Obstructive Pulmonary 2 Flashcards
What are some causes of COPD
cigs
recurrent resp infecitons
urban air pollution
genetic deficiency in a1-antitrypsin
Is it common to have both emphysema and chronic bronchitis
yes but one will dominate the other
What is needed to diagnose chronic bronchitis
Excess bronchial mucus with cough for at least 3 months during two successive years.
What are the manifestations of Cor pulmonalee
JVD
hepatomegaly with URQ tenderness
ascites, peripheral edema and weight gain
epigastric distress
What are some management strategies with cor pumonale
low flow O2
salt restriction and diuretics
digitalis if they have CHF
What are some complications of COPD
Resp tract infection
Peptic Ulcer Dis
GERD
Pneumonia
Why is peptic ulcer dis a possible complication of COPD
bec of long term steroid use
Why is GERD a possible comp for COPD
it may be associated with hiatal hernia
What is a special consideratioin with pneumonia infections with COPD
its symptoms (fever, chills, and leukocytosis) may not appear
What interventions are part of the collaborative care for COPD
annual pneumococcal and flu vaccines quit smoking treating resp infections quickly bronchodilator therapy O2 therapy postural drainage
What are some considerations for safe O2 therapy for COPD pts
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 `
What position do drains the anterior upper lungs
supine with knees bent
What position drains the posterior upper position
slightly leaned foward sitting in a chair so maybe have them sit in a chair with the back rest on their front side
What position drains the apical upper
supine fowlers
What position drains the lingula and right m (right on the nipple)
SIMs trendelenburg
What position drains the superior lower
prone, arms above head, pillow under stomahc
What positioni drains the lateral basal lower
lateral trendelenburg
What position drains the anterior basal
lateral trendelenburg with top arm resting above the head
What positioin drains the posterior basal lower
prone trendelenburg, arms above head
What is a big goal for COPD pats
ability to do ADL’s
What are some teaching points for optimising ADL’s for COPD
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)
What are some secual activity recommendations for COPD
dont right after eating or strenuous activity
dont assure top position
dont prolong foreplay
In order to get an accurate reading for PFT’s what is a guideline for meds
no bronchodilators for 6hrs before
What are some psychological problems COPD might be suseptable to
guilt depression aniety social isolation denial dependence
What are some interventions for psycho probs with COPD
relaxation techniques
social groups
What goals for COPD
effective coughing
normal breath sounds
return of PaO2 to normal range for patient
improved mental status
What are some COPD meds
Advair diskus
nebulisers
bronchodilators
What are some considerations for advair diskus
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
When doing chest physiotherapy what are some considerations
use bronchodi’s before
cough after done
remain in positions for min 5 min
dont perform 1hr bef or 3hrs after
What is never a good solution for stress for COPD
sedation
What is the procedure for pursed lip breathing
Inhale slowly through nose. Do not puff cheeks. Relax cheeks. Practice by blowing through a straw
What is the goal of pursed lip breathing
3:1 ratio of inspiration to expiration
How does a flutter airway clearance device work
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
What is cystic fibrosis and how to get it
Autosomal recessive disease 1 in 4 both parents have to have it
What are manifestations of cystic fib in newborns
Meconium ileus (obstruction) failure to grow clubbing of fingers persistent cough with mucous production Tachypnea Large frequent BM
What are the manifestations of cystic fib for adults
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)
What is the definitive diagnoostic test for cystic fib
sweat chloride test
What are some unique considerations for cystic fib
hot weather, ecercise and fevers can cause sweating and fluid loss so intake more fluids and salt so that secretions stay thinner
What is bronchiectasis
bronchial tubes are permenantly damaged, widdened and thickened
What are the manifestations of bronchiectasis
chronic daily cough
bloody cough
coughing up larger amounts of mucus
