management for COPD Flashcards

1
Q

COPD is characterized by

A

airflow limitation that is not fully reversible and is slowly progressive, airflow limitation on exhalation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

pathophysiology of COPD

A

airflow limitation is both progressive and associated with an abnormal inflammatory response of the lungs to noxious particles or gases; the inflammation occurs in primal and peripheral airways (if main airways are squeezed shut, the peripheral airways won’t get air)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

risk factors for COPD

A

smoking (any kinds), 2nd hand smoke, increased age, job exposure, air pollution, genetics

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

complications of COPD

A

hypoxia, respiratory acidosis, infections, narrowing of airways, HF, cardiac dysrhythmias, decreased quality of life, death (because CO2 levels are so high it can shut off brain)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

respiratory acidosis is what

A

high PaCO2

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

3 primary symptoms of COPD

A

chronic cough, sputum production, dyspnea (others are weight loss, DOE, use of accessory muscles)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

assessments and diagnosis for COPD

A

health hx, IS, ABGs, chest x ray, pulmonary function tests

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

bronchitis is AKA

A

big blue bloater, bronchiole tubes are inflamed (chronic inflammation and edema/ hypertrophy & hypersecretion of mucus glands)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

how to diagnosis bronchitis

A

cough with daily sputum production, at least 3 months/ year for 2 consecutive years

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

common characteristics of chronic bronchitis

A

used pursed lip breathing, stocky build, use of accessory muscles, fluid retention, side effects of steroid use (only give steroids when in exacerbation)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

signs of chronic bronchitis

A

cyanotic, recurrent cough and increased sputum production, hypoxia, hypercapnia, acidosis, increased RR, exertion dyspnea, clubbing, edematous, increased incident in smokers, cardiac enlargement, cor pulmonale

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

what is cor pulmonale

A

a condition that causes the right side of the heart to fail

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

why do you try not to give steroids for COPD

A

the do decrease inflammation but they increase glucose, increase risk of infection, increase risk of fractures, makes skin thin, increase gastric acid (pain & burning in stomach), they shut down adrenal cortex so they don’t make any steroids anymore making people diabetic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

after using steroid inhaler what will you do

A

rinse out mouth

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

emphysema

A

impaired oxygen and carbon dioxide exchange; destruction of the walls of over distended alveoli, progresses slowly for years

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

breakdown of alveolar walls in emphysema lead to

A

increase in dead space (the more dead space the less air er can get into the lungs leading to hypoxemia), no gas exchange can occur, CO2 elimination is impaired leading to hypercapnia & respiratory acidosis, leading to over inflation of alveoli and air trapping

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

emphysema AKA

A

pink puffer; gets flushed

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

common characteristics of emphysema

A

thin appearance, increased RR to maintain adequate oxygen levels, accessory muscle use, barrel shaped chest, purse lipped breathing

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

signs of emphysema

A

dyspnea, purse lip breathing, orthopneic, barrel chest, prolonged expiratory time, speaks in jerky sentences, anxious, use accessory muscles, thin, leads to right sided HF, ineffective cough, sleep sitting up

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

pulmonary function tests

A

deep breaths, blow out as hard as you can and they will measure that

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

how to reduce risk of COPD

A

stop smoking, eat smaller meals (high protein:source of energy, high fat, low carbohydrate), bronchodilators, costicosteriods, hydrate, surgery, pulmonary rehab

22
Q

why do you want low carb for COPD

A

because CO2 is a waste product of carbohydrates and if you already have a lot of CO2 you will increase your CO2 level even more which is what you don’t want

23
Q

what are pulmonary rehabs for COPD

A

breathing exercise, activity pacing, self care activities, physical conditioning, coping mechanism, oxygen

24
Q

what is asthma

A

chronic inflammatory disease of the airways -> airway hyper-responsiveness (each time you cough, they react more)-> mucosal edema -> increase mucus production -> cough, chest tightness, wheezing, & dyspnea

25
bronchospasm are part of
asthma but are usually reversible end not permanent lung changes
26
when an asthma attack occurs initially what do you see
hypoxia -> hyperventilation -> respiratory alkalosis
27
later in an asthma attack what do you see
increased CO2 -> respiratory acidosis -> respiratory failure
28
in an asthma attack what cells are the first to attack
neutrophils
29
characteristics of asthma
mast cells, macrophages, neutrophils, eosinophils, T lymphocytes play role in inflammation
30
trigger of asthma
allergens, medications, upper respiratory infections, GERD, strong odors, hormone levels (in females), exercise, stress, cold air, laughing
31
3 most common clinical manifestations of asthma
cough, dyspnea, wheezing
32
other symptoms of asthma
anxiety, chest tightness, prolonged expiration, diaphoresis, hypoxemia, tachycardia, tachypnea, widened pulse pressure
33
diagnostics for asthma
forced expiratory volume (FEV1), forced vital capacity, PFTs
34
forced expiratory volume
the amount of air expired after one, two, three seconds of forced vital capacity
35
FVC
the amount of air forced out of lungs after the greatest exhalation
36
albuterol is a
sympathomimetic; first shake, use spacer (not always), breath in slowly
37
nebulizer vs inhaler
nebulizer you can combine meds/ inhaler has a meter to tell how much med to take or took
38
after breathing after asthma attack what should happen
breath sounds from wheezing to clear, activity tolerance should increase, RR should decrease after breathing treatment
39
complications of asthma
status asthmatics, respiratory failure, pneumonia, atelectasis, hypoxemia
40
status asthmatics
very bad; asthma attack that does not respond to normal treatment, not able to get airways reversed, lasts longer than a normal asthma attack, go into respiratory alkalosis then acidosis then respiratory failure
41
dyspnea management: nonpharmacological
cool air on face, strengthen respiratory muscles thru exercise, improve nutrition to improve muscle mass, positioning, pursed lip & diaphragmatic breathing, oxygen therapy
42
dyspnea management: pharmacological
bronchodilators, opioids (not always for pain, but they will decrease RR to slow HR), anxiolytics
43
most effective inhaled costicosteriods for asthma and COPD
fluticasone, budesonide, flunisolide
44
anticholinergics for asthma and COPD
ipratropium (dry up secretions; no spit, no shit, no pee, no see(no tears))
45
short acting bronchodilator for all (rescue) for asthma and COPD
beta 2 adrenergic agonists, albuterol, levalbuteral (does not increase HR as much as albuterol)
46
long acting B2 adrenergic agonist (maintenance or prevention) for asthma and COPD
salmeterol, formoterol
47
combo meds for asthma and COPD
fluticasone- salmeterol/ budesonide- formoterol
48
leukotriene modifers for asthma and COPD
montelukast (black box warning for nueropsychiatric symptoms, suicidal thoughts)/ not a dilator but it does prevent restricting
49
immunomodulators for asthma and COPD
IgE-inhibiting IgG monoclonal antibody (omalizumab): decreases immune system; higher risk for infections & cancers
50
nursing interventions for all types of COPD
O2 management & respiratory therapy, conserve your engird, exercise promotion, dyspnea assessments, medications, administer fluids, cough enhancement, breathing exercising (pursed lip/ abd & diaphragm), anxiety reduction (but not hypoxia), nutritional balance