COPD and oxygenation Flashcards
1 cause of COPD
smoking
whats one of the most potent chemicals in cigarettes?
nicotine
nicotine’s affect on the body
acts as a stimulant to the SNS resulting in:
- increases HR, BP, and cardiac workload
- peripheral vasoconstriction
What scale can we use to measure dyspnea?
Visual Analog Dyspnea Scale (VADS) (mark on the continuum/line)
-also evaluate the use of accessory muscles to breath
normal ABG levels:
ph: 7.35-7.45
CO2: 35-45
HCO3: 22-26
common diagnostic tests for COPD
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
how to diagnose chronic bronchitis by patient’s presentation?
having a chronic cough lasting more than 3 months 2x in year for past 2 years
VC - Vital capacity
A volume of a full breath exhaled in the patient’s own time and not forced
RV – Residual Volume
Volume of gas that remains in the lungs following maximal expiration
TLC - Total Lung Capacity
The total amount of air in the lungs after taking the deepest breath possible
FEV1 (Forced expiratory volume in one second)
The volume of air expired in the first second of the exhalation (normal > 80%)
FVC – (Forced Vital Capacity
The total volume of air that can be forcibly exhaled in one breath
FVC > FEV1
Normal: > 80%
FEV1/FVC ratio
The fraction of air exhaled in the first second relative to the total volume exhaled
Normal: > 0.7-0.8, depending on age
What is the FEV1/FVC ratio in a typical COPD patient?
COPD patients: typical findings are reduced FEV1/FVC (ratio of
cor pulmonale
right-sided heart failure
Drug therapy for COPD patients
- bronchodialators (dec airway resistance and hyperinflation and reduces dyspnea) (i.e. albuterol)
- Anti-inflammatory/steriods
- Combination inhalers
What is the recommended oxygen therapy for a COPD patient?
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
home therapy O2 for COPD patients
Chronic O2 therapy at home Improved prognosis Improved neuropsychologic function Increased exercise intolerance Reduced pulmonary hypertension
respiratory therapy for a COPD patient?
- pursed-lip breathing
- diaphragmatic breathing
- incentive spirometer
recommended diet for COPD patients?
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
Important health education for COPD patients
- stop smoking
- get yearly flu vaccine
- get pneumonia vaccination
- avoid large crowds (to reduce risk of infection)
afterload
amount of pressure required to pump blood out to the circulation from the L ventricle (workload of the heart)
end diastolic volume (pressure BEFORE contraction), the amount of blood in heart chambers BEFORE contraction
preload
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:
forms a strong bond with hemoglobin, creating a functional anemia
A patient is admitted with the diagnosis of severe left-sided heart failure. The nurse expects to auscultate which adventitious lung sounds?
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
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?
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
using saline for suctioning?
No! Saline has been found to cause more side effects when suctioning and does not inc the amt of secretions removed
common nursing diagnoses for COPD patients
- impaired gas exchange
- inability to tolerate temp extremes
- activity intolerance
- inability to cope with changes in roles
- alteration in nutrition
inspiration is an_____ process
active
expiration is an _______ process
passive
decreased hemoglobin levels alterth the patient’s ability to
transport oxygen
impaired chest wall movement reduces the
level of tissue oxygenation
hypoventilation causes
CO2 retention
airway maintenance requires mobilization of secretions by:
increased fluid intake, humidification, or nebulization
airway maintenance may also require use of artificial airways and suctioning
breathing exercises improve:
ventilation, oxygenation, and sensations of dyspnea
