Week 3: COPD Flashcards
You are given the following orders for a pt just admitted with COPD exacerbation, what is your plan for implementing these orders?
1. Diet as tolerated
2. Out of bed with one-person assistance
3. Oxygen (O2) to maintain Spo2 of 90%
4. IV of D5W at 50 mL/hr
5. ECG monitoring
6. Complete blood count (CBC), Basic metabolic panel (BMP), and arterial blood gases (ABGs) now
7. Chest x-ray (CXR) daily
8. Sputum culture
9. Albuterol 2.5 mg plus ipratropium 250 mcg nebulizer treatment STATthen every 6 hours
10. Fluticasone/salmerotol (Advair) 100/50 mcg 2 puffs twice daily
Always think ABCs!
3. Start the O2 therapy
9. Administer albuterol nebulizer treatment and Advair
5. Place him on an ECG monitor
4. Establish IV access and start running D5W at 50 ml/hour
7. Order the CXR
Obtain bloodwork and perform physical assessment
8. Obtain sputum culture as soon as he can provide a specimen
1. Order him a dinner tray
2. Allow him out of bed at your discretion
Identify expected outcomes for COPD exacerbation patients as a result of nursing interventions
-Subjective reports of decreased dyspnea
-A decrease in respiratory rate
-An increase in SPO2
-A decrease in heart rate
-Lung sounds clear on auscultation
-Relief of dyspnea
What interventions should be included for a pt on azithromycin
A) Place pt on intake and output
B) Administer medication over 30 minutes
C) Request a hearing test before initiating therapy
D) Monitor IV site for inflammation or extravasion
E) Assess liver function study results and bilirubin levels
F) Carefully dilute the medication in the proper amount of solution
A, D, E, F
Rationale: risk for thrombophlebitis with IV administration therefore you must monitor the site, dilute medication properly and give over a minimum of 1 hour
Ototoxicity is not an adverse effect associated with macrolide antibiotics, aminoglycosides (i.e. gentamycin, tobramycin) are a class of abx that do carry this risk
Macrolides have been shown to cause liver enzyme elevations and carry the risk hepatotoxicity
What are the common SE of bronchodilator therapy?
Tremors, tachycardia, anxiety, nausea, palpitations
What interventions would the nurse consider to improve a pt with COPD’s caloric intake who struggles to finish their meals?
-Provide small (5-6 meals a day), nutrient-rich meals, eat protein rich/nutrient rich foods first
-Teach him to eat more slowly and chew foods thoroughly to use less energy, eat foods that require less chewing
-Have him drink fluids at the end of meals to avoid feeling full
-Counsel him to eat when his energy levels are highest
-Encourage periods of rest before and after meals
-Eating sitting up to ease lung pressure
-Have him limit salt and caffeine, eat foods rich in calcium and vitamin D, and avoid foods that cause gas and bloating
What breathing exercises are involved in pulmonary rehabilitation?
Pursed-lip breathing - prolonged expiratory phase and prevents bronchial collapse/air trapping
Diaphragmatic breathing - focuses on using the diaphragm instead of accessory muscles to achieve max inhalation and slow resp rate
Effective coughing - gaol to conserve energy, reduce fatigue and remove secretions
What caloric and fluid intake are required in a pt with COPD?
Caloric - 1.2-1.3x normal caloric maintenance
Fluid - 2-3 L/day
What possible complications must a nurse consider regarding a pt with COPD?
Cor pulmonale, pulmonary hypertension, HF, acute exacerbations/acute respiratory failure, pneumothorax, depression/anxiety
What are the common characteristics of COPD pathophysiology?
- bronchial inflammation, increased mucous production causing airflow limitation and air/CO2 trapping
- Air pockets/decreased elasticity in alveoli, hyperinflation of lungs, flattening of diaphragm causing increased accessory muscle use and barrel chest
What are the clinical manifestations of COPD?
-Intermittent cough (dry or productive)
-Dyspnea on exertion
-Prolonged expiratory phase, wheezes, diminished breath sounds, polycythemia and cyanosis
-Underweight with adequate caloric intake, anorexia, chronic fatigue
A 66-year-old client has marked dyspnea at rest, is thin, and uses accessory muscles to breathe. He’s tachypneic, with a prolonged expiratory phase. He has no cough. He leans forward with his arms braced on his knees to support his chest and shoulders for breathing. This client has symptoms of which of the following respiratory disorders?
A. ARDS
B. Asthma
C. Chronic obstructive bronchitis
D. Emphysema
Correct Answer: D. Emphysema
These are classic signs and symptoms of a client with emphysema. In the early stages of the disease, the physical examination may be normal. Patients with emphysema are typically referred to as “pink puffers,” meaning cachectic and non-cyanotic. Expiration through pursed lips increases airway pressure and prevents airway collapse during respiration, and the use of accessory muscles of respiration indicates advanced disease.
Exercise has which of the following effects on clients with asthma, chronic bronchitis, and emphysema?
A. It enhances cardiovascular fitness.
B. It improves respiratory muscle strength.
C. It reduces the number of acute attacks.
D. It worsens respiratory function and is discouraged
Correct Answer: A. It enhances cardiovascular fitness.
Exercise can improve cardiovascular fitness and help the client tolerate periods of hypoxia better, perhaps reducing the risk of heart attack. People with long-term lung conditions can help improve their symptoms through regular exercise. It can be tempting to avoid exercise because one may think it will make them breathless, but if the client does less activity he becomes less fit, and daily activities will become even harder.
Clients with chronic obstructive bronchitis are given diuretic therapy. Which of the following reasons best explains why?
A. Reducing fluid volume reduces oxygen demand.
B. Reducing fluid volume improves clients’ mobility.
C. Restricting fluid volume reduces sputum production.
D. Reducing fluid volume improves respiratory function.
Correct Answer: A. Reducing fluid volume reduces oxygen demand.
Reducing fluid volume reduces the workload of the heart, which reduces oxygen demand and, in turn, reduces the respiratory rate. It may also reduce edema and improve mobility a little, but exercise tolerance will still be harder to clear airways. As a result, diuretic drugs may be prescribed in COPD for a variety of reasons: pulmonary hypertension and cor pulmonale; pulmonary edema; systemic hypertension; and empirically for severe dyspnoea refractory to maximal conventional therapy
A 69-year-old client appears thin and cachectic. He’s short of breath at rest and his dyspnea increases with the slightest exertion. His breath sounds are diminished even with deep inspiration. These signs and symptoms fit which of the following conditions?
A. ARDS
B. Asthma
C. Chronic obstructive bronchitis
D. Emphysema
Correct Answer: D. Emphysema
In emphysema, the wall integrity of the individual air sacs is damaged, reducing the surface area available for gas exchange. Very little air movement occurs in the lungs because of bronchial collapse, as well. In the early stages of the disease, the physical examination may be normal. Patients with emphysema are typically referred to as “pink puffers,” meaning cachectic and non-cyanotic. Expiration through pursed lips increases airway pressure and prevents airway collapse during respiration, and the use of accessory muscles of respiration indicates advanced disease.
A client’s ABG results are as follows: pH: 7.16; PaCO2 80 mm Hg; PaO2 46 mm Hg; HCO3- 24 mEq/L; SaO2 81%. This ABG result represents which of the following conditions?
A. Metabolic acidosis
B. Metabolic alkalosis
C. Respiratory acidosis
D. Respiratory alkalosis
Correct Answer: C. Respiratory acidosis
PaCO2 > 40 with a pH < 7.4 indicates a respiratory acidosis. If the pH is in the normal range (7.35-7.45), use a pH of 7.40 as a cutoff point. In other words, a pH of 7.37 would be categorized as acidosis. Arterial blood gas interpretation is best approached systematically. Interpretation leads to an understanding of the degree or severity of abnormalities, whether the abnormalities are acute or chronic, and if the primary disorder is metabolic or respiratory in origin.
