management of patients with chronic pulmonary diseases Flashcards
describe COPD
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
describe the pathophysiology of COPD
airflow limitation is both progressive and associated with inflammatory response
the inflammation occurs in the proximal and peripheral airways, lung perenchyma, and pulmonary vasculature
what are some risk factors for COPD
- cigarette smoking, 2nd hand smoke, smoking other forms of tobacco
- increased age
- occupational exposure
- air pollution
- genetic abnormalities
what are some complications of COPD
- hypoxia
- respiratory acidosis
- infections
- narrowing of the airways
- heart failure (right sided)
- cardiac dysrhythmias
- decreased quality of life
- death
what are the clinical manifestations of COPD
three primary symptoms: chronic cough, sputum production, dyspneas
- weight loss
- DOE
- use of accessory muscles
what is used in the assessment and diagnosis of COPD
- health history (occupation, smoking, allergies, pasy exposures, past resp issues)
- spirometry (PFTs)
- ABGs
- chest xray/CT scan
describe chronic bronchitis
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)
what are some common characteristics of chronic bronchitis
- 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)
describe emphysema
impaired oxygen and carbon dioxide exchange, destruction of the walls of over extended alveoli, end stage, progresses slowly for years
describe the pathophysiology of emphysema
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
what are some common characteristics with emphysema
- thin appearance
- increase in resp rate to maintain O2 levels
- accessory muscle use
- barrell shaped chest
- purse lipped breathing
what is included in the treatment of COPD
- risk reduction
- bronchodilators and corticosteroids
- surgery
- pulmonary rehab
describe risk reduction for the treatment of COPD
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
describe surgery for the treatment of COPD
- lung volume reduction surgery
- lung transplant
describe pulmonary rehab for the treatment of COPD
- patient education
- breathing exercises
- activity pacing
- self care activities
- physical conditioning
- coping mechanisms
- oxygen
describe asthma
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
when asthma occurs initially, what happens?
hypoxia -> hyperventilation -> respiratory alkalosis
later in an asthma attack, what happens?
increased carbon dioxide -> respiratory acidosis -> respiratory failure
what are some different triggers for asthma
- allergens (stringest predisposing factor)
- medications
- upper resp infection
- GERD
- strong odors, fumes, smoke
- hormone levels (especially in females)
- exercise, stress, laughing
- cold air
describe the clinical manifestations of asthma
- 3 most common symptoms include cough, dyspnea, wheezing
- accessory muscle use
- anxiety/chest tightness
- prolonged expiration
- diaphoresis
- hypoxemia (<80)
- tachypnea/tachycardia
- widened pulse pressure
describe asthma assessment
- determine symptoms of airflow
- identify triggers
what diagnostics are used to assess asthma
- forced expiratory volume (FEV1)
- forced vital capacity
- PFTs
what is forced expiratory volume
amount of air forced out of lungs after greatest inhalation
what is sued for the evaluation of asthma treatment
- forced expiratory volume (FEV)
- oxygen levels
- breath sounds
- activity tolerance
- respiratory rate
whats included in patient teaching for asthma
- trigger recognition and avoidance
- change environment
- medication usage (how to use inhalers and nebulizer)
- self monitoring of PEF (peak expiratory flow)
what are some asthma complications
- status asthmaticus
- respiratory failure
- pneumonia
- atelectasis
- hypoxemia
what is status asthmaticus
asthma attack that does not respond to treatment and lasts longer than normal
whats soem nonpharmacological management of dyspnea
- 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
what are some pharmacological treatments of dyspnea
- bronchodilators
- opioids (morphine sulfate, not for pain but to decrease rr)
- anxiolytics
what inhaled corticosteroids may be used for asthma and COPD
these are most effective
- fluticasone
- budesonide
- flunisolide
what anticholinergic may be used for asthma and COPD
ipratropium
dries secretions
name some short acting bronchodilators
(rescue)
- beta 2 adrenergic agonists
- albuterol
- levalbuterol (doesnt increase HR like albuterol)
name some long acting B2 adrenergic agonists
used for maintenance or prevention
- salmeterol
- formoterol
what are some combo drugs used for asthma and COPD
- fluticasone-salmeterol
- budesonide-formoterol
steroid + agonist
NOT RESCUE DRUGS
name a leukotriene modifier and what should you remember about it
montelukast
black bow warning for psychotic events
given at night
prevents bronchoconstriction
name a immunomodulator that is used for asthma and COPD
omalizumab
IgE-inhibiting IgG monoclonal antibody
what are some nrusign interventions for COPD
- 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
