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adults > management of patients with chronic pulmonary diseases > Flashcards

management of patients with chronic pulmonary diseases Flashcards

1
Q

describe COPD

A

a preventable and treatable disease characterized by airflow limitation that is not fully reversible and is slowly progressive

airflow limitation on exhalation

variable combinations of chronic bronchitis, emphysema, and asthma

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2
Q

describe the pathophysiology of COPD

A

airflow limitation is both progressive and associated with inflammatory response

the inflammation occurs in the proximal and peripheral airways, lung perenchyma, and pulmonary vasculature

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3
Q

what are some risk factors for COPD

A
  • cigarette smoking, 2nd hand smoke, smoking other forms of tobacco
  • increased age
  • occupational exposure
  • air pollution
  • genetic abnormalities
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4
Q

what are some complications of COPD

A
  • hypoxia
  • respiratory acidosis
  • infections
  • narrowing of the airways
  • heart failure (right sided)
  • cardiac dysrhythmias
  • decreased quality of life
  • death
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5
Q

what are the clinical manifestations of COPD

A

three primary symptoms: chronic cough, sputum production, dyspneas

  • weight loss
  • DOE
  • use of accessory muscles
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6
Q

what is used in the assessment and diagnosis of COPD

A
  • health history (occupation, smoking, allergies, pasy exposures, past resp issues)
  • spirometry (PFTs)
  • ABGs
  • chest xray/CT scan
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7
Q

describe chronic bronchitis

A

disease of the airways, bronchial tubes become inflamed

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

  • hypertophy and hypersecretion of mucus glands
  • chronic inflammation and edema
  • cough
  • gradual structural changes r/t use of accessory muscles
  • most often occurs in the winter (cold air and viruses can trigger it)
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8
Q

what are some common characteristics of chronic bronchitis

A
  • use pursed lip breathing
  • stocky build
  • use of accessory muscles
  • fluid rentention
  • side effects of steroid use (only given for exacerbation)
  • respiratory acidosis and dusky/cyanotic color
  • cor pulmonale (right sided HF)
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9
Q

describe emphysema

A

impaired oxygen and carbon dioxide exchange, destruction of the walls of over extended alveoli, end stage, progresses slowly for years

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10
Q

describe the pathophysiology of emphysema

A

breakdown of alveolar walls
- increase in dead space
- no gas exchange can occur
- impaired diffusion -> hypoxemia
- CO2 elminiation impaired -> hypercapnia -> respiratory acidosis
- over inflation of alveoli and air trapping

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11
Q

what are some common characteristics with emphysema

A
  • thin appearance
  • increase in resp rate to maintain O2 levels
  • accessory muscle use
  • barrell shaped chest
  • purse lipped breathing
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12
Q

what is included in the treatment of COPD

A
  • risk reduction
  • bronchodilators and corticosteroids
  • surgery
  • pulmonary rehab
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13
Q

describe risk reduction for the treatment of COPD

A

smoking cessation
nutritional treatment:
- small, frequent meals
- high protein, low CHO, high fat diet (achieves most calories without relying on CHO bc they increase CO2)
- adequate hydration

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14
Q

describe surgery for the treatment of COPD

A
  • lung volume reduction surgery
  • lung transplant
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15
Q

describe pulmonary rehab for the treatment of COPD

A
  • patient education
  • breathing exercises
  • activity pacing
  • self care activities
  • physical conditioning
  • coping mechanisms
  • oxygen
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16
Q

describe asthma

A

chronic inflammatory disease of the airways -> airway hyper-responsiveness -> mucosal edema and increased mucu production -> cough, chest tightness, wheezing, and dyspnea

bronchospasm usually reversible, usually not permanent lung changes, chronic disease causes structural change

classified by severity with identifiable triggers

17
Q

when asthma occurs initially, what happens?

A

hypoxia -> hyperventilation -> respiratory alkalosis

18
Q

later in an asthma attack, what happens?

A

increased carbon dioxide -> respiratory acidosis -> respiratory failure

19
Q

what are some different triggers for asthma

A
  • allergens (stringest predisposing factor)
  • medications
  • upper resp infection
  • GERD
  • strong odors, fumes, smoke
  • hormone levels (especially in females)
  • exercise, stress, laughing
  • cold air
20
Q

describe the clinical manifestations of asthma

A
  • 3 most common symptoms include cough, dyspnea, wheezing
  • accessory muscle use
  • anxiety/chest tightness
  • prolonged expiration
  • diaphoresis
  • hypoxemia (<80)
  • tachypnea/tachycardia
  • widened pulse pressure
21
Q

describe asthma assessment

A
  • determine symptoms of airflow
  • identify triggers
22
Q

what diagnostics are used to assess asthma

A
  • forced expiratory volume (FEV1)
  • forced vital capacity
  • PFTs
23
Q

what is forced expiratory volume

A

amount of air forced out of lungs after greatest inhalation

24
Q

what is sued for the evaluation of asthma treatment

A
  • forced expiratory volume (FEV)
  • oxygen levels
  • breath sounds
  • activity tolerance
  • respiratory rate
25
Q

whats included in patient teaching for asthma

A
  • trigger recognition and avoidance
  • change environment
  • medication usage (how to use inhalers and nebulizer)
  • self monitoring of PEF (peak expiratory flow)
26
Q

what are some asthma complications

A
  • status asthmaticus
  • respiratory failure
  • pneumonia
  • atelectasis
  • hypoxemia
27
Q

what is status asthmaticus

A

asthma attack that does not respond to treatment and lasts longer than normal

28
Q

whats soem nonpharmacological management of dyspnea

A
  • cool air on face, use fan
  • strengthen respiratory muscles through exercise
  • improve nutrition to improve muscle mass
  • positioning (sit em up)
  • pursed lip and diaphragmatic breathing
  • oxygen therapy
29
Q

what are some pharmacological treatments of dyspnea

A
  • bronchodilators
  • opioids (morphine sulfate, not for pain but to decrease rr)
  • anxiolytics
30
Q

what inhaled corticosteroids may be used for asthma and COPD

these are most effective

A
  • fluticasone
  • budesonide
  • flunisolide
31
Q

what anticholinergic may be used for asthma and COPD

A

ipratropium

dries secretions

32
Q

name some short acting bronchodilators

(rescue)

A
  • beta 2 adrenergic agonists
  • albuterol
  • levalbuterol (doesnt increase HR like albuterol)
33
Q

name some long acting B2 adrenergic agonists

used for maintenance or prevention

A
  • salmeterol
  • formoterol
34
Q

what are some combo drugs used for asthma and COPD

A
  • fluticasone-salmeterol
  • budesonide-formoterol

steroid + agonist
NOT RESCUE DRUGS

35
Q

name a leukotriene modifier and what should you remember about it

A

montelukast

black bow warning for psychotic events
given at night
prevents bronchoconstriction

36
Q

name a immunomodulator that is used for asthma and COPD

A

omalizumab

IgE-inhibiting IgG monoclonal antibody

37
Q

what are some nrusign interventions for COPD

A
  • O2 management and therapy
  • energy conservation
  • exercise promotion
  • dyspnea assessment and management
  • medications
  • administer fluids
  • cough anhancement
  • breathing exercises (pursed lip or abdominal/diaphragm)
  • anxiety reduction (must make sure not hypoxia)
  • nutritional balance

adults (51 decks)

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