MedSurg Mod 6: Nursing Care in COPD Flashcards
___ is the primary risk of COPD
smoking (85-90%)
male smokers 12x and women 13x more likely to die from COPD as men who have never smoked
COPD is the ___ leading cause of death in America
3rd
COPD includes __ and __
bronchitis and emphysema
usually it is mixed but many have a predominance of one as well
S/S of Bronchitis
BLuish-red skin tones (blue from cyanosis with good lung perfusion/Bad ventilation; Red from polycythemia)
Tendency for oBesity
frequent cough
foul smelling sputum
frequent pulmonary infections
INCREASED RISK FOR DVT d/t H&H INCREASES
S/S of EmPhysema
Pursed lip breathing
obvious use of accessory muscles
barrel chest
underweight
progressive DOE (dyspnea on exertion)
Diminished breath sounds
PERSISTENT TACHYCARDIA D/T INADEQUATE OXYGENATION
Blue Bloater
Bronchitis
Pink Puffer
Emphysema
What occurs in COPD starting with chronic airway obstruction
Chronic airway obstruction –> airway collapse or inflammation –> bronchospasm, swelling, and excess mucus
With COPD what basically occurs with air
AIR GETS IN BUT CANNOT GET OUT (because exhaling is usually passive so its harder to work when things are obstructed)
Risk factors for COPD
1 - Direct and Second Hand Cigarette smoke (80%)
repeated lung damage from infections/pollution - indoor pollution and occupational; pollutants (15%)
Genetics (5%) - alpha 1 antitrypsin deficiency - rapid damage; cystic fibrosis
___ is the leading preventable cause of death in the US
smoking
Smoking causes more deaths each year than what combined
HIV
illegal drug use
alcohol use
motor vehicle injuries
firearm accidents/incidents
__% of all deaths from COPD are due to smoking
80%
What occurs if you quit smoking
within 2-5 years your risk for stroke can fall to that of a nonsmokers and cancer risk all drops by half in 5 years
within 10 years after your risk for lung cancer drops by half
What is as equally dangerous as smoking?
Second Hand Smoke
What allows for rapid nicotine distribution and what occurs when used?
smoking and vaping
it increases the addiction index and peaks and dissipates quickly meaning they want a lot fast - Sharp peak and sharp dissipation
How does nicotine addiction activate reward pathways
increases the level of dopamine
for many tobacco users, long term brain changes induced by continued nicotine exposure results in addiction - a physiologic reason for not stopping occurs
Nicotine withdrawal is not ___ and no __ __
pleasant and well understood
What is the strong behavioral component of nicotine addiction
the smoking may be associated with something you doe very day or some pattern so there may be a gap in the day when quitting that needs to be filled
Strategies for Smoking Cessation
Counseling - social support and problem solving approach
Medications - nicotine replacement therapies, E Cigs (not FDA approved), chantix, Zyban (acts on nicotine pathways)
Biofeedback
emotional support
counseling
EVALI: E Cigarette or Vaping Product Associated Lung Injury
An ACUTE lung injury involving the heating of a liquid and then inhaling the resulting aerosol
these liquids can have nicotine, THC, CBD, oils, flavoring, and other additives - not certified
Triad of COPD symptoms
- Increased sputum production
- Cough (bronchitis) - intermittent, usually in AM< expectorate small amounts of STICKY mucus
- dyspnea on exertion (emphysema) - gradually worsens and interferes with ADLs
Diagnostic Tests and Results for Bronchitis
CXR - enlarged heart, congested lung fields, normal or flat diaphragm
Pulmonary function test - incr residual air volume, decreased vital capacity, decreased FEV1/FVC ratio (<70%)
ABGs/pulse ox: Decreased PO2
Elevated RBC - elevated H&H in later stages
Diagnostic tests and Results for Emphysema
CXR - hyper inflated lungs and flat diaphragm
Pulmonary function test - incr residual air volume, decreased vital capacity, decreased FEV1/FVC ratio (<70%)
ABGs/pulse ox: decreased PO2
6MWT
6MWT
6 minute walk test
walk for 6 minutes and measure the distance to get functional measure of how well the COPD patient is doing (emphysema)
it is walking not jogging and is simple and effective
Complications and Consequences of COPD
Chronic reduced PaO2 levels
Pneumonia and other pulmonary infections
Pneumothorax
Atelectasis
Pulmonary hypertension
Lung cancer
Peptic Ulcer Disease
Severe weight loss and malnutrition
Right-sided heart failure
Respiratory failure
Increased risk of DVTs
Fatigue
Altered mobility
Depression
Limited socialization
Socio-economic consequences
Shortened lifespan
Mechanical ventilator
General Goals for COPD Medical Treatment
Early diagnosis
prevent further deterioration
alleviate symptoms
improve ability for ADLs and QOL issues
general Strategies for COPD Medical treatment
meds as appropriate for symptoms
regular oxygenation PRN
early intervention for infections - antibiotics
chest PT
adequate fluid intake
oral care
vaccinations for pneumonia and influenza
pulmonary rehabilitation
Nursing Goals for COPD
SMOKING CESSATION
Managing symptoms - maintain patent airway, promote adequate ventilation w/ appropriate resp rate, remain free from or with a reduced rate of resp infections
Maximizing functions - maintain performance of daily living activities, decrease anxiety
Decrease knowledge deficit - disease, treatment, medications
Nursing Diagnosis for the SOB of COPD
impaired gas exchange
impaired airway clearance
ineffective breathing pattern
Nursing Diagnosis for the depression of COPD
ineffective coping
Nursing Diagnosis for the weight loss of COPD
imbalanced nutrition: less than body requirements
Nursing diagnosis for the anxiety of COPD
knowledge deficit
What to assess for with COPD regarding respiratory status
Respiratory Status - Lungs, respiratory effort, signs of hypoxemia like confusion or spO2
VS - note pulse
Labs like H&H and WBC
O2 at prescribed flow rate
position for optimal respirations
assess education need
Education Ideas for COPD patients
avoid pulmonary irritants and extremes of temperature
humidifier at night to mobilize secretions
encourage smoking cessation
encourage pursed lip breathing
Pursed Lip Breathing
Reduces hyperventilation
Increased CO2 level in the alveoli which relaxes/dilates smooth muscles of airways
Keeps the airways open longer
Overall makes breathing more effective by increasing CO2 to encourage relaxation and allow more open airways longer and more efficient gas exchange
Net Result of Pursed Lip Breathing
decreases work of breathing
conserves oxygen
releases trapped air
Assessments and Interventions for Nutritional Status of COPD patients
Assess weight and I&O
encourage well balanced diet and fluids unless contraindicated
consider O2 during meals (nasal canulla)
allow adequate times for meals
position properly for eating
educate on easily prepared foods and lightweight cookware
A person with COPD can burn __x as many calories breathing as a healthy person does
10x
Assessments and Interventions for the Activity level of a COPD patient
assess self care and activity tolerance
pulmonary rehabilitation
maintain a level of physical activity
encourage self care
allow for adequate rest
Assessments and interventions for the skin of a COPD patient
assess redness and sponginess
moisturize
reposition
monitor for breakdown - cheeks and ears if using O2
Assessments and interventions for the coping of a COPD patient
assess behavior changes and mood swings
provide emotional support
allow and encourage autonomy
encourage verbalization of feelings, perceptions and fears
encourages identification of own strengths and abilities
provide education on disease, treatment, and medications
General Education points for COPD Patients
Personal infection control strategies
maintain high resistance
early recognition and treatment of respiratory infection
monitor sputum
develop energy conserving strategies
research treatment(s)
importance of immunizations
maintain adequate nutrition
teach safety with home O2 use
administer meds approp
know details of medications
What to educate COPD regarding personal infection control strategies
avoid large groups and peoples with URIs
good oral hygiene to reduce migrating infection
What to educate COPD regarding maintain high resistance
adequate rest
balanced diet
limiting stress
avoid exposure to dampness, cold, drafts
What to educate COPD regarding early recognition/treatment of respiratory infection
increased dyspnea
increased fatigue
chest tightness
increased sputum
What to educate COPD regarding developing energy conserving strategies
tripod sitting (sitting forward to open chest up and allow expansion)
adequate rest periods
What to educate COPD regarding importance of immunization
pneumOcoccal ( Once in a decade)
influenzA (Annually)
What to educate COPD regarding maintain adequate nutrition
balanced diet with adequate calories to compensate for breathing
adequate fluid within limits of right sided failure
less carbs since they metabolize to CO2 but a balanced diet is needed
What to educate COPD regarding safety with home O2 use?
maintain flow at prescribed rate
s/s of CO2 narcosis like drowsiness, confusion, increased respirations and pulse, diaphoresis
keep nasal passages moist with NON PETROLEUM (FAT) PRODUCTS - USE WATER SOLUBLE PRODUCTS
What is the point of giving bronchodilators to COPD patients
Relaxes muscles surround smaller airways
a hallmark treatment
What to educate about Bronchodilator use?
MDI and Spacer use (Metered dose inhaler)
floating inhalers no longer used - so MDIs do not float when empty and are less intense jetting on the back of the throat
How to correctly use a metered dose inhaler
Remove the cap from the MDI and shake well.
Breathe out all the way.
Place the mouthpiece of the inhaler between your teeth and seal your lips tightly around it.
As you start to breathe in slowly, press down on the canister one time.
Keep breathing in as slowly and deeply as you can. (It should take about 5 to 7 seconds for you to completely breathe in.)
Hold your breath for 10 seconds (count to 10 slowly) to allow the medication to reach the airways of the lung.
Repeat the above steps for each puff ordered by your doctor.
Wait about 1 minute between puffs.
Replace the cap on the MDI when finished.
If you are using a corticosteroid MDI, you should use a spacer.
Shake, Exhale fully, Put in mouth, 1 puff breathed in slowly - use spacer if using corticosteroids
Why should you NOT do 2 immediate puffs with inhalers and bronchodilators
the second one is basically wasted so take a break inbetween
Why is it important to use a spacer with an inhaler using corticosteroids
steroids can develop around the mouth and cause thrush or yeast infection - so use a spacer
Benefit of spacer
can take mult breaths in spacer so you dont have to coordinate press down and breath in
Beta Agonist (-erol) Bronchodilators
Effect od adrenaline without unwanted SE
relaxes muscles surrounding small airways
short acting as a rescue drug like albuterol or long acting routine like Formoterol
Anticholinergic Bronchodilators
Atrovent and Spiriva
blocks acetylcholine to prevent airways from narrowing
Corticosteroid Bronchodilators
interfere with the inflammatory process to open airways
long term usage has serious SE though
Beta Agonist, Anti Cholinergic, Corticosteroids Bronchodilators all cause…
airway opening with the difference being how fast it occurs
Other medications for COPD
anxiolytics
antibiotics
steroids
diuretics
calcium channel blockers
anti coagulants
MRC Breathlessness Scale
Quantifies breathlessness related to activities
1 means not troubled and 5 means breathlessness
underused but can quantify how someone is doing
