Transition COPD Flashcards
Wheeze
narrowed airway
Coarse Crackle vs Fine Crackle: Early or Late
Coarse crackles = early inspiration, harsh, moist, popping, air is being moved through fluid filled large airway
Fine crackles = late inspiration, air moving across fluid filled alveoli
DZ’s 88% SpO2 acceptable?
Yes - COPD
Elevated HR and BP cause for DZ?
compensatory for not getting oxygen
Hypoxemia vs Hypoxia?
Emia = blood: needs ABG to show
Hypoxia = low oxygen: no labs can show - monitor
Prioritize orders:
Diet as tolerated
Out of bed w/1P
O2 to maintain 90%
IV D5W
ECG
ABGs
Sputum culture
Nebulizer tx
Chest xray
- O2
- Neb tx (albuterol + ipatropium)
3.. EKG (tele monitor) - IV + fluids
- Chest Xray (order)
- Blood work (draw)
- Perform assessment
- Sputum culture (maybe while neb)
- Diet/meal
- Up w/1P
3 Independent nursing actions to be taken to help his O2
- Positioning = High Fowlers with arms resting
- Pursed lip breathing: keeps airways stay open longer, rid trapped air, improve capillary-membrane gas exchange
- Calming techniques - reduce anxiety: reduce stimulation
Solu-Medrol (generic)
Methylprednisolone
Methylprednisolone expected outcome for DZ
Glucocorticoid
Decrease inflammation in his lungs
Easier gas exchange
Zithromax (generic)
Azithromycin
Azithromycin
Broad spectrum
Macrolide abx: inhibit bacterial protein synthesis - reducing ability to reproduce/grow
Community acquired pneumonia
good for COPD peeps because: hemophilus, streptococcus
PO would be best on empty stomach
AE:
- liver problems
- GI upset
- superinfection
- photosensitivity
- Long QTC problems
Advair (generic)
Fluticasone + salmeterol
Fluticasone
Steroid for inflammation
Salmeterol
Long acting Beta agonist
Open airways
Advair is a maintenance drug for preventing bronchospasms
Vasotec (generic)
Enalapril
Enalapril
Hypertension maintenance
Albuterol
Beta agonist bronchodilator = relax airways
Ipratropium
Anticholinergic bronchodilator
Dry up secretions and
increase ciliary movement to clear secretions
Glucophage (generic)
Metformin
Metformin
Biguanide
AE: Need good kidneys to work; must have lactic acid to work
Heparin
Due to COPD and possible infection, decreased mobility may result in blood clots and DVT/PE
Precautions for Zmax
- I&O
- ABX can affect renal function: assessments (labs)
- Admin over 60 minutes for 500mg+
- Oral, IV, opthal, no IM
- No need to check hearing
- monitor site for extravasation
- liver function and bilirubin checks (labs)
- carefully dilute
Common AE of bronchodilator therapy
- tremors
- tachycardia
- anxiety
- nausea
- palpitations (SNS stim)
- paradoxical bronchospasm
- insom
- excitation
- irritability
- HA
4 interventions to increase caloric intake
- Eat slowly
- Encourage rest periods before meal
- refer dietician
- High nutrient intake in easy to eat, low energy meals
- Liquids after meal
- Eat when energy levels high
- Small meals, high nutrient density
- Limit sodium and caffeine as they make you thirsty, drink more, fill up, eat less, dehydrate, thicken secretions
