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
Common adverse effects of SABAs and LABAs
Palpitations, tachycardia, insomnia, irritability, tremors, hypokalemia
Common adverse effects of anticholingergics
xerostomia, metallic taste, HA, cough
Common adverse effects of theophylline
atrial and ventricular arrhythmias, grand mal convulsions, HA, nausea
Common adverse effects of inhaled corticosteroids
Oral candidiasis, skin bruising
Common adverse effects of Phosphodiesterase-4 inhibitor (PDE4)
Nausea, wt loss, diarrhea, headache, abd pain
What drug class is Roflumilast in?
PDE4
Drug classes used in COPD tx
- bronchodilators (beta agonists), anticholinergics, steroids, PDE4 inhibitors, methylxanthines
Discharge goals for COPD
- ventilation/oxygenation adequate to meet self care goals
- nutritional intake meeting caloric needs
- infection treated/prevented
- disease process/prognosis and therapeutic regimen understood
- plan in place to meet needs after discharge
Asthma definition
Chronic inflammatory disease of the the airways. Tracheobronchial tree has increased responsiveness to various triggers.
Signs and Symptoms of Asthma
- Expiratory wheezing, prolonged expiration
- recurrent nonproductive cough
- chest tightness
- SOB with activity or at rest
- diminished breath sounds
- tachycardia, tachypnea
- accessory muscle use
Asthma treatment
- Avoid triggers
- Airway maintenance and coughing techniques
- O2
- Bronchodilators
- Flu and pneumococcal vaccines
- corticosteroids
- luekotriene modifiers
- Anti-IgE antibody
- Allergen immunotherapy
Asthma: Nursing Care
- Educate pt about avoiding triggers
- administer O2
- increase fluids to thin secretions
- teach cough enhancing techniques
- teach about peak flow meter use
- teach about use of metered dose or dry powder inhalers
- anxiety reduction and rest during acute attacks
- educate about exercise regimen
Explain the pathophysiology of asthma
Hyperresponsiveness of the lower airways occurs as a result of an inflammatory response to a trigger. The inflammatory response causes the release of chemical mediators histamine, leukotrienes, and prostaglandins. It also leads to bronchoconstriction, vascular congestion, edema, and formation of thick mucous. This leads to airway obstruction. With long term inflammation airway remodeling occurs.
Asthma: Diagnostic tests
ABGs, SpO2, Hgb, Hct, Chest radiography, sputum samples, PERF
Asthma: Risk factors/Causes
- genetic
- allergen exposure
- pollution
- tobacco smoke
Asthma: potential complications
- respiratory acidosis
- cardiac dysrhythmias
- cardiopulmonary arrest
- chronic obstruction to airflow
