fund 51 - ch 20 Flashcards
COPD
COPD may include diseases that cause airflow obstruction (e.g., emphysema, chronic bronchitis) or any combination of these disorders
lung function
normally decrease with age—for example, vital capacity and forced expiratory volume in 1 second (FEV1)—COPD accentuates and accelerates these physiologic changes
in COPD, the inflammatory response occurs where? (just approximately perry)
throughout the proximal and peripheral airways, lung parenchyma, and pulmonary vasculature
COPD in proximal airways (COPD is proximately 2 mm)
(trachea and bronchi greater than 2 mm in diameter), increased goblet cells and enlarged submucosal glands lead to hypersecretion of mucus
COPD peripheral airways, (COPD perry is narrow and less than 2 mm)
(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)
COPD - alveolar wall
destruction leads to loss of alveolar attachments and a decrease in elastic recoil.
COPD - pulmonary vasculature
causes thickening of the lining of the vessel and hypertrophy of smooth muscle, which may lead to pulmonary hypertension
chronic bronchitis (3 Cs in chronic bronchitis = 3 months)
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.
chronic bronchitis - Mucus plugging of the airway reduces (c for chronic bronchitis = c for cilia)
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.
emphysema
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.
dead space - emphysema
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
2 types of emphysema
panlobular and centrilobular
panlobular
destruction of the respiratory bronchiole, alveolar duct, and alveolus. airspace in lobular is enlarged, but little inflammation.
symptoms of panlobular
(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.
centrilobular
pathologic changes take place mainly in the center of the secondary lobule, preserving the peripheral portions of the acinus.
symptoms of centrilobular
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.
genetic risk factor COPD (Pink is the alpha and omega)
deficiency of alpha1-antitrypsin, an enzyme inhibitor that protects the lung parenchyma from injury
COPD is a progressive disease characterized by (COPD has kids - CDS)
chronic cough, sputum production, and dyspnea
barrel chest
results from a more fixed position of the ribs in the inspiratory position (due to hyperinflation) and from loss of lung elasticity
COPD and spirometer (pink has trouble exhaling)
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.
tests for advanced COPD - screen for what deficiency? (COPD is missing the alpha and omega)
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.
COPD grade I
mild, FEV/FVC < 70%, FEV greater or equal to 80% predicted
COPD Grade II
moderate FEV/FVC < 70%, FEV 50-79% predicted
COPD grade III
FEV/FVC < 70%, FEV 30-49% predicted
COPD grave IV
very severe. FEV/FVC < 70%, FEV 30% predicted
COPD acute or chronic
Respiratory insufficiency and failure may be chronic (with severe COPD) or acute (with severe bronchospasm or pneumonia in a patient with severe COPD).
hypoxia in COPD symptoms (pink has hypoxia and is bored and tired)
fatigue, drowsiness, apathy, inattentiveness, and delayed reaction time may occur
O2 therapy for pts with respiratory disorders is to…
increase the partial pressure of arterial oxygen (PaO2) back to the patient’s normal baseline, which may vary from 60 to 95 mm Hg.
when giving O2, monitor COPD pt for..
lethargy, diaphoresis, pallor, tachycardia, tachypnea, and hypertension
respiratory and aging
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.
respiratory and aging
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.
long term oxygen and COPD - when to give O2? What percent? (Pink is at 88)
give oxygen for very severe COPD, below 88%. less than 88% need arterial blood gas
COPD meds
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.
Pressurized metered-dose inhaler (pMDI) (the meter is slow and deep)
slow and deep inhalation.
Breath-actuated pMDI (I can actually breathe but I’m not coordinated)
more rapid inhalation. May be particularly useful for patients unable to coordinate inhalation and actuation. May also be useful for older patients.
Dry-powder inhaler (DPI)
rapid deep inhalation. Dose is lost if patient exhales through device after actuating.
Small-volume nebulizer (SVN) (small and clumsy)
Slow tidal breathing with occasional deep breaths. Less dependent on patient’s coordination and cooperation.
COPD exacerbation (air trapping is exacerbated)
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.
use steroids for COPD exacerbation only IF….
pt has increase in dyspnea, increase in sputum volume, an1d sputum purulence
bullectomy
a surgical option for select patients with bullous emphysema.
Lung Volume Reduction Surgery
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
Pulmonary rehabilitation - how long
optimal 6 to 8 weeks
directed coughing
Directed coughing consists of a slow, maximal inspiration followed by breath-holding for several seconds and then two or three coughs.
Huff cough
“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.
lower and middle lobe bronchi drain is more
more effective when the head is down
upper lobe bronchi drain better in what position? (upper is up)
better when head is up
when is postural drainage performed? (think, it’s gross, so…) and how many times a day?
two to four times daily, before meals (to prevent nausea, vomiting, and aspiration) and at bedtime. drain lower lobes first, then upper lobes.
how to perform lung drainage
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
vibration
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
When performing CPT, the nurse ensures that
the patient is comfortable, is not wearing restrictive clothing, and has not just eaten
COPD - Impaired breathing patterns and shortness of breath are due to the
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
If a rapid onset of shortness of breath occurs (COPD) (Pink can get pneumothorax!)
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.
pleural fluid - amount
20 mL or less
larynageal cancer - you’ll feel what? (Larry is swelling)
feeling of swelling at the back of the throat
small amount of clear watery fluid after head trauma
test for glucose bc CSF contains glucose
C for COPD C for
chronic air trapping and lung hyperinflation - air can’t get out of the lungs
pink puffer
huffing and puffing,
(emphsyema) HIGH air trapping for
HIGH-per resonance
chronic bronchitis (BLUE) U is for
unusual lung sounds - crackles and wheezes
C for chronic bronchitis - C for
cor pulmone
