Week 3: Management of Patients w Chronic Pulmonary Diseases Flashcards
COPD
- what is it characterized by?
- is it reversible?
- is it a slow or fast progression?
- Characterized by airflow limitation that is not fully reversible
- slowly progressive
what is a COPD patient’s biggest struggle?
Airflow limitation on exhalation
COPD has variable combinations of which 3 conditions?
chronic bronchitis, emphysema, and asthma
describe the pathophysiology of COPD
Airflow limitation is both progressive and associated with an abnormal inflammatory response of the lungs to noxious particles or gases
where does the inflammation in COPD occur?
occurs in proximal (close) and peripheral airways, lung parenchyma, and pulmonary vasculature
what are complications of COPD? (list the 3 important ones)
hypoxia, hypoxemia, HF (especially right sided)
list the three primary symptoms of COPD
chronic cough, sputum production, and dyspnea
which type of COPD patients have weight loss? what is recommended for these patients?
emphysema; to have small frequent meals
which type of COPD patients have weight gain & why?
bronchitis patients; loss of muscle
what 3 tests are used to diagnose COPD and what do they measure?
Spirometry (pulmonary function tests): measures volume in lungs
ABGs: gas levels in blood (PaO2, PaCO2)
chest x-ray / CT scan: shows fluid in lungs; reveals HF
how do patients look when they have bronchitis?
“Big Blue Bloater”
what is bronchitis?
- what is the main symptom?
- how long must a patient have it to be diagnosed?
Disease of the airways (bronchial tubes are inflamed)
- cough w daily sputum production
- at least 3 months / year for 2 consecutive years
what are s/sx of bronchitis? (4)
- what season does it often occur in?
- hypertrophy (enlargement) & hypersecretion of mucus glands
- chronic inflammation & edema (going into right sided HF)
- cough
- gradual structural changes (belly breathing & retaining fluid)
- most often occurs in winter
name 3 common / important characteristics of bronchitis
- used pursed lip breathing
- go into respiratory acidosis
- core pulmonale (right sided HF)
when are COPD patients given steroids?
ONLY when they have exasterbations!!!
what is emphysema?
- what is destructed?
- progresses fast or slow?
- where is there lots of scar tissue?
Impaired oxygen and carbon dioxide exchange
- Destruction of the walls of over distended alveoli
- Progresses slowly for years
- Lots of scar tissue in the alveoli
what happens when the alveolar walls breakdown in emphysema patients? (3)
- Increase in dead space in the lungs (more dead space = less air to get in the lungs)
- CO2 elimination is impaired (retaining CO2) resulting in a red flushed face
- PaCO2 gets too high, going to shut down breathing (respiratory acidosis)
how do patients look when they have emphysema?
“pink puffer”
how must emphysema patients sleep?
sitting up
what are common characteristics seen in emphysema patients? (6)
- Thin appearance
- Increased respiratory rate to maintain adequate oxygen levels
- Accessory muscle use
- Barrel shaped chest
- Purse lipped breathing
- High CO2 level
how do pulmonary function tests work?
clip on nose & blow out as hard as you can
what type of diet should COPD patients be on?
high protein, low CHO, high fat (their source of energy) adequate hydration!
how do bronchodilators treat COPD?
open up airways
how do corticosteroids treat COPD?
decreases inflammation
what is asthma? what specifically happens?
Chronic inflammatory disease of the airways→ airway hyper-responsiveness
are bronchospasms in asthma reversible?
usually but not always
what are mast cells?
type of WBC
function of macrophages
clean up after attack
function of neutrophils
first attackers / responders
function of eosinophils
released / increased in times of allergies
function of T lymphocytes
part of immune system; survalance crew
what do mast cells do w asthma?
key role in the inflammation
what is the physiology when asthma attacks occur initially?
Hypoxia (oxygen level drops), hyperventilation (CO2 decreases), respiratory alkalosis
what is the physiology later on in asthma attacks?
increased CO2, respiratory acidosis, respiratory failure
list some triggers of asthma? (8) what is the strongest predisposing factor?
- Allergens - Strongest predisposing factor
- Medications
- Upper respiratory infection
- GERD
- Strong odors, fumes, smoke
- Hormone levels (during periods)
- Especially in females
- Exercise, Stress, Laughing
- Cold air
what are the 3 most common symptoms of asthma?
cough, dyspnea, and wheezing
list other s/sx of asthma (7)
- Accessory muscle use
- Anxiety / Chest tightness
- Prolonged expiration
- Diaphoresis
- Hypoxemia (<80 in blood)
- Tachypnea / Tachycardia
- Widened pulse pressure
EX: 130/70, 150/60, 220/60
how do you assess an asthma patient? (2)
- Determine symptoms of airflow (pulmonary function test)
- Identify triggers
how is asthma diagnosed? which tests are used? (2) what do they measure?
Forced Expiratory Volume (FEV1)
- Blowing into a tube & tells us how much air is coming out
Forced Vital Capacity
- Breathing treatments w pulmonary function tests
PFTs
how is the treatment of asthma evaluated?
FEV (forced expiratory volume): amount of air expired after 1, 2, 3 seconds of forced vital capacity (amount of air forced out of the lungs after the greatest inhalation)
Measures lung capacities, lung volume, rates of flow, gas exchange
how should O2 levels be after asthma treatment?
expect an increase
how should breath sounds be after asthma treatment?
wheezing to clear or diminished
what is important to educate an asthma patient about? (3)
- medication usage: how to use their inhalers (shake it, use spacer (helps get all medication down), place 1-2 inches away from mouth, breathe in slowly
- Self monitoring of PEF (peak expiratory flow): measures peak rate individually
- Exercise: use inhaler 15 min before exercising
list some asthma complications (5)
- Status asthmaticus: asthma attack that does not respond to the normal treatment; lasts longer than a normal asthma attack
- Respiratory failure
- Pneumonia
- Atelectasis
- Hypoxemia
nonpharmacological dyspnea management (6)
- Cool air on face, use fan (turn heat down in room)
- Strengthen respiratory muscles thru exercise training (diaphragmatic breathing)
- Improve nutrition to improve muscle mass
- Positioning (HOB up)
- Pursed lip & diaphragmatic breathing
- Oxygen therapy
pharmacological dyspnea management (3)
- Bronchodilators
- Opioids – Morphine Sulfate (decreases CNS & respiratory rate) – not only for pain!
- Anxiolytics
which medication is most effective for asthma & COPD? what is an intervention for this med?
Inhaled corticosteroids most effective (rinse mouth after) - can cause thrush!
- Fluticasone
- Budesonide
- Flunisolide
how do anticholinergics treat asthma & COPD? list the med; what is an intervention?
dries everything up!!
- Ipratropium
- Make sure pt. pees before you administer this med!
how do short acting bronchodilators treat asthma & COPD? list the meds (2)
rescue!!!
- Beta 2 adrenergic agonists
- Albuterol
- Levalbuterol (also known as zopenex)
how do long-acting adrenergic agonists treat asthma & COPD? which meds? (2)
- maintenance or prevention!
Salmeterol
Formoterol
a beta agonist is commonly combined w which med?
an inhaled steroid
how do combo drugs treat asthma & COPD? name them (2)
used for maintenance only!!
Fluticasone-salmeterol
Budesonide-formoterol
what is the leukotriene modifier that treats asthma & COPD?
when is it given?
list the BBW
- Montelukast: prevents bronchial tubes from constricting
- BBW: hallucinations
- Given at night
how do immunomodulators treat asthma & COPD? what do they decrease & what could this be a risk of? name the med
biological modifiers; work on specific targeted organs; decrease immune system (at higher risk for developing infections & cancers)
- IgE-Inhibiting IgG monoclonal antibody
omalizumab
list nursing interventions for O2 / oxygen therapy (4)
- not around anything flammable (signs posted at home)
- oxygen carrier
- change oxygen tubing if dirty
– do not use more than what’s ordered
dyspnea assessment & management (3)
- pursed lip breathing
- leaning over table
- sleeping w multiple pillows
which med helps w cough enhancement?
expectorant
