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NURS 3512 - Class 1-6 > Week 2 - COPD > Flashcards

Week 2 - COPD Flashcards

1
Q

what is COPD

A
  • respiratory disorder characterized by progressive, partially reversible airflow obstruction, systemic manifestations & increasing frequency and severity of exacerbations
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2
Q

what are causes of COPD (5)

A
  • smoking
  • occupational chemicals and dusts
  • infection
  • heredity
  • aging
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3
Q

what does COPD cause

A
  • airflow obstruction

- limited airflow

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4
Q

why is there limited airflow in COPD? what does this cause? what is this called?

A
  • loss of elasticity of the alveoli sacs from damage (emphysema)
    = inability to fully exhale
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5
Q

why is there airflow obstruction in COPD (4)? what is this called?

A

caused by:

  • inflammation
  • mucus hypersecretion
  • mucosal edema
  • bronchospasm

= bronchitis

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6
Q

what does COPD lead to? (6)

A
  • 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
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7
Q

how does COPD cause pulmonary HTN

A
  • 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
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8
Q

how does pulmonary HTN lead to hypertrophy of the right ventricle & right sided heart failure?

A
  • the pressure in the pulmonary arteries leads to blood backflowing into the right side of the heart
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9
Q

when should a diagnosis of COPD considered (5)

A

if the pt:

  • has cough
  • sputum production
  • dyspnea
  • history of smoking
  • exposure to risk factors
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10
Q

what effect does COPD have on the resp. system (9)

A
  • 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)
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11
Q

what effect does COPD have on body comp. (3)

A
  • barrel chest (due to hyperinflation)
  • thin in appearance (weight loss)
  • digital clubbing
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12
Q

what effect does COPD have on energy (3)

A
  • fatigue
  • lack of energy
  • unable to tolerate activity (SOB)
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13
Q

what effect does COPD have on ABGs`

A
  • low O2 (hypoxemia)
  • high CO2 (hypercapnia)
  • resp. acidosis
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14
Q

why might a person w COPD lose weight

A
  • pt spends a lot of energy breathing & in hypermetabolic state
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15
Q

what lung sounds might you hear in COPD (3)

A
  • wheezing
  • crackless (d/t mucus)
  • decreased breath sounds
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16
Q

what effect does mild COPD have on lung function?

A
  • SOB when hurrying on the level or walking up a slight hill
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17
Q

what effect does moderate COPD have on lung function & daily actvities

A
  • SOB causing the pt to stop after walking approx 100 m or a few min on the lvl
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18
Q

what effect does severe COPD have on lung function (SOB) (4)

A
  • 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
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19
Q

what position helps a pt with COPD breathe better

A

tripod position

- pt stands upright with arms on a fixed surface & is kinda bent over the surface

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20
Q

what are complications of COPD (4)

A
  • cor pulmonae
  • acute exacerbations
  • acute resp. failure
  • depression, anxiety, and panic
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21
Q

what is cor pulmonae

A
  • hypertrophy of the right side of the heart, with or without heart failure
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22
Q

what causes cor pulmonae

A
  • pulmonary HTN
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23
Q

what causes pulmonary HTN (2)

A
  • constriction of pulm vessels r/t alveolar hypoxia

- erythropoiesis = increased viscosity of blood

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24
Q

how does pulmonary HTN lead to cor pulmonae

A
  • 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
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25
Q

what are signs of cor pulmonale (9)

A
  • 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
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26
Q

what is the treatment for cor pulmonale (5)

A
  • continuous admin of low-flow O2
  • diuretics
  • low-sodium diet
  • bronchodilator therapy
  • calcium channel blockers and vasodilators
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27
Q

what must be monitored during treatment for cor pulmonale (2)

A
  • electrolytes (esp. hypokalemia r/t arythmias)

- serum creatinine & BUN (diuretics can cause volume depletion)

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28
Q

what is the treatment for cor pulmonale is medical treatment fails

A
  • lung transplantation
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29
Q

what is the most frequent cause of medical visit, hospitalizations, and death among people w COPD

A
  • acute exacerbations
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30
Q

what is an acute exacerbation of COPD

A
  • sustained worsening of dyspnea, cough, or sputum production
  • where sustained = change from baseline that lasts 48 hr or longer
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31
Q

what can cause acute exacerbations of COPD (6)

A
  • infection
  • allergens
  • irritants
  • cold air
  • fires
  • air pollution
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32
Q

what is important to note when treating an acute exacerbation of COPD

A
  • is the sputum purulent or nonpurulent (infection??)

- if an infection, given antibiotics for 7-10 das

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33
Q

what is treatment for an acute exacerbation of COPD (4)

A
  • a/b if infection
  • increase inhaled bronchodilators
  • oral systemic steroids
  • O2 therapy
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34
Q

what can be used to diagnose an acute exacerbation of COPD (5)

A
  • history
  • physical exam
  • ABGs
  • SaO2
  • chest xray
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35
Q

what is a frequent complication of COPD

A
  • pneumonia
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36
Q

what can lead to acute resp failure in a pt w COPD (4)

A
  • 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)
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37
Q

what can exacerbate acute resp failure (3)

A
  • beta blockers (ex. propanolo)
  • sedatives
  • narcotics
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38
Q

what can be done to avoid exacerbation of resp failure, if a pt has both cardio and pulmonary conditions

A
  • use of cardioselective beta blockers
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39
Q

how do sedatives and narcotics exacerbate or cause resp. failure? when is this imp. to remember/consider

A
  • suppress ventilatory drive

- imp. if post-op

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40
Q

what does acute resp. failure require

A
  • hospitalization

- specialized care

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41
Q

why do high rates of people w COPD experience dperession, anxiety, and panic (3)

A
  • 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
42
Q

what are the main goals of collaborative care for someone w COPD (6)

A
  • 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
43
Q

what is the most significant factor in slowing the progression of COPD

A
  • smoking cessation
44
Q

what is the benefit of smoking cessation r/t COPD (2)

A
  • 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
45
Q

what is the mainstay of pharmacological therapy for COPD

A
  • bronchodilators
46
Q

what do bronchodilators do (3)

A
  • relax smooth muscles in the airway
  • reduces airway resistance & hyperinflation
  • improves ventilation of the lungs = reduce the degree of breathlessness
47
Q

what are 4 categories of bronchodilators often used for COPD

A
  • SABA
  • LABA
  • anticholinergics
  • steroidal anti-inflammatorys
48
Q

what is a type of SABA

A
  • salbutamol (ventolin)
49
Q

what do SABA do (3)

A
  • improve pulm function
  • improve symptoms
  • improve exercise fnxn
50
Q

what two meds are often used together to produce superior bronchodilation

A
  • SABAs and anticholinergics
51
Q

what is a type of anticholinergic for COPD

A
  • ipatropium bromide (atrovent)
52
Q

what is the function of anticholinergic (2)

A
  • bronchodilates

- decreases mucus

53
Q

how is bronchodilator therapy usually used for pts w COPD

A
  • as maintenance therapy , 3-4 times/day

- with extra puffs as needed for breakthrough symptoms

54
Q

who are LABAs usually indicated for

A
  • pts w more severe COPD & who experience more persistent symptoms
55
Q

what is the fnxn of LABAs

A
  • relax smooth muscle in the airway = bronchodilation

- sustained improvements in pulm. function, activity-related dyspnea, quality of life

56
Q

what is a type of LABA

A
  • salmeterol (serevent)
57
Q

what are oral/parental corticosteroids used for r/t COPD

A
  • acute exacerbations
58
Q

what is the benefit of corticosteroids for COPD (3)

A
  • speed recovery time
  • reduce relapse rates
  • reduce need for hospitalization
59
Q

how long are people typically on corticosteroids for COPD? why?

A
  • 7-14 days

- continuous use can lead to side effects

60
Q

what effects for corticosteroids have (2)

A
  • anti-inflammatory

- immunosuppressive

61
Q

what is a type of corticosteroid used for COPD

A
  • hydrocortisone
62
Q

what are different types of treatment for COPD (7)

A
  • smoking cessation
  • meds
  • O2 therapy
  • surgery
  • nutritional therapy
  • breathing exercises
  • health promotion
63
Q

what is O2 therapy used to do? (2)

A
  • reduce work of breathing

- maintain PaO2 to reduce workload on the heart

64
Q

what should O2 sats be for a pt on O2 therapy for COPD

A
  • should be >90% or as prescribed
65
Q

O2 from cylinder or wall systems are dry. what indication does this have

A
  • the O2 must be humidified when administered, eitehr via humidification or nebulization
  • imp. bc dry O2 has irritating effect on mucus members & dries secretions
66
Q

what are some complications of O2 therapy (5)

A
  • combustion
  • O2 toxicity
  • carbon dioxide narcosis
  • infection
  • absorption atelectasis
67
Q

what is carbon dioxide narcosis

A
  • 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
68
Q

what type of breathing exercise is used for a pt w COPD

A
  • pursed lip breathing
69
Q

what is the benefit of pursed lip breathing

A
  • prolongs exhalation
  • prevents bronchiolar collapse & air trapping
  • assist w dyspnea
70
Q

explain how pursed lip breathing is done

A
  1. relax neck and shoulder muscles
  2. inhale thru the nose to count of 2
  3. pucker lips as if whisling
  4. exhale slowly & gently thru lips while counting to 6
  5. always exhale longer then inhale
71
Q

why is effective coughing imp. for pt w COPD

A
  • many pts have developed ineffective coughing patterns that do not adequately clear the airways of sputum
72
Q

what is huff coughing? how is it done?

A
  • effective technique that the pt can be taught easily
  • before the pt coughs, take deep breath & lean forward
  • cough 3-4 times of exhalation
73
Q

what are the main goals of huff coughing?

A
  • conserve energy
  • reduce fatigue
  • facilitate removal of secretions
74
Q

what things r/t to nutrition are common among people w COPD

A
  • weight loss

- mlanutrition

75
Q

why is weight loss and malnutrition common in COPD (4)

A
  • 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
76
Q

what can pts with COPD do to decrease dyspnea and conserve energy r/t nutrition (3)

A
  • rest at leasr 30 min before eating
  • use bronchodilator before meals
  • prepare foods in advance
77
Q

what other nutritional therapy is done for pts w COPD? (6)

A
  • 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
78
Q

what is the best prevention for COPD

A
  • cessation of smoking
79
Q

what are important preventive measures to maintain healthy lungs (4)

A
  • avoid or control occupational & enviro pollutants & irritants
  • influenze & pneumococcal vaccines
  • avoid large crowds during peak influenza times
  • hygeine
80
Q

what education should be given to a pt w COPD (9)

A
  • 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
81
Q

what are some energy conserving strategies to teach a pt with COPD (6)

A
  • 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
82
Q

what is important to teach a pt with COPD r/t sleep (3)

A
  • 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
83
Q

what are some psychosocial considerations during teaching of a pt w COPD

A
  • 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
84
Q

what are some relaxation techniques to teach a pt with COPD

A
  • progressive muscle relaxation
  • positive thinking
  • visualization
  • music
  • massage
  • use of humour
85
Q

what should you teach a pt regarding acute exacerbations (3)

A
  • S&S
  • prompt treatment of acute exacerbations & infections are important
  • aware of and avoid triggers
86
Q

why is digital clubbing a sign of COPD

A
  • clubbing occurs r/t prolonged hypoxemia
87
Q

what effect does COPD have on the hematological system? why?

A
  • causes polycythemia

- the body attempts to make more RBC to carry O2 to compensate for hypoxemia

88
Q

how is COPD diagnosed

A
  • spirometry is done after bronchodilator treatment –> certain lvls correlate to COPD stages
  • also look at severity of symptoms
89
Q

why are calcium channel blockers and vasodilators used as tx for COPD

A
  • relax sm. muscle

- decrease pulmonary vascular resistance

90
Q

why are diuretics and low sodium diets given for tx of COPD? what is imp to monitor for a pt on diuretics

A
  • decrease workload on heart by getting rid of fluid

- monitor electrolytes

91
Q

what is the effect of acute exacerbations of a pt with COPD

A
  • more often they happen= increase in damage & further progression of the disease
92
Q

what are nursing care interventions for a pt with COPD experiencing depression, anxiety, and panic

A
  • monitor for depression
  • refer to help
  • meds if needed
  • covery understanding
  • encourage relaxation , esp. when anxious (ex. meditation)
93
Q

what route of meds is most preferred for COPD

A
  • inhaled
94
Q

what is the goal of O2 therapy for a pt with COPD? why is this imp?

A
  • raise the PaO2 with just enough O2

- otherwise it could reduce ventilatory drive r/t carbon dioxide narcosis

95
Q

at what amt of O2, is it especially imp to humifiy the O2?

A

> 4L

96
Q

what are some signs that a pt with COPD/an acute exacerbation is doing better? (4)``

A
  • increased oxygenation
  • better mental status
  • decreased CO2 lvl
  • more productive cough
97
Q

a nursing diagnosis r/t COPD is ineffective breathing pattern. what nursing intervention can help the pt return to baseline resp function (7)

A
  • 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
98
Q

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)

A
  • facilitate deep breathing by sitting the pt up
  • ensure adequate hydration to liquefy ssecretions
  • teach coughing techniques
  • assist w inhaled bronchodilator admin
99
Q

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)

A
  • 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
100
Q

a nursing diagnosis r/t COPD is imbalanced nutrition. what nursing interventions can help this (5)

A
  • 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
101
Q

a nursing diagnosis r/t COPD is disturbed sleep patterns. what nursing interventions can help improve sleep (8)

A
  • 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
102
Q

a nursing diagnosis r/t COPD is risk of infection. what nursing interventions can reduce this risk (7)

A
  • 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

NURS 3512 - Class 1-6 (47 decks)

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