Nurse 51 - COPD Flashcards
COPD - where on list of causes of death?
slow progression and obstructive 4th leading cause of death
patho COPD (sCar and Copd)
Airflow limitation is progressive, associated with abnormal inflammatory response to noxious particles or gases
Chronic inflammation damages tissue
Scar tissue in airways results in narrowing
Scar tissue in the parenchyma decreases elastic recoil (compliance)
Scar tissue in pulmonary vasculature causes thickened vessel lining and hypertrophy of smooth muscle (pulmonary hypertension)
cor pulmone - symptoms (my apple core is full and puffy)
puffy, edema in legs, abdominal congestion, can’t eat feel full all the time.
Anorexia
Right abdominal upper quadrant pain
chronic bronchitis definition
Cough and sputum production for at least 3 months in each of 2 consecutive years
Ciliary dont work, bronchial walls thicken, bronchial airways narrow, and mucous may plug airways
Alveoli become damaged, fibrosed, and alveolar macrophage function diminishes
The patient is more susceptible to respiratory infections
smaller airways it’s the bronchiole walls.
3 main symptoms of COPD (and emphysema) (C for cough the sputum, I can’t breathe)
Three primary symptoms
Chronic cough
Sputum production
Dyspnea
Weight loss due to dyspnea
“Barrel chest” (also happens with ocean swimmers)
assess and diagnosis of COPD (what about blood tests?)
Health history, refer to Chart 20-2
Pulmonary function tests
Spirometry
Arterial blood gas
Chest x-ray
complications of COPD
Respiratory insufficiency and failure
Pneumonia
Chronic atelectasis
Pneumothorax (from rupture of bleb) (sudden SOB and pain from where bleb ruptured. sense of impending doom)
Cor pulmonale
medical management of COPD - what about meals? and use inhalers before or after food?
Promote smoking cessation
Reducing risk factors
Managing exacerbations
Providing supplemental oxygen therapy
Pneumococcal vaccine
Influenza vaccine
Pulmonary rehabilitation (small meals, use inhalers before eating, don’t drink too much fluid. don’t get full too fast)
Managing exacerbations.
make them cough.
meds for COPD
Bronchodilators, MDIs
Beta-adrenergic agonists
Muscarinic antagonists (anticholinergics)
Combination agents
Refer to Figure 20-5 and Tables 20-3 and 20-4
Corticosteroids
Antibiotics
Mucolytics
Antitussives (coughing meds)
surgery for COPD (surgery for COPD is bull)
Bullectomy (gets rid of area of alveoli that are pouching out)
Lung volume reduction
Lung transplant (can’t have any comorbidities to be able to get transplant)
management of COPD - and nutrition?
Assessing the patient: obtain history, review diagnostic tests
Achieving airway clearance
Improving breathing patterns
Improving activity tolerance
MDI (meter dose inhaler) patient education
CBC - make surenot anemic
nutrition - albumin and protein
no infections white count
make sure not fluid volume overload -
air open and clear
bronchiectasis - causes - can be genetic or not?
Bronchiectasis is a chronic, irreversible dilation of the bronchi and bronchioles
Caused by:
Airway obstruction, pulmonary infections
Diffuse airway injury
Genetic disorders
Abnormal host defenses
Idiopathic causes
clinical manifestations of bronchiectasis (mucus has clubs too)
Chronic cough
Purulent sputum in copious amounts
Clubbing of the fingers
nursing management of bronchiectasis - and what about energy?
Focus is on alleviating symptoms and clearing pulmonary secretions
Patient teaching
Smoking cessation
Postural drainage
Early signs and symptoms of respiratory infections
Conserving energy
cystic fibrosis - genetic disease of what glands?
Most common autosomal recessive disease among the Caucasian population
Genetic screening to detect carriers
Genetic counseling for couples at risk
Genetic mutation changes chloride transport which leads to thick, viscous secretions in the lungs, pancreas, liver, intestines, and reproductive tract
Respiratory infections are the leading cause of morbidity and mortality
genetic disease of endocrine glands
CF - don’t have normal transport (your fav)
of sodium and water so mucus is really thick. builds up on epithelial. if pancreas doesn’t work we can’t digest food.
CF increase in mucus causes what disease? (big CF, big bronchioles)
bronchiectisis
CF stool
foul smelling and greasy. intestinal blockage, constipation. lungs
management of CF (the pancreas is the conductor of CF)
Chronic: control of infections; antibiotics
Acute: aggressive therapy involves airway clearance and antibiotics based on results of sputum cultures
Anti-inflammatory agents
Corticosteroids; inhaled, oral, IV during exacerbations
Inhaled bronchodilators
Oral pancreatic enzyme (pancralipase) supplementation with meals
Cystic fibrosis transmembrane conductance regulator (CFTR) modulators are a new class of drugs and help to improve function of the defective CFTR protein
nursing management CF
Strategies that promote removal of pulmonary secretions
CPT (chest PT) and breathing exercises
Remind patient to reduce risk factors for resp infection
Adequate fluid and electrolyte intake
Palliative care
Discuss end-of-life issues and concerns
usually on re`sp isolation
CF symptoms (CF clubs, too)
fatigue, chronic cough, recurrent URIs, thick mucus, chronic hypoxia: clubbing barrel chest, low absorption of vitamins and enzymes, abdominal distention, rectal prolapse, stools, poor growth, skin is salty tasting
CF treatment
increased calories and protein, PT therapy, postural drainage, breathing exercises, aerosol therapy
CF meds
antibotics, supplemental vitamins, aerosol bronchodilators, mcuolytics, pancreatic enzymes
risk factors for COPD
Exposure to tobacco smoke
Older adults
Occupational exposure
Pollution
Genetic abnormalities
Refer to Chart 20-1
nursing care for COPD (what’s the incentive with COPD, vibrations?)
Evaluate exposure to respiratory irritants
Nursing interventions to promote oxygenation
Incentive spirometry
Postural drainage
Chest percussion and vibration
Breathing exercises
Administer medications to promote gas exchange and oxygenation
Oxygen
Bronchodilators
sarcoidosis - age (sarcastic granny)
Occurs between 20 and 40 years of age
More common in African American women
Interstitial lung disease that is inflammatory, multisystem, granulomatous with unknown origin (any organ may be affected)
Clinical picture depends on systems affected including dyspnea, cough, hemoptysis, congestion, anorexia, fatigue, and weight loss
diagnosis for sarcoidosis (don’t be sarcastic about biopsies)
Chest x-ray and CT scans
Mediastinoscopy or transbronchial biopsy
Pulmonary function test
Arterial blood gases
Need biopsy for definitive diagnosis
management of sarcoidosis (S for sarcoidosis and S for steroids)
Medical management
Corticosteroids
May have spontaneous remission without treatment
Immune modulator
Nursing management
Support all medical treatments
Patient education for medication and when to notify the primary provider
Chronic illness management
Contact Foundation for Sarcoidosis Research for community resources
pulmonary hypertension - artery or vein?
Vascular disorder of the pulmonary arteries
Characterized by elevated pulmonary arterial pressure
don’t need to know the
different pulmonary hypertensions
pulmonary hypertension manifestation (high blood pressure makes me faint)
Dyspnea with exertion, then at rest
Weakness
Fatigue
Syncope
Occasional hemoptysis
pulmonary hypertension management (think normal hypertension)
Manage underlying cause as per clinical classification
PH (Chart 19-12_
NYHA functional class
Diuretics, oxygen anticoagulation, digoxin, exercise training
Advanced pharmacologic therapy
Lung transplantation
cor pulmonale - causes (tweekers like apple cores)
enlargement of the right side of the heart
Caused by pulmonary HTN from COPD or other risks and disorders
collagen vascular disease, congenital heart disease, portal HTN, HIV infection, COPD, PE and use of stimulants and appetite depressants,
atalectasis symptoms (don’t lay down) and hypoxia or hypoxemia? (air is coming in, it’s just not moving)
dyspnea (shortness of breath), cough, and sputum production. difficulty breathing in the supine position and are anxious. can cause pulmonary infection. HYPOXEMIA.
PEEP - used for what? (my peeps have atelectisis on expiration) and is it inspiratory or expiratory?
a simple mask and one-way valve system that provides varying amounts of expiratory resistance. used when other measures to prevent atelectisis don’t work
acute tracheobronchitis - caused by what? (Your trach has strep)
acute tracheobronchitis, the inflamed mucosa of the bronchi produces mucopurulent sputum, usually caused by strep. can be fungal.
tracheobroncitis symptoms (dinosours start small and get bigger with fevers)
dry, irritating cough and expectorates a scanty amount of mucoid sputum. The patient may report sternal soreness from coughing and have fever or chills, night sweats, headache, and general malaise. As the infection progresses, the patient may be short of breath, and produce purulent (pus-filled) sputum.
Pseudomonal pneumonia - occurs in what pts?
occurs in patients who are debilitated, those with altered mental status, and those with prolonged intubation or with tracheostomy
Staphylococcal pneumonia - how is it spread? is it dangerous?
inhalation of the organism or spread through the hematogenous route. It is often accompanied by sepsis and positive blood cultures. Its mortality rate is high
what precautions for MRSA
contact
Pneumonia affects both (not inspiration)
both ventilation and diffusion
how to wean off vent
Removal from the ventilator, tube, and then oxygen
most serious complication of flu
staphylococcal pneumonia
signs of strep pneumonia
sudden onset of chills, rapidly rising fever (38.5° to 40.5°C [101° to 105°F]), and pleuritic chest pain that is aggravated by deep breathing and coughing. The patient is severely ill, with marked tachypnea (25 to 45 breaths/min),
bradycardia may be viral or bacterial?
viral infection
other signs of pneumonia - what is a late sign for anything…
orthopnea, late is cyanosis, sputum usually purlent
what disease to use a broncosopy?
severe pneumonia
warm inhalents for what?
pneumonia
dont forget
early ambulation with pneumonia, even older pts.
severe complications of pneumonia
septic shock and respiratory failure
empyema
empyema occurs when thick, purulent fluid accumulates within the pleural space,
bacterial pneumonia symptoms (bacteria is giving me chills and night sweats)
fever chills night sweats pleuritic pain
nursing management pneumonia - just breathing what?
encourage breathing exercises
kidneys excrete
hydrogen ions, and retains bicarbonate
upper respiratory infections end in
itis
pneumonia - simple
excess fluid in lungs due to inflammation. can be bacterial, viral, or fungal.
pneumonia - simple - alveoli
fluid in alveoli causes thickening of alveolar walls. this causes impaired gas exchange.
pneumonia - simple - diagnosis - (xray the pneumonia)
chest xray, which will show consolidation. encourage coughing and deep breathing. incentive spirometer.
test for TB
mantoux and sputum culture
asthma
airways become inflamed, narrow and swell, and produce extra mucus
bronchectisis - and what causes it? (and the big one)
airways of the lungs become widened, leading to a build-up of excess mucus that can make the lungs more vulnerable to infection. caused by infection or medical condition, such as pneumonia or cystic fibrosis.
lung abscess - who gets it and what causes it? (1 each)
pts at risk for aspiration. usually a complication of pneumonia.
lung abscess sounds
pleural friction rub, dullness on percussion (due to fluid). maybe crackles.
Sarcoidosis
Sarcoidosis is a type of interstitial lung disease that is also an inflammatory, multisystem, granulomatous disease
pleural effusion causes - just everything that causes fluid (water on my heart with TB and pneumonia)
heart failure, TB, pneumonia, pulmonary infections
ARDS definition
Acute respiratory distress syndrome (ARDS) occurs when fluid builds up in the alveoli. in critically ill or severe injuries.
danger with drowning
Acute respiratory distress syndrome
most important equiptment with mechanical ventilation?
Manual resuscitation bag, pulse ox
physical symptoms with CF - (sweat, heart, and lungs red roses)
diaphoretic, tachypnea, wheezing.
pulmonary hypertension risk factors (tweek is hyper during PE)
Risk and contributing factors include: collagen vascular disease, congenital heart disease, portal HTN, HIV infection, COPD, PE and use of stimulants and appetite depressants,
pulmonary hypertension patho (and end result)
dysfunction of endothelium and vascular smooth muscle.
vascular becomes increasing ”stiff” if can no longer handle the blood volume and the pressure in the arteries increases.
The pulmonary and PVR increases and affects the right ventricle. Right ventricular failure results due to hypertrophy.
bronchectisis - treatment
Postural drainage
Chest physiotherapy
Smoking cessation
avoid ppl with infections
bronchectisis meds - how often?
Antimicrobial therapy (daily usually)
Bronchodilators and mucolytics
trachiobronchitis - noisy on inspiration or expiration? and what type? (dinosaurs stride in, and wheezy out)
have noisy inspiration and expiration (inspiratory stridor and expiratory wheeze),
