COPD (EXAM 2) Flashcards
COPD, and Polycythemia
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
What is COPD
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
Is COPD reversible
Nah, but it is preventable and treatable. Its a chronic disease, majority are not going to have full cures
Is COPD obstructive, or restrictive
obstructive, the airways become damaged or clogged and it impairs gas exchange
COPD patho (Inflamation)
-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
Right heart failure patho from COPD (Cor Pulmonale)
-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
COPD patho
-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
Emphysema
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)
Chronic Bronchitis
-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
COPD variants
Emphysema
Chronic Bronchitis
Or both
Risk factors for COPD
-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+
T/F patients with chronic bronchitis are more prone to resp infections
True
-Presence of mucus trapping bacteria
-Decreased function of alveolar macrophages
Normal alveolar function
-Inhale, o2 in lungs
-Alveoli stretch open
-Gases are exchanged
-Exhale, alveoli shrink and CO2 is forced out
Normal APT
1/2, 1/1 is barrel chest
Tripod position
-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
Clinical manifestations of COPD
-Chronic cough
-SOB
-Sputum production
-Clubbing, Pursed lips, accessory muscles use
Assessment and diagnosis of COPD
Pulmonary Function and spirometry
-Arterial blood gas
-Chest X-ray
-Through health history
Pack years
How many packs a day, how many years
Health history COPD
-Tobacco use, work exposures
-Recurrant infections, childhood asthma (more prone)
-Family history of COPD, alpha-1 antitripsin deficiency
-ADL, QQL, O2 use
Physical exam COPD
-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)
FVC: Forced vital capacity
Total volume of air that can be exhaled during a max effort expiration
-Volume of lungs that you can exhale
FEV1/FVC ratio
-Evaluates airflow obstruction
-Total volume of air they are able to exhale in 1 second at max effort
-Main criteria for COPD
FEV1/FVC ratio Normal
Main criteria for COPD, Normal is 70%
-You should be able to exhale 70% of your FVC in one second
Gold 1
In patients with FEV1/FVC <70%
-Mild FEV1> 80% predicted
-Their is 80% of what is thought to be normal (70%)
Gold 2
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%)
Gold 3
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%)
Gold 4
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%)
Normal PH
7.35-7.45
Normal Partial pressure O2 (PPO2)
75-100 mmHg (Text says 60-95)
Normal Partial pressure of CO2 (PaCO2)
35-45 mmhg
Normal Bicarbonate
22-26 mEq/L
Normal O2 sat
94-100%
88 can allow for at home o2 in chronic patients
Complications of COPD
-Pneumonia
-Pleural effusion
-Resp insufficiency and failure
-Arrhythmias
-Pneumothorax
-Pulmonary HTN and cor pulmonary VTE
Medical mgmt of COPD
-Smoking cessation
-Reducing risk factors
-Mgmt of exasperation
-O2 therapy (88-90%)
-Vaccines
-Pulmonary rehab
Vaccines for COPD patients
Pneumococcal, Influenza, Covid-19
Drugs to treat COPD
-beta-adrenergic agonist
-Muscarinic antagonist (anticholinergics)
-Combination agents
-Corticosteroids
-Antibiotics
-Mucolytics
-Antitussives
-Alpha-1 antitrypsin augmentation therapy
Beta-adrenergic agonist
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
Anti-cholinergic effects
-(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
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
4.) RINSE MOUTH
Stop thrush formation
Bullectomy
Excise out large air pocket in the lung to allow the lung to expand more
Lung volume reduction
-Cut out part of lung (Usually diseased)
-Allows healthy part of ling to expand
Nursing mgmt of COPD
20-4 in textbook
-assessing the patient , history
-Achieving airway clearance
-Improving breathing patterns
-Improving activity tolerance
-MDI patient education
Nursing care of patients with COPD
-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
Oxygen therapy
-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)
Hypoxemia
Decrease in arterial o2 tension in the blood
-Decreases o2 supply to tissues and cells outside resp system
-Can be life threatening
Oxygen Toxicity
-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
Home O2
-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
O2 admin
-Cylinder
-Devices:
-Nasal cannula (In nose over the ears, may be needed while eating)
-Oropharyngeal catheter
-Masks (Many people are mouth breathers)
-Transtracheal catheter
Patient education for COPD
-Smoking cessation
-Avoid irritants
-Meds
-Nutrition
-Breathing
-Regular exercise
-Realistic goals
-Emergency mgmt
-Hospice/ palliative care
Nutrition COPD
-Small frequent meals, they desat easy if on o2
-High in protein
Health promotion
Smoking quit line
-Avoid second hand
-Use protective equipment
-Vaccines
Pulmonary rehab
-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
Hypoxemia symptoms
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
How much O2 should use for a patient with COPD
Only use the lowest amount that is effective
Normal FiO2 (Fraction of inspired O2)
21%, room air
Oxygen toxicity patho
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
Nasal canula
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
Nasal catheter
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
Simple mask
Low Flow (5-8L)
-O2 percent ranges from 40-60 percent
-Simple to use and cheap
-Fits poorly however , and must remove to eat
Partial rebreathing mask
Low flow (8-11L)
-O2 percent ranges 50-75%
-Moderate O2 concentration
-However it is warm, poorly fitting, and must remove to eat
Nonrebreathing mask
Low flow (10-15L)
-O2 concentration ranges 80-95%
-High O2 concentration
-Poorly fitting and must remove to eat
Venturi Mask
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
Trach oxygen catheter
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
Aerosol mask
High Flow (8-10 L)
28-100% O2 concentration
-Good humidity, accurate FiO2
-Uncomfy for some
Trach collar
High flow (8-10 L)
28-100% concentration O2
-Good humidity, comfy and accurate FiO2
-Needs surgery and cleaning as well as suctioning
T Piece
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
Face tent
High Flow (8-10L)
28-100% O2 concentration
-Good humidity, accurate FiO2
-Its bulky
Low flow O2 systems
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
High flow O2 systems
Provides the entire total air the patient breaths
-Specific FiO2
-Indicated for those who require constant O2
Side effect of administering too much O2
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
