resp 4

Question 1

COPD history

Answer 1

• age, gender, occupational history, fy history
• smoking hx
• breathing problems (when talking) other triggers
• cough/sputum when greatest (smokers morning)
• unplanned wt loss
• orthopnea, wheezing (not crackles)

Question 2

orthopnea

Answer 2

breathlessness worse when lying down

Question 3

COPD clinical manifestations- appearance

Answer 3

-thin w muscle mass loss in extremities w enlarged neck muscles, stooped forward bending (orthopneic or tripod), bathing and grooming neglected, barrel chest, cyanosis, clubbing, edema

Question 4

COPD clinical manifestations- respiratory changes

Answer 4

-rapid, shallow resp, accesory muscle use, asymmetric chest expansion, limited diaphrgmatic movement (excursion), fremitus decreased, fatigue

Question 5

COPD lab assessment

Answer 5

• oxygen decreases (hypoxemia) and CO2 increases (hypercarbia)
• chronic resp acidosis leads to metabolic alkalosis
• not all CO2 retainers
• polycythemia-compensatory increase in RBCs and iron in chronically hypoxic pt
• low phosphate, potassium, calcium, and mag
• serum AAT w fy hx

Question 6

COPD lung volumes measured

Answer 6

-VC/vital capacity, RV/residual volume (most important), FEV/forced expiratory volume, TLC/total lung capacity

Question 7

COPD diagnosis

Answer 7

based on FEV1, as disease progresses ratio of FEV1 to FVC becomes smaller
-O2 sat less than 90%

Question 8

COPD emphysema

Answer 8

• alveoli lose elasticity, hyperinflated lung flattens diaphragm, air hunger, inhalation starts before exhalation finished
• panlobular, centrilobular, or paraceptal

Question 9

COPD bronchitis

Answer 9

• bronchioles, not alveoli
• chronic inflammation, thick mucus, impaired airflow
• smoking biggest risk
• resp acidosis-Pao2 level decrease and PaCO2 level increase

Question 10

COPD treatment focus

Answer 10

airway maitenance most important focus of intervention to improve gas exchange, long term treatment

Question 11

COPD non surgical treatment

Answer 11

• breathing tech (diaphragmatic or pursed lip),
• effective coughing (morning, before meals, bedtime)
• fluids (thins mucus, 2-3L day)
• controlled activity/exercise (avoid lifting arms), positioning, use of vibratory positive pressure device

Question 12

COPD oxygen treatment

Answer 12

2-4 LPM via nasal cannula or 40% venti mask

-keep pulse ox between 88-92%

Question 13

COPD drug treatment

Answer 13

Brovana (LABA), Spiriva (LABA), Breo (combo drug)

• takes systemic meds as well->mucolytics, nebulizer
• Guafenesin/ mucinex DM
• stepped therapy

Question 14

COPD surgical treatment

Answer 14

transplant or lung reduction

Question 15

COPD weight loss interventions

Answer 15

• SOB interferes w eating
• increased caloric needs due to metabolism
• small meals, avoid dry foods and drinking before meals
• bronchodilators 30 min and rest prior to eating