COPD Part 2 Flashcards
Diagnostic Findings
Pulmonary function studies:
*Spirometry
*Arterial blood gas measurements
*chest x-ray
*Screening for alpha1-antitrypsin deficiency
SACS
are used to help confirm the diagnosis of COPD, determine disease severity, and monitor disease progression
Pulmonary function studies
is used to evaluate airflow obstruction, which is determined by the ratio of FEV1 to forced vital capacity (FVC).
Spirometry
used to determine reversibility of obstruction after the use of bronchodilator
Spirometry
How to do spirometry
Spirometry is initially performed, the patient is given an inhaled bronchodilator treatment according to a standard protocol, and then spirometry is repeated. The patient demonstrates a degree of reversibility if the pulmonary function values improve after administration of the bronchodilator
obtained to assess baseline oxygenation and gas exchange and are especially important in advanced COPD.
Arterial blood gas measurements
obtained to exclude alternative diagnoses
Chest xray
is suggested for all adults who are symptomatic, especially for patients younger than 45 years
Screening for alpha1-antitrypsin deficiency
Factors that determine the clinical course and survival of patients with COPD include history of
cigarette smoking, exposure to secondhand smoke, age, rate of decline of FEV1, hypoxemia, pulmonary artery pressure, resting heart rate, weight loss, reversibility of airflow obstruction, and comorbidities.
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primary differential diagnosis of COPD is
Asthma
may help in the differential diagnosis.
high-resolution CT scan
Key factors to diagnose
Pt. history, severity of symptoms and reactions to bronchodilator
PSR
Grade I
Mild
FEV1/FVC <70%
FEV1 ≥80% predicted
Grade II
Moderate
FEV1/FVC <70%
FEV1 50–79% predicted
Grade III
Severe
FEV1/FVC <70%
FEV1 30–49% predicted
Grade IV
Very severe
FEV1/FVC <70%
FEV1 <30% predicted
Complications
Acute/chronic Respiratory insufficiency and failure
pneumonia, chronic atelectasis, pneumothorax, and pulmonary arterial hypertension (cor pulmonale)
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are major life-threatening complications of COPD.
Respiratory insufficiency and failure
The acuity of the onset and the severity of respiratory failure depend on
baseline pulmonary function, pulse oximetry or arterial blood gas values, comorbid conditions, and the severity of other complications
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Severe copd
Chronic Resp. Insufficiency and failure
severe bronchospasm or pneumonia in a patient with severe COPD
Acute Resp. Insufficiency and failure
Medical mgt
Therapeutic strategies
*promoting smoking cessation as appropriate, providing supplemental oxygen therapy as indicated, prescribing medications, and managing exacerbations.
Some: surgical interventions
Advance copd: palliative care
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Risk Reduction
Modify environmental exposures
*Smoking cessation
the single most cost-effective intervention to reduce the risk of developing COPD and to stop its progression
Smoking cessation
Factors associated with continued smoking
strength of the nicotine addiction, continued exposure to smoking associated stimuli (at work or in social settings), stress, depression, and habit
promote cessation by
“at-risk” message
set a definite “quit date.”
smoking cessation program
Continued reinforcement
Relapses should be analyzed
identify possible solutions
a first-line pharmacotherapy that reliably increases long-term smoking abstinence rates—comes in a variety of forms (gum, inhaler, nasal spray, transdermal patch, sublingual tablet, or lozenge
Nicotine replacement
both antidepressants, may also increase longterm quit rates of smoking
Bupropion SR and nortriptyline
antihypertensive agent but limited use
Clonidine
a nicotinic acetylcholine receptor partial agonist, may assist in smoking cessation
Varenicline
Patients who are not appropriate candidates for pharmacotherapy
medical contraindications, light smokers (fewer than 10 cigarettes per day), pregnant women, and adolescent smokers
MAPL
is the administration of oxygen at a concentration greater than that found in the environmental atmosphere
Oxygen therapy
the concentration of oxygen in room air is
21%
to provide adequate transport of oxygen in the blood while decreasing the work of breathing and reducing stress on the myocardium
Oxygen therapy
Oxygen transport to tissues depends on factors
cardiac output, arterial oxygen content, concentration of hemoglobin, and metabolic requirements
CARM
Indications for oxygen therapy
change in the patient’s respiratory rate or pattern
*Hypoxia & Hypoxemia
a decrease in the arterial oxygen tension in the blood
Hypoxemia
How Hypoxemia is manifested
by changes in mental status, dyspnea, increase in blood pressure, changes in heart rate, arrhythmias, central cyanosis (late sign), diaphoresis, and cool extremities
a decrease in oxygen supply to the tissues and cells that can also be caused by problems outside the respiratory system, can be life-threatening.
Hypoxia
changes occur in the central nervous system because the neurologic centers are very sensitive to oxygen deprivation
rapidly developing hypoxia
Signs and symptoms of oxygen deprivation
depend on how suddenly
resemble that of alcohol intoxication, lack of coordination and impaired judgment.
fatigue, drowsiness, apathy, inattentiveness, and delayed reaction time may occur with this kind of hypoxia
long-standing hypoxia
need for oxygen is assessed by
arterial blood gas analysis, pulse oximetry, and clinical evaluation
CAP
Complications of oxygen therapy
*Oxygen toxicity effects on the lungs and central nervous system or may depress ventilation (lethal adverse effect)
*absorption atelectasis
*Combustion
*Bacterial contamination
CABO
is a medication, and except in emergency situations it is given only when prescribed by a health care provider.
Oxygen
a patient with any type of respiratory disorder is given oxygen therapy only to increase the
partial pressure of arterial oxygen (PaO2)
Normal: 60 to 95 mm Hg
oxyhemoglobin dissociation curve arterial hemoglobin at these levels is
80% to 98% saturated with oxygen
higher fraction of inspired oxygen (FiO2) may produce toxic effects on
lungs and central nervous system or may depress ventilation (lethal adverse effect)
is used to monitor oxygen levels
Intermittent or continuous pulse oximetry
may occur when too high concentration of oxygen is given for an extended period (generally longer than 24 hours)
Oxygen toxicity
caused by overproduction of oxygen free radicals, which are by-products of cell metabolism.
Oxygen toxicity
An additional adverse effect of the administration of high concentrations of
oxygen (greater than 50%) to patients who are sedated and breathing small tidal volumes of air
absorption atelectasis
It is important to post when oxygen is in use.
“No Smoking” signs
