COPD and oxygenation

Question 1

1 cause of COPD

Answer 1

smoking

Question 2

whats one of the most potent chemicals in cigarettes?

Answer 2

nicotine

Question 3

nicotine’s affect on the body

Answer 3

acts as a stimulant to the SNS resulting in:

• increases HR, BP, and cardiac workload
• peripheral vasoconstriction

Question 4

What scale can we use to measure dyspnea?

Answer 4

Visual Analog Dyspnea Scale (VADS) (mark on the continuum/line)
-also evaluate the use of accessory muscles to breath

Question 5

normal ABG levels:

Answer 5

ph: 7.35-7.45
CO2: 35-45
HCO3: 22-26

Question 6

common diagnostic tests for COPD

Answer 6

ABGs
CBC (look for polycythemia--having inc in RBCs is body's way of compensating)
Alpha-1 AntiTrypsin Serum Level (performed on young PTs and NONSMOKERS)--a deficiency in this can cause empysema
-sputum analysis
-decreased O2 sat (know PT's baseline)
-chest x-ray
-PT's presentation 
-Pulmonary function tests

Question 7

how to diagnose chronic bronchitis by patient’s presentation?

Answer 7

having a chronic cough lasting more than 3 months 2x in year for past 2 years

Question 8

VC - Vital capacity

Answer 8

A volume of a full breath exhaled in the patient’s own time and not forced

Question 9

RV – Residual Volume

Answer 9

Volume of gas that remains in the lungs following maximal expiration

Question 10

TLC - Total Lung Capacity

Answer 10

The total amount of air in the lungs after taking the deepest breath possible

Question 11

FEV1 (Forced expiratory volume in one second)

Answer 11

The volume of air expired in the first second of the exhalation (normal > 80%)

Question 12

FVC – (Forced Vital Capacity

Answer 12

The total volume of air that can be forcibly exhaled in one breath
 FVC > FEV1
 Normal: > 80%

Question 13

FEV1/FVC ratio

Answer 13

The fraction of air exhaled in the first second relative to the total volume exhaled
 Normal: > 0.7-0.8, depending on age

Question 14

What is the FEV1/FVC ratio in a typical COPD patient?

Answer 14

 COPD patients: typical findings are reduced FEV1/FVC (ratio of

Question 15

cor pulmonale

Answer 15

right-sided heart failure

Question 16

Drug therapy for COPD patients

Answer 16

• bronchodialators (dec airway resistance and hyperinflation and reduces dyspnea) (i.e. albuterol)
• Anti-inflammatory/steriods
• Combination inhalers

Question 17

What is the recommended oxygen therapy for a COPD patient?

Answer 17

Low Flow O2 Therapy
 Raises PO2 in inspired air
 2-4 liters/minute (maximum is 4 liters/minute) via nasal cannula or up to 40% via Venturi Mask
 Treats hypoxemia (avoid over-treatment)
 Goal: PaO2 – 60-65% and Saturation around 90%
 Humidification is commonly used

Question 18

home therapy O2 for COPD patients

Answer 18

Chronic O2 therapy at home
	Improved prognosis 
	Improved neuropsychologic function
	Increased exercise intolerance
	Reduced pulmonary hypertension

Question 19

respiratory therapy for a COPD patient?

Answer 19

• pursed-lip breathing
• diaphragmatic breathing
• incentive spirometer

Question 20

recommended diet for COPD patients?

Answer 20

high calorie and high protein (AVOID HIGH CARBs!!!)

• eat small meals often
• Why low carb? bc eating carbs yields the highest amt of carbon dioxide, carbs have the highest “respiratory quotient” and fats have the lowest

Question 21

Important health education for COPD patients

Answer 21

• stop smoking
• get yearly flu vaccine
• get pneumonia vaccination
• avoid large crowds (to reduce risk of infection)

Question 22

afterload

Answer 22

amount of pressure required to pump blood out to the circulation from the L ventricle (workload of the heart)

Question 23

end diastolic volume (pressure BEFORE contraction), the amount of blood in heart chambers BEFORE contraction

Answer 23

preload

Question 24

A patient is admitted to the emergency department with suspected carbon monoxide poisoning. Even though the patient’s color is ruddy, not cyanotic, the nurse understands that the patient is at a risk for decreased oxygen-carrying capacity of blood because carbon monoxide does which of the following:

Answer 24

forms a strong bond with hemoglobin, creating a functional anemia

Question 25

A patient is admitted with the diagnosis of severe left-sided heart failure. The nurse expects to auscultate which adventitious lung sounds?

Answer 25

inspiratory crackles in lung bases

Why? Bc dec effective contraction of L heart –>fluid back up in lungs–>inc hydrostatis pressure–>pulmonary edema–>crackles in lung bases

Question 26

A patient was admitted after a motor vehicle accident with multiple fractured ribs. Respiratory assessment includes signs/symptoms of secondary pneumothorax, which includes which of the following?

Answer 26

sharp pleuritic pain that worsens on inspiration

-when lung collapses, the thoracic space fills w/ air on each inspiration, and the atmospheric air irritates the parietal pleura, causing pain

Question 27

using saline for suctioning?

Answer 27

No! Saline has been found to cause more side effects when suctioning and does not inc the amt of secretions removed

Question 28

common nursing diagnoses for COPD patients

Answer 28

• impaired gas exchange
• inability to tolerate temp extremes
• activity intolerance
• inability to cope with changes in roles
• alteration in nutrition

Question 29

inspiration is an_____ process

Answer 29

active

Question 30

expiration is an _______ process

Answer 30

passive

Question 31

decreased hemoglobin levels alterth the patient’s ability to

Answer 31

transport oxygen

Question 32

impaired chest wall movement reduces the

Answer 32

level of tissue oxygenation

Question 33

hypoventilation causes

Answer 33

CO2 retention

Question 34

airway maintenance requires mobilization of secretions by:

Answer 34

increased fluid intake, humidification, or nebulization

airway maintenance may also require use of artificial airways and suctioning

Question 35

breathing exercises improve:

Answer 35

ventilation, oxygenation, and sensations of dyspnea