Respiratory Disorders Flashcards
What are risk factors for COPD?
- Irritant exposure (smoking, pollutants)
- Recurrent/chronic respiratory infections
- Genetic factors (Alpha1 Atitrypsin deficiency)
- allergies
What changes occur with COPD?
Airways become inflamed and thickened, excessive mucous production, cilia become impaired (poor mucous clearance), walls of alveoli are damaged (decreased surface area) and airways and alveoli become less elastic. Old air gets trapped in the alveoli d/t narrowing.
Is inspiration or expiration more difficult with COPD?
Expiration
Symptoms of COPD
- cough, sputum production
- expiratory wheezing
- barrel chest, accessory muscle use
- dyspnea, orthopnea
Symptoms of COPD
- cough, sputum production
- expiratory wheezing, diminished breath sounds
- barrel chest (AP to transverse ratio, normally 1:2), accessory muscle use, clubbing
- dyspnea, orthopnea, cyanosis
- tripod positioning, sleeping in a recliner
- pursed lip breathing
- RHF, increased red cells, ruddy skin color
- fatigue, wt loss
- tachypnea
Why can COPD lead to right sided HF (cor pulmonale)?
The changes in pulmonary function increase the pressure in the arteries of the lungs against which the right side of the heart has to pump.
How does the breathing pattern differ in a COPD patient in terms of inspiration and expiration vs. normal
Expiratory phase is prolonged. Normally it is shorter than inspiration.
Tests relevant to COPD
- PFT (FEV1)
- ABG
- CXR
- CBC
- Sputum culture
- ECG
Nursing Actions for COPD
- Maintain airway patency
- Administer SABAs and LABAs, inhaled glucocorticoids, mucolytics, corticosteroids, anticholinergics, and atropine as ordered
- Administer O2 (start low)
- small frequent feedings
- encourage fluids
- monitor breath sounds and ABGs
Client education for COPD
- exposure to pollutants
- smoking cessation
- when to call health care provider
- O2 therapy (risk of combustion and CO2 narcosis)
- breathing retraining (pursed lip, helps open up alveoli)
- coughing
- vaccinations, reduce exposure to infections
When to contact the Dr. for COPD
Exacerbation: Increase in sputum, change in color of sputum, s&s of infection (ie fever)
What does forced expiratory volume (FEV) measure?
The amount of air a person can exhale during a period of time (FEV1=1st second, FEV2=2nd second…)
What does the forced vital capacity (FVC) measure?
the total amount of air exhaled in a forced expiration from a full inspiration
What is the predicted/normal value for the FEV1?
4-6L, should be 80% or more of predicted to be considered normal
Below 1.5L/second for forced expiration is symptomatic of
COPD