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Block 2 Week 3 & 4 Respiratory System > COPD: Chronic Bronchitis and Emphysema > Flashcards

COPD: Chronic Bronchitis and Emphysema Flashcards

0
Q

Macrophage malfunction

What Chronic Obstructive Pulmonary Disorder does this cause?

A

Chronic Bronchitis

Study Tip: WBCs eat bad pathogens. If the WBCs cant work because of too much bacteria in the mucus it leads to a respiratory infections. The patient is unable to recover from the respiratory infection because of the decreased immune function.

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1
Q

Finish the Nursing Diagnosis for a patient with COPD: Chronic Bronchitis?
Ineffective airway clearance R/T

Hint: There are two different answers that are appropriate for this nursing diagnosis.

A

R/T Mucus Secretions

R/T Decreased Alveoli Function

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2
Q

What is parenchymal destruction caused by?

A

Caused by permanent enlargement of airspaces in the main bronchioles leads to destruction of respiratory walls.

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3
Q
  1. Smoking Cessation Therapy.
  2. Surgical Therapy to Remove up to 30% of Blebs. 3. Flu and Pneumonia Vaccines must be administered because of increased risk of infection.
  3. Small frequent meals
    - Increase Caloric intake [High Calorie Density Foods Ex. Jevity Milkshakes]
    These are Collaborative Nursing Interventions for Long Term Management of what Chronic Obstructive Pulmonary Disorder?
A

COPD: Both Emphysema and Chronic Bronchitis

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4
Q

COPD: Emphysema > ___________ > Increased Pulmonary Vasculature Resistance > Pulmonary Hypertension > Right Ventricular Hypertrophy > Cor Pulmonale > Right Sided Heart Failure

A

Reduction of Pulmonary Vascular Bed

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5
Q

This is caused by dilation of the bronchioles which leads to ineffective gas exchange. What Emphysema looks like this on a Bronchial Level?

A

Centrilobular Emphysema

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6
Q

What does AP diameter mean?

A

Anterior/Posterior Diameter and it should be 1:2 in patients without COPD.

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7
Q

Emphysema has a different ____________ than bronchitis.

A

pathophysiology

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7
Q

For long term management of _____ before educating your patient assess the patient and family knowledge base to determine a starting point, assess current lifestyle, assess areas for possible lifestyle changes, educate patient on avoiding emotional triggers, also stress the importance of medication compliance and proper administration of [inhaler] medication.

A

COPD: Both Emphysema and Chronic Bronchitis

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8
Q

Because the patient is hypoxic this will cause the body to release more red blood cells to increase perfusion which becomes polycythemia these blood cells are not oxygenated so they will cause the patient to appear cyanotic.
What Chronic Obstructive Pulmonary Disorder does this describe?

A

Chronic Bronchitis

Study Tip: Hence the name Blue Bloater. This is caused by air trapping in the lungs.

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9
Q

What does Cor Pulmonale mean?

A

A condition of increased pressure in the lungs which increases the cardiac workload of the right ventricle of the heart causing it to hypertrophy which decreases myocardial contractility this causes the Right Side of the Heart to Fail.

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10
Q

When administering Oxygen to patients with COPD what are the most important ranges to remember?

A

paO range 2: 50 -90 is Normal

O2 Sat: below 90%

Study Tip: The nurse doesn’t want the O2 Sat higher than 90% because it can decrease the CO2 respiratory drive and cause the patient to stop breathing.

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11
Q

Pursed lip Breathing (opens airways by increasing alveolar pressure)
Dyspnea (Inhales well. Exhales with difficulty)
Chronic Ineffective Cough (R/T lack of mucus)
Hyper-resonance on Chest Percussion (Sounds like a drum)
Orthopneic positioning (any position)
Barrel Chest
Dyspnea on Exertion (R/T decreased lung function)
Easily Fatigued
Prolonged Expiratory Time
Speaks in short jerky sentences (expiration dyspnea)
Anxious
Use of accessory muscles to breathe (exhale only)
No cyanosis (Normal ABGs R/T mild hypoxemia)
Thin Appearance (Anorexia)
Later in disease process leads to Right Sided Heart Failure (Cor Pulmonale)
Increased CO2 retention makes the patient pink
What Chronic Obstructive Pulmonary Disorder have these signs and symptoms?

A

Emphysema

Orthopneic positioning is however the patient needs to be positioned to breath easier can be tripod, high fowler’s, Ect. Hyperresonance occurs because of over inflated alveoli in the open blebs causes the lungs to sound hollow.

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11
Q

COPD: Chronic Bronchitis > Hypoxia > ___________ > Hyper-Viscosity > Pulmonary Hypertension > Right Ventricular Hypertrophy > Cor Pulmonale > Right Sided Heart Failure

A

Polycythemia
[Increased Red Blood Cells in Circulation]

Study Tip: Hyper-Viscosity means the blood is harder to Pump because it is thick like syrup.

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13
Q

Lining of the bronchial tube becomes inflamed because of recurring damage which leads to scar tissue. Scar tissue is not as flexible, pliable stretchy, as normal tissue and the airway won’t be able to expand and contract to perfuse oxygen efficiently. There is an increase in mucus cells lining the airway. Excess mucus can cause a chronic cough to try to expel the mucus. Decreased cilliary function makes this impossible. It is a vicious circle. What Chronic Obstructive Pulmonary Disorder does this describe?

A

Chronic Bronchitis

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14
Q 
Education on the benefits of 
- Smoking Cessation
- Vaccines
- Increasing Oxygen
- increasing Activity Tolerance
- Self-care
These are Collaborative Nursing Interventions for Long Term Management of what Chronic Obstructive Pulmonary Disorder?
A

COPD: Both Emphysema and Chronic Bronchitis

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15
Q

What is the definition of chronic bronchitis?

A

Presence of cough and sputum production for three months for 2 years. Chronic bronchitis is different from asthma because it is not reversible.

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16
Q

COPD: Chronic Bronchitis > _________ & _________ & _________

A

Hypoxia / Acidosis / Hypercapnia

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17
Q

Production Inflamed bronchi due to irritants or infection.

A

Listen to PPT again

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18
Q

COPD: Chronic Bronchitis > _________ & __________ > Pulmonary Vasoconstriction > Increased Pulmonary Vasculature Resistance > Pulmonary Hypertension > Right Ventricular Hypertrophy > Cor Pulmonale > Right Sided Heart Failure

A

Acidosis and Hypercapnia

Study Tip: Related to Retention of CO2

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20
Q

Over distended alveoli/bronchioles which makes it difficult for the patient to breathe out. They can breathe in just fine. Half of the air stays inside the alveoli’s when the patient exhales. The alveoli’s begin to press and rub up against each other because they become so large. As they rub against each other the walls dividing them are destroyed as well as the capillary bed that surrounds each alveoli. This causes the alveoli to become big floppy alveoli that can’t exchange gases due to the lack of blood flow. What Chronic Obstructive Pulmonary Disorder does this describe?

A

Emphysema

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20
Q

Finish the Nursing Diagnosis for a patient with COPD: Chronic Bronchitis?
Risk for Infection R/T

Hint: There are three different answers that are appropriate for this nursing diagnosis.

A

R/T Decreased Immune Function.
R/T Decreased Cilliary Function.
R/T Increased Mucus Secretions.

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21
Q

Alveoli’s become overinflated, distended, and stretched causing more air to become trapped in the alveoli. This causes the diaphragm to flatten and the AP diameter of the chest to change and becomes a barrel chest. What Chronic Obstructive Pulmonary Disorder does this describe?

A

Emphysema

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23
Q

What is the most classic sign of Emphysema?

A

Barrel Chest

Study Tip: R/T Increased size of alveoli pushed down the diaphragm to make space and also pushes the ribs outward because of the excess air left inside the alveoli after expiration.

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24
Q

Increase in mucous production (clogs airways) What Chronic Obstructive Pulmonary Disorder does this cause?

A

Chronic Bronchitis

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25
Q

Alveoli destroyed & capillary vasculature are reduced because the number of alveoli are reduced. This creates a gas exchange problem. This creates huge non-functioning spaces in the lungs that are called dead space or blebs. What Chronic Obstructive Pulmonary Disorder does this describe?

A

Emphysema

Study Tip: Surgery can remove the blebs (empty air pockets).

26
Q

_______ Is a disease state that is characterized by airway obstruction.

A

COPD: Both Emphysema and Chronic Bronchitis

27
Q

Skin Color: Dusky to Cyanotic
(R/T Increased Hypoxemia and Increased Polycythemia)
Wheezing (Obstructed Airway)
Recurrent Cough with Increased Sputum
Hypoxia & Hypercapnia & Acidosis
Frequent Respiratory Infections
Edematous (R/T Pulmonary Hypertension & Cor Pulmonale)
Increased Respiratory Rate (over 20 bpm)
Dyspnea on Exertion
Increased risk in heavy cigarette smokers
Clubbing of the fingers (R/T lack of perfusion)
Cardiac Enlargement (Rt Ventricle Hypertrophy)
Use of Accessory Muscles to Breathe (lift shoulders to breathe easier)
Tripod Position (opens up the lungs)
Cor Pulmonale (R/T increased pulmonary pressure)
What Chronic Obstructive Pulmonary Disorder have these signs and symptoms?

A

Chronic Bronchitis

Study Tip: Due to the cyanosis/blue skin the patient is commonly called a Blue Bloater. The increased respiratory rate is used to compensate and get rid of the excess CO2 retention because of the acidosis/hypercapnia/hypoxemia. The patient is called a Bloater because the obstruction of oxygen to the lungs causes an increase in residual lung volume which leads to a bloated appearance because of the inability to blow off CO2. Bloating can also occur due to Cor Pulmonale leading to systemic edema.

28
Q

What is the classic sign that a patient has Emphysema?

A

The Pink Puffer.

Study Tip: The patients skin is pink in color because they do not have cyanosis. The patient is called a puffer because they have a prolonged expiration because due to the retention of oxygen in the overinflated alveoli.

29
Q

Signs and Symptoms start to develop at 50 years old. Patients are usually smokers for 20 years or longer before symptoms arise. Starts with dyspnea that becomes progressive and occurs with exertion. Gets to the point where it prevents ability to perform ADLs. In later stages it is present at rest. What Chronic Obstructive Pulmonary Disorder does this describe?

A

COPD: Both Emphysema and Chronic Bronchitis

30
Q

Cough is initially intermittent then toward the end of the disease process the cough becomes an everyday occurrence increasing in severity. The cough can be productive or non-productive. What Chronic Obstructive Pulmonary Disorder have these signs and symptoms?

A

Chronic Bronchitis

31
Q

Cor Pulmonale is caused by an increased Right Ventricle Cardiac Workload R/T increased pulmonary pressure due to edema in the lungs because of pulmonary hypertension. What Chronic Obstructive Pulmonary Disorder is this caused by?

A

COPD: Emphysema and Chronic Bronchitis

Study Tip: Causes right ventricular hypertrophy which leads to Right-Sided Heart Failure.

32
Q

_________ can help patients with COPD if combined with proper education. When the nurses educated the patients on the benefits of smoking cessation in the hospital it caused more patients to stop smoking.

A

Nicotine Replacement Therapy

33
Q

Inflammation & formation of scar tissue = airway narrowing. What Chronic Obstructive Pulmonary Disorder does this cause?

A

Chronic Bronchitis

34
Q

Weight loss and anorexia is caused because the patient is in a hyper-metabolic state. Increased energy needs due to increased work required by the body to breathe. Patient loses weight because they cannot eat enough food to meet the caloric needs of the body. What Chronic Obstructive Pulmonary Disorder does this describe?

A

Emphysema

35
Q

_________ is a progressively worsening condition of decreased airflow into and out of the lungs. Associated with an abnormal inflammatory response in the lungs similar to asthma except that it is not reversible. Patients can have exacerbations of their symptoms but their latent state is not as normal respirations as someone with asthma.

A

COPD: Both Emphysema and Chronic Bronchitis

36
Q

1 cause is Cigarette smoking, high levels of air pollution, family history of pulmonary disease, and Genetic mutation in the Serpina 1 gene that can cause alpha one anti-tripsin deficiency (hereditary). What Chronic Obstructive Pulmonary Disorder does this cause?

A

Emphysema

37
Q

In a normal patient there is a Ratio of 1:2 with the chest being wider from side to side than from front to back. As _______ progresses the ratio becomes 1:1 with the chest being equal in size from front to back as side to side. This is called a barrel chest because it is round.

A

Emphysema

38
Q

Cilia malfunction (can’t clear lungs) What Chronic Obstructive Pulmonary Disorder does this cause?

A

COPD: Chronic Bronchitis and

Study Tip: Cilia malfunction is a clinical manifestation in Emphysema but not as of cause.

39
Q

Wheezing and chest tightness can be present. What Chronic Obstructive Pulmonary Disorder have these signs and symptoms?

A

COPD: Both Emphysema and Chronic Bronchitis

40
Q

What is the definition of Peripheral Airway Remodeling?

A

This is the thickening of the bronchioles and airways which limits airflow. This is irreversible.

41
Q

Edema in the ankles because the right side of the heart involved this is called Cor Pulmonale. What Chronic Obstructive Pulmonary Disorder does this describe?

A

Chronic Bronchitis

42
Q

What does Hypercapnia mean?

A

This is an abnormal increase in Carbon Dioxide levels in the blood.

Study Tip: Increased CO2 levels triggers a reflex to increase respiratory rate and access oxygen. This can be caused by hypoventilation, lung disease, and decreased LOC.

43
Q

When the patient inhales an irritant it can cause inflammation & formation of scar tissue in the bronchioles narrowing the airway causing an increase in mucous production which obstructs the airway. The thick mucus causes the cilia to malfunction and creates an ineffective cough reflex which cannot clear the mucus from the bronchiole. Macrophage malfunction occurs decreasing immunity because of the reduced capacity of macrophages from COPD patients to phagocytize bacteria and apoptotic cells.

When a patient has repeated, ongoing lung tissue injury & repair these indications can cause what Chronic Obstructive Pulmonary Disorder?

A

Chronic Bronchitis

44
Q

COPD > Hypoxia > Pulmonary Vasoconstriction > _____________ > Right Ventricular Hypertrophy > Cor Pulmonale > Right Sided Heart Failure

A

Increased Pulmonary Vasculature Resistance

45
Q

This is caused by destruction of the alveolar walls which leads to ineffective gas exchange. What Emphysema looks like this on the Bronchial Level?

A

Panlobar Emphysema

46
Q

Finish the Nursing Diagnosis for a patient with COPD: Chronic Bronchitis?
Insomnia R/T

A

Inability to Sleep Laying Down

47
Q

The patient gets fatigued and will assume the tripod position. Lean forward to breathe. Not in bed a lot in the hospital setting. Sit on the bed and lean forward on their knees or tray table. This position opens up the rib cage so there is more room to breathe. What Chronic Obstructive Pulmonary Disorder does this describe?

A

Chronic Bronchitis

Study Tip:
Tripod position in Chronic Bronchitis.
Orthopneic position in Emphysema.

48
Q

Why does destruction of capillary bed occur in COPD?

A

Each alveoli has a capillary bed (net) surrounding it. When the alveoli are overinflated they rub together causing the net of blood vessels surrounding the alveoli and the walls of the alveolus to be destroyed. This destroys the most important mechanism for effective gas exchange. This causes decreased perfusion and oxygenation of blood.

49
Q

Hypercapnia occurs with a CO2 greater than 45 mm/Hg normally. What Chronic Obstructive Pulmonary Disorder does this describe?

A

Chronic Bronchitis

50
Q

Finish the Nursing Diagnosis for a patient with COPD: Chronic Bronchitis?
Impaired gas exchange R/T

A

R/T Increased Mucus Secretions

51
Q
  1. Stay calm [Get help if you panic.]
  2. Assess respiratory system
  3. Yes/No questions [ Exhausts the Patient & uses Oxygen]
  4. Change Positioning? [High Fowler’s & Tripod Positioning]
  5. Breathing techniques? [Pursed Lip Breathing & Diaphragmatic Breathing]
  6. Cough enhancement [Diaphragmatic Breathing]
  7. Screen the patients visitors for Infections [No SICK visitors]
    These are Independent Nursing Interventions for Acute Management of what Chronic Obstructive Pulmonary Disorder?
A

COPD: Both Emphysema and Chronic Bronchitis

52
Q

What is inflammation of central airways caused by?

A

Caused by irritants in the bronchioles causing an inflammatory response.

53
Q

What pulmonary vascular changes occur during COPD?

A

The vessel walls thicken this stimulates the release of inflammatory cells including macrophages.

54
Q
  1. Oxygen Therapy.
  2. Nicotine Patch.
  3. IV Fluids [Hydration thins the secretions to help patient expectorate]
  4. Humidifier [to keep the air moist]
    These are Collaborative Nursing Interventions for Acute Management of what Chronic Obstructive Pulmonary Disorder?
A

COPD: Both Emphysema and Chronic Bronchitis

55
Q

When you administer medications to patients with COPD what is important to remember when choosing the order to administer medications?

A
  1. Quick relief Meds [Given First]
  2. Long term control [Given Second]
  3. Oxygen [Given Third]
56
Q

Noxious particles and gases including:
Tobacco
Smoke
Air Pollution
These all cause inflammation of the central airways, parenchymal destruction, peripheral airway remodeling, pulmonary vascular changes and destruction of the capillary bed this causes gas exchange to become a big problem.
What Chronic Obstructive Pulmonary Disorder does this cause?

A

COPD: Both Emphysema and Chronic Bronchitis

Study Tip:
Inflammation of central airways is caused by inflammatory response to irritants in the bronchioles.
Parenchymal destruction is caused by permanent enlargement of airspaces in the terminal bronchioles leading to destruction of respiratory walls.
Peripheral Airway Remodeling is irreversible.
Pulmonary Vascular changes cause vessel walls to thicken, and stimulates the release of inflammatory cells.
Destruction of Capillary Bed the airways destruction occurs because each alveoli has a capillary bed net surrounding it as alveoli is destroyed the capillary bed is destroyed too

57
Q

Finish the Nursing Diagnosis for a patient with COPD: Emphysema?
Imbalanced nutrition less than body requirements
R/T

A

R/T Hyper-Metabolic State

58
Q

When there is _________ in the lung it causes the Right Ventricle of the heart to work harder leading to Hypertrophy which leads to Cor Pulmonale [Right Sided HF]

A

Increased Pressure

Study Tip: Normally Pressure is Low in the Lung

59
Q

Patient will have hypoxemia causing the O2 Sat to stay in the high 80’s.
What Chronic Obstructive Pulmonary Disorder does this describe ?

A

Chronic Bronchitis

60
Q

Hypersecretion of Mucus [Clogs the Airways]
Cilia Dysfunction [Can’t effectively clear the mucus]
Limited Airflow
Hyperinflation of Lungs [Cant exhale effectively. Air trapping]
Gas Exchange Abnormalities [O2 can’t get in and CO2 can’t get out]
Pulmonary Hypertension [Increased PAP in Lungs]
Cor Pulmonale
What Chronic Obstructive Pulmonary Disorder have these signs and symptoms?

A

COPD: Both Emphysema and Chronic Bronchitis [Pathology]

61
Q

What is the parenchyma of the lung?

A

The alveolar tissue including the respiratory bronchioles, bronchi, blood vessels, alveolar ducts and terminal bronchioles. Considered the functional section of the lung.

62
Q

Cough is initially intermittent then toward the end of the disease process the cough becomes an everyday occurrence increasing in severity. The cough is ineffective in clearing mucus secretions. What Chronic Obstructive Pulmonary Disorder have these signs and symptoms?

A

Emphysema

Block 2 Week 3 & 4 Respiratory System (13 decks)

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