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CP Clin Management > COPD/Obstructive Diseases > Flashcards

COPD/Obstructive Diseases Flashcards

1
Q 
Definitions of:
TV
IRV
ERV
RV
TLC
VC
IC
FRC
A

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)
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2
Q

What do gas flow rates tell you?

A

Measure airflow rate during forced breaths

  • show FUNCTIONAL level
  • degree of impairement
  • general location of problem (small vs. big)
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3
Q

What is FVC testing?

A

Forced Vital Capacity

-max volume gas patient can exhale FORCEFUL and QUICKLY

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4
Q

What is FEV1?

A

Forced expiratory Volume in 1 sec

  • first second of FVC test
  • shows LARGE airway flow
  • avg 75%
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5
Q

What is FEV1/FVC?

A

% vital capacity expired in 1st second of maximum expiration

-75% normal

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6
Q

How does proportion of lung capacities change from obstructive to restrictive?

A

Obstructive: BIGGER volumes/capacities due to trapped air

Restrictive: LESS volumes/capacities due to decrease airflow in

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7
Q

What is COPD?

A

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

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8
Q

Clinical Presentation of COPD

A

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

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9
Q

What are the Risk factors for COPD?

A

Cigarete smoking
>40y.o.
Exposure to dust/chemicals
Exposure to indoor pollutants

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10
Q

What is the relationship between FEV scores and degree of obstruction?

A

Little-none: >2L - normal
Mild-Mod: 1-2L
Severe:

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11
Q

What is COPD disease staging based on FEV1 percentages of PREDICTED?

A

Stage 1: 50-79% of predicted
Stage 2: 35-49% of predicted
Stage 3:

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12
Q

What is the severity level ranking in regard to COPD and FEV1 total percentage?

A

Mild: >80%
Mod: 50-80%
Severe: 30-50%
Very Severe:

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13
Q

What is the GOLD initiative for classifying COPD based off management/treatment?

A

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

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14
Q

How does FEV1 predict prognosis and mortality?

A

55% means 96% chance survived in 5 years

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15
Q

What is the BODE index?

A

multidimensional index to asses the risk of death

4 Factors:
BMI, FEV1 (air obstruction), dyspnea, exercise capability (6MWT)

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16
Q

What is the 4 Year Survival Index based off of the BODE index?

A

0-2 points: 80% survival
3-4 points: 67% survival
5-6 points: 57% survival
7-10 points: 18% survival

17
Q

What are 5 possible causes of Hypoxemia (decreased PaO2)?

A
  1. Decreased inspired O2
  2. Hypoventilation
  3. Alveolocapillary diffusion problem
  4. V/Q mismatch
  5. Shunting (perfusion without ventillation ex: mucuous plug)
18
Q

What are the 3 findings of Dyspnea?

A

SOB is presenting symptom
SOB develops during assesment
Pt presents with incrased work of breathing

19
Q

What are diagnostic tests/results of Obstructive diseases?

A

Lung volumes/capacities >100%
-hyperinflated lungs signify obstruction

ABGS: CO2 amount
-increased CO2 signifies obstruction

20
Q

What are expected pulmonary auscultation results for COPD?

A

Stridor: turbulent flow/high pitched wheeze
Expiratory Wheeze
Can’t speak full sentances

21
Q

What are possible systematic effects of Inadequate respiration?

A 
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

22
Q

What are 8 Vital signs that can Asses SOB?

A
  1. Respiratory rate/effort
  2. SpO2
  3. Peak expiratory flow rate
  4. Pulse rate
  5. Orientation
  6. Temp
  7. FEV meter
  8. PERF: measures obstruction mod-severe relative to patient history
23
Q

What is the purpose of diaphramatic breathing intervention?

A

Do first to decrease accessory muscle use

-normalize/increase efficiency of pattern

24
Q

What is pursed-lip breathing?

A

Pursed Lip: increase positive pressure generated in airways; 2s in/4s out

  • buttress small bronchioles from premature collapse
  • promotes efficient expiration
  • Decrease FRC
25
Q

What does Sustained max inspiration do?

A

Gives visual and audio feedback

  • Prophylazis and treatment for atelectasis
  • improves strength/effectiveness
26
Q

What is segmental breathing?

A

Localized expansion breathing

  • inspired air directed to specific lung areas
  • enhances thoracic movment locally unilatteraly
27
Q

What are airway clearance techniques?

A

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
28
Q

When is a patient appropriate for Pulmonary Rehab?

A

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

CP Clin Management (8 decks)

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