COPD/Asthma Flashcards
Chronic Obstructive Pulmonary Disorder (COPD)
- a disease state that reduces airflow in the lungs, making it difficult to breathe
- usually progressive and not fully reversible
What is the 4th leading cause of death in the US?
COPD
COPD is an umbrella term used to describe progressive lung diseases including what?
- emphysema
- chronic bronchitis
- refractory (non-reversible) asthma
Emphysema
- alveoli are damaged
- over time the inner walls of alveoli weaken and rupture
- larger air spaces are created making it difficult to exhale
Chronic Bronchitis
- inflamed bronchial tubes produce excessive mucus
- increased cough and sputum production
- occurs in at least 3 consecutive month increments in 2 consecutive years
Non-reversible Asthma
- inflammation and edema of the bronchial airways
- no improvement or less than 12% in pulmonary function occurs w/ bronchodilators
Risk Factors for COPD
- tobacco smoke
- second-hand smoke
- heredity
- prolonged exposure to environmental or occupational chemicals
S/S of COPD
- Dyspnea
- chronic cough usually in morning
- sputum production
Dyspnea w/ COPD
- mild to severe
- may start initially w/ activity and progress to at rest
- ADL’s may become difficult
Sputum Production w/ COPD
may increase in severity, thickness, and have color w/ exacerbation
Diagnosing COPD
- history-worsening dyspnea/cough; smoke how much
- physical examination
- pulmonary function test
- incentive spirometer (first choice)
- bronchodilators after PFT
- ABG’s
- Chest x-ray
Physical Exam Findings w/ COPD
- barrel chest
- bilateral intercostal retractions
- diminished breath sounds w/ prolonged exhalation
- course crackles/wheezing on auscultation
Stages of COPD
- mild
- moderate
- severe
- very severe-late-palliative stage
Mild COPD
airflow is somewhat limited, but doesn’t notice much; cough w/ mucus occurs every once in a while
Moderate COPD
airflow is worse; often short of breath after doing something active
-this is the point where most people notice symptoms and get help
Severe COPD
airflow and SOB are worse; can not do normal exercise anymore
-symptoms flare up frequently, also called an exacerbation
Late COPD
airflow is limited; flares are more regular and intense and quality of life is poor
How is a patient w/ COPD managed?
- prevent disease progression
- relieve symptoms
- improve exercise tolerance
- improve health status
- prevent/treat complications
- prevent/treat exacerbations
- reduce mortality
COPD Treatment Options
- surgery
- oxygen
- pulmonary rehab
- inhaled corticosteroids
- bronchodilators
- smoking cessation
Short Acting Bronchodilators
- prn; works quickly within about 15 minutes
- albuterol
- Proventil
- Xopenex better for heart patients
- duoneb
- Atrovent
Long Acting Bronchodilator
- regularly or on maintenance basis
- Spiriva
- brovana
- serevent
What to monitor for when using a bronchodilator?
- tachycardia
- palpations
- increased BP
- avoid caffeine
Bronchodilators may cause what?
anxiety
nervousness
tremors
insomnia
Pulmonary Rehab
program of exercise, education, and support to help the patient to learn to breathe and function at highest level possible
What does Pulmonary Rehab work on?
- breathing exercises
- pacing of activities according to level of dyspnea
- endurance and strength training
- nutritional counseling
- medication education
Inhaled Corticosteroids
Flovent
Advair
Symbicort
Oral Corticosteroids
prednisone
Intravenous Corticosteroids
Solu-cortef
-Solu-medrol
Important Vaccine Education for Patients
- pneumonia vaccine 1 dose q 12 months x 2 types
- TDAP booster
- flu vaccine annually
Oxygen may be used with COPD when?
- as treatment for acute exacerbations
- long-term for severe COPD
- with sleep/exercise
Goals for Oxygen use w/ COPD
- keep O2 sat > 90%
- aid w/ increased cardiopulmonary workload including increased SOB, tachypnea, tachycardia, HPT
Concerns w/ using oxygen w/ COPD are?
- chronic hypercapnia
- may lead to loss of drive to breath (hypoxic drive)
- leads to undertreatment w/ oxygen
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
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
Exacerbation
a worsening or “flare up” of symptoms
-may indicate worsening of condition and/or decline in pulmonary function
What may cause an exacerbation?
infection in the lungs, but in some cases cause may never be known
- pneumonia
- influenza
- exposure to pollutants
Treatment for Exacerbations
- IV/oral corticosteroids
- increase use of bronchodilator
- antibiotics
- oxygen
Chronic Dyspnea often occurs w/o what?
visible signs of distress
Treatment for Chronic Dyspnea
- administer bronchodilator
- assist w/ ADL’s to decrease over-exertion
- administer O2 prn
- education to relieve SOB
Educations to Relieve SOB
- pursed-lip breathing
- cool air
- diaphragmatic breathing
- altering activity that increases SOB
What should be done for Impaired Gas Exchange?
- monitor O2 and ABG results
- administer supplemental O2 and educate on home use
- monitor neurological status
Cough/ Ineffective Airway Clearance
- remove or reduce irritants
- chest physiotherapy
- suctioning
- educate on controlled coughing
- controlled coughing spasms
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
Nutrition
- may need increased caloric intake
- increase protein
- weight reduction if overweight
- nutritional supplements
- vitamins
- dietary consult
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
-Improving Self-care/Coping Skills
- realistic goals/expectations
- stress management
- recognize limitations
- recognize s/s depression
- provide support
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
Asthma
chronic inflammation of the airways that is worsened with certain triggers
- allergens
- irritants
- no cure but reversible w/ treatment
What happens w/ asthma attack?
as airway swells muscles around them tighten increasing mucus production and makes breathing more difficult
Diagnosing Asthma
- patient history
- physical exam/symptoms
- spirometry findings
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
Goals for Asthma Treatment
- reduce impairment
- freedom from symptoms
- decreased need for short acting meds
- reduce risk of complications
- prevent recurrences
Peak Flow Monitoring
blow a fast hard blast rather than slow breathing emptying your lungs
What is peak flow monitoring used for?
- diagnose asthma in patient w/ normal spirometry
- assist in treatment for those who have trouble recognizing exacerbation
How to establish personal best w/ peak flow monitoring?
use peak flow meter at the same time every day for 2 weeks
Asthma exacerbations may lead to what?
- worsening disease
- status asthmaticus
- respiratory failure
- death
Status Asthmaticus
severe attack that is resistant to treatment
- rapid initiation of symptoms
- chest tightness
- wheezing
- dry cough
- SOB
Treatment for Status Asthmaticus
- ED/ICU monitoring
- O2
- IV fluids
- antibiotics if needed
- short acting bronchodilator
- theophylline-oral bronchodilator
Theophylline
oral bronchodilator
-take on empty stomach 1-2 hours before meals improves absorption/minimizes
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
Nursing Care for Asthma
- keep calm/reassure
- assess exposure to triggers, hx, symptoms, self management, response to treatment
- administer meds/monitor response
