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Chronic Alterations: Exam 1 > Module 3: Respiratory Disorders > Flashcards

Module 3: Respiratory Disorders Flashcards

1
Q

Chronic Obstructive Pulmonary Disease (COPD)

A

Respiratory disease characterized by airflow limitation and inflammation that is progressive and not fully reversible; it is usually a combination of emphysema and chronic bronchitis

Characteristics:

  1. Slow progression of disease
  2. Exacerbation caused by triggers (i.e. Infection, inhalation/exposure, poor air quality)

Caused by:

  1. Smoking (80-90%)
  2. Occupational dust and chemicals, outdoor air pollution, and secondhand smoke
  3. Alpha-1 antitrypsin deficiency (enzyme made in the liver that provides lungs protective properties)

Risk factors:

  1. Secondhand smoke
  2. Delayed lung growth during gestation and childhood
  3. Aging
  4. Airway hyperactivity (i.e. Asthma)
  5. Alcohol consumption
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2
Q

Emphysema

A

Destruction of alveoli; the air sacs of the lungs are damaged and enlarged

Pathophysiology of emphysema: Inhaled particles breakdown elastin, resulting in decreased alveolar recoil and damage

Characterized by:

  1. Premature collapse of small airways
  2. Air trapping
  3. Decreased gas exchange
  4. Respiratory acidosis
  5. Hypoxemia
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3
Q

Chronic Bronchitis

A

Diagnosis: Presence of cough and sputum production for at least 3 mos. in each of 2 consecutive years

Pathophysiology of chronic bronchitis: Chronic irritant exposure resulting in increased mucus production, thickening bronchial walls, and airway obstruction

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4
Q

COPD: Diagnosis

A

Past & PMHX:

  1. Cough
  2. Dyspnea
  3. Irritant exposure

Physical assessment

Oximetry

Spirometry (PFT) — measures lung volume and air flow:

  1. Forced vital capacity (FVC): amount of forced air exhaled
  2. Forced expiratory volume in 1 second (FEV1): maximum amount of air exhaled in the first second after maximum inspiration (measures the lungs’ ability to empty quickly)
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5
Q

COPD: Laboratory Studies

A

Laboratory studies of COPD:
1. Arterial blood gas (ABG) analysis

  1. Sputum culture (infection-induced exacerbations)
  2. Complete blood count (CBC) — i.e. Elevated WBC count (infection); elevated Hgb (hypoxemia)
  3. Alpha-1 antitrypsin deficiency screening if no other explanation of COPD symptoms
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6
Q

Normal Arterial Blood Gas (ABG) Reference

A

Normal ABG values:
PaO2 = 80-100

PaCO2 = 35-45

pH = 7.35-7.45

HCO3 = 22-26

  • *COPD patients:
    1. Decreased PaO2
    2. Elevated PaCO2
    3. Decreased pH (acidic)
    4. Increased HCO3 (compensatory mechanism)
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7
Q

COPD: Imaging

A

Imaging of patients with COPD:
1. Chest radiography (“gold standard”) — shows hyperinflation and flattened diaphragm

  1. CT scan (not as common) — thickened bronchial walls
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8
Q

COPD: Diagnostic Procedures

A

Diagnostic procedures of patients with COPD:
1. Electrocardiography (ECG) — RV hypertrophy (low oxygen levels cause pulmonary HTN, placing excess strain on the heart’s RV)

  1. Pulmonary function test (PFT) — measure FVC and FEV1
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9
Q

COPD: Physical Findings

A

Early physical findings of patients with COPD:

  1. Hyperinflation
  2. Decreased breath sounds
  3. Wheezes (constricted airways)
  4. Crackles at the lung bases
  5. Distant heart sounds
  6. Decreased diaphragmatic excursion
  7. Increased anteroposterior (AP) diameter

Patients diagnosed with end-stage COPD:

  1. Tripod position
  2. Full use of accessory respiratory muscles
  3. Barrel chest
  4. Pursed-lip expiration
  5. Hoover sign — inward movement during inspiration (implying flat diaphragm)
  6. Cyanosis
  7. Asterixis: tremor of the hand (due to hypercapnia)
  8. Enlarged, tender liver (RHF)
  9. Neck vein distention (RHF)
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10
Q

COPD Staging

A

Grade I (Mild COPD):

  1. Mild airflow limitation
  2. Some chronic cough and sputum production
  3. May/may not be aware of abnormal lung function

Grade II (Moderate COPD):

  1. Worsening airflow limitation
  2. SOB on exertion
  3. Patient seeks medical attention for chronic symptoms or exacerbation

Grade III (Severe COPD):

  1. Further worsening of airflow limitation
  2. Greater SOB and reduced exercise capacity
  3. Repeated exacerbations impact quality of life

Grade IV (Very Severe COPD):

  1. Severe airflow limitation
  2. Quality of life appreciably impaired
  3. Exacerbations may be life-threatening
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11
Q

COPD: Complications

A

Complications of patients with COPD:
1. RHF — the body compensates for decreased oxygen levels by increasing pressure in the arteries and lungs, causing pulmonary HTN; difficulty to send blood to the pulmonary arteries results in RV enlargement and wall thickening

  1. Cor pulmonale — any alteration in the structure and function of the RV caused by a primary disorder of the respiratory system
  2. Arrhythmias — any alteration in structure of the heart causing a change in the heart’s electrical conduction system
  3. Pneumonia — airways swell and become blocked with mucus, making it hard to breathe (leaves the respiratory system more susceptible to infections)
  4. Pneumothorax — damaged lung tissue can cause air to leak into the space between the lungs and chest wall, collapsing the lungs
  5. Severe weight loss and malnutrition — every bit of energy is used to breathe; patients with COPD have very high resting metabolic rates
  6. Osteoporosis — bone loss due to malnutrition, sharing of many risk factors (age, smoking, inactivity), and corticosteroid treatment
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12
Q

COPD: Treatment

A

Goals of COPD treatment:

  1. Assess and monitor the disease
  2. Reduce risk factors
  3. Manage stable COPD
  4. Manage exacerbations

Meds.:

  1. Bronchodilators (i.e. Short and long-acting beta-2 agonists)
  2. ICS if bronchodilators do not work — reduce inflammation, making air flow easier in the lungs
  3. Oxygen therapy
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13
Q

COPD: Oxygen Therapy

A

Oxygen therapy for patients with COPD:

  1. Goal: Achieve an oxygen saturation value >90%
  2. Precautions/complication due to oxygen toxicity
  3. Increased fall risk: Oxygen tubing

Normal lungs: Central chemoreceptors in medulla sense hypercarbia (stimulus to breathe), increasing RR

COPD: Over time, patients with COPD have gradual increase in CO2; there stimulus to breathe is hypoxia

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14
Q

Non-Invasive Positive Pressure Ventilation (NIPPV)

A

Provides continuous positive airway pressure (CPAP), allowing delivery of air and oxygen at a higher volume (and not at a higher oxygen percentage), thus preventing oxygen toxicity

Higher pressure gets past constricted airways, opens the alveoli, and makes it easier to exhale CO2

Considerations:

  1. Skin irritation and breakdown (device-related pressure injury)
  2. Nasal irritation and dryness
  3. Eye irritation
  4. Sinus pain and congestion
  5. Barotrauma: injury caused by a change in air pressure
  6. Gastric distention
  7. Nutrition (NPO status)
  8. Risk for falls
  9. Delirium
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15
Q

NIPPV: Nasal Mask

A

Advantages of NIPVV nasal masks:

  1. Best suited for patients who are cooperative, with low severity of illness
  2. Causes less claustrophobia
  3. Allows for speaking, coughing, and secretion clearance
  4. Decreased emesis aspiration risk
  5. Generally better tolerated

Disadvantages of NIPPV nasal masks:

  1. Increased risk of air leaks from mouth
  2. Limited effectiveness in patients with nasal deformities or blocked nasal passages
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16
Q

NIPPV: Orofacial Mask

A

Advantages of NIPPV orofacial masks:

  1. Best suited for less cooperative patients, with a high severity of illness
  2. Better for patients with mouth-breathing or pursed-lipid breathing
  3. Better for patients without teeth
  4. Provides more effective ventilation

Disadvantages:

  1. Increases claustrophobia
  2. Hinders speaking and coughing
  3. Increased emesis aspiration risk
17
Q

COPD: Nursing Assessment & Interventions

A

Nursing assessment of patients with COPD:

  1. Vitals — Elevated temp. (infection/inflammation), elevated HR (anxiety, hypoxemia, inhaled bronchodilator), varied BP, elevated RR
  2. Cough
  3. Sputum production
  4. Dyspnea
  5. Use of accessory muscles
  6. Ability to talk in full sentences
  7. Pursed-lip breathing
  8. Anxiety

Interventions of patients with COPD:

  1. Med. admin. as ordered (i.e. Bronchodilators & antibiotics)
  2. Provide supplemental oxygen
  3. Provide small, frequent meals with dietary supplements
  4. Position: Semi-fowlers

Monitoring COPD progression:

  1. Green (Good): Patient at baseline (determined by provider)
  2. Yellow (Call provider): Progressively worse SOB, rescue inhaler not as effective, general malaise, or change in nutrition habits
  3. Red (Emergency): Profound SOB (i.e. cannot speak in full sentences), abnormal chest pain, or high fever
18
Q

COPD: Education

A

Education:
1. Breathing techniques (i.e. Pursed-lip breathing)

  1. Activity
  2. Nutrition — small frequent meals (high protein, high caloric); supplements
  3. Inhaled med. admin.; completing full course of antibiotics
  4. Vaccines — Flu (every yr.) and pneumonia (every 5 yrs.)
  5. Symptoms of exacerbation
  6. Coping
  7. Family support
19
Q

Lung Cancer

A

Uncontrolled growth of abnormal cells in the lungs characterized by airway obstruction, and metastasis to thoracic structures, brain, liver, bone, or adrenal glands

Major types of lung CA:

  1. Non-small cell (85-90%)
  2. Small cell: grows and metastasizes quickly (poor 5 yr. survival rate)

Caused by:

  1. Smoking (90%)
  2. Secondhand smoke
  3. Radon exposure
  4. Occupational pollutants
  5. Asbestos

Risk factors:

  1. Smoking (16-fold increase in risk)
  2. Exposure to secondhand smoke or radon gas
  3. Exposure to carcinogenic and industrial air pollutants (i.e. asbestos, arsenic, chromium, coal dust, iron oxides, nickel, radioactive dust, and uranium)
  4. Genetic predisposition
  5. Pulmonary fibrosis
  6. Radiation therapy
20
Q

Lung Cancer: Clinical Manifestations

A

“Hallmark” CM: History of cough that does not go away

Physical findings of patients with lung CA:

  1. Dyspnea
  2. Cough & hemoptysis
  3. Wheezing
  4. Hoarseness
  5. Chest pain
  6. HA (often first sign of metastasis to brain)
  7. Bone pain
  8. Weight loss
21
Q

Lung Cancer: Diagnostic Studies

A

Diagnostics studies of patients with lung CA:
1. Chest X ray

  1. CT
  2. PET scan: identifies areas of hyper-metabolic activity
  3. Sputum for cytology
  4. Bronchoscopy
  5. Mediastinoscopy: needle is inserted into the mediastinum for biopsy
  6. Bone and abdominal scans (metastasis)
22
Q

Lung Cancer: Management

A

Management (Depends on staging, metastases, and patient goals of care):
1. Chemotherapy

  1. Radiation — Palliative or curative (i.e. Shrink tumor pressing against central structures)
  2. Surgery (i.e. Lobectomy, pneumonectomy, or wedge resection) — not curative; it is meant to relieve symptoms
  3. Pain management
23
Q

Lung Cancer: Complications

A

Complications of patients with lung CA:
1. Spread of primary tumors to intrathoracic structures

  1. Metastasis to liver, bone, brain, and/or adrenal glands
  2. Tracheal obstruction
  3. Esophageal compression with dysphagia
  4. Electrolyte imbalances, especially hypercalcemia (bone metastasis)
  5. Phrenic nerve paralysis with hemidiaphragm elevation and dyspnea (upon diaphragmatic obstruction)
  6. Hypoxemia
  7. Anorexia and weight loss, sometimes leading to cachexia
  8. Hypertrophic osteoarthropathy (bone metastasis)
24
Q

Lung Cancer: Nursing Assessment & Interventions

A

Nursing assessment of patients with lung CA:

  1. Vitals — Temp. varies (possible infection), elevated HR (pain, hypoxia), elevated RR (hypoxia), elevated BP (pain), low BP (cachectic, dehydrated, opioid treatment)
  2. Cough, wheezing, hemoptysis
  3. Dyspnea
  4. Chest pain
  5. HA
  6. Bone pain
  7. Nutrition: Appetite/weight
  8. Pain

Interventions of patients with lung CA:

  1. Med. admin. as ordered (i.e. Antibiotics, pain and anxiety meds., antiemetics, bronchodilators)
  2. Provide supplemental oxygen
  3. Provide small, frequent meals with supplements
  4. Position: Semi-fowlers
  5. Meticulous skin care
  6. Mobility
  7. Consult palliative care early and assist with advanced directives as indicated

Chronic Alterations: Exam 1 (5 decks)

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