Exam 3 - Chronic pulmonary obstruction disease

Question 1

COPD

Answer 1

4th leading cause of death in US
chronic bronchitis
emphysema

Question 2

chronic bronchitis

Answer 2

long term coughing with sputum

leads to inflammation/scarring of bronchial tubes

Question 3

emphysema

Answer 3

destruction of alveolar walls
creates one large airspace which reduces lung surface area and less oxygen in blod
difficulty exhaling old air

Question 4

causes

Answer 4

smoking
age
occupational chem/dust
ATT deficiency

Question 5

manifestation

Answer 5

dyspnea
cough with sputum
fatigue, weakness, activity intolerance (low oxygen)
changes in appearance (cachexia, clubbing, barrel chest, tripod use of accessory, blue red skin)

gas exchange abnormalities
hypoxemia
hypercapnia

lab abnormalities

Question 6

barrel chest

Answer 6

anterior posterior to transverse diameter = 1:1 ratio

Question 7

diagnostic

Answer 7

spirometry
FVC/FEV1 <70% confirms

forced vital capacity = optimal amount of exhalation
forced expiratory volume = amount of oxygen can forcefully exhale in one sec

Question 8

nursing management

Answer 8

stop smoking
breathing exercise
promote exercise
fluid, nutrition therapy
prevention

Question 9

medical management

Answer 9

smoking cessation

beta 2 agonist (stimulate beta 2 receptors = bronchodilate)

anticholinergic (blocks acetylcholine from bind to receptors = bronchodilate)

corticoid steroid (anti-inflam., gargle, bronchodilator several mins before steroid)

phosphodiestase 4 inhibitor (prevents enzyme which decreases inflam.)

continuous low flow oxygen therapy (dependent on oxygen to breathe)

surgery: lung volume reduction surgery (certain areas of lung removed), lung transplant

Question 10

complication

Answer 10

exacerbation
pneumonia
pulmonary HTN
cor pulmonale
respiratory failure
depression/anxiety

Question 11

dyspnea

Answer 11

difficulty breathing

Question 12

tachypnea

Answer 12

increased RR

Question 13

orthopnea

Answer 13

difficulty breathing supine

Question 14

hypoventilation

Answer 14

decreased speed, depth

Question 15

hyperventilation

Answer 15

increased speed, depth

Question 16

hypoxia

Answer 16

decreased oxygen in tissues

Question 17

hypoxemia

Answer 17

decreased oxygen in blood

Question 18

hypercapnia

Answer 18

increased carbon dioxide in blood

Question 19

ventilation perfusion V/Q mismatch

Answer 19

ventilation (the exchange of air between the lungs and the environment) and perfusion (the passage of blood through the lungs) are not evenly matched

Question 20

measurements of pulmonary function

Answer 20

pulse ox
6 min distance walk (needs to be greater than 80%)
ABG
pulmonary function testing (PFT): FVC, FEV1 (needs to be greater than 70%)
bronchoscopy

Question 21

ABG values

pH
PaCO2
Bicarb
PaO2
SaO2

base excess

Answer 21

pH 7.35-7.45

PaCO2 32-48

Bicarb 22-26

PaO2 80-100
SaO2 >95%

base excess +-2

Question 22

CBC values

RBC
Hmg (amount of oxygen carrying capacity)
Hct (amount of blood that is RBC)
Plt
WBC

Answer 22

RBC male 4.5-5.5 female 4.5

Hmg male 14-17 female 12-16

Hct male 42-52 female 36-48

Plt 150,000-400,000
WBC 5,000-10,000 (increased neutrophil = bact. infection)

Question 23

ABG interpretation

Answer 23

respiratory acidosis
low pH, high PaCO2

respiratory alkalosis
high pH, low PaCO2

metabolic acidosis
low pH, high bicarb

metabolic alkalosis
high pH, low bicarb