M103 T4 L10 Flashcards
What are the physical signs of COPD?
Barrel-shaped chest (hyperresonant) percussion Accessory muscles Prolonged expiration Pursed-lip breathing Tripod position Low BMI Nicotine-staining
What are the physiological effects of COPD?
Increased work of breathing
Reduced Exercise Tolerance
Impaired gas exchange
What are the physioloical effects of COPD?
Hypoxia Hypercapnia Raised pulmonary artery pressure RV dilatation, cor pulmonale Loss of Fat Free Mass
How are chronic diseases managed?
stop smoking inhalers flu vaccination educate and empower treat exacerbations pulmonary rehabilitation healthy BMI (LTOT)
How often are pulmonary rehabilitation meetings?
two supervised sessions for six weeks
What is focused on in pulmonary rehabilitation meetings?
Education
Psychosocial support/group work
supervised exercise training
What are other treatments for COPD?
Theophylline
Azithromycin
Lung volume reduction surgery
Lung transplantation
What additional therapy is used to treate the acute deterioration in symptoms of COPD?
Mild - SABA
Moderate - SABA +/- steroids +/- antibiotics
Severe - hospital admission or ED attendance
What conditions would require the patient to attend ED?
progressive dyspnoea/hypoxia
signs of infection
signs of r. HF
How is severe exascerbation of COPD treated?
Antibiotics if signs of infection (sputa results)
Oral steroids
Target saturations 88-92% (controlled oxygen)
Nebulisers (bronchodilate)
Consider diuretics
Nicotine replacement therapy/refer for smoking cessation
When would non invasive ventilation be used to treat COPD?
if decompensated hypercapnic respiratory failed despite controlled oxygen and nebulised treatments
When would invasive mechanical ventilation be used to treat COPD?
if respiratory failure occured despite nebulised therapy and controlled oxygen
if the patient is unable to tolerate NIV
When would palliate care be used to treat COPD?
if there had been respiratory failure on background of significant progressive decline over several months/years with no evidence of reversible event
How are COPD symptoms controlled? (LOFT, COT)
Lorazepam
Oromorph
Fan Therapy
CBT, Oxygen Therapy
Pacing/Breathing strategies
Hospice input
What are the features of chronic bronchitis?
a chronic productive cough for three months in two successive years
excludes other causes of chronic cough
