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NSG 470 > COPD (EXAM 2) > Flashcards

COPD (EXAM 2) Flashcards

1
Q

COPD, and Polycythemia

A

Increased RBC production as a result of chronic hypoxia in an effort to carry more Oxygen to bodily tissue. This back fires as it makes the blood more viscous

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2
Q

What is COPD

A

Chronic obstructive pulmonary disease

-Slow progression of respiratory disease of airflow obstruction
-Chronic bronchitis and or emphysema
-Involves the airways, pulmonary parenchyma (function) or both
-4th leading cause of death

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3
Q

Is COPD reversible

A

Nah, but it is preventable and treatable. Its a chronic disease, majority are not going to have full cures

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4
Q

Is COPD obstructive, or restrictive

A

obstructive, the airways become damaged or clogged and it impairs gas exchange

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5
Q

COPD patho (Inflamation)

A

-Repeated exposure to noxious particles or gas that cause an inflammatory response in the resp tract
-This causes chronic inflammation which dmges the tissue
-Body is dumb and tries to repair this damage, leading to scar tissue formation
-Over time the constant injury and repair causes scar tissue and narrowing of lumen, increasing resistance for gas exchange

Smoking is main cause

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6
Q

Right heart failure patho from COPD (Cor Pulmonale)

A

-Pulmonary hypertension exist from increased resistance and remodeling from COPD
-Blood isnt pumping as well to lungs, and the body is dumb and causes RV to hypertrophy to push stronger into the lungs.
-This works for a while but then the RV becomes hypertrophied and distended, leading to ineffective pumping
-This leads to issues in circulation, distended veins, ascites

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7
Q

COPD patho

A

-As a result of inflammation, more goblet cells and submucosal glands are present, leading to more mucus production
-Even smaller lumen
-Bronchioles become thickened and narrowed with the peribronchial fibrosis and exudate in the airway (Mucus and inflammation)
-Increased pressure leads to alveolar walls being destroyed, lowering surface area and elastic recoil
-Blood vessels become thickened, smooth muscle becomes hypertrophied and development of pulmonary hypertension

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8
Q

Emphysema

A

Loss of lung elasticity and hyperinflation of lungs
-Alveolar sacks become stretched
-Decreased surface area as a result of dmg to walls of alveoli, less o2 going to blood stream
-Alveoli cannot support the bronchial tubes, air gets trapped in the lungs
-Barrel chest

(Lungs are not able to retract as easily as before to empty due to inflammation and other factors so they blow up like a balloon)

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9
Q

Chronic Bronchitis

A

-Inflammation and excess mucus

Inflammation of bronchi and bronchioles due to chronic exposure to irritants
-Cough and sputum production for at least 3 mo out of the years for 2 consecutive years
-Decreased ciliary function, bronchial walls thicken , airways narrow, mucus plugs airway
-Alveoli become dmged, scared and alveolar macrophage decreases function
-Can be from smoke or other irritants

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10
Q

COPD variants

A

Emphysema
Chronic Bronchitis

Or both

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11
Q

Risk factors for COPD

A

-Smoking is number one , Vaping?
-Second hand smoke
-Occupational exposures, dust and chemicals (Asbestos)
-Environmental (Indoor, outdoor pollution)
-alpha1-Antitrypsin deficiency, (INHERITED, genetic)
-Aging, 40+

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12
Q

T/F patients with chronic bronchitis are more prone to resp infections

A

True
-Presence of mucus trapping bacteria
-Decreased function of alveolar macrophages

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13
Q

Normal alveolar function

A

-Inhale, o2 in lungs
-Alveoli stretch open
-Gases are exchanged
-Exhale, alveoli shrink and CO2 is forced out

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14
Q

Normal APT

A

1/2, 1/1 is barrel chest

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15
Q

Tripod position

A

-Position alot of people with COPD use to relieve resp distress
-Sit down with arms on knees leaning forward
-Assist in use of accessory muscles in breathing

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16
Q

Clinical manifestations of COPD

A

-Chronic cough
-SOB
-Sputum production

-Clubbing, Pursed lips, accessory muscles use

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17
Q

Assessment and diagnosis of COPD

A

Pulmonary Function and spirometry
-Arterial blood gas
-Chest X-ray
-Through health history

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18
Q

Pack years

A

How many packs a day, how many years

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19
Q

Health history COPD

A

-Tobacco use, work exposures
-Recurrant infections, childhood asthma (more prone)
-Family history of COPD, alpha-1 antitripsin deficiency
-ADL, QQL, O2 use

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20
Q

Physical exam COPD

A

-Cyanosis
-Clubbing, use of accessory muscles, labored breathing, o2, swelling in legs, able to talk comfortably, lung sounds (Wheezes and crackles) , heart sounds , barrel chest, cough, sputum
-Distended neck veins (late)

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21
Q

FVC: Forced vital capacity

A

Total volume of air that can be exhaled during a max effort expiration

-Volume of lungs that you can exhale

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22
Q

FEV1/FVC ratio

A

-Evaluates airflow obstruction
-Total volume of air they are able to exhale in 1 second at max effort
-Main criteria for COPD

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23
Q

FEV1/FVC ratio Normal

A

Main criteria for COPD, Normal is 70%

-You should be able to exhale 70% of your FVC in one second

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24
Q

Gold 1

A

In patients with FEV1/FVC <70%

-Mild FEV1> 80% predicted

-Their is 80% of what is thought to be normal (70%)

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25
Q

Gold 2

A

In patients with FEV1/FVC <70%
-Moderate FEV1 50-80% predicted

-They can exhale in one second 50-80% of what a normal person can (70%)

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26
Q

Gold 3

A

In patients with FEV1/FVC <70%
-Severe FEV1 30-50% predicted

-They can exhale in one second 30-50% of what a normal person can (70%)

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27
Q

Gold 4

A

In patients with FEV1/FVC <70%
-Very severe FEV1 <30% predicted

-They can exhale in one second <30% of what a normal person can (70%)

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28
Q

Normal PH

A

7.35-7.45

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29
Q

Normal Partial pressure O2 (PPO2)

A

75-100 mmHg (Text says 60-95)

30
Q

Normal Partial pressure of CO2 (PaCO2)

A

35-45 mmhg

31
Q

Normal Bicarbonate

A

22-26 mEq/L

32
Q

Normal O2 sat

A

94-100%

88 can allow for at home o2 in chronic patients

33
Q

Complications of COPD

A

-Pneumonia
-Pleural effusion
-Resp insufficiency and failure
-Arrhythmias
-Pneumothorax
-Pulmonary HTN and cor pulmonary VTE

34
Q

Medical mgmt of COPD

A

-Smoking cessation
-Reducing risk factors
-Mgmt of exasperation
-O2 therapy (88-90%)
-Vaccines
-Pulmonary rehab

35
Q

Vaccines for COPD patients

A

Pneumococcal, Influenza, Covid-19

36
Q

Drugs to treat COPD

A

-beta-adrenergic agonist
-Muscarinic antagonist (anticholinergics)
-Combination agents
-Corticosteroids
-Antibiotics
-Mucolytics
-Antitussives
-Alpha-1 antitrypsin augmentation therapy

37
Q

Beta-adrenergic agonist

A

Relax airway easing breathing

Call provider for serious side effects (Hives, skin rash, rapid HR, Palpitations)

-Side effects include: HA, N+V+D
-ANxiety
-Tremor

38
Q

Anti-cholinergic effects

A

-(Hot as a hare)Rise in body temp

-(Blind as a Bat) Dilated Pupils, mydriasis

-(Dry as a bone)Dry mouth, dry eye, no sweat

-(Red as a beet)flushed face

-(Mad as a hatter) Delirium

39
Q

Which of the following should a patient do after using a meter dose inhaler (MDI) containing a corticosteroid

1.) Wait 5 min to consume any liquid
2.) Use a soft bristle toothbrush for brushing any teeth during the next 24 hours
3.) Monitor for hyperthermia which can be a sign of infection
4.) Rinse mouth with water immediately after use

A

4.) RINSE MOUTH

Stop thrush formation

40
Q

Bullectomy

A

Excise out large air pocket in the lung to allow the lung to expand more

41
Q

Lung volume reduction

A

-Cut out part of lung (Usually diseased)
-Allows healthy part of ling to expand

42
Q

Nursing mgmt of COPD

A

20-4 in textbook
-assessing the patient , history
-Achieving airway clearance
-Improving breathing patterns
-Improving activity tolerance
-MDI patient education

43
Q

Nursing care of patients with COPD

A

-Evaluate exposure to irritants, Home
-Nursing interventions to promote oxygenation
-Incentive spirometry
-Postural draining (Changing position to have gravity help with drainage)
-Chest percussion and vibration
- Breathing exercises (Diaphragm/ pursed lips)
-Administer O2 to promote gas exchange
-O2
-Bronchodilators

44
Q

Oxygen therapy

A

-Giving o2 to provide transport of oxygen in the blood while decreasing the work of breathing (Oxygen is much more concentrated so you dont have to breath as hard)

45
Q

Hypoxemia

A

Decrease in arterial o2 tension in the blood

-Decreases o2 supply to tissues and cells outside resp system
-Can be life threatening

46
Q

Oxygen Toxicity

A

-Can occur if concentration of O2 admin is too high for an extended period
-Causes progressive resp difficulty, refractory hypoxemia, alveolar atelectasis and alveolar infiltrates
-Symptoms are similar to ARDS
-Diagnosed with chest X-ray

-Prevention is key, Use lowest concentration of O2 that is effective
-Peep or CPAP to prevent or reverse atelectasis and allow for lower concentration of O2

47
Q

Home O2

A

-Need is determined to be at 88% sat
-Caution in certain patients as their main resp drive is hypoxia and if they sat too high they can become apneic

-Safety stuff/ teaching
-No smoking
-Portable devices
-Humidity must be controlled
-Community resources

48
Q

O2 admin

A

-Cylinder

-Devices:

-Nasal cannula (In nose over the ears, may be needed while eating)
-Oropharyngeal catheter
-Masks (Many people are mouth breathers)
-Transtracheal catheter

49
Q

Patient education for COPD

A

-Smoking cessation
-Avoid irritants
-Meds
-Nutrition
-Breathing
-Regular exercise
-Realistic goals
-Emergency mgmt
-Hospice/ palliative care

50
Q

Nutrition COPD

A

-Small frequent meals, they desat easy if on o2
-High in protein

51
Q

Health promotion

A

Smoking quit line
-Avoid second hand
-Use protective equipment
-Vaccines

52
Q

Pulmonary rehab

A

-Increases exercise tolerance
-Increases dyspnea tolerance, decreases HR
-Improves quality of life and sense of well being
-Multidisciplinary, educational, psychosocial, behavioral and physical reconditioning, nutrition counceling

-Refer patients with COPD stage II or higher

53
Q

Hypoxemia symptoms

A

First seen in a change in mental status (Impaired judgment to agitation, disorientation, to confusion, to lethargy and coma

Can have CNS effects such as increase in BP,HR, arrhythmia, diaphoresis, and cool extemities

Leads to hypoxia

54
Q

How much O2 should use for a patient with COPD

A

Only use the lowest amount that is effective

55
Q

Normal FiO2 (Fraction of inspired O2)

A

21%, room air

56
Q

Oxygen toxicity patho

A

Overproduction of free radicals, by giving O2 for an extended period of time. These mediate an inflammatory response that can severely dmg alveolar capilary membranes, leading to pulmonary edema

57
Q

Nasal canula

A

Low flow (1-6 L)
-O2 percent ranges from 24-44% depending on L/min
-Lightweight, inexpensive, comfy, and can use with meals
-However it is easily dislodged and sores can develop on ears and in nares. can also dry mucosa, and some people are mouth breathers

58
Q

Nasal catheter

A

Low flow (1-6L)
-O2 percent 24-44%
-Cheap and doesnt require a trach
-Can irritate the nare and has to be changed frequently
Tube that looks like an NG tube on one nostril

59
Q

Simple mask

A

Low Flow (5-8L)
-O2 percent ranges from 40-60 percent
-Simple to use and cheap
-Fits poorly however , and must remove to eat

60
Q

Partial rebreathing mask

A

Low flow (8-11L)
-O2 percent ranges 50-75%
-Moderate O2 concentration
-However it is warm, poorly fitting, and must remove to eat

61
Q

Nonrebreathing mask

A

Low flow (10-15L)
-O2 concentration ranges 80-95%
-High O2 concentration
-Poorly fitting and must remove to eat

62
Q

Venturi Mask

A

High flow (4-8L)
-O2 ranges 24-40%
-Provides low levels of supplemental O2
-PRECISE FiO2
-Can add additional humidity

Often used in patients with COPD

-Needs to be removed to eat

63
Q

Trach oxygen catheter

A

High flow (1/4-4L)
-60-80% O2

-More comfy than other high flows and can be concealed, less L/min than nasal cannula
-However it requires frequent and regular cleaning and surgery to implement

64
Q

Aerosol mask

A

High Flow (8-10 L)
28-100% O2 concentration

-Good humidity, accurate FiO2
-Uncomfy for some

65
Q

Trach collar

A

High flow (8-10 L)
28-100% concentration O2
-Good humidity, comfy and accurate FiO2

-Needs surgery and cleaning as well as suctioning

66
Q

T Piece

A

High flow( 8-10 L)
-28-100% O2 concentration
-Good humidity, comfy, accurate FiO2
-However its heavy with tubing, but it has the same function as a trach collar without the surgery

67
Q

Face tent

A

High Flow (8-10L)
28-100% O2 concentration
-Good humidity, accurate FiO2

-Its bulky

68
Q

Low flow O2 systems

A

Contribute partially to the inspired gas the patient breaths, (Mixes room air and oxygen)
-Not precise in FiO2
-Amount of inspired O2 changes as the person breaths

69
Q

High flow O2 systems

A

Provides the entire total air the patient breaths
-Specific FiO2
-Indicated for those who require constant O2

70
Q

Side effect of administering too much O2

A

Too much O2 can lead to retention of CO2 from the suppression of chemoreceptors,

If your body thinks you have enough o2, why would it blow out CO2

NSG 470 (26 decks)

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