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NRSG 227 > COPD and Pneumonia > Flashcards

COPD and Pneumonia Flashcards

1
Q

What is the pack year life calculation?

A
  • number of packs smoked/ day X amount of years smokes
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2
Q

what are risk factors for COPD?

A
  • smoking
  • increased with number of pack years, 40 pack year strong indicator
  • fumes
  • organic/ inorganic dusts
  • heredity
  • aging
  • lung infections
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3
Q

What is the most important risk factor for developing COPD?

A

smoking

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4
Q

What are early signs of COPD?

A
  • morning cough
  • increased production of mucous/ sputum
  • breathlessness with exertion
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5
Q

What are not early signs of COPD?

A
  • chest pain
  • hemoptysis
  • barrel chest
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6
Q

what test provides the best indication that a client is experiencing a persistent airflow limitation?

A

pulmonary function tests including FEV1/ FVC

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7
Q

What do pulmonary function tests do?

A
  1. determine how well lungs work
  2. measure
    - lung volume
    - capacities
    - rate of flow
    - gas exchange
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8
Q

when testing for COPD respiratory therapists start by administering what? What does this do?

A
  • administer bronchodilator

- gets rid of any reversible airflow restriction (asthma)

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9
Q

Healthy peoples FEV1/FVC should be what?

A

80% or more out of lungs in first second

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10
Q

a pulmonary function test calculates 2 values what are they? describe them

A
  1. FEV1
    - forced expiratory volume in 1 second
    - total amount of air forcefully blown out of lungs in first second of exhalation
  2. FVC
    - forced vital capacity
    - total amount of air forcefully blown out of lungs after deep breath
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11
Q

How is someone diagnosed with COPD using pulmonary function tests?

A
  • decreased FVC and FEV1
  • hard time getting air out of lungs
  • longer FEV1 decreases even more than FVC (ration <70% someone is diagnosed)
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12
Q

What are some reasons for people with COPD having difficulty exhaling?

A
  • decreased elasticity of lungs (hard to push air out)
  • blocked air flow due to increased mucous production/ inflammation in airways
  • barrel chest
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13
Q

describe restrictive lng disease

A
  • person has trouble getting air IN lungs

- lungs restricted from expanding fully

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14
Q

What are some examples of restrictive lung disease?

A
  • large pleural effusion
  • neuromuscular disease (ALS)
  • ascites
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15
Q

What is ascites?

A

fluid in abdomen prevents lungs from expanding

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16
Q

describe chronic bronchitis

A
  • type of COPD
  • characterized by productive cough for 3+ months in each of 2 successive years
  • mainly affects small airways
  • refers to inflammation of the bronchi
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17
Q

describe inflammation of bronchi in regards to chronic bronchitis

A
  • inflammation irritates airways
  • causes production of thick, sticky mucous that can block airways
  • causes swelling in airways narrows space > makes more difficult for air to pass
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18
Q

describe emphysema

A
  • type of COPD
  • characterized by permanent enlargement of airspaces with destruction of airspace walls
  • affects alveoli in lungs
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19
Q

describe how alveoli are affected by emphysema

A
  • alveoli become damaged
  • individual alveoli merge together
  • causes one large air sac with less surface area for gas exchange
  • large air sacs less elastic don’t want to shrink back to normal shape
  • start acting like pillow cases > hard to get air out of lungs
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20
Q

some large emphysematous air sacs are what? What can happen?

A
  • are weak and easy to tear

- can cause air to leak into pleural space causing pneumothorax

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21
Q

describe COPD

A
  • respiratory disorder mainly caused by smoking
  • progressive
  • non-reversible
  • cannot be cured
  • leads to structural changes in lungs and chest
  • causes reduced airflow/ collapse of small airways
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22
Q

describe asthma

A
  • not a type of COPD
  • airways are twitchy (hyper-responsive)
  • caused by inflammation
  • key features > episodic, reversible with treatment
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23
Q

what are characteristics of asthma

A
  • airway inflammation with recurrent episodes of wheezing
  • breathlessness
  • chest tightness
  • coughing
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24
Q

what can trigger asthma?

A
  • allergens
  • exercise
  • infections
  • cold/ dry air
  • many other things
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25
Q

what are common manifestations of COPD?

A
  • easily fatigued after exercise
  • frequent respiratory infections
  • chronic cough
  • easily dyspneic
  • producing excessive sputum
  • use of accessory muscles to breathe
  • orthopneic
  • thin in appearance
  • wheezing
  • pursed-lip breathing
  • barrel chest
  • prolonged expiratory time
  • increased sputum
  • digital clubbing
  • cor pulmonale
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26
Q

describe the stepwise management approach

A
  1. quit smoking
  2. COPD becomes worse
    - short-acting bronchodilators PRN
    - lung function worsens longer-acting bronchodilators prescribed
  3. ADLs affected people referred to pulmonary rehabilitation program
  4. lung function continues to worsen
    - inhaled corticosteroids (often combined with long-acting bronchodilator) prescribed
  5. O2 levels decrease to hypoxemia > patient receives home oxygen therapy
  6. COPD progresses, no other treatment, becomes life threatening
    - lung reduction surgery considered
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27
Q

describe medical research council dyspnea scale, what does each level mean?

A

graded 1(best) - 5 (worst)

1 – not troubled by breathlessness, except with strenuous exercise

2 – troubled by shortness of breath when hurrying on the level or walking up a slight hill

3 – walk slower than people of the same age on the level b/c of breathlessness or has to stop for breath when walking at own pace on the level

4 – stops for breath after walking about 100 yards (90m) or after a few minutes on the level

5 – too breathless to leave the house, or breathless when dressing or undressing

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28
Q

What are some activities for COPD patients?

A
  • walking (best exercise)
  • stretching
  • strength training
  • aerobic fitness
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29
Q

describe walking in regards to COPD patients

A
  • low impact
  • doesn’t require special equipment
  • appropriate for mild-severe disease
  • initially aim to walk 15-20mins/ day
  • if not manageable start with slower pace, walk 2-5mins 3X/day
  • as strength/ endurance increases so should duration
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30
Q

What are some goals for commonly prescribed medications for COPD?

A
  • reduce symptoms
  • reduce frequency/ severity of exacerbations
  • improve exercise tolerance
  • improve health
  • no evidence that meds reduce long-term decline in persons’ lung function
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31
Q

What are the 6 general categories of COPD medications?

A
  1. beta adrenergic bronchodilators
  2. anticholinergic or anti-muscarinic bronchodilators
  3. inhaled corticosteroids
  4. oral or parental corticosteroids
  5. methylxanthines
  6. anti-inflammatories
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32
Q

in regards to the 6 general categories of COPD medications, describe beta adrenergic bronchodilators

A
  • mainstays
  • work on the sympathetic nervous system > dilate airways
  • best supported to be beneficial with fewest side effects
  • genetic names often end in -ol
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33
Q

what are the side effects of beta adrenergic bronchodilators ?

A
  • making people feel shaky
  • cause rapid HR
  • anxiety (due to adrenergic effects)
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34
Q

in regards to beta adrenergic bronchodilators describe beta2 adrenergic agonists

A
  • relax/ dilate airways
  • short acting beta-adrenergic agonists (SABAs)
  • long acting beta-adrenergic agonists (LABAs)
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35
Q

in regards to the 6 general categories of COPD medications, describe anticholinergic or anti-muscarinic bronchodilators

A
  • mainstay
  • work on the parasympathetic system
  • best supported by evidence to be beneficial with fewest side effects
  • relax/ dilate airways
  • short acting muscarinic antagonists (SAMAs)
  • long acting muscarinic antagonists (LAMAs)
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36
Q

in regards to anticholinergic or anti-muscarinic bronchodilators what do their genetic names end in? provide examples

A

end in -tropium and -ium

ex.
- ipratropium
- tiotroprium
- umeclidinium

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37
Q

in regards to the 6 general categories of COPD medications, describe inhaled corticosteroids

A
  • mainstay
  • best supported by evidence to be beneficial with fewest side effects
  • act locally to reduce inflammation
  • decrease acute exacerbations of COPD
  • mainly act on the respiratory tract
  • combination inhaler therapy
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38
Q

what are some common examples of inhaled corticosteroids?

A
  • budesonide

- fluticasone

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39
Q

in regards to inhaled corticosteroids what do their generic names end in? provide examples

A

end in -one

ex.

  • fluticasone
  • mometasone
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40
Q

in regards to inhaled corticosteroids what side effects can they have on the respiratory tract

A
  • suppress immune response > increase risk for opportunistic infections
  • cause development of yeast or candida infection in mouth
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41
Q

in regards to inhaled corticosteroids describe combination inhaler therapy

A
  • combines 2-3 drugs together
  • 3 common examples
    1. advair
    2. anoro
    3. trelegy
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42
Q

in regards to inhaled corticosteroids describe the first common combination inhaler

A

Advair

  • contains long acting beta-adrenergic agonist
  • salmeterol
  • inhaled corticosteroid fluticasone
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43
Q

in regards to inhaled corticosteroids describe the second common combination inhaler

A

Anoro

  • contains long acting beta-adrenergic agonist
    • vilanterol
  • long acting muscarinic antagonist
  • umeclidinium
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44
Q

in regards to inhaled corticosteroids describe the third common combination inhaler

A

Trelegy

  • contains long acting beta-adrenergic agonist
  • vilanterol
  • long acting muscarinic-antagonist
  • umeclidinium
  • inhaled corticosteroid fluticasone
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45
Q

in regards to the 6 general categories of COPD medications, describe oral or parental corticosteroids

A
  • avoid when possible, can have serious side effects especially when taken for long time
  • helpful when someone developed AECOPD
  • generic names end in -one
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46
Q

what are some examples of generic oral or parental corticosteroids?

A
  • prednisone
  • cortisone
  • dexamethasone
47
Q

in regards to the 6 general categories of COPD medications, describe methylxanthines

A
  • serious potential side effects
  • not most effective treatment
  • only used when COPD doesn’t respond well to other treatments
  • used more commonly in developing countries that have fewer resources
48
Q

describe phosphodiesterase (PDE -4 inhibitor)

A
  • another class of medication used to manage COPD

ex. roflumilast

49
Q

in regards to phosphodiesterase (PDE -4 inhibitor) describe roflumilast

A
  • pill
  • reduces inflammation/ relaxes smooth muscle in airways
  • used to prevent AECOPD with frequent exacerbations
50
Q

in regards to phosphodiesterase (PDE -4 inhibitor), what can roflumilast cause?

A
  1. weight loss
    - worrisome for people who might be underweight already due to lung disease
  2. GI upset
    - nausea
    - diarrhea
51
Q

acute exacerbation of COPD is considered to be what?

A

a sustained change (48hrs+) in dyspnea, cough, sputum, production that requires person to use more medication to manage symptoms

52
Q

what should people with COPD get immunized against?

A
  • influenza

- pneumococcus

53
Q

What is pneumococcus?

A

bacteria that can cause pneumonia, sinus infections, ear infections, meningitis and sepsis

54
Q

What is the most common cause of AECOPD?

A

respiratory infections

55
Q

what are clinical manifestations of community-acquired pneumonia?

A
  • Fever and chills
  • Cough
  • Dyspnea
  • Pleuritic chest pain
  • Tachypnea
  • Increased work of breathing
  • Adventitious lung sounds (course or fine crackles)
  • Mental status changes (especially in older adults)
56
Q

what are symptoms for bacterial community acquired pneumonia

A
  • More severe exacerbation of COPD
  • Increased production of sputum
  • Purulent sputum
57
Q

What is the difference between purulent and non-purulent AECOPD?

A

purulent

  • Sputum contains pus
  • Looks thick yellow or green
  • Suggests bacterial infection
  • Antibiotics recommended even if person hasn’t gotten a culture/ sensitivity test

non-purulent

  • less dyspnea
  • sputum without pus
  • viral infection
58
Q

what is empirical therapy for pneumonia?

A
  • Therapy based on healthcare providers observations/ experience when the actual causative organisms is not known
  • educated guess
  • Often given with antibiotics too
59
Q

what is community acquired pneumonia?

A
  • developing outside hospital

- having COPD greatest risk for hospitalization

60
Q

What lab values should be looked at specifically in regards to COPD?

A
  • hemoglobin
  • hematocrit
  • C-reactive protein
61
Q

what does an elevated Hemoglobin lab value tell us about COPD?

A
  • one of the ways body compensates for chronically low oxygen levels
  • also called polycythemia
62
Q

what does a hematocrit lab value tell us about COPD?

A
  • ratio of RBCs compared to amount of fluid or plasma in blood
  • elevated > more RBCs compared to plasma amount
63
Q

what does a C-reactive protein lab value tell us about COPD?

A

when elevated means:

  • acute phase reactant
  • infection or inflammatory process somewhere in body
64
Q

care plan for AECOPD and pneumonia includes what?

A
  • encourage rest
  • frequent turning and re-positioning
  • encouraging ambulation
  • incentive spirometry/ deep breathing and coughing exercises
  • increasing fluid intake
65
Q

in regards to a care plan for AECOPD and pneumonia what does encourage rest do?

A

reduce body demand for oxygen

66
Q

in regards to a care plan for AECOPD and pneumonia what frequent turning and re-positioning do?

A
  • prevent skin breakdown

- help improve drainage of secretions in lungs

67
Q

in regards to a care plan for AECOPD and pneumonia what does encouraging ambulation do?

A

prevents:

  • complications of immobility
  • skin breakdown
  • muscle de-conditioning
  • blood clots
68
Q

in regards to a care plan for AECOPD and pneumonia what does incentive spirometry/ breathing and coughing exercises do?

A
  • improve lung expansion

- mobilize lung secretions

69
Q

in regards to a care plan for AECOPD and pneumonia what does increasing fluid intake do?

A
  • keep lung secretions thin and easy to cough up
70
Q

What are other interventions for AECOPD and pneumonia?

A
  • Administering oral nutritional supplements
  • Administering SABAs via nebulizer or metred-dose inhaler
  • Administering SAMAs with SABAs in combination
  • Reviewing inhaler technique
  • Administering ordered antibiotics
71
Q

describe oxygen saturation and COPD

A
  • level depends on how bad COPD is

- always look at patients normal baseline, and aim to get back to that

72
Q

What are the different ranges for oxygen saturation in regards to the severity of COPD

A
  1. mild
    - may have normal O2STAT
    - 95+
  2. moderate
    - normally have slight decreased O2STAT
    - lower 90% range
  3. severe
    - baseline O2STAT
    - 80-90%
73
Q

When do you administer supplemental 02 for COPD patients?

A

if patients appears:

  • hypoxemic
  • tachycardia
  • decreased O2 STAT
  • shows increased work of breathing
  • gets overly anxious
74
Q

define hypoxic drive

A

when oxygen levels decrease, it stimulates increased ventilation

75
Q

describe hypoxic drive

A
  • chemoreceptors detect CO2 and O2 levels > control ventilation
  • affects blood pH
  • CO2 and pH levels have stronger influence on breathing than O2
76
Q

define hypercapnia

A
  • elevated CO2

- stimulates body to increase ventilation

77
Q

describe hypercapnia and advanced COPD

A

more advanced COPD tent to chronically have higher than normal levels of CO2 in bloodstream

78
Q

in regards to hypoxic drive what can happen over time ?

A
  • CO2 receptors in body become less sensitive to elevated levels
  • people with advanced COPD need to rely on O2 receptors t control ventilation
79
Q

describe long term oxygen therapy in regards to COPD

A
  • prescribed when people have severe resting hypoxemia

- Might also be recommended for people with COPD who are unable to tolerate exercise

80
Q

What are the 2 situations best supported by evidence for a person with COPD to receive home oxygen therapy?

A
  • Monitor a person’s arterial blood gases > find their partial pressure of oxygen is consistently < 55mmHg
  • Monitor person’s oxygen saturation levels and find it’s consistently < 88%
81
Q

Why is oxygen therapy recommended for people with COPD who are unable to tolerate exercise?

A
  • Oxygen only worn during exertion to improve dyspnea and the person’s tolerance for exercise
  • could help improve overall health/ quality of life
82
Q

What are signs of potential respiratory failure?

A
  • change in mental status
  • tachycardia
  • hypertension
  • tachypnea
  • worsening dyspnea
  • severe morning headache
83
Q

What is the first sign of potential respiratory failure and why?

A
  • change in mental status

- brain is really sensitive to low O2 levels

84
Q

what are common non-invasive ventilation (NIV) devices used to administer medication? What do they involve?

A
  • optiflow
  • airvo
  • BiPAP
  • all devices involve aerosol-generating medical procedures
85
Q

What does non-invasive ventilation not require? What does this lead to?

A
  • doesn’t require endotracheal intubation

- leads to lower risk of complications than a traditional mechanical ventilator

86
Q

describe non-invasive ventilation (NIV)

A
  • helps support person’s breathing when they’re still able to breath a bit on their own
  • improve oxygenation
  • Reduces person’s work to breath/ improves gas exchange in lungs
  • reduces length of person’s hospital stay/ improves survival rates
87
Q

how is non-invasive ventilation (NIV) administered?

A

face mask or nasal mask

88
Q

what are bullae?

A

large air spaces in the parenchyma

89
Q

What are blebs?

A

air spaces adjacent to pleurae

90
Q

are bullae and blebs effective in gas exchange?

A

no b/c capillary bed that normally surrounds each alveolus doesn’t exist in either

91
Q

What do bullae and blebs lead to?

A
  • significant ventilation perfusion mismatch

- hypoxemia

92
Q

why do people with COPD develop pulmonary hypertension?

A
  • occurs in later stages of COPD
  • Small pulmonary arteries undergo vasoconstriction resulting in thickening of vascular smooth muscle as disease advances
  • Due to loss of the alveolar walls and capillaries surrounding them pressure in pulmonary circulation increases
93
Q

how do the clinical manifestations of COPD differ from those of asthma?

A

COPD

  • > 40yrs
  • > 10 packs/year
  • clinical symptoms persistent
  • sputum production
  • infrequent allergies
  • spirometry findings may improve but never normalize
  • progressive worsening with exacerbations

Asthma

  • <40yrs
  • can be triggered from history
  • intermittent/ variable clinical symptoms
  • infrequent sputum production
  • allergies
  • spirometry findings normalize
  • stable with exacerbations
94
Q

What is the forced vital capacity (FVC) test used for in COPD?

A

Amount of air that can be quickly and forcefully exhaled after maximum inspiration

95
Q

what is the forced expiratory volume in the first second of expiration (FEV1) test used for in COPD?

A
  • Amount of air exhaled in the first second of FVC

- valuable clue to severity of airway obstruction

96
Q

What is the FEV1/ FVC test used for in COPD?

A
  • Ratio of value for FEV1 to value for FVC

- useful in differentiating obstructive and restrictive pulmonary dysfunction

97
Q

what is the peak expiratory flow rate (PEFR) test used for in COPD?

A
  • Maximum airflow rate during forced expiration

- aids in monitoring bronchoconstriction in asthma

98
Q

how are acute exacerbations of COPD (AECOPD) defined?

A

Sustained worsening of dyspnea, cough or sputum production that leads to increased use of maintenance medications or supplementation with additional medications

sustained > change from baseline that lasts 48+ hrs

99
Q

Why is it important to identify whether a client has a purulent or nonpurulent exacerbation of COPD?

A
  • Purulent exacerbations need to be treated with antibiotic therapy
  • often given 7-10 day antibiotic therapy
100
Q

if someone has a purulent exacerbation of COPD what antibiotics can they be put on?

A
  • amoxicillin
  • cefuroxime
  • cefixime
  • azithromycin
  • clarithromycin, trimethoprimsulphamethoxazole
  • doxycycline
  • moxifloxacin
  • levofloxacin
101
Q

What medications (commonly used to treat disorders in older adults) can worsen COPD symptoms?

A
  1. Nonspecific beta blockers
    - can block alpha 2 receptors in the airway
    - cause bronchoconstriction
  2. Angiotensin-converting enzyme inhibitors
    - cause a dry cough or worsen a current cough
102
Q

What physical characteristics of older adults can make management of COPD difficult?

A
  • Cognitive impairment
  • Arthritis in the hands
  • Poor memory
  • Visual impairment
103
Q

describe community-acquired pneumonia

A
  • Lower respiratory infection of the lung parenchyma with onset in the community or during the first 2 days of hospitalization
  • Highest in the winter months
  • Causative organism in CAP identified only 50% of the time
104
Q

What organisms commonly implicate in community acquired pneumonia?

A
  1. S. pneumoniae
  2. Atypical organisms
    - Legionella
    - Mycoplasma
    - Chlamydia
    - Viral
105
Q

describe hospital-acquired pneumonia

A
  • occurring +48hrs after hospital admission
  • not incubating at the time of hospitalization
  • Accounts for 25% of all intensive care unit infections
106
Q

What organisms commonly implicate in hospital acquired pneumonia?

A
  • Pseudomonas
  • Enterobacter
  • S. aureus
  • Methicillin resistant staphylococcus aureus (MRSA)
  • S. pneumoniae
107
Q

What are the 4 stages of the disease process in pneumonia?

A
  • congestion
  • red hepatization
  • grey hepatization
  • resolution
108
Q

in regards to the 4 stages of the disease process in pneumonia, describe congestion

A
  • After the pneumococcus organisms reach the alveoli via droplets or saliva, there is an outpouring of fluid into the alveoli
  • Organisms multiply in the serous fluid and infection is spread
  • Pneumococci damage the host by their overwhelming growth and interference with lung function
109
Q

in regards to the 4 stages of the disease process in pneumonia, describe red hepatization

A
  • Massive dilation of the capillaries, and alveoli are filled with organisms, neutrophils, RBCs and fibrin
  • Lung appears red and granular (similar to liver)
110
Q

in regards to the 4 stages of the disease process in pneumonia, describe grey hepatization

A
  • blood flow decreases

- leukocytes and fibrin consolidate in affected part of lung

111
Q

in regards to the 4 stages of the disease process in pneumonia, describe resolution

A
  • Complete resolution and healing occur if there are no complications
  • Exudate becomes lysed and is processed by the macrophages
  • Normal lung tissue is restored, person’s gas-exchange ability returns to normal
112
Q

What are the complications of pneumonia?

A
  • pleurisy
  • pleural effusion
  • atelectasis
  • delayed resolution
  • lung abscess
  • empyema
  • pericarditis
  • bacteremia
  • meningitis
  • endocarditis
113
Q

What types of pneumonia respond best to antibiotic therapy?

A
  • community acquired pneumonia

- bacterial and mycoplasma pneumonia

NRSG 227 (3 decks)

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