CPOD Flashcards
What is COPD?
Chronic Obstructive Pulmonary Disorder
Is COPD reversible?
1) Airflow limitation not fully reversible
2) Generally progressive
3) Abnormal inflammatory response of lungs to noxious particles or gases
What does COPD include?
Chronic bronchitis
Emphysema
These usually go hand in hand
What is chronic bronchitis?
Presence of chronic productive cough for 3 or more months in each of 2 successive years
What is emphysema?
Abnormal permanent enlargement of the air space distal to the terminal bronchioles. This is accompanied by destruction of their walls without obvious fibrosis.
What are some risk factors of COPD?
Infection – chronic repetitive infection Heredity – possible genetic link Aging Cigarette smoking – 80 to 90% deaths Occupational chemicals and dust Air pollution
What are the effects of nicotine (smoking)?
Stimulates sympathetic nervous system -Increases HR -Causes peripheral vasoconstriction -Increases BP and cardiac workload ↓ Amount of functional hemoglobin ↑ Platelet aggregation Compounds problems in CAD
What are the effects of nicotine on the respiratory tract?
Increased mucus production
Hyperplasia of mucus glands
Lost or decreased ciliary activity
What are the effects on carbon monoxide explosion?
Carbon monoxide
↓ O2 carrying capacity
↑ Heart rate
Impaired psychomotor performance and judgment
What are the problems with Involuntary smoke exposure (second-hand smoke).
↓ Pulmonary function
↑ Risk of lung cancer
↑ Heart rate and BP
↓ HDL
What are risk for COPD pts in environmental and occupational settings?
COPD can develop with intense or prolonged exposure to
- Dusts, vapors, irritants, or fumes
- High levels of air pollution
- Fumes from indoor heating or cooking with fossil fuels
What is negative for COPD pts who have infections?
Recurring infections impair normal defense mechanisms
Risk factor for COPD
Intensify pathologic destruction of lung tissue
Is COPD hereditary?
Antitrypsin (AAT) deficiency
Genetic risk factor for COPD
Accounts for ~3% of COPD
Does age increase risk of COPD?
Some degree of emphysema is common due to physiological changes of aging lung tissue
What are the natural changes in lungs due to aging?
Gradual loss of elastic recoil Lungs become rounded and smaller Loss of alveolar supporting structures Decreased number of functional alveoli Decreased arterial O2 levels Thoracic cage changes from osteoporosis and calcification of costal cartilage
What is the pathophysiology of COPD?
Primary process is inflammation
Inhalation of noxious particles
Mediators released cause damage to lung tissue
Airways inflamed
What does COPD do to the supporting structures of the lungs?
Supporting structures of lungs are destroyed
What does the destruction of the lung’s supporting structures do?
Air goes in easily, but remains in the lungs
Bronchioles tend to collapse
Causes barrel-chest look
How does COPD change the pulmonary vascular system?
Blood vessels thicken
Surface area for diffusion of O2 decreases
What are some common pathophysiological characteristics of COPD?
Mucus hypersecretion Dysfunction of cilia Hyperinflation of lungs Gas exchange abnormalities Commonly emphysema and chronic bronchitis coexist
What is the diagnosis of COPD considered with?
Cough
Sputum production
Dyspnea
Exposure to risk factors
What is the earliest symptom of COPD?
Intermittent cough is earliest symptom
What usually promotes COPD clients to seek medical attention ?
Dyspnea usually prompts medical attention
Occurs with exertion in early stages
Present at rest with advanced disease
What are clinical characteristics of COPD?
Characteristically underweight with adequate caloric intake
Chronic fatigue
What are some clinical physical examination findings of COPD clients?
Prolonged expiratory phase
Wheezes
Decreased breath sounds
↑ Anterior-posterior diameter (bowel chest)
What may develop overtime with COPD clients?
Hypoxemia with hypercapnia may develop over time.
PaO2 < 60mmHg or O2 sat 45mmHg
Why do some COPD clients have Bluish-red color of skin?
Polycythemia (body trying to create more RBC’s to compensate for hypoxemia) and cyanosis
What are some complications regarding COPD?
Cor pulmonale
Exacerbations of COPD
Acute respiratory failure
Depression/anxiety
What is Cor pulmonale?
Hypertrophy of right side of heart
Result of pulmonary hypertension
Late manifestation of chronic pulmonary heart disease
Eventually causes right-sided heart failure
How does a nurse assess for Cor pulmonale?
Distended neck veins (Jugard)
Hepatomegaly with upper quadrant tenderness
Ascites
Epigastric distress
What are some signals of exacerbation?
Dyspnea
Cough
Sputum
What is exacerbation usually associated with?
Associated with poorer outcomes
Tracheobronchial infection
Air pollution
What is acute respiratory failure in COPD pts caused by?
1) Exacerbations
2) Cor pulmonale
3) Discontinuing bronchodilator or corticosteroid medication
4) Overuse of sedatives, benzodiazepines, and opioids
5) Surgery: ventilator gives break, hard to wake lungs up.
6) Use LMA’s
7) Severe, painful illness involving chest or abdomen
What does depression / anxiety consist of in COPD clients?
Depression may be four times more likely for COPD patients
What are 3 anxiety complications of COPD clients?
Respiratory compromise
Dyspnea
Hyperventilation
How are COPD pts diagnosed?
Diagnosis confirmed by pulmonary function tests/spirometry
Chest x-rays, COPD assessment test (CAT), history, and physical examination are also important in the diagnostic workup
What are typical results of COPD clients using spirometer?
Reduced FEV1/FVC ratio (<70%)
The lower the FEV1 – the sicker the patient
Increased residual volume
The lower the FEV1 usually indicates…
Sicker client
What is Gold 1?
Mild
FEV1 equal or above 80% predicted
What is Gold 2?
Moderate
FEV1 50% to 80% predicted
What is Gold 3?
Severe
FEV1 30% to 50% predicted
What is Gold 4?
Very severe
FEV1 below 30% predicted
When are ABG’s usually assessed in COPD client’s?
ABG’s are usually assessed in the severe stages (FEV1<50%) or in pts hospitalized with acute exacerbation.
What are the usually ABG results of COPD clients?
Low PaO2 Normal is 80-100 ↑ PaCO2 Normal is 35-45 ↓ pH Normal is 7.35-7.45 ↑ or Normal Bicarbonate level Normal is 22-26
What does the exercise diagnostic test for COPD consist of?
6-Minute walk test to determine O2 desaturation in the blood with exercise
What can EKG show in COPD clients?
ECG can show signs of right ventricular failure
What are the primary goals for COPD clients?
Prevent progression Relieve symptoms Prevent/treat complications Promote patient participation Prevent/treat exacerbations Improve quality of life and reduce mortality risk
What is the most effective intervention for COPD clients?
Smoking
Most effective intervention
Accelerated decline in pulmonary function slows and usually improves if cessation.
What drug therapy is used in COPD clients?
Bronchodilators
When is inhaled corticosteroid therapy used?
Used for moderate-to-severe cases
Not used as monotherapy in COPD- typically combined with LABA (Ex. Advair)
What is O2 therapy used to do?
Reduce work of breathing
Maintain PaO2
What does O2 therapy do for the heart?
Reduces work load.
What estimates the amount of O2 to administer?
Administer the amount of oxygen (FIO2) based on patients condition and dyspnea and PaO2.
What does Long term O2 therapy improve?
Survival
Exercise capacity
Cognitive performance
Sleep in hypoxemic patients
When may some pts only use O2?
At night
Explain low flow O2.
Low flow is mixed with room air and delivery is less precise than high flow
Most common
What is humidification?
Used because O2 has a drying effect on the mucosa
Supplied by nebulizers, vapotherm, and bubble-through humidifiers
What are some complications regarding O2?
1) Combustion
2) CO2 narcosis
3) O2 toxicity
4) Infection
5) Absorption Atelectasis
How do you prevent combustion?
Stress no smoking with O2 therapy
What is CO2 Narcosis?
Over time COPD pts may grow tolerant to high CO2 levels. Hypoxemia then becomes the “drive to breathe”
O2 toxicity?
may result from prolonged exposure to high levels of O2
Explain infection gained from O2 administration?
can be a major complication of O2 administration. Warm, moist. Need to know how to clean equipment.
Explain absorption atelectasis.
With high O2 administration, nitrogen may be washed out of the alveoli & replaced with O2. If the O2 is absorbed into the bloodstream, the alveoli can collapse.
What does chronic O2 therapy improve in home clients?
Prognosis
Mental acuity
Exercise intolerance
Chronic O2 therapy at home reduces..
Hematocrit
Pulmonary hypertension
Can pts have surgery to improve COPD symptoms.
Yes, but not very popular.
What consists of respiratory and physical therapy for COPD pts?
Breathing retraining
Effective coughing
Aerosol nebulization therapy
Chest physiotherapy
What consists of Chest physiotherapy?
Percussion
Vibration
Postural drainage
What does breathing retraining promote?
Decreases dyspnea, improves oxygenation, and slows respiratory rate
Pursed-lip breathing
What is pursed-lip breathing?
Prolongs exhalation and prevents bronchiolar collapse and air trapping
Explain effective coughing.
Conserve energy
Reduce fatigue
Facilitate removal of secretions
What is chest physiotherapy indicated for?
Excessive, difficult-to-clear bronchial secretions
Retained secretions in artificial airway
Lobular atelectasis from mucous plug
What consists of postural drainage?
- Gravity assists in bronchial drainage
- Techniques are individualized according to patient’s pulmonary condition and response to initial treatment
What are the benefits of percussion?
Air-cushion impact facilitates movement of thick mucus
Where do you not percuss?
Kidneys Sternum Spinal cord Bony prominences Tender or painful area
What does vibration therapy do for COPD pts?
Facilitates movement of secretions to larger airways
Mild vibration tolerated better than percussion
What is high frequency chest compression?
Inflatable vest that vibrates the chest
Works on all lobes
More effective than CPT
What is Aerosol-nebulization therapy?
Deliver suspension of fine particles of liquid (medication) in a gas
Easy to use
Must be kept clean at home to prevent bacterial growth
Why are a majority of COPD clients underweight?
Pressure on diaphragm from a full stomach causes dyspnea
Difficulty breathing while eating leads to inadequate consumption
What can a client do to increase nutritional status?
To decrease dyspnea and conserve energy:
1) Rest at least 30 minutes prior to eating
2) Use bronchodilator before meal
3) Prepare foods in advance: want have enough rest time before if not
What should a COPD pt’s meal schedule be?
Eat 5 to 6 small meals to avoid bloating and early satiety
What kind of foods should a COPD pt eat?
Cold foods may cause less fullness than hot foods
High-calorie, high-protein diet is recommended
How many liters of water should a COPD pt consume?
Fluids (intake of 3 L/day) should be taken between meals
What foods should a COPD client avoid?
Foods that require a great deal of chewing
Exercises and treatments 1 hour before and after eating
Gas-forming foods
What are some nursing diagnoses?
Ineffective airway clearance
Impaired gas exchange
Imbalanced nutrition: Less than body requirements
Risk for infection
Insomnia: Sleep with the head of the bed elevated.
What are the goals of COPD clients?
Prevention of disease progression Ability to perform ADLs Relief from symptoms No complications related to COPD Knowledge and ability to implement long-term regimen Overall improved quality of life
What is the most important aspect of ambulatory and home care?
Most important aspect is teaching: Pulmonary rehabilitation Activity considerations Sexual activity Sleep Psychosocial considerations
How often should COPD pts walk?
Walk 15 to 20 minutes a day at least three times a week with gradual increases
When should exercise dyspnea return to normal?
Return to baseline within 5 mins
What can COPD and smoking cause?
COPD and smoking may cause erectile dysfunction
What can help clients with COPD sleep?
Nasal saline sprays or rinses may help
Supplemental O2 if prescribed may help
Sleep apnea may be a co-existing problem.
What are some psychosocial considerations?
Denial
Guilt
Use relaxation techniques and support groups
What are expected outcomes for COPD clients?
Normal breath sounds Effective coughing Return of PaO2 to normal range for patient Improved mental status Maintenance of normal body weight Normal serum protein levels Feeling of being rested Improvement in sleep pattern Awareness of need to seek medical attention Behaviors minimizing risk of infection No infection
