Week 2 Flashcards
COPD signs and symptoms
Cardinal symptoms of COPD include dyspnea, chronic cough, and or sputum production
Other signs and symptoms include decreased activity tolerance, wheezing, recurrent lower respiratory infections, chest tightness, fatigue, weight loss, anorexia, increased anterior posterior diameter of the thorax, use of accessory muscles for aspirations, prolonged expiration, hyperresonance on percussion, decrease heart/breath sounds, tachypnea, neck pain dissension during expiration and absence of heart failure, cyanotic skin color and clubbing of nail beds
COPD
Obstructive disease not fully reversible due to airflow limitations and hyper reactivity of airways, hyperinflation of lungs
Exacerbations and comorbidities determine the severity
COPD risk factors
Smoking, aging high and 65 to 75 year old, recurrent infections, repeated chemical/gases/irritants exposures, long-term asthma, alpha-1 antitrypsin defficiency
COPD diagnostic criteria
Gold standard is spirometry testing. Should be done and symptomatic patients only.
FEV1/FVC less than 0.70 & FEV1 less than 80%
Chest x-ray is not used to diagnose COPD however can rule out other diagnoses such as CHF, pneumonia, cardiomegaly, and pulmonary fibrosis
Spirometry testing for COPD
Symptoms for considering a diagnosis and performing spirometry including dyspnea, cough, chronic sputum production, recurrent lower respiratory tract infections, history of risk factors including family history of COPD and or childhood factors
COPD stage of severity
Stage 1: mild COPD
FEV1 greater or equal to 80% predicted
COPD stage of severity
Stage 2: moderate COPD
FEV1 less than 50% to less than 80% predicted
COPD stage of severity
Stage 3: severe COPD
FEV1 greater than 30% to less than 50% predicted
COPD stage of severity
Stage 4: very severe COPD
FEV1 less than 30% predicted
Management of COPD
Smoking cessation, flu vaccination annually, pneumonia vaccination at the age of 65 and older, reduce risk factor exposures, person centered and shared decision-making management plan, pulmonary rehab, oxygen use
COPD medication goals
Reduce symptoms, reduce exacerbations risk in severity, and prove exercising overall health
COPD radiographic findings
Chest x-ray alone is not diagnostic of COPD but can provide value in excluding differential diagnosis such as pulmonary disease, pneumonia, cardiomegaly.
Abnormalities associated with COPD may be present on a chest x-ray findings such as hyper inflation of the long, hyperlucency of the long, or tapering of vascular markings. Structural long disease may be seen on the chest imaging which is consistent with COPD.
COPD lab test
CBC with differential to rule out anemia, polycythemia which occurs in advanced COPD with hypoxemia, detecting the presence of infection with the white blood cell count, or if eosinophilia is present, considering an allergic/asthmatic component
Serum alpha-1 anti-trips in levels are recommended for individuals presenting with COPD at early ages less than 45 years in age and in non-tobacco users with emphysema or family history of COPD
COPD EKG changes
And COPD patients atrial arrhythmias are common. Peaked P waves and leads II, III, and AVF are often apparent in patients with pulmonary disease. An EKG in advance COPD may demonstrate evidence of a right axis deviation, sinus tachycardia, and pulmonary hypertension with the presence of ongoing as waves in the lateral precordial leads.
COPD exacerbations medication management
Usually occurs after URI‘s
Mild: Saba only
Moderate: Saba and oral corticosteroids
Severe: ER/hospital for acute respiratory failure
COPD action plan imperative to reduce rest of future exacerbation
