COPD and Pneumonia Flashcards
1
Q
How do you calculate pack-years?
A
multiply the number of packs of
cigarettes that someone smokes each day, times the number of years that they’ve smoked.
2
Q
What is the pack-year HX for someone who smokes 4 cigs a day for 20 years?
A
80 pack years
3
Q
what is the MOST important risk factor for developing COPD
A
Smoking!
4
Q
other than smoking, what are some other risk factors of developing COPD?
A
environmental, heredity, aging, and lung infections.
5
Q
a history of more than a)…. is a
strong indicator that an individual may develop COPD
A
a) 40 pack-years
6
Q
What is one of the most common early signs of COPD?
Barrel chest
Chest pain
Morning cough
Hemoptysis
A
Morning cough
7
Q
Other than a morning cough, what are two other EARLY signs of COPD
A
- increased production of mucous or sputum.
- beathlessness with exertion.
8
Q
If a HCP suspects that a client has COPD, which diagnostic test provides the best indication that the client is experiencing a persistent airflow limitation?
Chest x-ray with anterior/posterior and lateral views
Pulmonary function tests, including FEV1/FVC
Continuous oxygen saturation monitoring
Bronchoscopy with tissue biopsy
A
Pulmonary function tests, including FEV1/FVC
9
Q
Pulmonary function tests are used to determine what three things?
A
how well the lungs are working.
1. They measure lung volume and capacities,
2. the rate of flow
3. and gas exchange.
10
Q
what does FEV1 stand for?
A
The FEV1 is the forced expiratory volume in 1 second.
That’s the total amount of air that you can forcefully blow out of your
11
Q
When testing for COPD, the respiratory therapist starts by FIRST A).. which B)..
A
A) administering a bronchodilator.
B) which gets rid of any reversible airflow restriction, such as asthma
12
Q
What does FVC stand for?
A
FVC is the forced vital capacity.
That’s the total amount of air that you can forcefully blow
out of you
13
Q
In people who have normal, healthy lungs, the FEV1/FVC should be A)..?
A
80% or more.
That means that you can get 80% (or more) out of your lungs in the first
14
Q
people with COPD have difficulty A)..
A
A) exhaling.
15
Q
People with COPD have Decreased a)… of their lungs
A
a) elasticity
This makes it harder for them to get air out of their lungs.
16
Q
People with COPD also have increased a).. , and they have b) .. and both of these block the flow of air.
A
a) production of mucous
b) inflammation of their airways
17
Q
COPD is classified as an ?
A
OBSTRUCTIVE LUNG DISEASE…
18
Q
in patients with COPD does FEV1 or FVC decrease more?
A
the FEV1 decreases
even more than the FVC
19
Q
When the ratio of FEV1 and FVC gets to be less than a).., a person is usually diagnosed with COPD.
A
70%
20
Q
Which form of COPD mainy affects the
small airways?
A
Chronic Bronchitis
21
Q
What happens in Chronic Bronchitis?
A
inflammation of the bronchi irritates the airways
and causes them to produce thick, sticky mucous that can block the airways…
the inflammation also causes swelling in the airways that narrows the space and makes it more difficult for air to pass.
22
Q
What type of COPD affects the aveoli?
A
emphysema.
23
Q
In emphysema what happens?
A
the aveoli (little air sacs) become damaged, and
the individual little alveoli start to merge together, like many small bubbles merging into a single larger
bubble. This results in decreased surface area for gas exchange.
The alveoli also come less elastic.
24
Q
Barrel chest is causes by what?
A
After years of the lungs becoming hyperinflated, structural changes occur.
25
what is chronic bronchitis characterized by?
a chronic, productive cough for three or more months, in each of two successive years.
26
Emphysema is characterized by what?
it’s characterized by a permanent enlargement of airspaces, with destruction of the airspace walls.
27
what are the characteristics of asthma?
airway inflammation with recurrent episodes of wheezing, breathlessness, chest tightness, and coughing
28
what can trigger asthma?
allergens, exercise, infections, cold dry air
29
what are the two key features of asthma?
it is episodic and it’s reversible with treatment.
30
COPD is
progressive and it’s not fully reversible.
31
People with more advanced COPD may also report A).. that are worse in the morning.
**headaches**
That’s caused by 2 problems
- getting enough oxygen overnight
- levels of CO2 increasing overnight.
32
Name the stepwise management steps.
1.
2.
3.
4.
5.
6.
1. short-acting bronchodilators
2. longer-acting bronchodilators
3. pulmonary rehabilitation program.
4. inhaled corticosteroids (often combined with a long-acting bronchodilator)
5. oxygen therapy.
6. surgical procedure, such as lung-reduction surgery
33
**A nurse is teaching a client with COPD about exercise. What information is the MOST important to include in the teaching plan? **
Stop exercising if you feel short of breath
Breathe in and out through your mouth when you exercise
If dyspnea doesn’t resolve 5 minutes after exercising, take a short-acting bronchodilator
Do not perform upper body exercises, to avoid dyspnea
If dyspnea doesn’t resolve 5 minutes after exercising, take a short-acting bronchodilator
34
What is one of the best workouts for people with COPD?
Walking
35
oral or IV steriods are usually avoided as they have nasty long-term side effects, **however** one of the situations where we DO find oral or parenteral corticosteroids can be helpful, is?
when a person develops an acute exacerbation of COPD.
36
what are the three “mainstays” of COPD treatment.
1. beta adrenergic bronchodilators
2. anticholinergic bronchodilators, and
3. inhaled corticosteroids.
37
When are methylxanthines used for COPD treatment?
they’re typically avoided unless the client’s COPD doesn’t respond well to other treatments
38
example of a short-acting beta adrenergic agonists – or SABAs
salbutamol
39
example of a long-acting
beta adrenergic agonists – or LABAs –
salmeterol.
40
name a short-acting muscarinic antagonists – or SAMAs –
ipratropium
41
name a long-acting
muscarinic antagonists – or LAMAs –
tiotropium
42
what part of the nervous system do beta adrenergic agonists work?
SYMPATHETIC nervous system
43
what part of the nervous system do anticholinergics work on?
the PARASYMPATHETIC system
44
inhaled corticosteroids CAN increase the risk for opportunistic infections in the respiratory tract. What is is one infection they are at risk for?
yeast – or candida – infection in their mouth or throat
45
How do inhaled corticosteroids work to help COPD?
They act locally in the airways to reduce inflammation, and they’ve been shown to decrease acute
exacerbations of COPD.
46
What are phosphodiesterase-4 inhibitor (or PDE-4 inhibitor) used for, (for example Roflumilast).
it’s a pill that people can take to reduce inflammation and relax smooth muscle in their airways.
47
What are some side effects of phosphodiesterase-4 inhibitor (or PDE-4 inhibitor) used for, (for example Roflumilast).
weight loss, GI upset, such as nausea or
diarrhea.
48
What are the **three cardinal signs** of acute exacerbation of COPD?
1. dyspnea,
2. cough, or
3. sputum production…
and it might also cause tachypnea or tachycardia
49
**What intervention should be recommended to a client with COPD to prevent the MOST COMMON cause of an acute exacerbation of COPD (AECOPD)? **
Weight loss
Smoking cessation
Immunization for influenza and pneumococcus
Practice meditation, progressive relaxation, or mindfulness
Immunization for influenza and pneumococcus
50
what are at least half acute exacerbations of COPD thought to be brought on by?
infection
51
what is the **most common** cause of exacerbations of COPD?
bacterial respiratory infections.
52
Typical clinical manifestations of community-acquired pneumonia include: (8)
1. Fever and chills,
2. cough,
3. dyspnea,
4. pleuritic chest pain,
5. tachypnea,
6. increased work of breathing,
7. adventitious lung sounds
8. mental status changes (especially in older adults)
53
**What does it mean if a client receives “empirical therapy” for pneumonia? **
Therapy is based on culture and sensitivity testing
Therapy is based on the client’s CURB-65 prognostic model
Therapy involves supportive care only, including nutritional support, IV therapy, pulmonary hygiene,
and pain control
Therapy is based on the healthcare provider’s observations and experience (an educated guess) when the actual causative organisms is not known
Therapy is based on the healthcare provider’s observations and experience (an educated guess) when the actual causative organisms is not known
54
when people with COPD seek medical treatment for an exacerbation of COPD what is it important for them to access?
Purulent sputum
55
Two commonly prescribed antibiotics for severe AECOPD?
IV moxifloxacin or piperacillin
tazobactam.
56
during the winter months, most exacerbations of COPD are caused by?
respiratory viruses (such as the common cold and the flu).
57
**Which stage of pneumonia is characterized by massive dilation of the capillaries, and the alveoli are filled with organisms, neutrophils, red blood cells, and fibrin?**
Consolidation
Red hepatization
Grey hepatization
Resolution
Red hepatization
58
some people with COPD might also have elevated a)... and b)...
a) hemoglobin
b) red blood cells
That’s one of the ways that the body compensates for chronically low oxygen levels.
59
What are 2 ways people with pneumonia can develop dehydration?
1. fever and diaphoresis (losing water through sweat),
2. tachypnea (because people lose water vapour when they breathe).
60
when would C reactive protein be elevated.
becomes elevated in the blood when there’s an infection or inflammatory process somewhere in the body.
61
what is a pleural effusion?
When excess fluid builds up in the pleural space and prevents the lung from expanding fully.
62
**What should the nurse do FIRST if a client with COPD reports feeling anxious about how difficult it is to
breathe? **
Administer supplemental oxygen and titrate to keep saturations at least 92%
Implement a high-protein, high calorie diet for the client
Administer a prn dose of an anti-anxiety medication (e.g. lorazepam)
Teach the client how to effectively use pursed lip breathing
Teach the client how to effectively use pursed lip breathing
63
**A hospitalized client with pneumonia is started on antibiotic therapy. After 36 hours, there’s no improvement in the client’s condition. What is the nurse’s most appropriate action? **
Hold the antibiotic therapy, as it is not effective
Call the physician to request that the antibiotics be changed
Continue to administer the ordered antibiotic therapy
Have the lab draw a peak and trough level for the antibiotic
Continue to administer the ordered antibiotic therapy
64
How many days should a nurse wait before worrying if a antibiotic is effective?
atleast 3 days
65
What range should we aim to keep O2 sats for people with COPD
88-92%
66
If the respiratory system can’t provide enough oxygen… that’s called?
HYPOXEMIC respiratory failure.
67
If the respiratory system can’t remove enough carbon dioxide from the blood, that’s called?
HYPERCAPNIC respiratory failure.
68
what is usually the FIRST manifestations of respiratory failure
Neurological changes such as confusion, restlessness, or anxiety
69
**A nurse teaches a client with COPD to watch for signs of cor pulmonale and right-sided heart failure. What
symptoms should the client be instructed to report to his healthcare provider? **
Peripheral edema
Weight loss
Weak thread pulse
Increased bleeding and bruising
Peripheral edema
70
what is the COPD action plan used for?
- recognize a flare-up,
- know how to manage a flare-up,
- understand when to seek immediate medical attention.
71
* Describe the inflammatory process in COPD.
**1.** starts with inhalation of noxious particles and gases.
**2.** Tissue destruction occurs due to abnormal inflammatory processes and disrupts the normal defense mechanisms and repair processes of the lungs.
**3.** Neutrophils, macrophages, and lymphocytes.
- The inflammatory cells in COPD attract other inflammatory mediators (e.g., leukotrienes, interleukins).
**4. ** Inflammatory process results in the activation of proinflammatory cytokines.
- the activity of proteases (which break down the connective tissue of the lungs) increases, and the antiproteases (which protect against the breakdown) are inhibited
72
What is a Bullae?
large air spaces in the parenchyma
73
What is a bleb?
air spaces adjacent to pleurae
74
Why are blebs and bullae not effective at gas exchange
- Bullae and blebs are not effective in gas exchange because the capillary bed that normally surrounds each alveolus does not exist in the bullae and bleb
75
* Why do people with COPD develop pulmonary hypertension?
In response to alveolar hypoxia, vasoconstriction occur. Acidosis also further worsens vasocontriction
76
* What systemic (extrapulmonary) changes can result from COPD?
- hypertrophy of the right ventricle of the heart or to cor pulmonale.
77
* What is cor pulmonale, and how can it result from COPD?
- Cor pulmonale is hypertrophy of the right side of the heart, with or without heart failure, that results from pulmonary hypertension.
78
* Why is it important to identify whether a client has a purulent or nonpurulent exacerbation of COPD?
- Purulent exacerbations necessitate antibiotic therapy.
79
* What causes AECOPD?
- Can be hard to determine.
- exposure to allergens, irritants, cold air, and air pollution.
- Viral or bacterial infections.
80
* How is the MRC Dyspnea Scale used to assess shortness of breath and dyspnea in COPD?
- The severity of breathlessness is determined by identifying the magnitude of the task (often an activity of daily living [ADL]) necessary to cause discomfort in breathing
81
when are short-acting bronchodilators indicated for help in COPD?
- Best for mild lung function impairment
82
when are long-acting bronchodilators indicated to help in COPD?
- indicated for patients with mild to severe COPD
83
* How is pursed-lip breathing performed?
- Exhalation should be at least three times longer than inhalation. 2 seconds in through the nose, and 6 seconds out through the mouth.
84
How much fluid should a person with COPD consume a day
- Fluid intake should be at least 2 to 3 L per day
85
What medication classifications can make COPD worse
- Nonspecific β-blockers
- ACE inhibitors may cause a dry cough or worsen a current cough.
86
* How can a nurse promote effective sleep in a client with COPD?
- The use of LABDs before bed may help.
87
patients with COPD should be taught to - a)... when pushing, pulling, or exerting effort during an activity and to b)... during rest.
a) exhale
b) inhale
88
* What is pneumonia?
- Pneumonia is an acute inflammation of the lung parenchyma caused by a microbial agent
89
* Why is it helpful to classify pneumonia as community-acquired or hospital-acquired?
- Classifying pneumonia is important because of differences in the likely causative organisms and the selection of appropriate antibiotics.
90
* What are the characteristics of community-acquired pneumonia (CAP)?
- Community-acquired pneumonia (CAP) is defined as a lower respiratory tract infection of the lung parenchyma with onset in the community or during the first 2 days of hospitalization
91
* What is the definition of hospital-acquired pneumonia (HAP)?
- Hospital-acquired pneumonia (HAP) is pneumonia occurring 48 hours or longer after hospital admission and not incubating at the time of hospitalization.
92
What are the 3 types of aspiration pneumonia?
- If the aspirated material is an inert substance (e.g., barium), the initial manifestation is usually caused by **mechanical obstruction of airways.**
- When the aspirated materials contain toxic fluids, such as gastric juices, there is chemical injury to the lung with infection as a secondary event, usually 48 to 72 hours later; this is identified as **chemical (noninfectious) pneumonitis**
- The most important form of aspiration pneumonia is **bacterial infection**
93
* What are the 4 stages of the disease process in pneumonia?
1. Conjestion
2. Red hepatization
3. Grey hepatization
4. Resolution
94
Explain what happens in **congestion** during the disease process of pneumonia
pneumococcus organism reaches the alveoli via droplets or saliva
=
outpour of fluid in alveoli
=
organism mutiples and spreads
95
Explain what happens in **red hepatization** during the disease process of pneumonia.
massive dilation of the capillaries, and alveoli are filled with organisms, neutrophils, red blood cells, and fibrin. The lung appears red and granular.
| , similar to the liver, which is why the process is called hepatization.
96
Explain what happens in **grey hepatization** during the disease process of pneumonia.
Blood flow decreases, and leukocytes and fibrin consolidate in the affected part of the lung.
97
Explain what happens in **resolution** during the disease process of pneumonia.
Complete resolution and healing occur if there are no complications.
98
What sounds are auscultated in pneumonia
bronchial breath sounds, and crackles.
99
What are typical signs of pneumonia
- sudden onset of fever, chills, a cough producing purulent sputum, and pleuritic chest pain.
100
* When caring for a client with pneumonia, what should be done first: administer the first dose of antibiotics, or collect a sputum culture?
- A sputum culture should be collected before initiating antibiotic therapy
101
* What types of pneumonia respond best to antibiotic therapy?
- bacterial and mycoplasma pneumonia
102
* How many hours does it take for the signs and symptoms of pneumonia to improve after starting antibiotic therapy?
- 48 to 72 hours
