Oxygenation: COPD

Question 1

Kyphosis

Answer 1

hunching over

Question 2

Pulmonary Changes in OA

Answer 2

• reduced pulmonary reserve
• decreased cough reflex with risk of aspiration pneumonia
• increased risk of infection and bronchospasm with ariway obstruction
• thinning of alveoli

Question 3

COPD

Answer 3

chronic, progressive, lung disease

• # 1 cause: smoking
• irreversible
• developes over many years

Question 4

Small Airway Disease

Answer 4

• airway inflammation
• airway fibrosis, luminal plugs
• increased airway resistance

Question 5

Parenchymal Destruction

Answer 5

• loss of alveolar attachments

- decrease of elastic recoil

Question 6

COPD: Prevention

Answer 6

• decrease exposure to second hand smoke
• decrease occupational respiratory irritants
• decrease air pollutants

Question 7

which population has increased risk of COPD

Answer 7

hispanics

• education levels
• alcohol and substance abuse

Question 8

Pulmonary Functional Testing

Answer 8

FEV, FVC

Question 9

FVC

Answer 9

forced vital capacity

-the maximal amount of air that can be rapidly and forcefully exhaled from the lungs after maximal inspiration

Question 10

FEV

Answer 10

forced expired volume

-achieved in one second, the volume of air expired in the first second of FVC

Question 11

Proof of Obstruction

Answer 11

FVC is less than 70%, normal is more than 70%

Question 12

Serum Alpha1

Answer 12

antitrypsin levels

-protects lungs from injury

Question 13

Polycythemia

Answer 13

increased number of RBC’s

Question 14

Bacterial Infection normally shows….

Answer 14

increased WBC count and higher % immature WBCs

Question 15

ABG’s

Answer 15

arterial blood gas

-evaluates gas exchange especially during COPD exacerbations

Question 16

Chronic Bronchitis

Answer 16

marked hypoxemia and hypercapnia with respiratory acidosis

Question 17

Emphysema

Answer 17

mild obstruction

-normal or low carbon dioxide tension

Question 18

Chest X-Rays: bronchitis

Answer 18

larger white areas: secretions are present or fluid retention

Question 19

Chest X-Rays: emphysema

Answer 19

• small white patches: hyper-inflated alveolar sacs filled with secretions
• flattening of the diaphragm: hyperventilation and evidence of pulmonary infection

Question 20

Pulse O2 for COPD

Answer 20

less than 95%, severe is less than 90%

Question 21

Main Goal for COPD

Answer 21

promote oxygen

Question 22

Bronchodilators (4)

Answer 22

• albuterol
• ipratropium bromide
• salmeterol
• theophylline

Question 23

Albuterol

Answer 23

most used, short acting

Question 24

Ipratropium Bromide

Answer 24

anticholinergic agent by MDI, longer duration

Question 25

Salmeterol

Answer 25

long acting beta2 agonist, can be given with corticosteriod to reduce risks of cardiac side effects

Question 26

Theophylline

Answer 26

weak bronchodialator, not used often, narrow therapeutic range

Question 27

Cough Suppressants

Answer 27

usually ineffective

Question 28

Sedatives

Answer 28

generally avoided, may cause retention of secretions, decreased respirations

Question 29

Vasodilators and Mucosurpressant and COPD....

Answer 29

not recommended

Question 30

Pulmonary Rehabilitation

Answer 30

- exercise training | - aerobic exercise, walking 20min at least 3 times a week

Question 31

Oxygen Therapy

Answer 31

CAUTION!! too much oxygen will have reverse effect, monitor closely, only use in later stages -MAX 2L/min

Question 32

Surgery

Answer 32

LAST RESORT - bullectomy - lung reduction surgery - lung transplant

Question 33

Bullectomy

Answer 33

removing enlarged alveolar air spaces, compress lung tissues

Question 34

Lung Reduction Surgery

Answer 34

removes non functional lung areas, improves survival for more than 50 months

Question 35

Lung Transplant

Answer 35

single/bilateral transplants, increases survival rate of 75% to 2 years (NOT OFTEN)

Question 36

Dietary Measures: COPD

Answer 36

- reduce diary products and salt - need protein, high fat, low carbs - hot herbal teas with peppermint RELIEVE chest congestion

Question 37

Need for Protein

Answer 37

patients burn a lot of calories trying to breath, thats why the need for high protein is important

Question 38

Promote Airway Clearence

Answer 38

fowlers, high fowlers, encourage coughing and deep breathing at least q2hrs

Question 39

Enhance Breathing Pattern

Answer 39

pursed lip breathing, abdominal breathing/diaphragmatic breathing, relaxation techniques

Question 40

5 R's

Answer 40

- Relevance to quit smoking - Risks of using tobacco - Rewards of quitting - Roadblocks to quitting - Repetition with each new encounter with the patient

Question 41

STAR quit plan

Answer 41

- Set a quit date (2 weeks from decision) - Tell family - Anticipate challenges - Remove all tobacco products

Question 42

What do you give first?

Answer 42

Bronchodilator to open airway, then give broad spectrum antibiotic for infection