fund 51 - ch 20

Question 1

COPD

Answer 1

COPD may include diseases that cause airflow obstruction (e.g., emphysema, chronic bronchitis) or any combination of these disorders

Question 2

lung function

Answer 2

normally decrease with age—for example, vital capacity and forced expiratory volume in 1 second (FEV1)—COPD accentuates and accelerates these physiologic changes

Question 3

in COPD, the inflammatory response occurs where? (just approximately perry)

Answer 3

throughout the proximal and peripheral airways, lung parenchyma, and pulmonary vasculature

Question 4

COPD in proximal airways (COPD is proximately 2 mm)

Answer 4

(trachea and bronchi greater than 2 mm in diameter), increased goblet cells and enlarged submucosal glands lead to hypersecretion of mucus

Question 5

COPD peripheral airways, (COPD perry is narrow and less than 2 mm)

Answer 5

(bronchioles less than 2 mm diameter), inflammation causes thickening of the airway wall, peribronchial fibrosis, exudate in the airway, and overall airway narrowing (obstructive bronchiolitis)

Question 6

COPD - alveolar wall

Answer 6

destruction leads to loss of alveolar attachments and a decrease in elastic recoil.

Question 7

COPD - pulmonary vasculature

Answer 7

causes thickening of the lining of the vessel and hypertrophy of smooth muscle, which may lead to pulmonary hypertension

Question 8

chronic bronchitis (3 Cs in chronic bronchitis = 3 months)

Answer 8

a disease of the airways, is defined as the presence of cough and sputum production for at least 3 months in each of 2 consecutive years.

Question 9

chronic bronchitis - Mucus plugging of the airway reduces (c for chronic bronchitis = c for cilia)

Answer 9

ciliary function. Bronchial walls also become thickened, further narrowing the bronchial lumen. wall also thicken. alveoli become damaged and fibrosed, which affects the macrophages there. thus the pt is more susceptible to respiratory infections. more likely to occur in winter.

Question 10

emphysema

Answer 10

impaired oxygen and carbon dioxide exchange results from destruction of the walls of overdistended alveoli. In addition, a chronic inflammatory response may induce disruption of the parenchymal tissues. progresses for years.

Question 11

dead space - emphysema

Answer 11

This causes an increase in dead space (lung area where no gas exchange can occur) and impaired oxygen diffusion, which leads to hypoxemia. later stages, CO2 elimination is impaired and pt has hypercapnia and respiratory acidosis. resistance to pulmonary blood flow is increased, forcing the right ventricle to maintain a higher blood pressure in the pulmonary artery = cor pulmonale. then back up of blood in the venous system, resulting in dependent edema, distended neck veins, or pain in the region of the liver

Question 12

2 types of emphysema

Answer 12

panlobular and centrilobular

Question 13

panlobular

Answer 13

destruction of the respiratory bronchiole, alveolar duct, and alveolus. airspace in lobular is enlarged, but little inflammation.

Question 14

symptoms of panlobular

Answer 14

(hyperexpanded) chest, marked dyspnea on exertion, and weight loss typically occur.Instead of being an involuntary passive act, expiration becomes active aqnd requires muscular effort.

Question 15

centrilobular

Answer 15

pathologic changes take place mainly in the center of the secondary lobule, preserving the peripheral portions of the acinus.

Question 16

symptoms of centrilobular

Answer 16

chronic hypoxemia, hypercapnia, polycythemia (i.e., an increase in red blood cells), and episodes of right-sided heart failure. This leads to central cyanosis and respiratory failure. The patient also develops peripheral edema.

Question 17

genetic risk factor COPD (Pink is the alpha and omega)

Answer 17

deficiency of alpha1-antitrypsin, an enzyme inhibitor that protects the lung parenchyma from injury

Question 18

COPD is a progressive disease characterized by (COPD has kids - CDS)

Answer 18

chronic cough, sputum production, and dyspnea

Question 19

barrel chest

Answer 19

results from a more fixed position of the ribs in the inspiratory position (due to hyperinflation) and from loss of lung elasticity

Question 20

COPD and spirometer (pink has trouble exhaling)

Answer 20

with obstruction, the patient either has difficulty exhaling or cannot forcibly exhale air from the lungs, reducing the FEV1. can determine if it is reversible after using bronchodilators.

Question 21

tests for advanced COPD - screen for what deficiency? (COPD is missing the alpha and omega)

Answer 21

Arterial blood gas measurements may also be obtained to assess baseline oxygenation and gas exchange and are especially important in advanced COPD. chest xray. screening for alpha1-antitrypsin deficiency.

Question 22

COPD grade I

Answer 22

mild, FEV/FVC < 70%, FEV greater or equal to 80% predicted

Question 23

COPD Grade II

Answer 23

moderate FEV/FVC < 70%, FEV 50-79% predicted

Question 24

COPD grade III

Answer 24

FEV/FVC < 70%, FEV 30-49% predicted

Question 25

COPD grave IV

Answer 25

very severe. FEV/FVC < 70%, FEV 30% predicted

Question 26

COPD acute or chronic

Answer 26

Respiratory insufficiency and failure may be chronic (with severe COPD) or acute (with severe bronchospasm or pneumonia in a patient with severe COPD).

Question 27

hypoxia in COPD symptoms (pink has hypoxia and is bored and tired)

Answer 27

fatigue, drowsiness, apathy, inattentiveness, and delayed reaction time may occur

Question 28

O2 therapy for pts with respiratory disorders is to…

Answer 28

increase the partial pressure of arterial oxygen (PaO2) back to the patient’s normal baseline, which may vary from 60 to 95 mm Hg.

Question 29

when giving O2, monitor COPD pt for..

Answer 29

lethargy, diaphoresis, pallor, tachycardia, tachypnea, and hypertension

Question 30

respiratory and aging

Answer 30

muscles weaken and the large bronchi and alveoli become enlarged, the available surface area of the lungs decreases, resulting in reduced ventilation and respiratory gas exchange. cilia become less.

Question 30

respiratory and aging

Answer 30

muscles weaken and the large bronchi and alveoli become enlarged, the available surface area of the lungs decreases, resulting in reduced ventilation and respiratory gas exchange. cilia become less.

Question 31

long term oxygen and COPD - when to give O2? What percent? (Pink is at 88)

Answer 31

give oxygen for very severe COPD, below 88%. less than 88% need arterial blood gas

Question 32

COPD meds

Answer 32

grade 1 - short-acting bronchdilator. grade II and III short-acting bronchodilator and regular treatment with one or more long-acting bronchodilators. grade III or IV, regular treatment with long-acting bronchodilators and/or inhaled corticosteroids (ICSs) for repeated exacerbations.

Question 33

Pressurized metered-dose inhaler (pMDI) (the meter is slow and deep)

Answer 33

slow and deep inhalation.

Question 34

Breath-actuated pMDI (I can actually breathe but I’m not coordinated)

Answer 34

more rapid inhalation. May be particularly useful for patients unable to coordinate inhalation and actuation. May also be useful for older patients.

Question 35

Dry-powder inhaler (DPI)

Answer 35

rapid deep inhalation. Dose is lost if patient exhales through device after actuating.

Question 36

Small-volume nebulizer (SVN) (small and clumsy)

Answer 36

Slow tidal breathing with occasional deep breaths. Less dependent on patient’s coordination and cooperation.

Question 37

COPD exacerbation (air trapping is exacerbated)

Answer 37

During an exacerbation, there is increased dyspnea that is a result of amplified hyperinflation and air trapping. usually related to viral infections, particularly human rhinovirus (i.e., the common cold). However, bacterial infections and environmental factors as well.

Question 38

use steroids for COPD exacerbation only IF….

Answer 38

pt has increase in dyspnea, increase in sputum volume, an1d sputum purulence

Question 39

bullectomy

Answer 39

a surgical option for select patients with bullous emphysema.

Question 40

Lung Volume Reduction Surgery

Answer 40

Treatment options for patients with advanced or end-stage COPD (grade IV) with a primary emphysematous component are limited, although lung volume reduction surgery is a palliative surgical option. removal of a portion of the diseased lung parenchyma

Question 41

Pulmonary rehabilitation - how long

Answer 41

optimal 6 to 8 weeks

Question 42

directed coughing

Answer 42

Directed coughing consists of a slow, maximal inspiration followed by breath-holding for several seconds and then two or three coughs.

Question 43

Huff cough

Answer 43

“Huff” coughing may also be effective. The technique consists of one or two forced exhalations (huffs) from low to medium lung volumes with the glottis open.

Question 44

lower and middle lobe bronchi drain is more

Answer 44

more effective when the head is down

Question 45

upper lobe bronchi drain better in what position? (upper is up)

Answer 45

better when head is up

Question 46

when is postural drainage performed? (think, it’s gross, so…) and how many times a day?

Answer 46

two to four times daily, before meals (to prevent nausea, vomiting, and aspiration) and at bedtime. drain lower lobes first, then upper lobes.

Question 47

how to perform lung drainage

Answer 47

patient to remain in each position for 10 to 15 minutes and to breathe in slowly through the nose and out slowly through pursed lips to help keep the airways open so that secretions can drain

Question 48

vibration

Answer 48

technique of applying manual compression and tremor to the chest wall during the exhalation phase of respiration. After three or four vibrations, the patient is encouraged to cough, contracting the abdominal muscles t

Question 49

When performing CPT, the nurse ensures that

Answer 49

the patient is comfortable, is not wearing restrictive clothing, and has not just eaten

Question 50

COPD - Impaired breathing patterns and shortness of breath are due to the

Answer 50

modified respiratory mechanics of the chest wall and lung resulting from air trapping (i.e., incomplete emptying of alveoli during expiration), ineffective diaphragmatic movement, airway obstruction, the metabolic cost of breathing, and stress

Question 51

If a rapid onset of shortness of breath occurs (COPD) (Pink can get pneumothorax!)

Answer 51

the nurse should quickly evaluate the patient for potential pneumothorax by assessing the symmetry of chest movement, differences in breath sounds, and a decrease in pulse oximetry.

Question 52

pleural fluid - amount

Answer 52

20 mL or less

Question 53

larynageal cancer - you’ll feel what? (Larry is swelling)

Answer 53

feeling of swelling at the back of the throat

Question 54

small amount of clear watery fluid after head trauma

Answer 54

test for glucose bc CSF contains glucose

Question 55

C for COPD C for

Answer 55

chronic air trapping and lung hyperinflation - air can’t get out of the lungs

Question 56

pink puffer

Answer 56

huffing and puffing,

Question 57

(emphsyema) HIGH air trapping for

Answer 57

HIGH-per resonance

Question 58

chronic bronchitis (BLUE) U is for

Answer 58

unusual lung sounds - crackles and wheezes

Question 59

C for chronic bronchitis - C for

Answer 59

cor pulmone