COPD part 2

Question 1

What’s are the most common used of anticholinergic inhaler (2)?

Answer 1

Ipratropium (Atrovent)
Trutropium (Spiriva)

Question 2

What is the non pharmacy therapy for COPD? (4)

Answer 2

Stop smoking
Avoid exposure
Covid & Flu & pneumonia vaccine
Pulmonary rehab
- PTOT ( vest that vibrates that break that mucus )

Question 3

Can you get surgery for COPD? But is it really recommend for them or more so are they good candidates? And why?

Answer 3

Yes
But they aren’t good candidates due to the fact that they have other underlying problems

Question 4

What are the 4 type of surgery that go into surgical therapy for COPD?

Answer 4

LVRS ( lung volume reduction surgery )
bronchoscopic lung volume reduction surgery
Bullectomy
Lung transplant

Question 5

How does LVRS ( lung volume reduction surgery ) work?

Answer 5

Removed diseased tissue so healthy tissue works better

Question 6

What is bronchoscopic lung volume reduction surgery?

Answer 6

Place 1 way valve in airways to diseased lung leads to collapse

Question 7

What is bullectomy?

Answer 7

Removal of one more Bullae to decrease work of breathing

Question 8

What is lung transplant?

Answer 8

Removing and replacing one or both lung

Question 9

COPD is not a curable disease, it’s a progressive disease for your lungs, though if you’re young with COPD you may be what?

Answer 9

Eligible for lung transplant

Question 10

Can we give oxygen to COPD ? Why? And what does it treat?
And we want to make sure there room is what?
In order to what?^ (4)

Answer 10

Yes
In order to help hypoxemia
Humidified
To avoid nosebleeds & inflammation

Question 11

Keeping O2 saturation above ___? During rest sleep and exertion or
PaO2 > ____?

Answer 11

90
60

Question 12

What are the complications of oxygen therapy? (4)

Answer 12

Combustion - if they smoke
Infection - humidity supports bacterial growth
CO2 narcosis - no longer stimulus to breathe
O2 Toxicity - prolonged high O2 - inflammation

Question 13

These COPD patients live at a low what?
These patients will come in for a broken leg and they are breathing just fine, their pulse ox says 88% but they live at that level. So it’s important to say what? And if they are breathing fine, what do we do?

Answer 13

They live at a low oxygen
We can keep them at 88%

Question 14

Oxygen is a prescribed what??

Answer 14

Medication !!
We need a doctor order

Question 15

Nasal cannula can put you at risk of infection and you can get what?
So we do what with the equipment?

Answer 15

Pneumonia
Dispose equipment

Question 16

What are some breathing techniques we can teach a patient? (4)

Answer 16

Pursed lip breathing
Diaphragmatic breathing
Airway clearance techniques
Effective cough or huff coughing

Question 17

What is pursed lip breathing?

Answer 17

Like breathing into a paper bag
Prolonges expiration to reduce bronchial collapse and air trapping

Question 18

What is diaphragmatic breathing?

Answer 18

Teaching to breath anatomically better than using accessory muscles

Like sitting up
No tripod

Question 19

What is an airway clearance techinique?

Answer 19

Giving them medication
Bronchodilator

Question 20

What’s effective coughing or huff coughing?

Answer 20

Conserves energy
Reducing fatigue
Facilitate removal of secretion

Question 21

What are 3 other treatments for breathing? And meaning ?

Answer 21

Percussion - patting their back
Vibration - machine to break mucus
CPT
Chest physiotherapy
- pulmonary rehab, break up muscus

Question 22

What is cheat therapy ?
High frequency Chest wall oscillation

Answer 22

Inflatable vest connect to high frequency pulse generator that vibrates the chest

Question 23

Can the patient use the chest wall vibration of their own? And is it portable?

Answer 23

Yes

Question 24

What is the function of the chest wall vibration?

Answer 24

Dislodges and mobilizes mucus to larger airways

Question 25

Due to malnutrition in COPD patients we want to provide what type of therapy?

Answer 25

Nutritional therapy

Question 26

Since COPD patients are malnourished we will see what? (3)

Answer 26

Increase in inflammatory mediators Increase metabolic rate Lack of appetite

Question 27

In the advance stages of COPD, weight loss is a predictor of what?

Answer 27

Poor prognosis

Question 28

In order to decrease dyspnea and converse energy we will teach patients to? (3)

Answer 28

Rest at least 30mins before eating Avoid exercise for 1 hour before eating and after eating Use bronchodilator before meals

Question 29

We want to give what type of food for COPD patients? (5)

Answer 29

High calorie High protein Moderate carbohydrates Moderate fats 5-6 small meals

Question 30

What do we want to avoid for COPD nutritional therapy? (3)

Answer 30

Avoid a lot of chewing Exercise and treatments 1 hour before Gas forming food

Question 31

COPD has a great risk of choking, you want them to what? And they should be on a what diet?

Answer 31

Chewing meals completely Soft diet

Question 32

Gerontologic considerations How do you treat COPD elderly different than younger? They have what (4)?

Answer 32

Reduce lean body mass Decrease respiratory muscle strength at base line Increase dyspnea Increase lower exercise Tolerances leads to higher incidence of acute exacerbations

Question 33

Gerontologic considerations have more complications like what? (3) And why?

Answer 33

Increase complications, stress and drug interactions Because these patients are on other medications

Question 34

Gerontologic considerations Adherence may be an issue? (3) Reason for each

Answer 34

Cognitive impariment : memory - they have a lot of other things to worry about - as well teaching them Complex medication regimens - taking a lot of patients Physical issues : arthritis, vision, side of effects of medications ( ICS ) - make sure they even have the strength to even use an inhaler

Question 35

Gerontologic considerations Quality of life issues (2) And reason for each

Answer 35

Psychological and emotional - supporting them Palliative care and hospice - later stages - how to keep up with change COPD is a hard diagnosis to live and be diagnosed with, we want to make sure they are prepared and how they can live with it

Question 36

What are the 4 nursing diagnosis?

Answer 36

Impaired breathing Activity intolerance Impaired nutritional status Difficulty coping

Question 37

What’s the nursing plan? (3)

Answer 37

Goals relief from symptoms Perform ALDS educating they have it for life but you give tools to make it manageable

Question 38

What is the health promption for COPD? (5)

Answer 38

No smoking Early diagnosis & treatment Avoid exposure Flu & pneumonia vaccine Awareness of family history ( AAT genetic )

Question 39

Nurses will normally see the acute care for COPD what does that mean? We’ll see what? And what type of complications?

Answer 39

Acute exacerbations Pneumonia Cor pulmonare ( right heart failure ) Acute Respiratory failure

Question 40

What’s the nursing implementation upon discharge?

Answer 40

Pulmonary rehab - exercise - smoking cessation - nutrition

Question 41

How do we help with activity with COPD? Like how will we help them?

Answer 41

How to comb their hair Shaving Showering 15-20mins walking Break during excerise 5mins

Question 42

How to help sleep COPD?

Answer 42

They won’t sleep because of the increase of CO2 Teach them how to sleep or using oxygen to sleep

Question 43

Symptoms can be managed but COPD cannot be what?

Answer 43

Cured

Question 44

Teaching COPD of palliative care, end of life decision, and hospice care we are what?

Answer 44

Doing our job as a nurse