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233 > dyspnea and COPD ppt > Flashcards

dyspnea and COPD ppt Flashcards

1
Q

what are signs of inc WOB

A

WOB: use of accessory muscles, nasal flaring, tracheal tug, supraclavicular indrawing

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2
Q

what did we cover in class as resp assessments

A 
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)

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3
Q

stage 1 of COPD

A

Stage 1. Mild FEV =80%, &/or FEV1/FVC 0.7

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4
Q

stage 2 copd

A

Stage 2. Moderate FEV 50% >80% , &/or FEV1/FVC 0.7

pt will feel SOBOE

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5
Q

stage 3 copd

A

Stage 3. Severe FEV 30%>50%, &/or FEV1/FVC 0.7

: quite severe. Significant ADLs impacted, social, work life

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6
Q

stage 4 COPD

should we assume pt is at this stage? why not?

A

Stage 4. Very Severe FEV1

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7
Q

patho of COPD

A

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

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8
Q

what type of mnfts would you see from COPD

A

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?

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9
Q

why R sided HF

A

there is

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10
Q

what is cor pulmonale and why does it occur

A

e

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11
Q

when does paradoxical breathing occur

A

Very advanced disease=paradoxical breathing (using the wrong muscles)

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12
Q

of these mnfts what are the primary things we will see w COPD

A

dyspnea
cough
sputum

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13
Q

what types of diagnostics are used for COPD

A 
Spirometry (``tests their lung fx)
O2 sats
ABGs
Chest Xray 
CT 
RBC
Blood work for alpha trypsylin (rare but if genetic hx)
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14
Q

what types of scans are used and why?

which is more common

A

CXR to rule out pneumonia and pneumothorax

CT is not often used

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15
Q

why would RBCs be looked at with copd

A

looking for polycythemia that might occur in response to inc EPO secretion that occurs from chronic hypoxia

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16
Q

what kind of ABG results might be seen

A

er

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17
Q

what was emphasied other than giving meds/ medical mgmt for nursing care

A

helping them with ADLs a they may become very breathless

18
Q

nursing dx that are physiological

A

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

19
Q

which physiological nursing dx is most important

A

Ineffective airway clearance related to bronchoconstriction, increased mucous production, ineffective cough, bronchopulmonary infection, and other complications

20
Q

holistic nursing diagnoses

A

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

21
Q

what are the complications that can result with COPD

A 
Respiratory failure
Atelectasis
Pulmonary infection
Pneumonia
Pneumothorax
Malnutrition
Pulmonary hypertension
22
Q

what type of goals would you have for COPD pt

A 
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
23
Q 
know these Risk Reduction
Pharmacologic Therapy
Management of Exacerbation
Oxygen Therapy
Surgical Management
Pulmonary Rehabilitation
A

d

24
Q

what type of meds might be used for COPD

A

abx
vaccines
corticosteroids
bronchodilators

25
Q

what type of bronchodilators (classes) might be used for COPD

A

Beta 2-adrenergic agonists:
Anticholinergics: eg atrovent
Methylxanthines: aminophyllines

26
Q

eg ofbeta 2 adrenergic agonists

A

albuterol/ventolin

27
Q

egs of corticosteroids

A

Beclomethasone (Beclovent):
Budesonide (Pulmicort)
Fluticasone (Flovent)

28
Q

what is a common side effect of beclomethasone that can easily be avoided

A

thrush-rinse mouth after

29
Q

what type of vaccines could be expected for COPD pt

how often should these be done

A

pneumonia q5yrs and flu vaccines yearly

30
Q

why use Abx for these pts

A

used to prevent infection d/t impaired mucociliary clearance impaired ability to cough etc

31
Q

why use caution with oxygen? what theories support this caution

A

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)

32
Q

assessments for pt with COPD

A

Assess for respiratory distress, signs of hypoxia, hypercapnia, respiratory acidosis

Check pulse oximetry and Arterial Blood Gases (ABGs)

33
Q

pt has FEV of 40% what stage are they in

A

Stage 3. Severe FEV 30%>50%, &/or FEV1/FVC 0.7

34
Q

less than ____FEV is stage 4 of COPD

A

30%

35
Q

what is nomal FEV or FEV1/FVC

A

“80% and or FEV1/FVC 0.7

36
Q

what is obstructive pulm disease

A

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.

37
Q

eg of obstructive pulm disease

A

(COPD),
Asthma
Bronchiectasis
Cystic fibrosis

38
Q

eg of restrictive pulm disease

A

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)
39
Q

why are pulm fx tests done

A

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

40
Q

Tidal Volume (TV) the next 3 defns arent big deal she says

A

amount of air breathed in and out in normal breathing

41
Q

forced vital capacity

A

maximum air forced out of lungs as hard, fast, long as possible(lung volume- restrictive disease)

42
Q

forced expiratory volume

A

Forced air expelled in 1 second (obstructive disease)

233 (17 decks)

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