Management of COPD and heart failure

Question 1

What are the symptoms of right sided heart failure?

Answer 1

SOB
Orthopnea - propping themselves up on pillows
Paroxysmal nocturnal dyspnea - waking up with shortness of breath whilst sleeping
Cough
Peripheral oedema

Question 2

Name a chronic condition that can causes right sided heart failure

Answer 2

COPD

Question 3

What does the sputum look like in someone that has pulmonary oedema?

Answer 3

pink and frothy

Question 4

At what point do you know that the current treatment that a person with COPD is on isn’t enough and needs to be stepped up?

Answer 4

If they are having 3 or more infections a year

Question 5

When listening to a chest and hearing course crackles, what can this indicate?

Answer 5

Infection - especially if unilateral

Question 6

When listening to a chest and hearing fine crackles, can does this indicate?

Answer 6

Pulmonary fibrosis

Heart failure - esp if bilaterally

Question 7

When listening to a trachea and hearing bronchial breath sounds, what can this indicate?

Answer 7

pneumonia

Question 8

When listening to a chest and hearing a wheeze, can does this indicate?

Answer 8

COPD
Asthma
Pulmonary oedema

Question 9

When percussing the chest and hearing a stony dull sounds, can does this indicate?

Answer 9

pleural effusion

Question 10

What is the oxygen saturation aim with someone who has COPD?

Answer 10

88-94%

Question 11

What does a ‘bats wing’ appearance on an x-ray indicate?

Answer 11

pulmonary oedema

Question 12

Explain the management of heart failure in the first instance?

Answer 12

Diuretics - normally furosemide IV. Aiming to remove 1/2-1kg in 24h
Oxygen
DVT prophylaxis
AF treatment is appropriate - B blocker/digoxin, anticoagulate
U&Es - check K+ esp

Question 13

What imaging can be used to diagnose heart failure?

Answer 13

Echo

Question 14

What is cardiac re synchronisation?

Answer 14

Used when ventricles don’t contract at the same time
Wires connected to the ventricles
Causes the ventricles to contract

Question 15

What are the signs of heart failure?

Answer 15

Low BP
Irregular HR (if AF)
High resp rate
Oedema
Wheeze bilaterally

Question 16

What are the signs and symptoms of a acute exacerbation of COPD?

Answer 16

Tachycardic
SOB
Reduced exercise tolarence
Cough with lots of sputum (change in colour could occur)
Leg swelling

Question 17

How do you manage an acute exacerbation of COPD in the first instance?

Answer 17

Oxygen - controlled flow using a venturi mask
B agonists
Anticholinergics
Steriods orally
DVT prophylaxis

Question 18

What are further investigations/treatments that can be done for the acute exacerbation of COPD?

Answer 18

ABG
Smoking cessation
Inhaler change - inc inhaler technique
Pulmonary rehab