Week 1 Flashcards
COPD
A preventable disease characterized by persistent airflow limitation that is usually progressive
COPD Characteristics
Difficulty breathing
SOB
Activity limitations
Skeletal muscle dysfunction
RHF
Secondary polycythemia
Depression
Altered nutrition
COPD Common in Canada?
Population 35 and older - 9.4% (2 million Canadians)
What causes COPD?
- Tobacco Smoke
- Occupational chemicals and dusts
- Infection
- Heredity
- Aging
Physiological changes with COPD
- Chronic inflammation in airways, lung bronchi/alevoli
- Airflow obstruction from mucus and secretion build up
Bullae
Large air spaces in the parenchyma
Blebs
air spaces adjacent to pleurae
Why do ppl with COPD develop pulmonary hypertension?
Pulmonary arteries vasoconstrict from hypoxemia, and thickening of vascular smooth muscle occurs. From loss of alveolar walls surrounding capillaries, pulmonary circulation pressure increases
Systemic changes from COPD
Cachexia (loss of skeletal muscle mass - sarcopenia)
Muscle weakness
Anemia
Anxiety
Depression
C-reactive protein increase
Clinical manifestations with COPD
Cough
Sputum
Dyspnea
Diminished breath sounds
Hypoxemia
Clinical manifestations of asthma
<40 years
Not casual smoking but can be a trigger
Intermittent and variable symptoms
Infrequent sputum
Allergies often
Stable disease course with exacerbations
What FEV1/FVC ratio establishes the diagnosis of COPD?
Less than 70%
How are pulmonary function tests (PFTs) conducted?
Spirometer is used
Age, sex, height, and weight are entered into the PFT computer to calculate the predicted values
Patient takes deep breath and exhales hard and fast as long as possible
Computer calculates achieved vs wanted
FVC
Amount of air that can be quickly and forcefully exhaled after maximum inspiration
FEV1
Amount of air exhaled in the first second of FVC; valuable clue to severity of airway obstruction
FEV1/FVC
Ratio of value for FEC1 to value for FVC; useful in differentiating obstructive and restrictive pulmonary dysfunction
PEFR
Maximum airflow rate during forced expiration; aids in monitoring bronchoconstriction in asthma
Cor pulmonale
Hypertrophy of the right side of the heart, with or without HF, that results from pulmonary hypertension
Pulmonary hypertension is caused primarily by constriction of pulmonary vessels in response to alveolar hypoxia in COPD
Why is it important to identify whether a client has a purulent or nonpurulent exacerbation of COPD?
Because this assists in determining the need for antibiotic therapy (purulent needs)
What causes AECOPD?
Airflow obstruction
Exposure to allergens
Cold air
Pollutants
H influenza, S pneumoniae
What vaccinations should be recommended for people with COPD?
Annual influenza and pneumococcal vaccinations
How can COPD lead to acute respiratory failure?
An acute exacerbation of COPD can cause this, many people wait too long to seek help
How is depression, anxiety, and panic related to COPD?
Depression from isolation, hopelessness or grief that accompany the disease
Anxiety with dyspnea
Panic causes faster breathing which affects the oxygenation status
What assessments should a nurse perform on a client with COPD?
Thorough history (smoking, pack years, symptoms, SOB
Physical examination for swelling, weight loss, airflow obstruction
Chest radiographic studies to rule out comorbid conditions
How are “pack-years” calculated for people with a history of cigarette smoking?
By multiplying the number of cigarette smoked daily by the number of years smoking
What are the 7 primary COPD management goals?
Prevent disease progression (smoking cessation)
Reduce frequency and severity of exacerbations
Alleviate breathlessness and other respiratory symptoms
Improve exercise tolerance
Treat exacerbations and complications of the disease
Improve the health status and quality of life
Reduce associated mortality and morbidity
How does smoking cessation slow the progression of COPD?
The accelerate decline in pulmonary function stops and usually improves
Why are bronchodilators the mainstay of treatment for COPD?
Relaxes smooth muscles in the airway, reduces airway resistance and dynamic hyperinflation of lungs thus decreasing breathlessness
What are the most commonly medications used to treat COPD?
B2 adrenergic agonists
Muscarinic meds
Methylxanthines
SABDs
SABA
SAMA
Why are inhaled corticosteroids (ICS) and long-acting β2 adrenergic agonists (LABAs) often combined in the treatment of COPD?
They both have b2 adrenergic agonist that prevent exacerbations in patients who have higher peripheral eosinophilia counts with previous acute exacerbations
Why are oral or parenteral corticosteroids used in the treatment of COPD?
To speed recovery time, reduce relapse rates, reduce need for hospitalization, and improve FEV1 and partial pressure of oxygen
Which three surgical procedures have been used to manage severe COPD? (and how do they help?)
Lung volume reduction surgery to reduce the size of the hyperinflated emphysematous lungs, airway obstruction is decreased and room for remaining normal alveoli
Bullectomy removes bulla to decompress adjacent lung parenchyma
Lung transplantation when all else fails to achieve substantial improvements in their exercise capacity
What are the components of an effective pulmonary rehabilitation program?
Exercise conditioning, breathing exercises, energy conservation, nutrition, smoking cessation, environmental factors, health promotion, patient education, self management, psychological support, psychological counseling, vocational rehabilitation
How much fluid should a client with COPD take in daily?
2-3L
What is pneumonia?
An acute inflammation of the lung parenchyma caused by a microbial agent
What are all of the things that can cause pneumonia?
Decreased LOC, trach intubation obstruction, air pollution, cig smoke, viral URI, aging changes, malnutrition, certain diseases, immobility, HIV, altered flora
Why is it helpful to classify pneumonia as community-acquired or hospital-acquired?
Community is before or within first 2 days of hospitalization whereas hospital acquired is after 48 hours in the hospital
What are the characteristics of community-acquired pneumonia (CAP)?
Congestion, red hepatization, grey hepattization, resolution
Which factors increase the risk of a person developing aspiration pneumonia?
HX of LOC, tube feedings
What are the 3 types of aspiration pneumonia?
Chemical, mechanical, bacterial
Tidal volume
volume of air inhaled and exhaled with each breath; only a small proportion of total capacity of lungs
Minute volume(MV)
total amount of air inhaled and exhaled per minute
Expiratory Reserve Volume (ERV)
Additional air that can be forcefully exhaled after normal exhalation is complete
Residual volume
amount of air remaining in lungs after a forced expiration; air available in lungs for gas exchange between breaths
Inspiratory Reserve Volume
maximum volume of air that can be inhaled forcefully after normal inspiration
Total lung capacity (TLC)
max value of air that lungs can contain
Functional residual capacity
volume of air that can be exhaled after maximum inspiration
Inspiratory capacity
max volume of air that can be inhaled after normal expiration
Maximal midexpiratory flow rate
measurement of airflow are in middle half of forced expiration; early indicator of disease of small airway
Maximal voluntary ventilation
deep breathing as rapidly as possible for specified period; test for airflow, muscle strength, coordination, airway resistance; important factor for exercise tolerance
Maximum inspiratory pressure or negative inspiratory force
amount of negative pressure generated on inspirations indication of ability to breathe deeply and cough
