Unit 4 Resp Flashcards
COPD is
Progressive, Preventable, Chronic inflammation or airway and lungs, persistent airflow limitations
When someone has COPD and inhale chemicals what happens
Chronic inflammation response
Carbon monoxide attaches to what in COPD
hgb limiting gas exchange (gas tripping)
What does nicotine do
vasoconstriction and hypertension
Cellular hyperplasia causes
excess mucous production
Muscous blocks airway causing
obstruction
Obstructions lead to
Alveolar dilation
Long term hyperinflation of the alveoli causes
Thoracic remodelling
Parenchymal destruction
Imbalance between proteinase and antiprotenase.
Pulmonary Vascular changes COPD
Thick vessels, inflammatory cells infiltrate Collagen deposit, destruction of capillary bed
Emphysema
Emphysema is a lung disease that results from damage to the walls of the alveoli in your lungs. A blockage (obstruction) may develop, which traps air inside your lungs. If you have too much air trapped in your lungs, your chest may appear fuller or have a barrel-chested appearance.
What happens to the Alveoli with COPD
Abnormal permanent enlargment of air spaces distal to the terminal bronchioles accompanied by the destruction of alveoli
Impaired gas exchange
-Progresses for years
-Alveoli walls become over-distended, increase in dead space, CO2 retention, increased CO2, resp acidosis, decreased O2. (hypoxia
Diagonising COPD
Chronic productive cough lasting at least 3 months in 2 consecutive years
what does AAT do
Protein in the blood that protects the lungs from damage caused by activated enzymes. Labratory tests measure the level of AAT in blood or identify abbnormal forms of AAT that a person has inherited to help diagnose alpha 1 antitrypsin
Subjective questions to ask patients with COPD
Current reason for seeking care, related illness, other health history, medications, pain, risk factors, family history
Signs and Symptoms
Cough (esp morning), Characteristic of sputum, smoking history, recurrent resp infections, SOB/SOBOE/ADL limit, nutritional deficiency, disabling dyspnea
How to calculate packs per year
Multiply number of cigarette packs smoked daily by number years smoked (Pack-year history)
Vitals for COPD
Increased Pulse
Increased resp
Increased BP
lower O2
Higher pain
Inspection for COPD
SOB/SOBOE, Cynosis, tripod positioning, purse lip breathing, accessory muscle use, barrel chest, malnutrition
Palpate
loss of muscle mass, lower limb deem, Tachycardia, tactile fremits
Why would lungs sound dull
Air or fluid in or around the lungs (such as pneumonia, heart failure, and pleural effusion) Increased thickness of the chest wall. Over-inflation of a part of the lungs
Why would someone have hyper resonance
air has filled the space around your lungs and is prohibiting them from expanding fully
What will you hear when auscultating the lungs of someone with COPD
-Prolonged expiration, wheeze, crackles, decreased breath sounds
Lab tests for people with COPD
Inflammatory cascade, ABG;s, RBC’s, Alpha 1-Antitrypsin
Diagnostic test
CXR, Sputum C and S, Spirometry/PFT’s, Exercise tolerance test, ECG, Cardio ECHO
With infection what are blood results going to look like
-High WBC
-High RBC
-Low hemoglobin
-high hemotocrit
-High Neurtrrophils
-High lymphocytes
Arterial blood gases
Measures, acidity, level of oxygen, level of carbon dioxide, check how well lungs move oxygen into the blood and remove carbon dioxide from the blood
What to expect for people with COPD when getting Arterial blood gases
-low pH
-low PaO2
-High PaCO2
-High HCO3
-Low O2
Mild spirometry
SOB on mild exertion
Moderate Spirometry
SOB after 100 meters
Severe spirometry
SOB housebound, Resp failure, Right heart failure
Complications with COPD
-Pulmonary hypertension
-Hypercapnia
-Cor pulmonale
-Malnourishment
-Reccurent infections
-Osteoporosis
-anemia
-depression
-cardiovascular disease
-oxygen toxicity
Bronchodilators
decrease broncho spasm
Corticosteroids
decreased inflammation
Referrals for COPD
pharmacy, social work, cardiac rehab, live well with chronic disease, respology, Resp therapy, Dietician, Home O2 program
Teach
smoking cessation, med use scheduled, rescue, O2 therapy, exercise, nutrition/fluids, ADL
SOS for SOB
-Stop and rest
-head down
-Shoulders down
-Breath in through mouth
-Blow out through mouth
-Breathe in and blow out as fast as necessary
-Blow out longer not forcefully
-Begin to slow your breathing
-Diaphragm breathing
-Stay in position for 5 mins
Pursed lips
-Breath in slowly for 1 count
-purse your lips as if you were going to whistle
-Breath out gently through pursed lips for 2 slow counts
-Let the air escape naturally don’t force the air out of your lung.
Diet for COPD
-Nutritent dense
-small volume
-multiple small meals
-Increased fluids
-daily weights
Difference between asthma and COPD
Asthma: Airways (Reversible)
-Airway hyper responsiveness
-airway obstruction
COPD: Airways and Lung (Non reversible)
-Airway obstruction
-Emphysema
What can affect sleep quality
-Sleep disorder
-abN resp problems with sleep
-Snoring
-Apnea
-Retained CO2
-Frequent waking
-Daytime fatigue
Lack of sleep effects
-cognitive impairment
-behaviour changes
-Impaired function
-Heart disease
-Increased BP
-Stroke
-Increased obesity
-GERD
Obstructed sleep Apnea (OSA)
Partial or complete upper airway obstruction during sleep creating periods of apnea
(Muscles in the back of your throat relax, Airway narrows or closes lowers the oxygen levels, brain senses the inability to breath -Briefly roused from sleep to reopen airway. Snort, choke, gasp, Impaired ability to reach REM Sleep
STOP BANG
Snoring (do you snore), Tired (during day) , Obstruction (stop breathing while sleeping), Pressure (high?)
BMI (Greater then 28), Age (greater then 50, Neck greater then 43, Greater then 41cm, Gender male
Diagnosis factors for Sleep apnea
More then 5 apnea/hypopnea per hour, at least 10 seconds, corresponding decrease in O2 sats by minimum 3%
Sleep apnea effect on health
-sleep deprivation
-increased risk for cardiovascular event
-MI
-Dysrhythmia
-CVA
-HTN
-Increase injury risk
Oral appliance used for sleep apnea
-Mandibular advancement device
-It forces lower jaw forward and down slightly, bringing tongue and tissue down as well, keep airway open
CPAP
-Delivers air pressure through a mask
-The air pressure splints the airway open
Uvulopalatopharyngoplasty
-Tonsillectomy
-Trimming tonsillar pillars
-Excision of the uvula and posterior palate
Teaching for Sleep Apnea
-Weight loss, sleep on side not back, wide or more pillow
Asthma path
-increased airway resistance
-smooth muscle bronchospasm
-destruction of lung tissue
-Combination of any/all
(hear weases)
-recurrent/chronic
-sudden
-inflammatory
-triggers
-Inflammatory response
Bronchospasm
Smooth muscle contraction
Early Asthma
Exposure = permeability
-IgE, Mast Cells, Histamine
-Mucous/Thick sputum
-Wheeze/SOB/Tightness
Late asthma
Inflammation: limits airway diameter and increases airflow resistance
(Eosinophil, basophils neutrophil, more mast cells, histamine, inflammation)
Cough variant asthma
usually exercise induced, limited bronchospasm/edema, irritation not outgrow
Assesss triad
- known diagnosis of asthma
- presence of nasal polyps
- NSAID sensitivity (Increase bronchospasm)
NSAID
Non-steroidal anti-inflammatory drugs
Examples of NSAIDS
ibuprofen.
naproxen.
diclofenac.
celecoxib.
mefenamic acid.
etoricoxib.
indomethacin.
aspirin for pain relief (low-dose aspirin is not normally considered to be an NSAID)
Warning signs of an asthma attack
-Headache, stuffy nose, sore throat coughing or wheeze after exercise, difficulty sleeping, feeling moody irritable, tiredness or weakness during activity
Symptoms of asthma attack
chest tightness, coughing (at night or when laughing), difficulty breathing, SOB, Sleep problems resulting from issues, a wheezing sound in chest when exhaling
If someone who is having an asthma attack stops wheezing what is happening
airway blockage
Lab tests to do for someone with asthma
WBC, differential, Arterial blood gas, CO2 will be high because they are getting enough oxygen but cannot get rid of O2
Diagnostic tests
-Pulmonary function tests
-CXR
-allergy testing
-symptom tracking
What lab values will be abnormal
Eosinophils, basophils because Sometimes your body produces these immune cells in higher amounts. They overreact and can cause inflammation in the body, including in the lungs. And swelling in the airway
Medications for Asthma attack
Rescue inhaler (Ventolin), Bronchodilators, inhaled steroids
Goal of medications
-reduce inflammation, reduce mucous production, reduce bronchospasm
