OSPE Flashcards
What are the symptoms of COPD
Dyspnoea [breathlessness]
a chronic cough
chronic sputum production
barrel chest- hyperinflated
Why is COPD referred to as an “Umbrella term”?
Because COPD patients suffer from both chronic bronchitis and emphysema
What causes COPD?
the most common risk factor is tobacco smoking but occupational exposure [factories, mining, mills] can also contribute. Leads to changes in the structure and function of the lungs.
What is the general pathophysiology of COPD?
Irritation of the airway or alveolar walls leads to release of inflammatory mediators [Neurophil Granulocytes, Macrophages and CD8 T-Lymphocytes] and the release of protease and inactivation of anti-protease enzymes
Development of oxidative stress leading to over-activity and uncontrolled, regular and chronic neutrophil and macrophage activity in lung tissue
~Damage to airway/alveolar walls
~Excessive mucus production
~Lack of opportunity for rest and repair (consider
smoking habit – no rest)
What is the pathophysiology of chronic bronchitis
~Hypertrophy of mucous gland tissue in trachea, bronchi and bronchioles
Thickening of the mucous membrane
~Increased levels of sputum production
~Increase in airways obstruction due to sputum and changes in airway wall structure.
~Increased bronchospasm as a result of intra-airway turbulence
What is the pathophysiology of emphysema
~Destruction of alveolar walls leads to loss of elasticity and support – become “floppy” and prone to collapse during expiration.
~Affects alveoli and terminal bronchioles
Further obstruction to airflow
~Reduction in surface area for gaseous exchange
~Thickening of the respiratory membrane
~Bullae (distended over-large air sacs) reduce overall lung functional volumes
What does COPD stand for?
Chronic Obstructive Pulmonary Disease
What is emphysema?
Destruction of alveoli leading to loss of surface area and reduced gaseous exchange with/without thoracic shape changes
What is Chronic bronchitis?
Presence of a cough and sputum for at least 3 months for 2 consecutive years
What is pulmonary rehab?
multidisciplinary comprehensive intervention for patients with chronic respiratory diseases. The programme has two parts; circuit-based exercise and education /coping techniques
When is COPD normally diagnosed? What is the classic COPD patient?
Long-term smoker/ occupational worker
How is COPD diagnosed?
Pulmonary function tests [PETs] used to evaluate the resp. system. Can help define severity and progression of COPD. FEV1/FVC ratio is equal to or less than 70%
What functional limitations can be caused by COPD?
Breathlessness affects activities of daily living (ADL) SOB on exertion(SOBOE) and in later stages of disease –SOB at rest (SOBAR)
Depression
- Affects over 40% of elderly patients with COPD
- severity is greater in those most disabled by
their condition
- Affects quality of life and ability to perform ADL
Early retirement, activity avoidance and secondary health complications (obesity, osteoporosis)
What does FEV1 stand for?
Forced Expiratory Volume in one second- the volume of air in the first second in a forced expiration
What does FVC stand for?
Forced Vital Capacity- maximum volume of air that can be forced out of the lungs.
What can cause an acute exacerbations of COPD?
- Only 40-50% of exacerbations are primarily caused by a bacterium
- Lifestyle, activity, stress, fatigue, atmospheric conditions and time of year can also play a significant part in them
What is the possible medical management for COPD?
Inhaled bronchodilators [2 types]
Preventers: Corticosteroid and Anticholinergics
Relievers: Beta-2 agonists- short acting or long acting
What are some examples of short term goals for a COPD patient?
Sputum clearance
Control of dyspnoea
Assess ventilation and O2 levels
Assess mobility
What are some examples of long term goals for a COPD patient?
Self-management
Sputum clearance and Breathing Control
Pulmonary rehab MDT
Smoking cessation
What does the educational aspect of pulmonary rehab cover?
What is COPD?Breathlessness management Anxiety management Energy Conservation Chest Clearance Medications Benefits of exercise Management of own condition MDT input from Dietician, OT, Stop Smoking Service, Breathe Easy Group & Expert Patient Programme
What MDT members are typically involved with pulmonary Rehab?
Respiratory Nurses Dieticians Occupational Therapists Stop Smoking Service British Lung Foundation Expert Patient Programme Social Worker (? Caution needed) Pharmacist Consultant Active Case Manager
What can be used to monitor response to exercise?
Modified BORG Scale (0-10) Oxygen Saturations Respiratory Rate Heart Rate Blood Pressure Self-Score (fitness to exercise
What are the contraindications for Pulmonary rehab?
Recent MI (in last 6 weeks) Unstable angina Severe hypoxic lung failure unable to be corrected with supplementary oxygen Uncompensated heart failure Severe psychiatric impairment Patient non-consenting
What are the cautions for Pulmonary rehab?
Very severe COPD (FEV1 <30%) Requirement for ambulatory oxygen (consider number of people in group with oxygen) Cardiac arrhythmia disorders Substance abuse issues Mental health concerns Ongoing metastatic lung disease Epilepsy Heart failure Mobility issues / falls Recent stroke Recent thoracic or upper GI surgery Recent fracture / soft tissue injury Ongoing LBP
What outcome measures can be used to measure physical changes in COPD patients?
Six Minute Walk Test (6MWT)
Incremental Shuttle Walk Test (ISWT)
Timed Up and Go Test (TUG)
Ten Metre Walk Test
What outcome measures can be used to measure psychological/ ADLs changes in COPD patients?
-St George’s Respiratory Questionnaire (SGRQ)
-Chronic Respiratory Disease Questionnaire (CRDQ)
-London Chest Activities of Daily Living Scale (LCADL)
Hospital Anxiety and -Depression Scale (HAD) ?
-Medical Outcomes Short Form 36 Questionnaire (SF-36)
-Patient Health Questionnaire 9 (PHQ-9)
What are the benefits of pulmonary rehab?
- Improved exercise tolerance and quality of life.
- Reduction in healthcare utilisation.
- Greater ability to manage their condition in everyday life
- Increased social interaction
- Reduced hospital admissions
How is pulmonary rehab different from cardiac rehab?
Less intense (work on 2-3 levels above resting Borg rather than maximal heart rate) Rest rather than active recovery Encouragement for patient to set own limits (links with long-term self-management, consider nature of disease) Otherwise, format and structure of group similar
What does a wheeze sound like? What does it suggest?
Continuous high pitched musical tones- caused by Monophonic wheeze is a single obstructed airway (inhaled a pea, small tumour) whereas polyphonic wheeze is due to widespread disease (bronchospasm)
What does a crackle sound like? What does it suggest?
Clicking sounds- fine crackles is the opening of resp. bronchioles and alveoli
coarse crackles is the opening of bronchioles
What does plural rub sound like? What does it suggest?
Creaking or rubbing sound “walking on snow”
What is an MI?
Myocardial Infarction is the irreversible death (necrosis) of heart muscle secondary to prolonged lack of oxygen supply (ischemia).
What is CAD?
Coronary Artery Disease
Who is most likely to suffer an MI?
men (3x more likely), family history of premature coronary heart disease, hypertension, psycho-social stress
What are the risk factors of an MI?
High cholesterol, Smoker, Depression, Physical activity
History, Age, Hypertension, Alcohol, Obesity
What are the contraindications for cardiac rehab?
Unstable angina Uncontrolled arrhythmia Uncontrolled tachycardia (>100bpm) Moderate / severe aortic stenosis Dissecting aneurysm Active thrombophlebitis Active pericarditis / myocarditis Severe uncontrolled hypertension (200/110mmHg) Significant drop (>20mmHg) SBP Symptomatic CCF Resting ST displacement >3mm Uncontrolled metabolic disorders – diabetes, thyroid Poorly controlled mental disturbance Physician decision due to other chronic illness
How long is cardiac rehab?
minimum of two supervised sessions a week; 6-12 weeks are recommended, in community
What are the four stages of cardiac rehab
Step 1- Step change; in hospital [2-5 days/ however long they are in hospital]; “get going” quad exercises; dvt exercises. Try to get them out of bed asap. Important to monitor BP and HR <30 above rest
Step 2- The early post-discharge period- within two weeks discharge. 2/52- non STEMI/ACS 4/52-STEMI 6/52- CABL/valve some exercise; gentle walking 5x week 25-40 mins
Step 3- Structured exercise training with continuing education and psychological support and advice on risk factors
Step 4- Long term maintenance or physical activity and lifestyle change
What is cardiac rehab?
The coordinated sum of activities required to influence favourably the underlying cause of cardiovascular disease, as well as to provide the best possible physical, mental and social conditions, so that the patients may, by their own efforts, preserve or resume optimal functioning in their community and through improved health behaviour, slow or reverse progression of disease