Obstructive Pulmonary 2

Question 1

What are some causes of COPD

Answer 1

cigs
recurrent resp infecitons
urban air pollution
genetic deficiency in a1-antitrypsin

Question 2

Is it common to have both emphysema and chronic bronchitis

Answer 2

yes but one will dominate the other

Question 3

What is needed to diagnose chronic bronchitis

Answer 3

Excess bronchial mucus with cough for at least 3 months during two successive years.

Question 4

What are the manifestations of Cor pulmonalee

Answer 4

JVD
hepatomegaly with URQ tenderness
ascites, peripheral edema and weight gain
epigastric distress

Question 5

What are some management strategies with cor pumonale

Answer 5

low flow O2
salt restriction and diuretics
digitalis if they have CHF

Question 6

What are some complications of COPD

Answer 6

Resp tract infection
Peptic Ulcer Dis
GERD
Pneumonia

Question 7

Why is peptic ulcer dis a possible complication of COPD

Answer 7

bec of long term steroid use

Question 8

Why is GERD a possible comp for COPD

Answer 8

it may be associated with hiatal hernia

Question 9

What is a special consideratioin with pneumonia infections with COPD

Answer 9

its symptoms (fever, chills, and leukocytosis) may not appear

Question 10

What interventions are part of the collaborative care for COPD

Answer 10

annual pneumococcal and flu vaccines 
quit smoking 
treating resp infections quickly 
bronchodilator therapy
O2 therapy 
postural drainage

Question 11

What are some considerations for safe O2 therapy for COPD pts

Answer 11

bec their drive is on O2 now, limit flow to 2-3L, aim for O2 >90%, if O2 keeps falling risk it and increase the O2 flow `

Question 12

What position do drains the anterior upper lungs

Answer 12

supine with knees bent

Question 13

What position drains the posterior upper position

Answer 13

slightly leaned foward sitting in a chair so maybe have them sit in a chair with the back rest on their front side

Question 14

What position drains the apical upper

Answer 14

supine fowlers

Question 15

What position drains the lingula and right m (right on the nipple)

Answer 15

SIMs trendelenburg

Question 16

What position drains the superior lower

Answer 16

prone, arms above head, pillow under stomahc

Question 17

What positioni drains the lateral basal lower

Answer 17

lateral trendelenburg

Question 18

What position drains the anterior basal

Answer 18

lateral trendelenburg with top arm resting above the head

Question 19

What positioin drains the posterior basal lower

Answer 19

prone trendelenburg, arms above head

Question 20

What is a big goal for COPD pats

Answer 20

ability to do ADL’s

Question 21

What are some teaching points for optimising ADL’s for COPD

Answer 21

get physical therapy like strengthening arms bec eventually chair bound
keep nutrition up
poss use bronchodi’s before meals and have small meals
build up activity tolerance with consistent activity for 15-20 mins 3 times weekly (make sure its not strenuous)

Question 22

What are some secual activity recommendations for COPD

Answer 22

dont right after eating or strenuous activity
dont assure top position
dont prolong foreplay

Question 23

In order to get an accurate reading for PFT’s what is a guideline for meds

Answer 23

no bronchodilators for 6hrs before

Question 24

What are some psychological problems COPD might be suseptable to

Answer 24

guilt 
depression 
aniety 
social isolation 
denial 
dependence

Question 25

What are some interventions for psycho probs with COPD

Answer 25

relaxation techniques

social groups

Question 26

What goals for COPD

Answer 26

effective coughing
normal breath sounds
return of PaO2 to normal range for patient
improved mental status

Question 27

What are some COPD meds

Answer 27

Advair diskus
nebulisers
bronchodilators

Question 28

What are some considerations for advair diskus

Answer 28

inhale rapidly so it doesnt stick onto tongue
dont shake bc its dry powder
no spacers
dont cough or huff after inhaling-let it settle

Question 29

When doing chest physiotherapy what are some considerations

Answer 29

use bronchodi’s before
cough after done
remain in positions for min 5 min
dont perform 1hr bef or 3hrs after

Question 30

What is never a good solution for stress for COPD

Answer 30

sedation

Question 31

What is the procedure for pursed lip breathing

Answer 31

Inhale slowly through nose. Do not puff cheeks. Relax cheeks. Practice by blowing through a straw

Question 32

What is the goal of pursed lip breathing

Answer 32

3:1 ratio of inspiration to expiration

Question 33

How does a flutter airway clearance device work

Answer 33

breathing through it causes the ball to vibrate and causes a back up of pressure that keeps the bronchi open for longer and the vibrations help to loosen mucus

Question 34

What is cystic fibrosis and how to get it

Answer 34

Autosomal recessive disease 1 in 4 both parents have to have it

Question 35

What are manifestations of cystic fib in newborns

Answer 35

Meconium ileus (obstruction)
failure to grow 
clubbing of fingers 
persistent cough with mucous production 
Tachypnea 
Large frequent BM

Question 36

What are the manifestations of cystic fib for adults

Answer 36

Cough (first sign) becomes productive with purulent green mucous.
Increasingly recurring lung infections with periods of stabilization
can have distal bowel obstructions (RLQ pain N/V. Anorexia)

Question 37

What is the definitive diagnoostic test for cystic fib

Answer 37

sweat chloride test

Question 38

What are some unique considerations for cystic fib

Answer 38

hot weather, ecercise and fevers can cause sweating and fluid loss so intake more fluids and salt so that secretions stay thinner

Question 39

What is bronchiectasis

Answer 39

bronchial tubes are permenantly damaged, widdened and thickened

Question 40

What are the manifestations of bronchiectasis

Answer 40

chronic daily cough
bloody cough
coughing up larger amounts of mucus