Week 1: COPD

Question 1

What happens to the lungs of a patient with COPD

Answer 1

Bronchioles lose their shape and become clogged with mucous.
Wall of the alveoli are destroyed forming larger but fewer alveoli.

Question 2

What are the characteristics of COPD

Answer 2

Chronic bronchitis and emphysema

Resulting in progressive airflow limitation

Question 3

What are some risk factors for COPD

Answer 3

Women are at higher risk
Cigarette smoking/ nicotine inhalation
Carbon dioxide 
Occupational chemical and dust exposure 
Infection (Damage to the alveoli)
Premature babies 
Heredity- Protein kinase alpha inhibitor gene
Aging

Question 4

Why are women at higher risk of COPD

Answer 4

Because they have smaller vasculature so they are already at a disadvantage

Question 5

How does nicotine damage the body

Answer 5

Causes vasoconstriction, reduces blood flow

Question 6

What is the what does inhalation of noxious particles and gases cause?

Answer 6

Inflammation of airway
Peripheral airway remodeling
Parenchymal destruction
Pulmonary vascular changes

Question 7

What is the patho of COPD

Answer 7

Mucus hypersecretion
Cilia dysfunction
Airflow limitation
Hyperinflation of lungs
Alveolar destruction
Loss of elastic recoil
Impaired gas exchange
Pulmonary hypertension
Col pulmonale 
Systemic effects

Question 8

What happens to the supporting structure of the lungs?

Answer 8

Destroyed

• Air goes in easily but gets trapped
• Bronchioles tend to collapse
• Creates barrel chest

Question 9

What is the target range for O2 saturation in a COPD patient and why?

Answer 9

88-92%

Impaired gas exchange lungs are unable to expel CO2 as easily therefore ^ O2= ^CO2

Question 10

Physical exam finding for COPD patient

Answer 10

Prolonged expiratory phase
Wheezes
Decreased breath sounds
^ Anterior-posterior diameter

Question 11

What are signs would you look out for if you suspect a diagnosis of COPD?

Answer 11

Cough- Early morning 
Sputum production
Dyspnea 
Weight loss 
Chronic fatigue 
All in combination with risk factors

Question 12

What are the stages of COPD

Answer 12

Mild
Moderate
Severe
Very Severe

Question 13

What would a Spirometry result of FEV >80%, FEV/FVC <0.7 indicate?

Answer 13

Mild COPD

Question 14

What would a Spirometry result of FEV <50%, <80% predicted, FEV/FVC <0.7 indicate?

Answer 14

Moderate COPD

Question 15

What would a Spirometry result of FEV <30%, <50% predicted, FEV/FVC <0.7 indicate?

Answer 15

Severe COPD

Question 16

What would a Spirometry result of FEV <30%, FEV/FVC <0.7 indicate?

Answer 16

Very severe COPD

Question 17

What are the complications of COPD

Answer 17

Cor pulmonale
Exacerbation
Acute respiratory failure (ARDS)
Peptic ulcer disease
Depression/ Anxiety 
Pneumonia 
Frailty

Question 18

Patho of Cor pulmonale

Answer 18

When pulmonary hypertension develops, the pressures on the right side of the heart must increase to push blood into the lungs.

Question 19

What are the manifestations of Cor Pulmonale

Answer 19

Dyspnea
Distended neck veins
Hepatomegaly with right upper quadrant tenderness
Peripheral edema
Weight gain
Ascites
Epigastric distress
Lung sounds are normal, or crackles may be heard in the bases of the lungs bilaterally.

Question 20

What is the primary management of Cor Pulmonale and why

Answer 20

Continuous low-flow O2

• Pulmonary hypertension results from hypoxia that leads to polycythemia and pulmonary vasoconstriction
• However dyspnea results from hyperinflation so it is important to reduce this and not overload the lungs

Question 21

Key features for a COPD exacerbation

Answer 21

Change in baseline >48hrs

Caused by: infection, allergens, cold air, irritants

Question 22

Diagnostics of COPD

Answer 22

Chest X-Ray , spirometry, history and physical exam
6 min Walk test (measure O2 desaturation)
ECG- RT side HF

Question 23

Typical spirometry findings for COPD patient

Answer 23

Reduced FEV1/FVC ratio

Increased residual volume

Question 24

Typical ABG findings for COPD patient

Answer 24

• Low PaO2
• ^PaCO2
• v pH
• ^ Bicarbonate

Question 25

When reviewing the arterial blood gases of a client with COPD, the nurse identifies late-stage COPD with which of the following results?

1. pH 7.26, PaCO2 58 mmHg, PaO2 60 mmHg, HCO3− 30 mmol/L
2. pH 7.30, PaCO2 45 mmHg, PaO2 55 mmHg, HCO3− 18 mmol/L
3. pH 7.40, PaCO2 40 mmHg, PaO2 70 mmHg, HCO3− 25 mmol/L
4. pH 7.52, PaCO2 30 mmHg, PaO2 80 mmHg, HCO3− 35 mmol/L

Answer 25

Answer: 1
Rationale: In late-stage COPD, the client will have a low or low normal pH, high normal or above-normal PaCO2, and high normal or above-normal HCO3−. This indicates compensated respiratory acidosis, as the client has chronically retained CO2 and the kidneys have conserved HCO3− to increase the pH to near or within the normal range.

Question 26

What are the grades in the MRC dyspnea scale?

Answer 26

Grade 1: Breathlessness with strenuous exercise
Grade 2: SOB with minimal exercise
Grade 3: Walks slower than ppl of the same age, stops to catch breath
Grade 4: Stops for breath when walking 100yrds
Grade 5: Too breathless to leave house/ when dressing

Question 27

Primary goals for care for COPD patient

Answer 27

Prevent progression.
Reduce frequency and severity of exacerbations.
Alleviate breathlessness.
Improve exercise tolerance and daily activity.
Treat exacerbations and complications.
Improve quality of life and reduce mortality risk.

Question 28

What are some pharmacological intervention’s you would expect for a patients with COPD

Answer 28

• Bronchodilators
• Glucocorticoids
• Phosphodiesterase-4 inhibitors
• SABAs (specifically inhaled, either alone or in combination with inhaled anticholinergics) are preferred for bronchodilation during COPD exacerbations
• Systemic glucocorticoids
• Antibiotics
• Supplemental oxygen to maintain an oxygen saturation of 88% to 92%

Question 29

How do bronchodilators work to treat COPD

Answer 29

• Provide symptomatic relief
• Through activation of beta2 receptors in the smooth muscle of the lung, these drugs promote bronchodilation, relieving bronchospasm
• Beta2 agonists have a limited role in suppressing histamine release in the lung and increasing ciliary motility

Question 30

How do SABAs work to treat symptoms of COPD

Answer 30

Taken PRN to abort an ongoing attack
EIB: Taken before exercise to prevent an attack
Hospitalized patients undergoing a severe acute attack: Nebulized SABA is the traditional treatment of choice

Question 31

How do LABAs work to treat symptoms of COPD

Answer 31

Long-term control in patients who experience frequent attacks
Dosing is on a fixed schedule, not PRN
Effective in treating stable COPD
When used to treat asthma, must always be combined with a glucocorticoid
Use alone in asthma is contraindicated

Question 32

What are some adverse effects the nurse should monitor for a patient taking a bronchodilator?

Answer 32

Inhaled preparations
- Systemic effects: Tachycardia, angina, tremor

Oral preparations
- Excessive dosage: Angina pectoris, tachydysrhythmias, Tremor

Question 33

What drug is tiotropium

Answer 33

A Long-acting, inhaled anticholinergic agent approved for maintenance therapy of bronchospasm associated with COPD

Question 34

How does tiotropium work?

Answer 34

Relieves bronchospasm by blocking muscarinic receptors in the lung, With subsequent doses: Bronchodilation continues to improve, reaching a plateau after eight consecutive doses (8 days)

Question 35

What drug is Aclidinium

Answer 35

Newest long-acting anticholinergic for management of bronchospasm associated with COPD

Question 36

How are Aclidinium and Tiotropium similar?

Answer 36

Both anticholinergic- Block muscarinic receptors to prevent bronchospasm

Question 37

How are Aclidinium and Tiotropium different?

Answer 37

Tio peaks at 30mins, Acl peaks at 10mins

Acl has more adverse effects

Question 38

What are some available glucocorticoid/ LABA combinations

Answer 38

Fluticasone/salmeterol [Advair]
Budesonide/formoterol [Symbicort]
Mometasone/formoterol [Dulera]

Question 39

Which information should the nurse include when teaching a patient about inhaled glucocorticoids?

A. Inhaled glucocorticoids have many significant adverse effects.
B. The principal side effects of inhaled glucocorticoids include hypertension and weight gain.
C. Use of a spacer can minimize side effects.
D. Patients should rinse the mouth and gargle before administering inhaled glucocorticoids.

Answer 39

Answer: C
Rationale: Inhaled glucocorticoids are generally very safe. Their principal side effects are oropharyngeal candidiasis and dysphonia, which can be minimized by using a spacer device during administration and by rinsing the mouth and gargling after use.

Question 40

Which of the following is NOT a serious adverse effect of long-term oral glucocorticoid therapy?

A. Adrenal suppression
B. Osteoporosis
C. Hypoglycemia
D. Peptic ulcer disease

Answer 40

Answer: C
Rationale: Serious adverse effects include adrenal suppression, osteoporosis, hyperglycemia, peptic ulcer disease, and growth suppression.