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nurse 251 > week 3 COPD > Flashcards

week 3 COPD Flashcards

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1
Q

what is COPD?

A

is a respiratory disorder causes largely by smoking and is characterized by progressive, partially reversible airflow obstruction, with increased and frequency of exacerbations

  • very common and are very sick
  • if they start acting differently in any way- inform doctor
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2
Q

what are some cardinal symptoms of COPD?

A
  • dyspnea (most disabling symptoms) -most common
  • Difficulty breathing -most common
  • shortness of breath
  • limitations in activity (chair to bathroom)
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3
Q

what percent of ppl over the age of 35 have COPD?

A

4.4%

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4
Q

what is the past definition of COPD?

A

included the terms emphysema and chronic bronchitis

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5
Q

what is emphysema?

A

described only one pathological change present in COPD; destruction of the alveoli

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6
Q

what is chronic bronchitis?

A

presence of chronic productive cough for 3 months in 2 successive year

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7
Q

what is a pink puffer?

A

emphysema -skinny, look like they are wasting away, barrel chest air trapping

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8
Q

what is a blue bloater?

A

chronic bronchitis- blue fingertips, poor color, aren’t getting enough 02

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9
Q

in what situation should a COPD pt be hospitalized?

A

when symptoms worsen from infection

  • this accounts for more than 50% of COPD exacerbations
  • the average length of stay is 9.6 days
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10
Q

what are some predisposing factors for COPD?

A
  • butane (lighter fluid)
  • Acetic acid (vinegar)
  • methane (sewer gas)
  • aracaic (poison)
  • carbon monoxide
  • methanol (rockey fuel)
  • fuel
  • paint
  • ammonia (toilet cleaner)
  • nicotine (insecticide)
  • batteries
  • candle wax
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11
Q

what is the primary cause of COPD?

A
  • exposure to tobacco smoke is the primary cause of 80-90% od COPD cases in Canada
  • when cig are smokes, aprox 4000 chemicals and gases are inhaled inot the lungs
  • 60 carcinogens are isolated in cig smoke - include cyanide, formaldehyde, and ammonia
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12
Q

what are the physiological effects that cig smoke?

A
  • causes hyperplasia of goblet cells (make them bigger), which subsequrntly result in teh increased production of muceus and is the basis of chronic cough and sputum accumulation
    -produced abmornal dialation of the distal air space with destruction of the alveolar walls
    -
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13
Q

what is the difference of gas exchange for a normal person compared to a COPD pt?

A

Normal gas exhange: in the alveoli, 02 gas goes out and co2 goes out
COPD pt: damage to teh alveoli causes co2 ro get stucj include, resulting in an acidosis

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14
Q

what is a component of tobacco smoke? what does it do to the body?

A

carbon monoxide
-has high affinity for hemoglobin and combines it with more readily than it does 02, thereby reducing the smokers oxygen carrying capacity

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15
Q

do smokers inhale a lower percentage or higher percentage than normal?

A

lower pecentage, as result, less 02 is available at the alveolar level
-because the bloods oxygen-carrying capacity is reduced, the heart must pump rapidly to adequately supply tissues with oxygen

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16
Q

what are the characteristics of COPD?

A

characterized by:

  • chronic inflammation found in the airways
  • lungs parenchyma (bronchioles and alveoli)
  • pulmonary blood vessles
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17
Q

what are some features of COPD?

A

1) airflow limitations during forced exhalation caused by loss of elastic recoil (cant get air out)
2) airflow obstruction caused by mucus hypersecretion, mucosal edema and brochospasm

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18
Q

what does abnormal gas exchange result in?

A

hypoemia (low 02 in blood) and hypercapnia (increased carbon dioxide) may be present as the disease progresses

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19
Q

what can result from air trapping in the lungs from the alvioli being destroyed?

A

bullae (large air spaces in parechyma)
blebs (air spaces afjacent to pleurae)
-these are not effective in gas exchange because the capillary bed that normally surrounds each alveolus does not exist in the bullae or bleb
= WAY eless area for gas exchange

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20
Q

what results from blebs and bullae?

A

a significant ventilation-perfusion (V/Q) mismatch and hypoxemia results

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21
Q

what is V/Q?

A

the ratio of the amount of air reaching the alveoi per min ot the amount of blood reaching the alveoi per min

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22
Q

what may occur late in the course of COPD?

A

pulmonary hypertension resulting from pulmonary vasculature changes

  • small pulmonary arteries undergo vasocontriction as a consequence of hypoemia, resulting in thickening of the vascular smooth muscle as the disease progresses
  • this can lead to hypertrophy of the right ventricle OR cor pulmonale, with or without right heart failure
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23
Q

what is pulmonary artery hypertension?

A

the right ventricle needs to pump more blood because it needs to work harder to push blood to the lungs, making the left heart smaller and the right heart becomes bigger =right heart failure

24
Q

what is cor pulmonale?

A

is hypertrophy of the right side of the heart, with or without right heart failure that result from pulmonary hypertension

  • usually the right side of the heart has less pressure, but this needs to increase because the heart needs to pump blood to the lungs
  • is a late manifestation of COPD with a poor prognosis
  • eventually right heart failure develops
25
Q

when should a diagnosis of COPD be considered?

A

when a person experiances symptoms of cough, sputum production, or dyspnea and has a history of smoking

-pts usually seek medical help when they have acute respiratory infection, with dyspnea being the mean concern

26
Q

what subjective data may indicate presence of COPD?

A

“my breath does go in all the way”

“ its hard work to breath”

27
Q

when does progressive dyspnea occur in COPD?

A

happens as more alveoli become over distended, trapping increasing amounts of air (more air trapping =harder to breath)

28
Q

what does a physical exam for COPD include?

A
  • a prolonged expiratory phase of respiration, wheezes or decreased breath sounds
  • tripod positioning (leaning over trying to breath better)
  • pursed-lip breathing
  • use of accessory muscles
  • edme a in the ankles (if right side heart involvement- can indicate heart failure)
  • clubbing fingernails
29
Q

what does a clinical assessment include for COPD?

A
  • begins with a throrough history
  • tobacco history - quantified and expressed in pack-years
  • pack years are calculated by multiplying the number of cigs daily by number of years smoked
  • nurses must also include an assessment of symptoms associated with comormid conditions or complications of COPD. (ankle swelling, weight loss, not being able to eat, too exhasted to, anixety, depression, low quality of life, and the cureent medical tx
30
Q

what is the most frequent cause of medial visits and hospitalization amoungst those with COPD?

A

exacerbations

-thought to be infectious in nature

31
Q

what is an acute exacerbation?

A

defined as a sustained worsening of dyspnea, cough, or sputum production that leads to increased use of maintence medications (fever, chills, leukocytosis may not be present)

32
Q

how can exacerbations be characterized?

A

charcterized as purulent (gross, thick, greenish brown yellow color)
OR
non purulent: require antibiotic therapy

33
Q

what is a frequent complication of COPD?

A

pneumonia

34
Q

what do COPD pts with purulent sputum receive?

A

they reicive antibiotics from 7-10 days (ex, amoxicillin, moxifloxcin, levofloxacin, and an amoxicillin with clavulanic acid)

35
Q

what are COPD pts often sent home with?

A

an action plan

36
Q

what should be encouraged for COPD pts?

A

annual influenze vaccination and pneumococcal vaccination

37
Q

what do pts with moderate to severe airflow obstruction need?

A

oral corticosteriods

38
Q

what should pts with copd be assessed for?

A

pneumonia and congestive heart failure

39
Q

what are the components of primary COPD managment?

A
  • Prevent disease progession (smoking cessation)
  • Reduce the frequency and severtity of exacerbations
  • releive breathlessness and other resp symptoms
  • improve excersie tolerance and daily acitivity
  • tx exacerbations and complications of the disease
  • improve health status and QOL
  • Reduce risk of mortaility
40
Q

what is the most significnt factor for slowing the progression of COPD?

A

stopping smoking
-the sooner the pt stops smoking, the less pulmonary function lost and the sooner the symptoms decrease, particularly cough and sputum production

41
Q

what is the mainstay of pharmacological therapy for COPD?

A

bronchodilators

42
Q

what do bronchodilators do?

A
  • relaxes smooth muscle in the airway
  • reduces airway resistance and dynamic hyperinflation of the lungs
  • improves the ventilation of the lungs, thus reducing the degree of breathlessness
43
Q

what is the preferred route for bronchodilators?

A

inhalation - directly targets the lungs

44
Q

what do short acting bronchodilator medications do?

A

(meds such as beta 2 adrenergic agonists -salbutamol, or anticholinergic agents (ipratropium)
-improve pulmonary function, symtoms and exercise function

45
Q

what two drugs can be combined to produce superior bronchodilation?

A

B2 adrenergic agonists and anticholingics

46
Q

how often do most COPD pts use bronchodilator as maintenance therapy?

A

3-4 times per day, with extra puffs as needed

47
Q

what is frequently used to treat COPD?

A

oxygen therapy

48
Q

How does administering oxygen help raise in a COPD pt?

A

Raises the partial pressure of O2 inspired air (normal amount of O2 in atmosphere is 20.95%)

49
Q

What is the goal of O2 administration?

A

Is to supply the patient with adequate O2 to maximize the O2-carrying ability of the blood

50
Q

How is the method for O2 selected?

A

Depends on factors such as fraction of inspired O2, mobility of pt, humidification required, pt cooperation, comfort, and cost

51
Q

What is a safety issue that is important to remember when someone is receiving O2?

A

O2 supports combustion and increases the rate of burning, this is important that smoking be prohibited in area where O2 is being used

52
Q

What should all pts with COPD be encouraged to do?

A

Maintain an active lifestyle

53
Q

What are pulmonary rehab programs used for?

A

Used to optimize the functional status of pts with COPD as well as their quality of life, experience of dyspnea, exercise endurance, psychological functioning and overall autonomy to reduce their use of health care services and exacerbations of their conditions

54
Q

What is the duration of pulmonary rehab?

A

Duration of 4-12 weeks

55
Q

what exercises are involved in pulmonary rehab?

A

involves both upper and lower extremity training and improves dyspnea and exercise performance
-includes walking, treadmill, and bicycling

56
Q

what two nutritionally related things are common with ppl with COPD

A

weight loss (eating becomes difficult as result of dyspnea) and malnutrition

  • a full stomach presses up on the flattened diaphragm, further increasing dyspnea.
  • difficult for some pts to eat and breath at the same time - resulting in eating inadequate amounts of food
57
Q

what should nurses encourage for a COPD pts nutritional health?

A

should encourage high protein, high calorie foods and to plan periods of rest before and after food intake to assist with controlling fatigue

nurse 251 (14 decks)

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