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N353: Practice of Nursing II > MedSurg Mod 6: Nursing Care in COPD > Flashcards

MedSurg Mod 6: Nursing Care in COPD Flashcards

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1
Q

___ is the primary risk of COPD

A

smoking (85-90%)

male smokers 12x and women 13x more likely to die from COPD as men who have never smoked

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2
Q

COPD is the ___ leading cause of death in America

A

3rd

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3
Q

COPD includes __ and __

A

bronchitis and emphysema

usually it is mixed but many have a predominance of one as well

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4
Q

S/S of Bronchitis

A

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

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5
Q

S/S of EmPhysema

A

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

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6
Q

Blue Bloater

A

Bronchitis

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7
Q

Pink Puffer

A

Emphysema

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8
Q

What occurs in COPD starting with chronic airway obstruction

A

Chronic airway obstruction –> airway collapse or inflammation –> bronchospasm, swelling, and excess mucus

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9
Q

With COPD what basically occurs with air

A

AIR GETS IN BUT CANNOT GET OUT (because exhaling is usually passive so its harder to work when things are obstructed)

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10
Q

Risk factors for COPD

A

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

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11
Q

___ is the leading preventable cause of death in the US

A

smoking

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12
Q

Smoking causes more deaths each year than what combined

A

HIV

illegal drug use

alcohol use

motor vehicle injuries

firearm accidents/incidents

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13
Q

__% of all deaths from COPD are due to smoking

A

80%

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14
Q

What occurs if you quit smoking

A

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

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15
Q

What is as equally dangerous as smoking?

A

Second Hand Smoke

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16
Q

What allows for rapid nicotine distribution and what occurs when used?

A

smoking and vaping

it increases the addiction index and peaks and dissipates quickly meaning they want a lot fast - Sharp peak and sharp dissipation

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17
Q

How does nicotine addiction activate reward pathways

A

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

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18
Q

Nicotine withdrawal is not ___ and no __ __

A

pleasant and well understood

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19
Q

What is the strong behavioral component of nicotine addiction

A

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

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20
Q

Strategies for Smoking Cessation

A

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

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21
Q

EVALI: E Cigarette or Vaping Product Associated Lung Injury

A

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

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22
Q

Triad of COPD symptoms

A
  1. Increased sputum production
  2. Cough (bronchitis) - intermittent, usually in AM< expectorate small amounts of STICKY mucus
  3. dyspnea on exertion (emphysema) - gradually worsens and interferes with ADLs
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23
Q

Diagnostic Tests and Results for Bronchitis

A

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

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24
Q

Diagnostic tests and Results for Emphysema

A

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

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25
Q

6MWT

A

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

26
Q

Complications and Consequences of COPD

A

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

27
Q

General Goals for COPD Medical Treatment

A

Early diagnosis

prevent further deterioration

alleviate symptoms

improve ability for ADLs and QOL issues

28
Q

general Strategies for COPD Medical treatment

A

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

29
Q

Nursing Goals for COPD

A

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

30
Q

Nursing Diagnosis for the SOB of COPD

A

impaired gas exchange

impaired airway clearance

ineffective breathing pattern

31
Q

Nursing Diagnosis for the depression of COPD

A

ineffective coping

32
Q

Nursing Diagnosis for the weight loss of COPD

A

imbalanced nutrition: less than body requirements

33
Q

Nursing diagnosis for the anxiety of COPD

A

knowledge deficit

34
Q

What to assess for with COPD regarding respiratory status

A

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

35
Q

Education Ideas for COPD patients

A

avoid pulmonary irritants and extremes of temperature

humidifier at night to mobilize secretions

encourage smoking cessation

encourage pursed lip breathing

36
Q

Pursed Lip Breathing

A

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

37
Q

Net Result of Pursed Lip Breathing

A

decreases work of breathing

conserves oxygen

releases trapped air

38
Q

Assessments and Interventions for Nutritional Status of COPD patients

A

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

39
Q

A person with COPD can burn __x as many calories breathing as a healthy person does

A

10x

40
Q

Assessments and Interventions for the Activity level of a COPD patient

A

assess self care and activity tolerance

pulmonary rehabilitation

maintain a level of physical activity

encourage self care

allow for adequate rest

41
Q

Assessments and interventions for the skin of a COPD patient

A

assess redness and sponginess

moisturize

reposition

monitor for breakdown - cheeks and ears if using O2

42
Q

Assessments and interventions for the coping of a COPD patient

A

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

43
Q

General Education points for COPD Patients

A

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

44
Q

What to educate COPD regarding personal infection control strategies

A

avoid large groups and peoples with URIs

good oral hygiene to reduce migrating infection

45
Q

What to educate COPD regarding maintain high resistance

A

adequate rest

balanced diet

limiting stress

avoid exposure to dampness, cold, drafts

46
Q

What to educate COPD regarding early recognition/treatment of respiratory infection

A

increased dyspnea

increased fatigue

chest tightness

increased sputum

47
Q

What to educate COPD regarding developing energy conserving strategies

A

tripod sitting (sitting forward to open chest up and allow expansion)

adequate rest periods

48
Q

What to educate COPD regarding importance of immunization

A

pneumOcoccal ( Once in a decade)

influenzA (Annually)

49
Q

What to educate COPD regarding maintain adequate nutrition

A

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

50
Q

What to educate COPD regarding safety with home O2 use?

A

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

51
Q

What is the point of giving bronchodilators to COPD patients

A

Relaxes muscles surround smaller airways

a hallmark treatment

52
Q

What to educate about Bronchodilator use?

A

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

53
Q

How to correctly use a metered dose inhaler

A

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

54
Q

Why should you NOT do 2 immediate puffs with inhalers and bronchodilators

A

the second one is basically wasted so take a break inbetween

55
Q

Why is it important to use a spacer with an inhaler using corticosteroids

A

steroids can develop around the mouth and cause thrush or yeast infection - so use a spacer

56
Q

Benefit of spacer

A

can take mult breaths in spacer so you dont have to coordinate press down and breath in

57
Q

Beta Agonist (-erol) Bronchodilators

A

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

58
Q

Anticholinergic Bronchodilators

A

Atrovent and Spiriva

blocks acetylcholine to prevent airways from narrowing

59
Q

Corticosteroid Bronchodilators

A

interfere with the inflammatory process to open airways

long term usage has serious SE though

60
Q

Beta Agonist, Anti Cholinergic, Corticosteroids Bronchodilators all cause…

A

airway opening with the difference being how fast it occurs

61
Q

Other medications for COPD

A

anxiolytics

antibiotics

steroids

diuretics

calcium channel blockers

anti coagulants

62
Q

MRC Breathlessness Scale

A

Quantifies breathlessness related to activities

1 means not troubled and 5 means breathlessness

underused but can quantify how someone is doing

N353: Practice of Nursing II (14 decks)

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