COPD/dyspnea readings Flashcards
COPD how is it characterized
• A common preventable and treatable disease, characterized by persistent airflow limitation that is usually progressive and associated with an enhanced chronic inflammatory response in the airways and the lung to noxious particles or gasses
patho of COPD
-• progressive airflow limitation assoc w abn inflm response airways, parenchyma, and pulmonary vasculatureto noxious particles or gases.
• small a/w narrowing
• narrowing and scar formation
• Obstruction may be d/t parenchymal destruction
• Protineases and antiprotineases are released and damage the parenchyma of the lung–>a/w limitation
• Cigarette smoke or tobacco use may cause thickening of the vessel wall.
chronic bronchitis what must you have for dx
• Presence of cough and sputum production for at least 3 months in each 2 consecutive years
chronic bronchitis what are the patho issues
- irritants–>hypersec of mucus (d/t inc number and size of glands), dec ciliary fx and inflm
- thickened bronchial walls
- alveolia adjacent to bronchioles may get damaged and fibrosed
- alt fx of alveolar macrophages
- susceptible to infection
when is pt susceptible to chronic bronchitis exacerbation
winter
emphysema patho
- destr of walls of over distended alveoli byond terminal bronchioles
- dec alveolar SA–>inc dead space–> which dec pulm capillaries–>hypoxemia.
- once co2 elim is impaired–>hypercapnia–>resp acidosis
how does destr of pulm capillaries affect CV system
- Consequently, pulm blood flow is inc forcing the R. ventricle to maintain a higher bp in the pulm artery.
- R. sided heart failure- complication
mnfts of emphysema
• hyperinflated chest (barrel chest), - marked dyspnea on exertion - wt loss -Pt is SOB, chest is rigid, and ribs are fixed at joints • Derangement of ventilation-perfusion ratios, producing -chronic hypoxemia, -hypercapnia (inc co2 in arterial blood), -polycythemia, -episodes of r. sided heart failure. • Leads to central cyanosis, - peripheral edema - resp failure
outcome!! et/risk factors for COPD
- Env’t exposures
- Cigarette smoking, pipe, cigar, tobacco use. Second hand
- Smoking depresses activity of scavenger cells and affects ciliary cleansing mechanism, which keeps breathing passages free of inhaled irritants, bacteria, and other foreign matter. Airflow is then obstructed and alveoli are trapped and are greatly distended)
- Smoking irritates the goblet cells and mucous glands- inc accum of mucus- more irriation, infection, and damage to the lung
- Carbon monoxide also damaging
- Prolonged and intense exposure to occupational dusts and chemicals, indoor air pollution and
- A host risk factor- def of alpha1 antitrypsin (enzyme that protects the lung parenchyma from injury)
what can be offered to pt with A1 antitrypsin deficiency
how might their disease course present
tx
genetic counselling
- they will be v susceptible to a/w irritants
- may be given alpha protease replacement therapy which is $$$
3 classic mnfts of COPD
other mnfts
• Cough, sputum, dyspnea
- Wt loss- dyspnea interferes with eating
- Barrel chest- chronic hyperinflation d/t fixation of the ribs in the inspiratory position and loss of lung elasticity.
- Retraction of the supraclavicular fossae occurs on inspiration, causing the shoulders to heave upward
how is obstructive lung disease defined
post bronchodilator FEV1/FVC ratio of less than 70%
how is airflow obstr evaluated
• Spirometry- evaluate airflow obstruction by comparing FEV1 to FVC
how are spirometric results expressed
theyre given as absolute volume and as percent predicted using appropriate normal values for gender, age, and height
how is asthma ruled out
• Bronchodilator reversibility testing to rule out asthma and guide early tx
pts spirometry is obtained. pt is then given bronchodilator and spirometry is repeated .
who would get Alpha 1 antitrypsin testing
pts under 45 or those w strong famhx of COPD
which disease can COPD get confused with easily
• Rule out asthma which has key characteristics of: early onset in life, variation in daily symptoms, day to day occurrence or timing of symptoms, family hx, allergy, rhinitis or eczema
complications of COPD
- Resp insuff and failure
- Acuity of the onset of symptoms and severity depend on baseline pulm function, spo2, ABGs, comorbid conditions
- Pneumonia, atelectasis, pneumothorax, and cop pulmonae
headings of medical mgmt of COPD
- risk reduction
- pharm therapy: bronchodilators, corticosteroids
- mgmt of exacerbation
- oxygen
- surgical mgmt
- pulm rehabilitation
risk reduction how to quit smoking how else to mitigate risk of smoking
- smoke cessation (promoting and encourage to quit)–this is important to start in teen years as early age use is assoc w higher levels of dependence
- factors associated with continued smoking- strength of nicotine addiction, continued exposure to smoking, stress, depression, habit. Prevelant – low incomes, low education, and psychosocial problems
- psychosocial support and pharmacotherapy for smoking cessation for patients with COPD
- Explain risks. Set a “quit date” follow up 3-5 days after date.
- Refer to a program
- Emphasize success over failures
- First line pharmacotherapy that reliable increases long-term smoking abstinence rates is nicotine replacement (gum, inhaler, nasal spray, transdermal patch, SL tablet)
- Second line include antihypertensive agents such as clonidine (pregnancy and adolescents and light smokers are not recomm)
- Smoking cessation can begin anywhere- clinic, pulmonary rehab, community, hospital, home
surgical mgmt of COPD (name of sx and reason)
bullectomy (if have bullous emphysema)
lung volume reduction sx (if its isolated to one area of lung)
lung transplant
what is a bullae and how does it impact pt
. Bullae are enlarged airspaces in the thorax- may be surgically excised.
• Bullae compress areas of the lung that have adequate gas exchange.
who is candidate for lung transplant
• Single-lung transplant can be considered for patients with end-stage emphysema who have an FEV1
other than meds and sx what medical mgmt is avail for COPD
pulm rehab
how does pulm rehab work and what does it incude
• Improves exercise tolerance, reduce dyspnea, and inc QOL
• primary goal is Restore pt to highest level of independent function possible
• Educational, psychosocial, and behavioural, and physical components
-good for all stages of COPD and even asthma, other resp issues
• Breathing exercises and retraining
• Min length of an effective program is 2 months
what areas does nursing mgmt focus on
- breathing exercises
- inspiratory muscle trainiing
- acitivy pacing
- self-care activities
- physical conditioning
- oxygen therapy
- nutritional therpy
- coping measures
- pt teahing
what enables pt to gain control and dec dyspnea and feelings of panic
breathing exercises like pursed lip breathing
what types of breathing exercises are taught to COPD pt
- Diaphragmatic breathing, which reduces rep rate, inc alveolar ventiliation and sometimes helps to expel as much air as possible
- Pursed-lip breathing helps to slow expiration, prevents collapse of small airways and helps the patient control the rate and depth of respiration
- Promotes relaxation, enabling the patient to gain control of dyspnea and reduce feelings of panic
what is focused on for pt teaching of COPD
- A&P of lung, patho and changes with COPD
- Medications and home o2,
- Nutrition
- Resp therapy treatments
- Symptom alleviation
- Smoking cessation
- Sexuality and COPD
- Coping with chronic disease, planning for future
after breathing exercses are astered what should the pt be taught/do
Inspiratory Muscle Training
• After breathing exercises- this program prescribed
• Patient breathes against resistance to condition muscles for specific period every day
-they should continue at home
how can the nurse help with activity pacing
Activity Pacing
• Dec exercise tolerance during specific periods of the day
• Bronchial secretions collect in the lungs during the night while the person is lying down
• May have difficulty bathing or dressing
• Activities requiring the arms to be supported above the level of the thorax may produce fatigue or resp distress but may increase as patient moves around for an hour+
-work with pt to plan self care by determining when the best times of day for various activities are
when should diaphragmatic breathing be used
- Coordinate diaphragmatic breathing with walking, bathing, bending, or climbing stairs
- Should do the above activities with resting as needed
what else should nurse teach for self care and tell pt to have readily avail
- Fluid readily avail
* If postural drainage is to be done at home, the nurse instructs and supervises the patient before discharge
why is exercise good for COPD pt. what kind is good?
Physical Conditioning
• Breathing and general exercises to conserve energy and inc pulmonary ventilation.
• Treadmills, stationary bikes, and measured level walks can improve symptoms and inc work capacity
-can have portable O2 for pt
what to teach pt about ocygen therapy
- Explain flow rate and req number of hours for o2 and dangers of arbitrary changes in flow rates or duration
- Smoking near o2 is dangerous
- Reassures patient that this is not addictive
why does wt loss and muscle wasting occur w COPD
• Wt loss and loss of fat mass are primarily the result of negative balance between dietary intake and energy expenditure, whereas muscle wasting is a consequence of an impaired balance between protein synthesis and protein breakdown
what type of nutritional guidanc/monitoring does pt need
• Calorie needs assessment and counselling for meal planning
must monitor wt continually
how might COPD emotionally affect pt/family
- Any factor that interferes with normal breathing quite naturally induces anxiety, depression and changes in behavior.
- Any exertion is exhausting and fatigue is a major symptom
- Constant SOB may make irritable and apprehensive.
- Anger and depression from restricted activity
- Sexual function may be compromised- dimishes self-esteem
- Provide education and support to spouse and family b/c endstage COPD is difficukt
health hx questions to ask copd pt
resp diff for how long? does/what kind of exertion inc dyspnea? exercise tolerance limits? when during day are you most SOB? how is eating and sleeping affected? smoking hx? primary and secondary occupational smoke/pollutants triggering events?
what type f inspection and exam findings do you look for
-what position does pt assume during interview
-pulse and resp rates?
-char of resps
-can pt finish sentence wout having to take breath
-does pt contract abdm muscles during inspiration
-does pt use accesory muscles of shoulder/neck to breat
-prolonged exhalation?
-central cyanosis
-engorged neck veins
-peripheral edema
-coughing
-colour amount consistency sputum
-clubbing
type of breath sounds
-pts sensorium
-LT or ST memory impairment
-inc stupor?
apprehensive\?
diagnoses for COPD pt
- Impaired gas exchange and airway clearance d/t chronic inhalation of toxins
- Impaired gas exchange r/t ventilation-perfusion inequality
- Ineffective airway clearance r/t bronchoconstriction, increased mucous production, ineffective cough, bronchopulmonary infection, and other compliations
- Ineffective breathing pattern r/t SOB, mucus, bronchoconstriction, and airway irritatnts
- Activity intolerance d/t fatigue, ineffective breathing patterns, and hypoxemia
- Deficient knowledge of self-care strategies to be performed at home
- Ineffective coping r/t reduced socialization, anxiety, depression, lower activity level, and inability to work
potential complic
- Resp insufficiency or failyure
- Atelectasisi
- Pulmonary infection
- Pneumona
- Pneumothorax
- Pulmonary htn
focuses of nursing mgmt
- smoking cessation
- improving gas exchange
- achieving a/w clearance
- improving breathing patterns
- improving activitiy tolerance
- enhancing self care strategies
- enhancing indiv coping strateges
- prevnt complic
what sign indicates bronchospasm
ad bronchospasm relief
wheezing or diminished breath sounds when auscultating
measured improvement in expiratory flow rates and volumes s well as dec dyspnea
how to improve gas exchange
monitor dyspnea and hypoxemia
give meds
how to help pts acheive a/w clearance
- Dimish sputum to improve ventilation and gas exchange
- Pulmonary irritants should be eliminated
- Directed or controlled coughing more effective than undirected forceful coughing
- Directed coughing- slow, maximal inspiration followed by breath holding for several seconds and then 2 or 3 coughs
- Huff sounds may also be effective: Consists of one or two forced exhalations from low to med lung vol
- Chest physiotherapy with postural drainage, intermittent positive-pressure breathing, increased fluid intake, and band aerosol mists are useful
how to improve breathing patterns
- Ineffective breathing patterns and SOB are d/t ineffective resp mechnisms of the chest wall and lung resulting from air trapping, ineffective diaphragmatic movement, airway obstruction, metabolic cost of breathing and stress
- Inspiratory muscle training and breathing retraining improves patterns
- Disphragmatic breathing reduces RR, and inc alveolar ventilation and helps to expel air in expiration
- Pursed lip breathing helps to slow expiration, prevent airway collapse and control rate and depth of resp
how to enhance self care strategies with pt
set realistic goals if severe (objective of treatment is to preserve current pulmonary function and relieve symptoms) if mild objective is to inc exercise tolerance prevent further loss of function
• Avoiding Temperature extremes-avoid extreme heat and cold. Heat raises o2 requirements and cold promotes bronchospasm. Air pollutants may also initiate a spasm. High altitudes aggravate hypoxemia
• Modifying lifestyle: avoid stress. Review medication instructions. Smoking cessation
how to improve activity toleranc
- Rehab therapies to promote ADLs
- Pace activities throughout the day
- Evaluate tolerance and limitations
what to teach pt about Monitoring and managing potential complications
s/s of resp infection (for pt with COPD thse will be less obvious) eg fever, change in sputum, worsening fo symptoms
what kind of changes might indicate hypoxemia and impending resp failure
• Increasing dyspnea, tachypnea, and tachycardia –may indicate increasing hypoxemia
other than assessing rep system what could indicate hypoxia
monitor cognitive changes
prevention of infection 1 methd
vaccines against step pneumonae ad haemophilus influenzae
prevention of exacerbation of symptoms
• Avoid outdoors when pollen is high. Avoid hot temp and high humidity or low temp and wind
what to do if pt has sudden SOB
• If develops a rapid onset of SOB, quickly evaluate the atient for a potential pneumothorax by assessing symmetry of chest movement, differnces in breath sunds and pulse oximetry. Can lead to pulmonary htn because pulmonary arteries constrict when hypoxemia occurs
why does pulm HTN develop and how can it be prevented
d/t chronic hypoxemia which causes pulm artery constriction. can be prevented by maint adequate oxygenation
