques
Effective coughing or huff coughing
Short-term O2 therapy
up to 30 days
Long-term O2 Therapy (LTOT)
15 or more hours/day
Chest physiotherapy (CPT) indicated for
i. Excessive, difficult-to-clear bronchial secretions
ii. Postural drainage, percussion, and vibration
Positive expiratory pressure (PEP) to mobilize secretions
- Flutter
- Acapella
- TheraPEP
Diet for COPD
v. High-calorie, high-protein, moderate carbohydrates, and moderate fats diet is recommended
Avoid foods that:
- Foods that require a great deal of chewing
- Exercises and treatments 1 hour before and after eating
- Gas-forming foods
Health Promotion for COPD
i. Abstain from or stop smoking
ii. Early diagnosis and treatment of respiratory tract infections; avoidance measures
iii. Avoid or control exposure to occupational and environmental pollutants and irritants.
iv. Influenza and pneumococcal vaccines
v. Awareness of family history of COPD and AAT deficiency
Hospitalization required for acute exacerbations or complications:
Pneumonia
Cor Pulmonale
Acute respiratory failure
Pt/caregiver teachings
- Pulmonary rehabilitation
- Activity considerations
- Sexual activity
- Sleep
- Psychosocial considerations
Interfering factors with sleep
- Current tobacco use, depression, anxiety, meds, congestion, coughing or wheezing, sleep apnea
