COPD Part 4 Flashcards
Surgical Management
Bullectomy
Lung Volume Reduction Surgery
Lung Transplantation
is a surgical option for select patients with bullous emphysema
bullectomy
are enlarged airspaces that do not contribute to ventilation but occupy space in the thorax; these areas may be surgically excised.
Bullae
compress areas of the lung and may impair gas exchange
Bullae
Bullectomy help
reduce dyspnea and improve lung function
Bullectomy can be performed via
video-assisted thoracoscope
limited thoracotomy incision
Treatment options for patients with advanced or end-stage COPD (grade IV) with a primary emphysematous component are limited
Lung Volume Reduction Surgery
What surgical option is Lung Volume Reduction Surgery
Palliative
LVRS helps to
reduces hyperinflation
functional tissue to expand resulting
improved elastic recoil and
diaphragmatic mechanics
involves the removal of a portion (homogenous) of the diseased lung parenchyma.
Lung volume reduction surgery
These bronchoscopic procedures were developed to collapse areas of emphysematous lung and thus improve aeration of the functional lung tissue.
Bronchoscopic lung volume reduction therapies
Bronchoscopic lung volume reduction techniques include
endobronchial placement of one way valve
bronchoscopic instillation of nitinol coils
allows air and mucus to exit the treated area but does not allow air to reenter
endobronchial placement
Installation into the airway of the hyperinflated lung tissue of patients with advanced emphysema
bronchoscopic instillation of nitinol coils
is a viable option for definitive surgical treatment of severe COPD in select patients
Lung transplantation
Limited not only by the shortage of donor organs, it is also a costly procedure with financial implications for months to years because of complications and the need for costly immunosuppressive medication regimens
Lung transplantation
one of the most cost-effective treatment strategies, is a holistic intervention aimed at improving physical and psychological health of patients with COPD
Pulmonary rehabilitation
The primary goals of rehabilitation are to
reduce symptoms, improve quality of life, and increase physical and emotional participation in everyday activities
The benefits of this therapy include
improvement of exercise capacity, reduction in the perceived intensity of breathlessness, improvement in health-related quality of life, reduction in hospitalization days, reduction in thw anxiety and depression
is reflected in severity of symptoms, degree of disability, and prognosis.
Nutritional status
is often not considered until the disease is far advanced. to manage symptoms and improve the quality of life for patients and families with advanced disease
Palliative care
are fundamental components of treatment for patients with advanced COPD
Palliative, hospice care, and end-of-life care
Nursing mgt
Assessing the Patient
Achieving Airway Clearance
Improving Breathing Patterns
Promoting Self-Care
Improving Activity Tolerance
Encouraging Effective Coping
Monitoring and Managing Potential Complications
Promoting Home, Community-Based, and Transitional
Bronchospasm can sometimes be detected on
Auscultation
Wheezing and diminished breath sounds
consists of a slow, maximal inspiration followed by breath-holding for several seconds and then two or three coughs
Directed coughing or huff coughing
consistent with improved airway clearance as they are to remove bronchial secretions, improve ventilation, and increase the efficiency of the respiratory muscles.
Chest Physiotherapy
CPT includes
postural drainage, chest percussion and vibration, and breathing retraining
allows the force of gravity to assist in the removal of bronchial secretion
Postural drainage
The secretions drain from the affected bronchioles into the bronchi and trachea and are removed by
Coughing and suctioning
are used so that the force of gravity helps move secretions from the smaller bronchial airways to the main bronchi and trachea
Postural drainage
lower and middle lobe bronchi drain more effectively when the
Head is down
the upper lobe bronchi drain more effectively when the
Head is up
used to identify the areas that need drainage and assess the effectiveness of treatment
Auscultation of the chest before and after the procedure
Postural drainage is usually performed when
two to four times daily, before meals
(to prevent nausea, vomiting, and aspiration) and at bedtime
The nurse instructs the patient to remain in each position in PD for
10 to 15 minutes with pursed lip breathing
is carried out by cupping the hands and lightly striking the chest wall in a rhythmic fashion over the lung segment to be drained
Chest percussion
Percussion, alternating with vibration, is performed for …. In each position
3-5 minutes
Avoid percussion on
over chest drainage tubes and the sternum, spine, liver, kidneys, spleen, or breasts
is the technique of applying manual compression and tremor to the chest wall during the exhalation phase of respiration
Vibration
The vest uses air pulses to compress the chest wall 8 to 18 times/sec, causing secretions to detach from the airway wall and enabling the patient to expel them by coughing
inflatable HFCWO vest
Help improve breathing pattern
Breath retraining
reduces the respiratory rate, increases alveolar ventilation, and sometimes helps expel as much air as possible during expiration.
Diaphragmatic breathing
helps slow expiration, prevent collapse of small airways, and control the rate and depth of respiration
Pursed-lip breathing
consists of exercises and breathing practices that are designed to achieve more efficient and controlled ventilation and to decrease the work of breathing.
Breathing Retraining
