COPD - EXAM 3 Flashcards
COPD
An abnormal inflammatory response of the lungs to noxious particles and gases causing obstruction, air trapping in the alveoli and impaired exhalation. COPD impacts work, family, obligations, leisure, and ADLs
Preventable and treatable disease state characterized by chronic and progressive airflow limitation that is not fully reversible.
Precipitating Factors
- Cigarette smoke
- Frequent exposure to air pollutants
- Increased risk for those with asthma, untreated TB, or frequent resp. infection
- Genetics (alpha-1 antitrypsin deficiency)
Emphysema
- Irreversible destruction of alveolar walls leads to rupture of alveoli which leads to decreased number of alveoli and enlargement of remaining alveoli which leads to decreased elasticity and overinflation of the lungs
- 3 types
- centriacinar
- panacinar
- distal acinar
- 3 classfications
- compensatory
- type A (dry)
- type B (wet)
Chronic Bronchitis
- Increased site and number of goblet cells and mucus production
- Leads to damaged cells
- Leads to muscle hyperplasia
- Leads to inflammation and bronchial wall thickening
- Leads to muscle hyperplasia
- Leads to damaged cells
The presence of a chronic cough for three months in each of two succesive years. Excessive mucus in the airways causes scarring and decreased airflow.
Similiarities between Emphysema and Chronic Bronchitis
- There is restricted airflow requiring increased pressures to force air out of alveoli. This leads to bronchial collapse and air trapping.
- Prognosis is affected by age, smoking status, resting HR, airway responsiveness, and concurrent medical conditions (such as hypoxemia, pulmonary HTN, corpulmonale, or CHF)
Emphysema Symptoms
- Barrel chest due to hyperinflation
- Prolonged expiration
- Wheezing or decreased breath sounds
- Distant heart sounds
- Hyper-resonance on percussion
Later in disease process:
- Increased RR (proportional to degree of disease severity)
- Use of accessory muscles
- Cyanosis
- Peripheral edema
Chronic Bronchitis Symptoms
- Associated with frequent respiratory infections (such as acute bronchitis or pneumonia)
- Rhonchi or wheezing on auscultation
- Concurrent cor pulmonale with signs of cyanosis
- Edema associated with right sided heart failure
Diagnostics
- Pulmonary function tests (PFTs)
- Chest X-Ray
- small heart and flat diaphragm in emphysema
- increased bronchial markings in chronic bronchitis
- EKG to rule out right ventricular hypertrophy
- Blood Samples
- ABGs
- HgB/Hct to evaluate polycythemia
Emphysema
Abnornal permanent enlargement of the airspaces distal to the terminal bronchioles, accompanied by destruction of their walls and without obvious fibrosis
COPD Pathophysiology
- Inflammation of central airways due to noxious particles and gases
- Increase in the number of mucus-producing goblet cells
- Structural remodeling of airways walls due to repeated cycles of injury and repair
- Increase in scar tissue formation in airway walls causing fibrosis and loss of elastic recoil
- Air is trapped in the distal alveoli
- Loss of alveolar walls and capillary destruction
- End result is a decrease in the surface area for the diffusion of oxygen, also known as Impaired Gas Exchange
T or F: Cigarette smoking is the most preventable cause of premature death in the US
True
T or F: Of the 4,000 chemicals and gases inahled into the lungs with cigarettes, none of them are proven carcinogens
False
T or F: Breathing in another person’s smoke can cause many breathing problems in children as well as cancer and heart disease in adults
True
T or F: A person’s sense of taste and smell are affected by tobacco smoke
True
T or F: It is not harmful to smoke cigarettes while using nicotine replacement therapy
False
T or F: Patients have a better chance of quitting tobacco use if they use more than one method for cessation
True
T or F: Support and encouragement from family and friends are key factors in improving the success of smoking cessation
True
T or F: The nurse who smokes or uses tobacco should have no difficulty in helping a patient change tobacco use habits
False
T of F: Strong evidence suggests that nursing interventions are effective in reducing smoking
True
T or F: Only patients who express a desire to quit tobacco should be offered treatment
False
The five As in Smoking/Tobacco Cessation Intervention
- ASK every patient whether he/she uses tobacco (include type and amount)
- ADVISE users about the risks of tobacco use and benefits of a tobacco-free lifestlye
- ASSESS their willingness to make a quit attempt (stage of change)
- ASSIST them in quitting (use of community services, pharmacotherapy, etc)
- ARRANGE for follow-up (phone calls, referrals)
Pursed-Lip Breathing
The patient is taught to inhale slowly through the nose and then to exhale slowly through pursed lips, almost as if whistling.
Purpose: To prolong exhalation and thereby prevent bronchiolar collapse and air trapping (keeps alveoli open)
Desired Outcome: Exhalation should be at least 3 times as long as exhalation
Intrustions to patient:
- Blow as though through a straw in a glass of water to form small bubbles
- Blow as if at a lit candle to bend flame, not blow it out
- Steadily blow a table-tennis ball across the table
- Blow a tissue held in the hand until it gently flaps
How often: 8-10 repitiions, 3-4 times/day
Postural Drainage and Cupping (Percussion) AKA PD&C
Uses the principle of gravity
Purpose: to assist bronchial drainage, percussion, vibration and postural drainage may assist in bringing secretions into larger, more central airways
When to perform: 1 hour before meals or 1-3 hours after meals: individualized schedule, position should be maintained for 5-15 minutes to mobilize secretions VIA gravity, administer bronchodilator 15 minutes before procedure, often ordered 2-4 times/day
Equipment: hands, pillows, blocks, blankets, chair, tissues, emesis basin
Assessment of patient: tolerance of procedure, lung sounds pre and post procedure, effectiveness of cough, sputum production and quality
Explanation to patient: procedure, goal, report any discomfort
Contraindications to treatment: should not percuss over kidneys, sternum, spinal cord, or any painful or tender area. CPT is contraindicated for patients with hemoptysis, PTX, right sided heart failure or bronchospasms
Procedure: After each drainage position change, the patient should be given time to cough and deep breathe. Some postural drainage positions should not be performed with patients expeirencing chest trauma, hemoptysis, heart disease, or head injury
Evaluation of outcomes: relief of symptoms of dyspnea, sensation of “fullness”
vibration vests can also be used to loosen secretions