dyspnea and COPD ppt Flashcards
what are signs of inc WOB
WOB: use of accessory muscles, nasal flaring, tracheal tug, supraclavicular indrawing
what did we cover in class as resp assessments
resp depth, rate, rhythm Visually inspect Auscultate to bases Cap refill, 02 sats WOB: use of accessory muscles, nasal flaring, tracheal tug, supraclavicular indrawing
Assess the skin of area
Palpate for tactile of vocal fremitus
Look at costal angle (it should be less than 90 degrees)
stage 1 of COPD
Stage 1. Mild FEV =80%, &/or FEV1/FVC 0.7
stage 2 copd
Stage 2. Moderate FEV 50% >80% , &/or FEV1/FVC 0.7
pt will feel SOBOE
stage 3 copd
Stage 3. Severe FEV 30%>50%, &/or FEV1/FVC 0.7
: quite severe. Significant ADLs impacted, social, work life
stage 4 COPD
should we assume pt is at this stage? why not?
Stage 4. Very Severe FEV1
patho of COPD
Progressive AIRFLOW LIMITATION associated with INFLAMMATORY PROCESS throughout airways
Leads to narrowing of airways r/t edema and development of scar tissue and destruction of walls of alveoli
Results in decreased ventilation and perfusion potential
Excess mucous production
what type of mnfts would you see from COPD
Increasing dyspnea
Cough and sputum (usually)
Rigid chest, ribs fixed at joints, “barrel chest”
“Clubbed” fingers
Weight loss (d/t emphysema and SOB)
Limited ADLs
Use of accessory muscles, supraclavicular fossae retraction, tracheal tug, stage 4 “parodoxical respiration”
Chronic hypoxemia, hypercapnia, polycythemia
Right sided heart failure, cor pulmonale
Explain?
why R sided HF
there is
what is cor pulmonale and why does it occur
e
when does paradoxical breathing occur
Very advanced disease=paradoxical breathing (using the wrong muscles)
of these mnfts what are the primary things we will see w COPD
dyspnea
cough
sputum
what types of diagnostics are used for COPD
Spirometry (``tests their lung fx) O2 sats ABGs Chest Xray CT RBC Blood work for alpha trypsylin (rare but if genetic hx)
what types of scans are used and why?
which is more common
CXR to rule out pneumonia and pneumothorax
CT is not often used
why would RBCs be looked at with copd
looking for polycythemia that might occur in response to inc EPO secretion that occurs from chronic hypoxia
what kind of ABG results might be seen
er
what was emphasied other than giving meds/ medical mgmt for nursing care
helping them with ADLs a they may become very breathless
nursing dx that are physiological
Impaired gas exchange and airway clearance due to chronic inflammation
Impaired gas exchange related to ventilation-perfusion inequality
Ineffective airway clearance related to bronchoconstriction, increased mucous production, ineffective cough, bronchopulmonary infection, and other complications
Ineffective breathing pattern related shortness of breath, mucous, bronchoconstriction, and airway irritants
which physiological nursing dx is most important
Ineffective airway clearance related to bronchoconstriction, increased mucous production, ineffective cough, bronchopulmonary infection, and other complications
holistic nursing diagnoses
Activity intolerance due to fatigue, ineffective breathing patterns, and hypoxemia
Weight loss due to dyspnea causing difficulty eating
Deficient knowledge of self-care strategies to be performed at home
Ineffective coping related to reduced socialization, anxiety, depression, lower activity level, and the inability to work
what are the complications that can result with COPD
Respiratory failure Atelectasis Pulmonary infection Pneumonia Pneumothorax Malnutrition Pulmonary hypertension
what type of goals would you have for COPD pt
Smoking cessation Improved gas exchange Airway clearance Improved breathing pattern Improved activity tolerance Maximal self-management Improved coping ability (have them access resources) Adherence to therapeutic program and home care Absence of complications
know these Risk Reduction Pharmacologic Therapy Management of Exacerbation Oxygen Therapy Surgical Management Pulmonary Rehabilitation
d
what type of meds might be used for COPD
abx
vaccines
corticosteroids
bronchodilators
what type of bronchodilators (classes) might be used for COPD
Beta 2-adrenergic agonists:
Anticholinergics: eg atrovent
Methylxanthines: aminophyllines
eg ofbeta 2 adrenergic agonists
albuterol/ventolin
egs of corticosteroids
Beclomethasone (Beclovent):
Budesonide (Pulmicort)
Fluticasone (Flovent)
what is a common side effect of beclomethasone that can easily be avoided
thrush-rinse mouth after
what type of vaccines could be expected for COPD pt
how often should these be done
pneumonia q5yrs and flu vaccines yearly
why use Abx for these pts
used to prevent infection d/t impaired mucociliary clearance impaired ability to cough etc
why use caution with oxygen? what theories support this caution
2 theories regarding why not to give too much 02
Hypoxic Drive Theory (this is older and not used as much)
-dec oxygenation stimulates breathing in pts with COPD. We wanted them to fx with just a slight deficiency in 02 as this stimulated them to breathe
Haldane Effect
-when too much 02 attached to hg, pt cant rid themselves of c02, becomes acidotic, inc pulse, inc RR, inc distress. ACIDOTIC D/T C02 RETENTION!!! She says this isnt overly important.
Copd pts have lost compliance (in terms of elasticity of their lungs) and its hard to breathe out their C02. The more of a reserve the pt has (if they had a bag attached this would be a form of their reserve)
assessments for pt with COPD
Assess for respiratory distress, signs of hypoxia, hypercapnia, respiratory acidosis
Check pulse oximetry and Arterial Blood Gases (ABGs)
pt has FEV of 40% what stage are they in
Stage 3. Severe FEV 30%>50%, &/or FEV1/FVC 0.7
less than ____FEV is stage 4 of COPD
30%
what is nomal FEV or FEV1/FVC
“80% and or FEV1/FVC 0.7
what is obstructive pulm disease
People with obstructive lung disease have shortness of breath due to difficulty exhaling all the air from the lungs. Because of damage to the lungs or narrowing of the airways inside the lungs, exhaled air comes out more slowly than normal. At the end of a full exhalation, an abnormally high amount of air may still linger in the lungs.
eg of obstructive pulm disease
(COPD),
Asthma
Bronchiectasis
Cystic fibrosis
eg of restrictive pulm disease
Restrictive lung disease most often results from a condition causing stiffness in the lungs themselves. In other cases, stiffness of the chest wall, weak muscles, or damaged nerves may cause the restriction in lung expansion.
Some conditions causing restrictive lung disease are:
Interstitial lung disease, such as idiopathic pulmonary fibrosis Sarcoidosis, an autoimmune disease Obesity, including obesity hypoventilation syndrome Scoliosis Neuromuscular disease, such as muscular dystrophy or amyotrophic lateral sclerosis (ALS)
why are pulm fx tests done
To assess respiratory function
To stage COPD (1-4)
To determine whether the lung condition is restrictive or obstructive
To determine if treatment is working
Tidal Volume (TV) the next 3 defns arent big deal she says
amount of air breathed in and out in normal breathing
forced vital capacity
maximum air forced out of lungs as hard, fast, long as possible(lung volume- restrictive disease)
forced expiratory volume
Forced air expelled in 1 second (obstructive disease)
