Respiratory COPD Flashcards
COPD is?
emphysema and/or bronchitis (most patients have both)
COPD obstructs?
expiratory airflow
What are these signs and symptoms of?
feelings of not having enough air to breathe, progressive dyspnea and fatigue.
COPD
what are pathologic changes that occur to the airways of patients with COPD?
lung parenchyma & the vasculature
COPD: inflammation and narrowing of the airways leads to?
loss of pulmonary function, lung destruction, and impaired gas exchange. (increased mucus-producing cells, chronic inflammation in varying parts of the lungs, structural changes that result in a cycle of destruction and repair - airflow limitation, more susceptible to infection)
COPD: respiratory infections is the leading cause of?
exacerbations.
___________ is when air sacs or alveoli become enlarged with lack of structure in the lung when breathing occurs.
emphysema
What are emphysema breath sounds?
Diminished.
areas of destroyed alveoli are called?
bullae
the blebs which make up the bullae are fragile and susceptible to injury, possible _________, which is one of the complications for ______________.
pneumothorax,
end-stage emphysema
___________ is the presence of cough and sputum production for at least 3 months in each of two consecutive years.
bronchitis
Bronchitis: b/c of chronic inflammation and mucus hyper secretion lung function?
declines with repeated infections and exacerbations
Bronchitis causes __________ of the airways, which causes the airway lumen to become smaller, which predisposes the patient to have repeated episodes of ____________.
remodeling,
bronchospasm
Major modifiable risk factor for COPD?
exposure to smoke!
What are the three categories of risk assessment for smokers?
smokers, non-smokers(quit), and never smokers.
20 - 30 % of smokers have?
COPD
What irritates the airways and results in mucus hyper secretion and airway inflammation?
smoking
Smoking paralyzes the mucociliary escalator, which inhibits?
expectoration of mucus.
What is an example of COPD that is a non modifiable risk factor?
Alpha 1 Antitrypsin Deficiency - genetic leads to liver and lung disease.
_______ inhibits/protects the lungs from injury?
A1AT
Alpha 1 Antitrypsin can be?
treated if diagnosed (only 5% have been ID’ed)
What is the treatment for alpha 1 antitrypsin?
Reducing risk and aggressive treatment of URI; Augmentation therapy, infusions of the human protein from donors.
Other non-modifiable factors of COPD:
prematurity, age-related changes to the respiratory system
comorbid conditions, co-existing disorders of COPD:
asthma, OSA, pulmonary fibrosis, bronchiectasis, HF, CVD, PVD, stroke, anxiety, and depression.
_____________ is abnormal widened bronchioles related to infection.
bronchiectasis
COPD: Systemic functions affected are r/t?
hypoxemia and lack of tissue perfusion
COPD: Skeletal functions affected?
muscle weakness, anorexia, cachexia(wasting), decreased muscle mass, barrel chest
COPD: Cardiovascular functions affected?
cor pulmonale, arrhythmias
COPD: Neurologic functions affected?
changes in cognitive function r/t brains affinity for oxygen, insomnia, sleep disturbances
COPD: Psychiatric functions affected?
anxiety, depression
COPD: Endocrine functions affected?
side effects from medications, Cushing’s syndrome r/t corticosteroid treatment.
COPD: End-stage lead to problems with gas exchange which can lead to?
respiratory failure.
Two predictors of disease progression for COPD?
increased frequency of exacerbations and weight loss.
Leaning forward, arms braced, maximizing pulmonary expansion is called?
tripod position
End-stage COPD:
- impaired gas exchange
- chronic hypoxemia
- hypercapnia
- respiratory failure
_________ _________ is suspected in patients with extreme dyspnea and fatigue.
pulmonary hypertension
Chronic hypoxia leads to?
pulmonary arterial narrowing of the vessels and remodeling.
Pulmonary artery constriction, resistance to blood flow leads to
increased workload on right ventricle.
When the right ventricle is compensating for pulmonary artery constriction; over time it will ________ and ________ causing _____ ___________ ____________.
This type of side sided heart failure is called?
enlarge and dilate.
right ventricular hypertrophy
cor pulmonale
What are these S/S related to:
- fluid is evident, systemically.
- JVD
- abdominal distention (ascites)
- hepatomegaly and peripheral edema
- pulmonary embolus
cor pulmonale
COPD: diagnostic tests
- pulmonary function tests
- spirometry
- chest x-ray
- CT
- EKG
- CBC
- BNP
Pulmonary function tests are used to?
help confirm the diagnosis, determine severity, and monitor progression.
PFTs are not performed in the acute setting, or on admission with?
exacerbation
Spirometry is used to evaluate _________ __________, and compared to normal values for age, gender, race, weight, and height.
airflow obstruction
With obstruction the patient has difficulty ________ or cannot forcibly ______ ____ from lungs.
- exhaling
- exhale air
Obstruction reduces?
forced expired volume in one second (FEV1)
Lung obstructive disease is defined as?
FEV1 of less than 80% OR a ratio of FEV1/FVC of <70%
When lung function declines and the FEV1 is less than 50%, the COPD is classified as?
severe.
ABG measurements obtained to assess?
baseline oxygenation and gas exchange
ABG measurements on admission with?
exacerbation to determine severity
ABG’s are not usually repeated if?
the patient responds clinically with improvement to the treatment.
ABG’s will be drawn to evaluate treatment if?
intubated and on a ventilator
A PaO2 < and PaCO2 > indicates respiratory failure.
For a COPD patient this can be acute or chronic
PaO2 < 60%
PaCO2 > 50%
A chest x-ray is obtained to establish?
patients baseline and to exclude alternative diagnosis.
A chest x-ray is seldom diagnostic in COPD unless?
obvious bullous emphysema disease
bullous are?
large, air filled “blisters”
With severe hyperinflation what is present?
a flat diaphragm
Chest x-rays a more commonly used in? why?
exacerbations, to determine if the patient has abnormalities such as infiltrate, pneumothorax or a concomitant lung mass.
CT scan of the chest may be done to rule out?
a differential diagnosis of PE.
1 in 5 patient with COPD exacerbation have a?
PE
EKG is useful to evaluate any ________ or __ ___________.
- ischemia
- RV hypertrophy
(P Pulmonale - p wave depression inferior leads)
Telemetry is used to monitor for?
arrhythmias
CBC/diff to r/o?
infection
BNP levels increase from?
FVO cardiac ventricles: HF r/t PHTN and RVH
COPD patients live with?
hypoxia
Key symptoms for COPD?
dyspnea, cough and sputum production
WOB means
work or breathing
Nursing process to determine the plan of care for the COPD patient ID and prioritize these problems:
- impaired gas exchange
- ineffective breathing pattern
- ineffective airway clearance
- activity tolerance
- nutrition (less than body requirement)
Impaired gas exchange intervention:
oxygen therapy - goal to maintain tissue oxygenation and decrease the work of the cardiopulmonary system
Impaired gas exchange s/s:
SOB, tachypnea, tachycardia, or increased B/P
O2 parameters for a COPD patient?
greater than or equal to 90%
Ventri mask is?
precise and controlled delivery.
Higher levels of oxygenation than needed can lead to?
hyperoxia and risk of increasing hypercapnia and respiratory acidosis.
COPD patients drive to breathe is?
hypoxia
Ineffective breathing pattern intervention:
- Positioning - allow patient to find the most comfortable position to move the air in and out of the lungs.
Ex: semi-fowlers w/arms support by pillows, or tripod. - Pursed-lip breathing (PLB)
- Fans and relaxation techniques.
What helps slow exhalation and is thought to prevent the collapse of the small airways, effectively allowing more air to be exhaled, decreasing hyperinflation and CO2 retention?
pursed-lip breathing
Ineffective airway clearance intervention:
managing coughing and secretions
Managing coughing and secretions can be accomplished by?
- teaching techniques such as controlled cough, HUFF cough x 3
- adequate fluid intake
- nebulizer bronchodilators and monolytics (mucomyst or pulmozyme)
- acapella and CPT
Activity Intolerance intervention:
Exercises - to do in bed or in a chair (while exhaling through pursed lips) to improve exercise tolerance and conserve energy
Corticosteroid treatment side effects:
muscle weakness, osteoporosis and thromboembolism! (contributes to condition of activity intolerance)
Nutrition intervention:
adequate PO intake and calories. Dietician will be needed for COPD patients.
BMI should be between:
20 - 25
end-stage COPD patients experience weight loss and anorexia due to?
fatigue, increased work of breathing and hypermetabolism. **Weight gain improves exercise capacity.
strategies for COPD patients needing more nutrients for a high metabolism:
- nutritional supplements
- administer bronchodilators before meals or wear oxygen during meal
- eat small frequent meals
- intake of fluids should be outside of meal time
- choose calorie rich foods.
Theobromine is a bronchdilator and is found in?
dark chocolate
Goals for nursing management of COPD:
manage symptoms, maximize function and teach patient skills of self-care
Vaccinations:
Flu, Pneumococcal
obstruction of the airways leads to alveolar collapse: the result of infections, viral or bacterial, with increased production of mucus and congestion is called?
atelectasis
what is often the presenting problem with COPD exacerbation?
Pneumonia (which is a complication of atelectasis)
Pulmonary hypertension and chronic hypoxia lead to?
cor pulmonale
With severe emphysematous changes, bullae may rupture requiring a chest tube this is a?
pneumothorax (less common complication)
short term acting medications are used as?
preventative when anticipating SOB with activities, meal, etc.
long term acting medications are?
preferred they are around the clock like COPD!
bronchodilators are mostly delivered via?
inhalation route its faster.
corticosteroids need to be weaned off to prevent?
adrenal suppression.
inhaled corticosteroids steroids require rinsing are use to decrease?
oral thrush
medications primarily used for patients with COPD?
aerolizer - formoterol (Foradil) LABA
Handihaler - tiotropium (Spiriva) long term acting anticholinergic.
Adverse effects on the body from e-cig:
- immunosuppression
- popcorn lung
- MRSA infections
Smoking history is usually expressed in?
packs/years
Pulmonary rehab goals:
- to reduce symptoms
- optimize functional ability
- improve quality of life
long-term oxygen therapy decreases?
breathlessness
long-term oxygen therapy improves?
- exercise capacity and endurance
- cognitive performance
- sleep quality
- preserve organ function: brain, heart, lungs
A bullectomy may be necessary if bullae is?
compressing against healthier lung sacs resulting in impaired gas exchange.
lung volume reduction surgery is usually for patients with?
severe emphysema.
thoracic lung surgery that involves removal of a portion of the diseased lung parenchyma improvement %?
10%
what is an alternative for end-stage COPD?
lung transplant surgery
what is is the specific criteria for referral for lung surgery?
- based on age and prognosis.
- limited organ availability
- single lung transplants
- < 65 yrs, no major organ dysfunction, substance free, no obesity or malignancy
Grade dyspnea:
Not troubled by breathlessness except with strenuous exercise.
Grade 0
Grade dyspnea:
Troubled by SOB when hurrying on a level path or walking up a slight will.
Grade 1
Grade dyspnea:
Walks more slowly on a level path because of breathlessness than do people of the same age or has to stop to breathe when walking on a level path at his own pace.
Grade 2
Grade dyspnea:
Stops to breathe after walking about 100 yards (91m) on a level path.
Grade 3
Grade dyspnea:
Too breathless to leave the house or breathless when dressing or undressing.
Grade 4
Name this disorder:
Tactile fremitus: Increased
Percussion: Dull
Auscultation: Bronchial breath sounds, crackles, bronchophony, egophony, whispered pectoriloquy
consolidation (ex: pneumonia)
Name this disorder:
Tactile fremitus: Normal
Percussion: Resonant
Auscultation: Normal to decreased breath sounds wheezes
Bronchitis
Name this disorder:
Tactile fremitus: Decreased
Percussion: Hyperresonant
Auscultation: Decreased intensity of breath sounds, usually prolonged with expiration
emphysema
Name this disorder:
Tactile fremitus: Normal to decreased
Percussion: Resonant
Auscultation: Wheezes
Asthma (SEVERE ATTACK)
Name this disorder:
Tactile fremitus: Normal
Percussion: Resonant
Auscultation: Crackles at lung bases, possibly wheezes
Pulmonary edema
Name this disorder:
Tactile fremitus: Absent
Percussion: Dull
Auscultation: Decreased to absent breath sounds, bronchial breath sounds and bronchophony, egophony, and whispered pectoriloquy above the effusion one the area of compressed lung.
Pleural effusion
Name this disorder:
Tactile fremitus: Decreased
Percussion: Hyperresonant
Auscultation: Absent breath sounds
Pneumothorax
Name this disorder:
Tactile fremitus: Absent
Percussion: Dull (if large)
Auscultation: Decreased to absent breath sounds, fine crackles
Atelectasis
