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COPD/Asthma Flashcards

1
Q

Chronic Obstructive Pulmonary Disorder (COPD)

A
  • a disease state that reduces airflow in the lungs, making it difficult to breathe
  • usually progressive and not fully reversible
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2
Q

What is the 4th leading cause of death in the US?

A

COPD

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3
Q

COPD is an umbrella term used to describe progressive lung diseases including what?

A
  • emphysema
  • chronic bronchitis
  • refractory (non-reversible) asthma
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4
Q

Emphysema

A
  • alveoli are damaged
  • over time the inner walls of alveoli weaken and rupture
  • larger air spaces are created making it difficult to exhale
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5
Q

Chronic Bronchitis

A
  • inflamed bronchial tubes produce excessive mucus
  • increased cough and sputum production
  • occurs in at least 3 consecutive month increments in 2 consecutive years
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6
Q

Non-reversible Asthma

A
  • inflammation and edema of the bronchial airways

- no improvement or less than 12% in pulmonary function occurs w/ bronchodilators

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7
Q

Risk Factors for COPD

A
  • tobacco smoke
  • second-hand smoke
  • heredity
  • prolonged exposure to environmental or occupational chemicals
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8
Q

S/S of COPD

A
  • Dyspnea
  • chronic cough usually in morning
  • sputum production
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9
Q

Dyspnea w/ COPD

A
  • mild to severe
  • may start initially w/ activity and progress to at rest
  • ADL’s may become difficult
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10
Q

Sputum Production w/ COPD

A

may increase in severity, thickness, and have color w/ exacerbation

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11
Q

Diagnosing COPD

A
  • history-worsening dyspnea/cough; smoke how much
  • physical examination
  • pulmonary function test
  • incentive spirometer (first choice)
  • bronchodilators after PFT
  • ABG’s
  • Chest x-ray
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12
Q

Physical Exam Findings w/ COPD

A
  • barrel chest
  • bilateral intercostal retractions
  • diminished breath sounds w/ prolonged exhalation
  • course crackles/wheezing on auscultation
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13
Q

Stages of COPD

A
  • mild
  • moderate
  • severe
  • very severe-late-palliative stage
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14
Q

Mild COPD

A

airflow is somewhat limited, but doesn’t notice much; cough w/ mucus occurs every once in a while

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15
Q

Moderate COPD

A

airflow is worse; often short of breath after doing something active
-this is the point where most people notice symptoms and get help

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16
Q

Severe COPD

A

airflow and SOB are worse; can not do normal exercise anymore
-symptoms flare up frequently, also called an exacerbation

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17
Q

Late COPD

A

airflow is limited; flares are more regular and intense and quality of life is poor

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18
Q

How is a patient w/ COPD managed?

A
  • prevent disease progression
  • relieve symptoms
  • improve exercise tolerance
  • improve health status
  • prevent/treat complications
  • prevent/treat exacerbations
  • reduce mortality
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19
Q

COPD Treatment Options

A
  • surgery
  • oxygen
  • pulmonary rehab
  • inhaled corticosteroids
  • bronchodilators
  • smoking cessation
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20
Q

Short Acting Bronchodilators

A
  • prn; works quickly within about 15 minutes
  • albuterol
  • Proventil
  • Xopenex better for heart patients
  • duoneb
  • Atrovent
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21
Q

Long Acting Bronchodilator

A
  • regularly or on maintenance basis
  • Spiriva
  • brovana
  • serevent
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22
Q

What to monitor for when using a bronchodilator?

A
  • tachycardia
  • palpations
  • increased BP
  • avoid caffeine
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23
Q

Bronchodilators may cause what?

A

anxiety
nervousness
tremors
insomnia

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24
Q

Pulmonary Rehab

A

program of exercise, education, and support to help the patient to learn to breathe and function at highest level possible

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25
What does Pulmonary Rehab work on?
- breathing exercises - pacing of activities according to level of dyspnea - endurance and strength training - nutritional counseling - medication education
26
Inhaled Corticosteroids
Flovent Advair Symbicort
27
Oral Corticosteroids
prednisone
28
Intravenous Corticosteroids
Solu-cortef | -Solu-medrol
29
Important Vaccine Education for Patients
- pneumonia vaccine 1 dose q 12 months x 2 types - TDAP booster - flu vaccine annually
30
Oxygen may be used with COPD when?
- as treatment for acute exacerbations - long-term for severe COPD - with sleep/exercise
31
Goals for Oxygen use w/ COPD
- keep O2 sat > 90% | - aid w/ increased cardiopulmonary workload including increased SOB, tachypnea, tachycardia, HPT
32
Concerns w/ using oxygen w/ COPD are?
- chronic hypercapnia - may lead to loss of drive to breath (hypoxic drive) - leads to undertreatment w/ oxygen
33
Uncontrolled Oxygen Use
- amount of O2 received is dependent upon depth and rate of breathing - nasal cannula - best used after patient is stabilized after acute exacerbation or chronic use at home
34
Controlled Oxygen Use
- oxygen of a known concentration is delivered and titrated according to the patients oxygen saturation and is not dependent on patient breathing - Venturi mask - best used w/ acute exacerbation when O2 levels cannot be controlled
35
Exacerbation
a worsening or "flare up" of symptoms | -may indicate worsening of condition and/or decline in pulmonary function
36
What may cause an exacerbation?
infection in the lungs, but in some cases cause may never be known - pneumonia - influenza - exposure to pollutants
37
Treatment for Exacerbations
- IV/oral corticosteroids - increase use of bronchodilator - antibiotics - oxygen
38
Chronic Dyspnea often occurs w/o what?
visible signs of distress
39
Treatment for Chronic Dyspnea
- administer bronchodilator - assist w/ ADL's to decrease over-exertion - administer O2 prn - education to relieve SOB
40
Educations to Relieve SOB
- pursed-lip breathing - cool air - diaphragmatic breathing - altering activity that increases SOB
41
What should be done for Impaired Gas Exchange?
- monitor O2 and ABG results - administer supplemental O2 and educate on home use - monitor neurological status
42
Cough/ Ineffective Airway Clearance
- remove or reduce irritants - chest physiotherapy - suctioning - educate on controlled coughing - controlled coughing spasms
43
Exercising for patient w/ decreased tolerance
- early, frequent ambulation short distances - deep breathing q hour WA - turn q 2 hours - leg lifts, ankle flexation - arm raises - up to chair at least 3 times daily - walking aids - physical therapy
44
Nutrition
- may need increased caloric intake - increase protein - weight reduction if overweight - nutritional supplements - vitamins - dietary consult
45
Tips for id SOB occurs while eating or right after meals
- clear airway at least one hour before eating - eat slowly - choose easy to chew foods - five or six small meals - drink liquids at the end of meals - eat while sitting up - pursed lip breathing
46
-Improving Self-care/Coping Skills
- realistic goals/expectations - stress management - recognize limitations - recognize s/s depression - provide support
47
What to asses for S/S of impending respiratory failure?
- unresponsive dyspnea - alternating tachypnea/bradypnea - anxiety - mental status changes - unresponsive hypoxemia/increasing hypercapnia - increasing use of accessory muscles
48
Asthma
chronic inflammation of the airways that is worsened with certain triggers - allergens - irritants - no cure but reversible w/ treatment
49
What happens w/ asthma attack?
as airway swells muscles around them tighten increasing mucus production and makes breathing more difficult
50
Diagnosing Asthma
- patient history - physical exam/symptoms - spirometry findings
51
Physical Exam findings w/ Asthma
- symptoms occur most often at night or early morning - may occur suddenly or over several days - recurrent cough - wheezing - chest tightness/dyspnea - worsening of symptoms w/ exposure to triggers - excessive mucus production
52
Goals for Asthma Treatment
- reduce impairment - freedom from symptoms - decreased need for short acting meds - reduce risk of complications - prevent recurrences
53
Peak Flow Monitoring
blow a fast hard blast rather than slow breathing emptying your lungs
54
What is peak flow monitoring used for?
- diagnose asthma in patient w/ normal spirometry | - assist in treatment for those who have trouble recognizing exacerbation
55
How to establish personal best w/ peak flow monitoring?
use peak flow meter at the same time every day for 2 weeks
56
Asthma exacerbations may lead to what?
- worsening disease - status asthmaticus - respiratory failure - death
57
Status Asthmaticus
severe attack that is resistant to treatment - rapid initiation of symptoms - chest tightness - wheezing - dry cough - SOB
58
Treatment for Status Asthmaticus
- ED/ICU monitoring - O2 - IV fluids - antibiotics if needed - short acting bronchodilator - theophylline-oral bronchodilator
59
Theophylline
oral bronchodilator | -take on empty stomach 1-2 hours before meals improves absorption/minimizes
60
Studies have shown that long acting bronchodilators should only be used in combination with what?
Used in combination w/ inhaled corticosteroids to prevent increased exacerbations and/or death
61
Nursing Care for Asthma
- keep calm/reassure - assess exposure to triggers, hx, symptoms, self management, response to treatment - administer meds/monitor response

Adult Health 2 (5 decks)

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