Oxygenation: COPD Flashcards
Kyphosis
hunching over
Pulmonary Changes in OA
- reduced pulmonary reserve
- decreased cough reflex with risk of aspiration pneumonia
- increased risk of infection and bronchospasm with ariway obstruction
- thinning of alveoli
COPD
chronic, progressive, lung disease
- # 1 cause: smoking
- irreversible
- developes over many years
Small Airway Disease
- airway inflammation
- airway fibrosis, luminal plugs
- increased airway resistance
Parenchymal Destruction
- loss of alveolar attachments
- decrease of elastic recoil
COPD: Prevention
- decrease exposure to second hand smoke
- decrease occupational respiratory irritants
- decrease air pollutants
which population has increased risk of COPD
hispanics
- education levels
- alcohol and substance abuse
Pulmonary Functional Testing
FEV, FVC
FVC
forced vital capacity
-the maximal amount of air that can be rapidly and forcefully exhaled from the lungs after maximal inspiration
FEV
forced expired volume
-achieved in one second, the volume of air expired in the first second of FVC
Proof of Obstruction
FVC is less than 70%, normal is more than 70%
Serum Alpha1
antitrypsin levels
-protects lungs from injury
Polycythemia
increased number of RBC’s
Bacterial Infection normally shows….
increased WBC count and higher % immature WBCs
ABG’s
arterial blood gas
-evaluates gas exchange especially during COPD exacerbations
Chronic Bronchitis
marked hypoxemia and hypercapnia with respiratory acidosis
Emphysema
mild obstruction
-normal or low carbon dioxide tension
Chest X-Rays: bronchitis
larger white areas: secretions are present or fluid retention
Chest X-Rays: emphysema
- small white patches: hyper-inflated alveolar sacs filled with secretions
- flattening of the diaphragm: hyperventilation and evidence of pulmonary infection
Pulse O2 for COPD
less than 95%, severe is less than 90%
Main Goal for COPD
promote oxygen
Bronchodilators (4)
- albuterol
- ipratropium bromide
- salmeterol
- theophylline
Albuterol
most used, short acting
Ipratropium Bromide
anticholinergic agent by MDI, longer duration
Salmeterol
long acting beta2 agonist, can be given with corticosteriod to reduce risks of cardiac side effects
Theophylline
weak bronchodialator, not used often, narrow therapeutic range
Cough Suppressants
usually ineffective
Sedatives
generally avoided, may cause retention of secretions, decreased respirations
Vasodilators and Mucosurpressant and COPD….
not recommended
Pulmonary Rehabilitation
- exercise training
- aerobic exercise, walking 20min at least 3 times a week
Oxygen Therapy
CAUTION!! too much oxygen will have reverse effect, monitor closely, only use in later stages
-MAX 2L/min
Surgery
LAST RESORT
- bullectomy
- lung reduction surgery
- lung transplant
Bullectomy
removing enlarged alveolar air spaces, compress lung tissues
Lung Reduction Surgery
removes non functional lung areas, improves survival for more than 50 months
Lung Transplant
single/bilateral transplants, increases survival rate of 75% to 2 years (NOT OFTEN)
Dietary Measures: COPD
- reduce diary products and salt
- need protein, high fat, low carbs
- hot herbal teas with peppermint RELIEVE chest congestion
Need for Protein
patients burn a lot of calories trying to breath, thats why the need for high protein is important
Promote Airway Clearence
fowlers, high fowlers, encourage coughing and deep breathing at least q2hrs
Enhance Breathing Pattern
pursed lip breathing, abdominal breathing/diaphragmatic breathing, relaxation techniques
5 R’s
- Relevance to quit smoking
- Risks of using tobacco
- Rewards of quitting
- Roadblocks to quitting
- Repetition with each new encounter with the patient
STAR quit plan
- Set a quit date (2 weeks from decision)
- Tell family
- Anticipate challenges
- Remove all tobacco products
What do you give first?
Bronchodilator to open airway, then give broad spectrum antibiotic for infection
