OXYGENATION - COPD

Question 1

What is COPD?

Answer 1

An obstruction of the airway which narrows over time causing an airflow obstruction and an abnormal response of the lungs to gases.

Question 2

True or False: COPD is reversible.

Answer 2

False.

Question 3

What does progressive means?

Answer 3

Damage advances slowly, and that it cannot be reverted to the
normal state, even with medical management (irreversible).

Question 4

What are the structures affected by the COPD?

Answer 4

Proximal airways (trachea and
bronchi > 2 mm in diameter)

Peripheral airways (bronchioles
< 2 mm diameter)

Alveoli ducts and alveoli

Question 5

What happens in the proximal airways in COPD?

Answer 5

Increased numbers of goblet cells

and enlarged submucosal glands which results to increased mucus secretion.

Question 6

What happens in the peripheral airways in COPD?

Answer 6

Thickening of the airway wall, peribronchial fibrosis and

exudates in the airway leading to airway narrowing.

Question 7

What happens in the alveoli ducts and alveoli in COPD?

Answer 7

Damage and enlargement of
alveolar wall and
loss of elastic recoil

Question 8

True or False: The ongoing injury-and-repair process causes scar tissue formation and narrowing of the airway lumen.

Answer 8

True.

Question 9

What are the disease associated with COPD?

Answer 9

Chronic Bronchitis

Emphysema

Question 10

Is asthma considered as under COPD? Why?

Answer 10

No. AZTH is reversible.

Question 11

What is the characteristic of chronic bronchitis?

Answer 11

Inflammation of bronchi resulting to large amount of mucus secretion and obstruction.

Question 12

What is the characteristic of emphysema?

Answer 12

Abnormal enlargement of alveoli with the

destruction of alveolar walls.

Question 13

True or False: High lung compliance results to

destruction of alveolar walls and hyperinflation of the alveoli

Answer 13

True.

Question 14

What are the sequence of assessment?

Answer 14

a) History taking
b) Physical Examination
c) Diagnostic Examination

Question 15

What should you determine in the history taking?

Answer 15

Determine the etiology or the cause of the health problem

Question 16

Define the sx of COPD.

Answer 16

Dyspnea
Sputum production
Cough
These occur for at least 3 months in each of 2 consecutive year

Question 17

How is sputum produced?

Answer 17

produced when the goblet cells are irritated by smoke, causing an increase in sputum production.

Question 18

How does smoking affect the cilia?

Answer 18

Smoke paralyzes
the cilia, it the cilia cannot perform its role of filtering the gasses that
enters the upper respiratory tract. C

Question 19

What is the defense mechanism of the RT for increased mucus secretion?

Answer 19

Cough.

Question 20

What is cough?

Answer 20

Cough is a reflex that protects the lungs from accumulation

of secretions or inhalation of foreign bodies.

Question 21

If the cough is not managed, what would happen?

Answer 21

Dyspnea

Question 22

Dyspnea on exertion (DOE) results from

Answer 22

Inadequate
oxygen that enters during inspiration and the accumulation
of carbon dioxide (CO2).

Question 23

As the COPD progresses, what are its other sx?

Answer 23

Weight loss
Risk for respiratory insufficiency and respiratory infections
Barrel chest in emphysema

Question 24

Barrel chest is caused by _____.

Answer 24

chronic hyperinflation leads to Barrel chest” thorax configuration. The chronic hyperinflation of
the alveoli and loss of lung elasticity leads to a more fixed position of the ribs in the inspiratory position.

Question 25

True or false: In assessing the past history, one should use retrospective approach.

Answer 25

True.

Question 26

What is the purpose of assessing the past history?

Answer 26

Determine the risks/etiology of COPD.

Question 27

What are the risk factor of COPD?

Answer 27

Environmental factors (External)  Tobacco Smoke- active and passive smoking (80-90% of COPD cases)  Occupational exposure (dust, chemicals)  Air pollution Genetic - alpha 1 antitrypsin deficiency

Question 28

Where is the alpha 1 antitrypsin produced?

Answer 28

Liver

Question 29

What is the function of alpha 1 antitrypsin?

Answer 29

protects the lungs from neutrophil elastase (enzyme that digests damaged or aging cells and bacteria to promote healing).

Question 30

What happens when there is a deficiency in AAT?

Answer 30

Neutrophil elastase enzyme to attack the healthy lung tissue

Question 31

AAT testing is recommended for _____.

Answer 31

Pt with a diagnosis of COPD or adult-onset asthma (WHO)

Question 32

True or False: Subjective and objective data is needed for initial dx.

Answer 32

True.

Question 33

What is the characteristic of cough and sputum that the nurse must observe?

Answer 33

Color and consistency of sputum and amount

Question 34

What is the characteristic of other body parts during dyspnea that the nurse must observe?

Answer 34

``` Rapid and shallow breathing Increase RR Use of accessory muscles  Flaring of alai nasi  a rise in sternocleidomastoid muscles  intercostal retraction Cyanosis-late sign ```

Question 35

What is PE technique to identify emphysema and bronchitis?

Answer 35

Auscultation

Question 36

During auscultation, _____ in emphysema can be heard.

Answer 36

Faint and inaudible breath sounds

Question 37

During auscultation, _____ in bronchitis can be heard.

Answer 37

Wheezes, crackles

Question 38

Define the role of dx exam.

Answer 38

Confirm the impression or initial dx

Question 39

What is the The GOLD international advise for dx COPD?

Answer 39

Spirometry is he gold standard for accurate | and repeatable measurement of lung function.

Question 40

How is bronchodilator reversibility test performed?

Answer 40

Spirometry is initially performed The patient is given an inhaled bronchodilator treatment Spirometry is repeated.

Question 41

What is the abnormal result of bronchodilator reversibility test?

Answer 41

FEV1/FVC ratio of < 70% means that there is the presence of airflow limitation after an inhaled bronchodilator, showing a degree of irreversibility.

Question 42

Whys is ABG is obtained?

Answer 42

Arterial blood gas (ABG) is obtained to assess baseline oxygenation and gas exchange

Question 43

Whys is chest X-ray is obtained?

Answer 43

to exclude alternative diagnoses. Contraindicated in pregnant women

Question 44

Screening for alpha1-antitrypsin deficiency may be performed for patients ________?

Answer 44

Younger than 45 | years of age and those with a strong family history of COPD

Question 45

What is the first step in the management of patients with COPD?

Answer 45

correct diagnosis

Question 46

What are the general management for COPD?

Answer 46

smoking cessation prescribing medications oxygen therapy

Question 47

What is the action of bronchodilators?

Answer 47

relieve bronchospasm and reduced airway obstruction

Question 48

What is the action of corticosteroids?

Answer 48

anti inflammatory

Question 49

What is the action of antibiotics?

Answer 49

infection/anti microbial

Question 50

Mucolytic and antitussive

Answer 50

liquefies secretion and cough suppressant

Question 51

Antitussives aluminum nitroxide – prevents side effects of corticosteroid – ranitidine.

Answer 51

True. If oral corticosteroid, antitussive should also be oral

Question 52

Side effects of corticosteroids

Answer 52

Increase blood sugar Weight gain Gastric irritation – medication given after eating

Question 53

What happens when pt is in prolonged inhaler?

Answer 53

dryness of the oral mucosa and irritation of the throat: advise patient to gargle

Question 54

Impaired gas exchange can be used if

Answer 54

the oxygen saturation is low or there is data from arterial blood g

Question 55

Ineffective breathing pattern

Answer 55

used if RR, abnormality In breathing, accessory muscles

Question 56

Ineffective airway clearance

Answer 56

client is unable to remove the secretion