week 10- COPD

Question 1

Characteristics

Answer 1

 Resistance to airflow r/t obstructed airways
 Increased mucous secretion
 Decreased inner lumen related to edema, inflammation, or bronchospasm
 Destruction of lung tissue
 Irreversible in nature

Question 2

COPD Diseases

Answer 2

 Chronic Bronchitis
 Emphysema
 Asthma
• Sometimes included in umbrella group of obstructive pulmonary diseases but…
• Actually an inflammatory process
• Condition of reversible airflow limitation (at least in the early stages)
• Not truly considered COPD

Question 3

COPD Epidemiology

Answer 3

	more common in whites than blacks
	affects men more than women
	4th leading cause of death in US
	Doubled in the last 25 years
	Affects middle aged & older

Question 4

Emphysema

Answer 4

 destruction of the walls of the alveoli, resulting enlargement of abnormal air spaces
 Wall destruction causes alveoli & air spaces to enlarge with loss of corresponding portions of the pulmonary capillary bed

Question 5

Manifestations of Emphysema

Answer 5

 Progressively worsening dyspnea
 Minimum cough with small amounts of sputum
 Barrel chest
 Hypoxemia (early), and Hypercapnea (late)
 Finger clubbing (late)
 Thin, malnourished state

Question 6

Chronic Bronchitis

Answer 6

 Disorder of excessive bronchial mucus secretion
 Characterized by a productive cough lasting 3 or more months in 2 consecutive years
 Inhaled irritants lead to a chronic inflammatory process with vasodilatation, congestion, and edema of the bronchial mucosa

Question 7

Manifestations of Chronic Bronchitis

Answer 7

 Productive cough – copious amounts of thick tenacious sputum, worse in AM & winter, “smokers cough”
 Frequent respiratory infections
 Dyspnea upon exertion
 Hypoxemia/ hypercapnea
 Cyanosis
 Normal to husky weight
 Evidence of Right-sided HF – distended neck veins, edema, enlarged heart
 Adventitious sounds – loud ronchi & possible wheezes are prominent on auscultation

Question 8

Effects of Cigarette Smoke

Answer 8

 Hyperplasia of cells
 Goblet cells produce more mucous
 Narrowing of inner lumen of airways
 Reduced ciliary activity, and proliferation
 Destruction of alveolar walls
 inhibit the function of alveolar macrophages

Question 9

Cor pulmonale

Answer 9

 Right sided ventricular failure caused by pulmonary disease
 Enlargement of right side of heart r/t pulmonary hypertension
 Air trapping, airway collapse and inelastic alveolar walls cause it to be more difficult for blood to flow through the lung vessels.

Question 10

More Complications

Answer 10

 Pneumonia
 Acute respiratory failure
 Be careful with β blockers and narcotics
 Respiratory drive changes to O2
 Elevated CO2 no longer triggers respiration
 Elevated O2 could stop respirations altogether

Question 11

Assessment

Answer 11

	Respiratory assessment
	Cardiovascular assessment
	Clubbed fingers
	Barrel chest 
	Dyspnea assessment **sixth vital sign 
Subjective feeling of breathlessness
Most disabling symptom
Do not confuse with changes in RR or depth

Question 12

Presenting Symptoms: Acute Exacerbations

Answer 12

	Worsening:
	 dyspnea
	sputum production
	cough
	Increasing use of medications
	Elevated HR and RR

Question 13

Incapacitating dyspnea is the most common presenting symptom of AECOPD.

Answer 13

People living with COPD experience 2-3 AECOPD per year.

Question 14

As the dyspnea worsens individuals are less able to complete a full sentence and experience
alterations in the level of consciousness

Answer 14

.

Question 15

Assessment Findings

Answer 15

	Accessory muscle use
	RR > 30/min
	DBP less than 60, SBP less than 90
	Increased temperature
	O2 saturation less than 90% on room air (RA)
	Change in volume, colour or viscosity of sputum
	Less able to complete a full sentence*
	Changing LOC

Question 16

Goals OF TREATMENT

Answer 16

	Improve ventilation
	Promote removal of secretions
	Prevent complications, delay progression
	Promote comfort & participation
	Improve quality of life

Question 17

Smoking Cessation

Answer 17

Ask, advise, assess, assist, & arrange
Quitting slows progression of disease
Most common cause of COPD

Question 18

Drug therapy

Answer 18

	Βeta 2 agonist (Ventolin)
	Inhaled Anticholenergics (Atrovent) eg: Spiriva
	Oxygen
	Corticosteroids 
	Antibiotics prn 
	Psychotropics for anxiety

Question 19

CO2 Narcosis/Oxygen Therapy

Answer 19

 High CO2 retainers will obtain respiratory drive from O2 instead of CO2 thus high % FIO2 can depress respirations similar to narcotics
 Maintain lowest FiO2 to yield goal O2 sat 88-92% (individualized)
 Frequent ABGs used to confirm Pa O2%
 Monitor V/S and mental status

Question 20

O2 Therapy: Complications

Answer 20

Combustion
 Promotes combustion but is not itself combustible
 Watch those smokers!

Question 21

Infection

Answer 21

Humidified air or O2 and/or dirty equipment increases risk

Question 22

Breathing Retraining

Answer 22

Diaphragmatic breathing*
Pursed lip breathing*
Positioning
--Sitting: tripod position improves oxygenation
--Standing
Controlled coughing
*Describe and demonstrate 

Question 23

Breath Retraining

Answer 23

• Pursed lip breathing
o Prolongs expiratory phase
o Prevents brochiolar collapse and air trapping
o Inhale through nose and slowly exhale through pursed lips (similar to whistling)
• Cascade/ Huff coughing
o Decreases ineffective coughing patterns, and helps clear secretions
o From sitting position, have pt take deep pursed lip breaths as they lean forward, then have pt sit upright again. Repeat 4x, then have pt take deep breath, lean forward and give 3-4 coughs per exhalation

Question 24

Hydration

Answer 24

Drink 2-3 liters/day to liquefy secretions

Humidifiers (but must be cleaned daily to prevent growth the mold spores).

Question 25

Nutrition

Answer 25

food intolerance
nausea
early satiety
Anorexia
meal-related dypsnea
Peppermint herbal tea may act as an expectorant
Licorice root – expectorant & anti-inflammatory properties

Question 26

Interventions

Answer 26

Monitor nutrition status
Serve several small meals
Teach to use pursed lip and abdominal breathing to reduce dypsnea
Bronchodilator 30 min before eating
Choose foods that are easy to chew and not gas forming.
Avoid dry foods –cause coughing
Avoid milk & salt – increased thickness of secretions
Encourage to eat high protein and high calorie foods.
Dietary supplements
If early satiety- avoid drinking fluids before and during meals
Offer oral hygiene before meals

Question 27

Interventions

Answer 27

•	Relaxation Techniques
o	Progressive muscular relaxation
o	Yoga
o	Music 
o	Positioning (tripod-leaning forward)
o	Use of fresh air or fan
•	Energy Conservation
o	Pacing activity 
o	Using a wheeled walker

Question 28

Vaccinations

Answer 28

Annual influenza vaccine in Fall

Pneumoccal vaccine at least once in their lives (q 5-10 years in very high risk individuals)