COPD/Obstructive Diseases Flashcards
Definitions of: TV IRV ERV RV TLC VC IC FRC
VOLUMES:
- Tidal Volume: normal breath
- Ins. Reserve Vol: max amount inhaled air ABOVE normal inspiration
- Ex. Reserve Vol: max amount air expended AFTER normal exhale
- Residual Volume: gas remaining in lungs at end max inspiration
CAPACITIES:
- Total Lung Capacity: amount lung contains at end max inspiration (IC+FRC)
- Vital Capacity: max amount expelled with forceful effort after max inspiration (IRV+TV+ERV) (TLC-RV)
- Inspiratory Capacity: max amount of air inspired when starting at resting expiration level (IRV+TV)
- Functional Residual Volume: volume air after resting expiratory level (ERV+RV)
What do gas flow rates tell you?
Measure airflow rate during forced breaths
- show FUNCTIONAL level
- degree of impairement
- general location of problem (small vs. big)
What is FVC testing?
Forced Vital Capacity
-max volume gas patient can exhale FORCEFUL and QUICKLY
What is FEV1?
Forced expiratory Volume in 1 sec
- first second of FVC test
- shows LARGE airway flow
- avg 75%
What is FEV1/FVC?
% vital capacity expired in 1st second of maximum expiration
-75% normal
How does proportion of lung capacities change from obstructive to restrictive?
Obstructive: BIGGER volumes/capacities due to trapped air
Restrictive: LESS volumes/capacities due to decrease airflow in
What is COPD?
Chronic airflow limit; obstruction breathing out
- alveolar emphysema
- small airway diseases: chronic chronchitis
- asthma
Smoking 1st preventative cause
-age, duration, timing at diagnosis
Mucus in airway makes problem worse
Clinical Presentation of COPD
Worsening SOB and PHLEGM cough with WHEEZING episodes
History:
- previous dx of chronic bronchitis >2yrs
- smoker
- childhood asthma
- exacerbations of increased wheezes, chest tightness, brown sputum, episodic deterioration
Symptoms:
- catelectic or cyanotic
- dyspnea
- accessory muscle use
- wheezing
- Increased RR
- Decreased O2 sat
Increased Limitations with ADLS
What are the Risk factors for COPD?
Cigarete smoking
>40y.o.
Exposure to dust/chemicals
Exposure to indoor pollutants
What is the relationship between FEV scores and degree of obstruction?
Little-none: >2L - normal
Mild-Mod: 1-2L
Severe:
What is COPD disease staging based on FEV1 percentages of PREDICTED?
Stage 1: 50-79% of predicted
Stage 2: 35-49% of predicted
Stage 3:
What is the severity level ranking in regard to COPD and FEV1 total percentage?
Mild: >80%
Mod: 50-80%
Severe: 30-50%
Very Severe:
What is the GOLD initiative for classifying COPD based off management/treatment?
Stage 1: smoker cough, little-no SOB, no clinical sx COPD, FEV1 >80%
Stage 2: SOB on exertion, sputum cough, some clin sx, FEV1 50-80%
Stage 3: SOB on mild exertion, FEV1 30-50%
Stage 4: SOB on mild exertion, R HF, cyanosis, FEV1
How does FEV1 predict prognosis and mortality?
55% means 96% chance survived in 5 years
What is the BODE index?
multidimensional index to asses the risk of death
4 Factors:
BMI, FEV1 (air obstruction), dyspnea, exercise capability (6MWT)
What is the 4 Year Survival Index based off of the BODE index?
0-2 points: 80% survival
3-4 points: 67% survival
5-6 points: 57% survival
7-10 points: 18% survival
What are 5 possible causes of Hypoxemia (decreased PaO2)?
- Decreased inspired O2
- Hypoventilation
- Alveolocapillary diffusion problem
- V/Q mismatch
- Shunting (perfusion without ventillation ex: mucuous plug)
What are the 3 findings of Dyspnea?
SOB is presenting symptom
SOB develops during assesment
Pt presents with incrased work of breathing
What are diagnostic tests/results of Obstructive diseases?
Lung volumes/capacities >100%
-hyperinflated lungs signify obstruction
ABGS: CO2 amount
-increased CO2 signifies obstruction
What are expected pulmonary auscultation results for COPD?
Stridor: turbulent flow/high pitched wheeze
Expiratory Wheeze
Can’t speak full sentances
What are possible systematic effects of Inadequate respiration?
Pulmonary: RR29 Weak Respiratory effort Diminished or assymetric breath sounds Oxy sat 120bpm Pallor, cyanosis, clammy skin Exhaustion
Cognitive:
mental confusion due to hypozia
Failing level of conciousness
What are 8 Vital signs that can Asses SOB?
- Respiratory rate/effort
- SpO2
- Peak expiratory flow rate
- Pulse rate
- Orientation
- Temp
- FEV meter
- PERF: measures obstruction mod-severe relative to patient history
What is the purpose of diaphramatic breathing intervention?
Do first to decrease accessory muscle use
-normalize/increase efficiency of pattern
What is pursed-lip breathing?
Pursed Lip: increase positive pressure generated in airways; 2s in/4s out
- buttress small bronchioles from premature collapse
- promotes efficient expiration
- Decrease FRC
What does Sustained max inspiration do?
Gives visual and audio feedback
- Prophylazis and treatment for atelectasis
- improves strength/effectiveness
What is segmental breathing?
Localized expansion breathing
- inspired air directed to specific lung areas
- enhances thoracic movment locally unilatteraly
What are airway clearance techniques?
Mobilize secretions, increase ventilation/O2, and improve V/Q mismatch
- prevents atelectasis/pneumonia
- decrease dyspnea
- maximize excercise and function
- assists with cough, huff, percussion, vibration, and shaking
When is a patient appropriate for Pulmonary Rehab?
If symptoms on DAILY basis!
- decrease exercise tolerance
- impaired ADL ability
- decreased QOL
Improves:
- exercise capacity
- SOB
- QOL
- risk of hospitilization
- strength/endurance
- respiratory muscles
- pyschosocial intervention
