Week 2 - COPD Flashcards
what is COPD
- respiratory disorder characterized by progressive, partially reversible airflow obstruction, systemic manifestations & increasing frequency and severity of exacerbations
what are causes of COPD (5)
- smoking
- occupational chemicals and dusts
- infection
- heredity
- aging
what does COPD cause
- airflow obstruction
- limited airflow
why is there limited airflow in COPD? what does this cause? what is this called?
- loss of elasticity of the alveoli sacs from damage (emphysema)
= inability to fully exhale
why is there airflow obstruction in COPD (4)? what is this called?
caused by:
- inflammation
- mucus hypersecretion
- mucosal edema
- bronchospasm
= bronchitis
what does COPD lead to? (6)
- inability to expire air = hyperinflation
- abnormal gas exchange = hypoxemia & hypercapnia
- V/Q mismatch
- excess mucus production
- pulmonary HTN
- hypertrophy of the right ventricle of the heart –> right sided heart failure
how does COPD cause pulmonary HTN
- small pulmonary arteries undergo vasoconstriction in response to hypoxemia
- changes in structure
- body tries to compensate by increasing RBC production
- -> thickening of vascular sm. m
how does pulmonary HTN lead to hypertrophy of the right ventricle & right sided heart failure?
- the pressure in the pulmonary arteries leads to blood backflowing into the right side of the heart
when should a diagnosis of COPD considered (5)
if the pt:
- has cough
- sputum production
- dyspnea
- history of smoking
- exposure to risk factors
what effect does COPD have on the resp. system (9)
- chronic dyspnea
- chronic cough
- sputum (esp. w bronchitis)
- accessory muscle breathing
- pursed lip breathing
- prolonger expiratory time
- abnormal lung sounds
- orthopneic
- bluish-red color (cyanosis r/t hypoxia & erythema r/t polycythemia)
what effect does COPD have on body comp. (3)
- barrel chest (due to hyperinflation)
- thin in appearance (weight loss)
- digital clubbing
what effect does COPD have on energy (3)
- fatigue
- lack of energy
- unable to tolerate activity (SOB)
what effect does COPD have on ABGs`
- low O2 (hypoxemia)
- high CO2 (hypercapnia)
- resp. acidosis
why might a person w COPD lose weight
- pt spends a lot of energy breathing & in hypermetabolic state
what lung sounds might you hear in COPD (3)
- wheezing
- crackless (d/t mucus)
- decreased breath sounds
what effect does mild COPD have on lung function?
- SOB when hurrying on the level or walking up a slight hill
what effect does moderate COPD have on lung function & daily actvities
- SOB causing the pt to stop after walking approx 100 m or a few min on the lvl
what effect does severe COPD have on lung function (SOB) (4)
- SOB resulting in the pt being to breatheless to leave the house
- breathless when dressing or undressing
- presence of chronic resp failure
- signs of right sided HF
what position helps a pt with COPD breathe better
tripod position
- pt stands upright with arms on a fixed surface & is kinda bent over the surface
what are complications of COPD (4)
- cor pulmonae
- acute exacerbations
- acute resp. failure
- depression, anxiety, and panic
what is cor pulmonae
- hypertrophy of the right side of the heart, with or without heart failure
what causes cor pulmonae
- pulmonary HTN
what causes pulmonary HTN (2)
- constriction of pulm vessels r/t alveolar hypoxia
- erythropoiesis = increased viscosity of blood
how does pulmonary HTN lead to cor pulmonae
- the increase pressure in the pulmonary arteries causes the right side of the heart to have to increase its work to push blood into the lungs
- eventually leads to heart failure
what are signs of cor pulmonale (9)
- dyspnea
- distension of neck veins
- hepatomegly
- peripheral edema
- weight gain
- ascites
- epigastric distress
- lung sounds normal or w crackers at bases
- changes to heart sounds
what is the treatment for cor pulmonale (5)
- continuous admin of low-flow O2
- diuretics
- low-sodium diet
- bronchodilator therapy
- calcium channel blockers and vasodilators
what must be monitored during treatment for cor pulmonale (2)
- electrolytes (esp. hypokalemia r/t arythmias)
- serum creatinine & BUN (diuretics can cause volume depletion)
what is the treatment for cor pulmonale is medical treatment fails
- lung transplantation
what is the most frequent cause of medical visit, hospitalizations, and death among people w COPD
- acute exacerbations
what is an acute exacerbation of COPD
- sustained worsening of dyspnea, cough, or sputum production
- where sustained = change from baseline that lasts 48 hr or longer
what can cause acute exacerbations of COPD (6)
- infection
- allergens
- irritants
- cold air
- fires
- air pollution
what is important to note when treating an acute exacerbation of COPD
- is the sputum purulent or nonpurulent (infection??)
- if an infection, given antibiotics for 7-10 das
what is treatment for an acute exacerbation of COPD (4)
- a/b if infection
- increase inhaled bronchodilators
- oral systemic steroids
- O2 therapy
what can be used to diagnose an acute exacerbation of COPD (5)
- history
- physical exam
- ABGs
- SaO2
- chest xray
what is a frequent complication of COPD
- pneumonia
what can lead to acute resp failure in a pt w COPD (4)
- acute exacerbation
- exacerbation of cor pulmonale
- discontinuing of bronchodilators or corticosteroids
- surgery or severe, painful illness involving the chest or abdomen (leads to splinting, ineffective ventilation, resp. failure)
what can exacerbate acute resp failure (3)
- beta blockers (ex. propanolo)
- sedatives
- narcotics
what can be done to avoid exacerbation of resp failure, if a pt has both cardio and pulmonary conditions
- use of cardioselective beta blockers
how do sedatives and narcotics exacerbate or cause resp. failure? when is this imp. to remember/consider
- suppress ventilatory drive
- imp. if post-op
what does acute resp. failure require
- hospitalization
- specialized care
why do high rates of people w COPD experience dperession, anxiety, and panic (3)
- feelings of loss (ex. of hobbies, social activities, work) & grief associated w the progressive course of disease
- heightened dyspnea –> anxiety –> trying to breathe faster
- guilt of smoking
what are the main goals of collaborative care for someone w COPD (6)
- prevent disease progression
- reduce frequency and severity of exacerbations
- alleviate breathlessness & other symptoms
- improve exercise tolerance
- improve health status and quality of life
- reduce risk of mortality
what is the most significant factor in slowing the progression of COPD
- smoking cessation
what is the benefit of smoking cessation r/t COPD (2)
- after a pt stops smoking, the accelerated decline in function slows and improve
- sooner the pt stops smoking, the less pulmonary function is lost & sooner symptoms decrease
what is the mainstay of pharmacological therapy for COPD
- bronchodilators
what do bronchodilators do (3)
- relax smooth muscles in the airway
- reduces airway resistance & hyperinflation
- improves ventilation of the lungs = reduce the degree of breathlessness
what are 4 categories of bronchodilators often used for COPD
- SABA
- LABA
- anticholinergics
- steroidal anti-inflammatorys
what is a type of SABA
- salbutamol (ventolin)
what do SABA do (3)
- improve pulm function
- improve symptoms
- improve exercise fnxn
what two meds are often used together to produce superior bronchodilation
- SABAs and anticholinergics
what is a type of anticholinergic for COPD
- ipatropium bromide (atrovent)
what is the function of anticholinergic (2)
- bronchodilates
- decreases mucus
how is bronchodilator therapy usually used for pts w COPD
- as maintenance therapy , 3-4 times/day
- with extra puffs as needed for breakthrough symptoms
who are LABAs usually indicated for
- pts w more severe COPD & who experience more persistent symptoms
what is the fnxn of LABAs
- relax smooth muscle in the airway = bronchodilation
- sustained improvements in pulm. function, activity-related dyspnea, quality of life
what is a type of LABA
- salmeterol (serevent)
what are oral/parental corticosteroids used for r/t COPD
- acute exacerbations
what is the benefit of corticosteroids for COPD (3)
- speed recovery time
- reduce relapse rates
- reduce need for hospitalization
how long are people typically on corticosteroids for COPD? why?
- 7-14 days
- continuous use can lead to side effects
what effects for corticosteroids have (2)
- anti-inflammatory
- immunosuppressive
what is a type of corticosteroid used for COPD
- hydrocortisone
what are different types of treatment for COPD (7)
- smoking cessation
- meds
- O2 therapy
- surgery
- nutritional therapy
- breathing exercises
- health promotion
what is O2 therapy used to do? (2)
- reduce work of breathing
- maintain PaO2 to reduce workload on the heart
what should O2 sats be for a pt on O2 therapy for COPD
- should be >90% or as prescribed
O2 from cylinder or wall systems are dry. what indication does this have
- the O2 must be humidified when administered, eitehr via humidification or nebulization
- imp. bc dry O2 has irritating effect on mucus members & dries secretions
what are some complications of O2 therapy (5)
- combustion
- O2 toxicity
- carbon dioxide narcosis
- infection
- absorption atelectasis
what is carbon dioxide narcosis
- CO2 usually drives us to breath
- the constant high lvls of CO2 during COPD makes the resp. center lose its sensitivity to COPD
- so now the drive to breath is hypoxemia
= administered O2 weakens their drive to breath
what type of breathing exercise is used for a pt w COPD
- pursed lip breathing
what is the benefit of pursed lip breathing
- prolongs exhalation
- prevents bronchiolar collapse & air trapping
- assist w dyspnea
explain how pursed lip breathing is done
- relax neck and shoulder muscles
- inhale thru the nose to count of 2
- pucker lips as if whisling
- exhale slowly & gently thru lips while counting to 6
- always exhale longer then inhale
why is effective coughing imp. for pt w COPD
- many pts have developed ineffective coughing patterns that do not adequately clear the airways of sputum
what is huff coughing? how is it done?
- effective technique that the pt can be taught easily
- before the pt coughs, take deep breath & lean forward
- cough 3-4 times of exhalation
what are the main goals of huff coughing?
- conserve energy
- reduce fatigue
- facilitate removal of secretions
what things r/t to nutrition are common among people w COPD
- weight loss
- mlanutrition
why is weight loss and malnutrition common in COPD (4)
- increased WOB = increased energy expenditure
- eating become an effort d/t dyspnea
- difficulty breathing while eating = inadequate comsumption
- pressure on diaphragm from a full stomach causes dyspnea
what can pts with COPD do to decrease dyspnea and conserve energy r/t nutrition (3)
- rest at leasr 30 min before eating
- use bronchodilator before meals
- prepare foods in advance
what other nutritional therapy is done for pts w COPD? (6)
- 2-3 L of fluid per day (unless contraindicated for other medical conditions like HF)
- sodium restriction if has HF
- corticosteroid use can lead to osteoporosis = calcium and vitamin D intake imp.
- avoid foods that form intestinal gas
- high cal
- high protein
what is the best prevention for COPD
- cessation of smoking
what are important preventive measures to maintain healthy lungs (4)
- avoid or control occupational & enviro pollutants & irritants
- influenze & pneumococcal vaccines
- avoid large crowds during peak influenza times
- hygeine
what education should be given to a pt w COPD (9)
- breathing exercises
- energy conserving strategies
- sleep
- psychosocial consideration
- meds & how to use an inhaler
- need for home O2
- smoking cessation
- pulmonary rehab –> walk 20 min/day
- nutrition
what are some energy conserving strategies to teach a pt with COPD (6)
- using a tripod position
- use O2 therapy during activities of hygeine
- exhale when pushing, pulling, or exerting effort
- sit as much as possible when doing activities
- exercise training of upper extremities reduce dyspnea
- alternative energy saving practices for ADLs
what is important to teach a pt with COPD r/t sleep (3)
- adequate sleep is v important
- LABA may help with coughing during the night
- postnasal drip can be treated w nasal saline sprays, rinses, or steroids
what are some psychosocial considerations during teaching of a pt w COPD
- use of relaxation techniques for dyspnea
- emotional support for feelings of guilt, anxiety, depression, etc.
- use of support groups
- understanding the difficulty of the lifestyle changes, decreased ability to do ADLs, social activities, etc. they are experiencing
what are some relaxation techniques to teach a pt with COPD
- progressive muscle relaxation
- positive thinking
- visualization
- music
- massage
- use of humour
what should you teach a pt regarding acute exacerbations (3)
- S&S
- prompt treatment of acute exacerbations & infections are important
- aware of and avoid triggers
why is digital clubbing a sign of COPD
- clubbing occurs r/t prolonged hypoxemia
what effect does COPD have on the hematological system? why?
- causes polycythemia
- the body attempts to make more RBC to carry O2 to compensate for hypoxemia
how is COPD diagnosed
- spirometry is done after bronchodilator treatment –> certain lvls correlate to COPD stages
- also look at severity of symptoms
why are calcium channel blockers and vasodilators used as tx for COPD
- relax sm. muscle
- decrease pulmonary vascular resistance
why are diuretics and low sodium diets given for tx of COPD? what is imp to monitor for a pt on diuretics
- decrease workload on heart by getting rid of fluid
- monitor electrolytes
what is the effect of acute exacerbations of a pt with COPD
- more often they happen= increase in damage & further progression of the disease
what are nursing care interventions for a pt with COPD experiencing depression, anxiety, and panic
- monitor for depression
- refer to help
- meds if needed
- covery understanding
- encourage relaxation , esp. when anxious (ex. meditation)
what route of meds is most preferred for COPD
- inhaled
what is the goal of O2 therapy for a pt with COPD? why is this imp?
- raise the PaO2 with just enough O2
- otherwise it could reduce ventilatory drive r/t carbon dioxide narcosis
at what amt of O2, is it especially imp to humifiy the O2?
> 4L
what are some signs that a pt with COPD/an acute exacerbation is doing better? (4)``
- increased oxygenation
- better mental status
- decreased CO2 lvl
- more productive cough
a nursing diagnosis r/t COPD is ineffective breathing pattern. what nursing intervention can help the pt return to baseline resp function (7)
- monitor resp and O2 status
- auscultate breath sounds
- encourage DB&C
- encourage turning
- administer meds
- position to minimize resp efforts (HOB elevated, table to lean on)
- monitor for resp muscle fatigue to detect need for ventilatory assistance
- initiate a program of resp muscle strength and/or endurance training
a nursing diagnosis r/t COPD is ineffective airway clearance. what are some nursing interventions that can help improve effective coughing, clear airway, decrease dyspnea (4)
- facilitate deep breathing by sitting the pt up
- ensure adequate hydration to liquefy ssecretions
- teach coughing techniques
- assist w inhaled bronchodilator admin
a nursing diagnosis r/t COPD is impaired gas exchange. what nursing interventions can help decrease CO2 lvls, increase O2 lvls, improve dyspnea & mental status? (8)
- monitor resp and O2 status
- teach pursed-lip breathing to prolong expiratory phase
- assist pt to position of comfort (tripod, etc.)
- admin and teach how to use bronchodilators
- teach S&S and consequences of hypercapnia
- teach avoidance of CNS depressants (further depress resp)
- admin O2 if appropriate
- select O2 supply systems and devices
a nursing diagnosis r/t COPD is imbalanced nutrition. what nursing interventions can help this (5)
- monitor caloric intake, weight, serum albumin, protein lvls
- provide menu suggestions for high protein & cal foods
- give pt high protein & high cal liquid supplements
- plan periods of rest before & after food intake
- refer to agency for financial and nutrional assistance
a nursing diagnosis r/t COPD is disturbed sleep patterns. what nursing interventions can help improve sleep (8)
- identify usual sleep habits and elicit reasons for difficulty sleeping
- monitor pts sleep pattern and physical circumstances
- observe for S&S of sleep apnea
- identify pt-specific methods of relaxaion and teach methods
- encourage activity and exercise during daylight
- provide pt with activitity that promotes wakefulness to limit daytime sleep
- instruct pt in arranging surrounds to produce an enviro conductive to sleep
- teach pt to avoid alcohol beverages, caffeine products, and other stimulants before bedtime
a nursing diagnosis r/t COPD is risk of infection. what nursing interventions can reduce this risk (7)
- monitor for S&S
- teach pt to assess indicators of infection
- teach pt good handwashing and hygeine techniques & avoid contact w people w resp infections
- encourage vaccination
- teach proper care and cleaning of home resp equipment
- teach pt to seek medical attention for signs of infection
- teach pt to follow plan of care for managing exacerbations
