Exam 3 - COPD Flashcards
Describe the difference between Type I and Type II cells of alveolar wall
Type 1 - give structure to alveolar wall
Type 2 - where surfactant (lipoprotein) is produced; fluid that reduces surface tension and contributes to elasticity of pulmonary tissue
**Both types make up alveolar epithelium
Describe the Bicarb/Carbonic acid buffering system
CO2 is produced by aerobic respiration. If you can’t breath it all out your body retains CO2, increasing your acidity level. Body compensates by producing more bicarbonate
Name two examples of nutritional status and pulmonary function being interdependent
- Macronutritents are fueled using oxygen and CO2
* Malnutrition can evolve from pulmonary disorders and contribute to declining pulmonary status
What are ABGs and what do they look at?
Arterial blood gasses
• pCO2
• PO2
What is pulmonary consolidation?
When lung parenchyma becomes engorged wiht fluid
Describe pulmonary effusion
When fluid exists between lung and chest wall, displacing lung upwards
What is the goal %O2 in the Hgb?
> 95% (approx pO2 saturation)
Give three factors that influence the pulmonary function test parameters
- Malnutrition
- Obesity - displacement of lungs by fat mas
- Development/progression of obstructive respiratory disease
What three things does pulmonary function measure?
- Oxygen saturation (want >95%)
- pH
- Minute ventilation
What does it mean when bicarbonate (HCO3) is high?
Compensatory response for acidic CO2 retention
Define COPD
Chronic Obstructive Pulmonary Disease - Progressive disease which limits airflow through INFLAMMATION OF BRONCHIAL TUBES (bronchitis) or DESTRUCTION OF ALVEOLI (emphysema)
• These usually occur together
Give the risk factors for COPD
- **SMOKING
- air pollution
- second-hand smoke
- history of childhood infections
- occupational exposure to certain industrial pollutants
Describe CHRONIC BRONCHITIS
- Productive cough and shortness of breath
- 3 months each year for 2+ years
- Decreased cilia function, increased phagocytosis, suppressed amounts of IgA
- Chronic inflammation leads to hyperplasia of mucus secreting cells; excess mucus sets up for infections
Describe EMPHYSEMA
- Develops gradually due to smoking; 95% occurs in people >45years
- Inflammation of airways causing oxidative stress/destruction of lung tx
- Loss of lung surface area and decreased amounts of surfactant
- Bronchioles lose their elasticity; collapse during exhalation
List the clinical manifestations of CHRONIC BRONCHITIS
• Decreased air flow rates • Dyspnea • Hypoxemia (low O2 due to inflammation) •Hypercapnia (high Co2) - cyanosis, clubbing, secondary polycythemia (making more red blood cells - sets up for stroke) • QOL diminishes • Require substantial oxygen • Cor pulmonale - increased size of rt ventricle due to increased resistance of passage of blood through lungs (leads to heart failure)
List the clinical manifestations of EMPHYSEMA
- Barrel chest - from increased use of accessory muscles for expiration
- Orthopnea (discomfort breathing while laying down)
- Hypercapnia - high PCO2
- Respiratory acidosis (low pH)
Describe dyspnea in emphysema and bronchitis
(shortness of breath)
EMPHYSEMA
• occurs from irreversible destruction of lung tx that causes loss of elasticity in alveoli and thus collapsing when air is exhaled
•as alveoli are destroyed the lungs are less able to transfer oxygen to bloodstream, causing shortness of breath
BRONCHITIS
•Excessive mucus production and productive cough
Describe HYPERCAPNEA
Elevated CO2 common early in AM due to decreased respiratory rate over night and less CO2 released
Describe pedal edema
When heart (R ventricle) has to work harder in response to decreased overall oxygen saturation the increased pressures are eventually transmitted to the venous circulation, resulting in peripheral edema
Describe why increased bp is a s/s of COPD
As oxygen saturation drops, the message to CNS is that circulating blood volume is decreasing
This signals to SNS to release norephinepherine, causing generalized arterial and venous vasoconstriction and increase in BP
Give five methods of treatment for COPD
- Lifestyle changes, smoking cessation, and avoidance of other pollutants
- Exercise as tolerated
- GOOD NUTRITION
- Pharmacologic treatment
- Pulmonary rehab
Mounting evidence correlates the role of dietary ______ with healthy lung function. Explain.
ANTIOXIDANTS
- study of antioxidants and lung function found improved pulmonary function in those with higher serum Vit C, E, and carotenoids
- cigarette smoking assoc w/reduced levels of antioxidants
Name some ways respiratory disease may affect dietary intake
- Early satiety after only small intake due to dyspnea
- Anorexia from fatigue, dyspnea, and side effects of medication
- Weight loss (from above)
- Cough
- Fatigue (from dyspnea) leading to problems with food prep and consumption
- Dysgeusia - taste changes due to meds, acid/base imbalances, cigarette smoking
Give four components of COPD nutritional assessment
- Anthropometric measures
- Food/nutrition-related history
- Medication use
- Physical activity and function
