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NURSADN6 Med Surg > Week 4 Chapter 20 Management of Patients with COPD > Flashcards

Week 4 Chapter 20 Management of Patients with COPD Flashcards

1
Q

What is COPD?

A

Slowly progressive respiratory disease of airflow obstruction

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2
Q

What does COPD include?

A
  1. Chronic Bronchitis
  2. Preventable and treatable but not fully irreversible
  3. Involving the airways, pulmonary parenchyma, or both
  4. 4th leading cause of death of all ages
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3
Q

Name other chronic pulmonary diseases

A

Bronchiectasis, asthma, cystic fibrosis

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4
Q

Pathophysiology of COPD

A
  1. Airflow limitation is progressive, associated with abnormal inflammatory response to noxious particles or gases
  2. Chronic inflammation damages tissue
  3. Scar tissue in airways results in narrowing
  4. Scar tissue in the parenchyma decreases elastic recoil (compliance)
  5. Scar tissue in pulmonary vasculature causes thickened vessel lining and hypertrophy of smooth muscle (Pulmonary HTN)
  6. Body tries to self repair which increases the number of goblet cell and hypersecretion of mucus
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5
Q

A preventable and treatable disease with some significant extrapulmonary effects

A

COPD

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6
Q

Disease state characterized by airflow limitation that is not fully reversible

A

COPD

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7
Q

COPD is currently what?

A

4th leading cause of death and 12t leading cause of disability

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8
Q

The incidences of COPD increases with?

A

Age
- Symptoms begin in “middle adult” years

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9
Q

COPD includes diseases that cause airflow obstruction

A
  1. Emphysema
  2. Chronic Bronchitis
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10
Q

COPD is overfunded. T/F

A

False most underfunded

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11
Q

Name the 3 primary symptoms of COPD

A
  1. Chronic cough
  2. Sputum production
  3. Dyspnea on exertion (as disease progresses dyspnea occur at rest)
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12
Q

Other symptoms of COPD

A
  • Weight loss
  • Accessory muscles
  • Resp. insufficiency and resp. infections
  • Polycythemia
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13
Q

Assessment and Diagnosis of COPD

A

Health History
PFT
Spirometry
ABG
Chest Xray

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14
Q

Name the risk factors of COPD

A

Exposure to tobacco smoke
Older adults
Occupational exposure
Pollution
Genetic abnormalities

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15
Q

What causes most of COPD?

A

80-90 % pf COPD cases

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16
Q

Risk factors of COPD

A

Passive smoking
Occupational exposure
Ambient and outdoor air pollution
Genetic abnormalities: Alpha 1- antitrypsin deficiency (A1AD)
- 25 M carriers of this genetic defect
- Lethal disease, develop emphysema by 30s and 40s
- Affects 100,000 Whites
- Tx: Alpha protease inhibitor replacement therapy

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17
Q

Common adverse effects of tobacco smoking

A
  • Larynx cancer/ Oral cavity cancer
  • MI
  • Systemic atherosclerosis
    -Bladder cancer
  • Pancreas Cancer
    -Peptic ulcer
  • Emphysema
  • Lung cancer
  • Chronic Bronchitis
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18
Q

Name the complications of COPD

A
  1. Resp. insufficiency and failure
  2. Pneumonia
  3. Chronic Atelectasis
  4. Pneumothorax
  5. Cor pulmonale
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19
Q

Name the medical management of COPD

A

-Promote smoking cessation
- Reducing risk factors
- Managing exacerbations
- Providing supplemental oxygen therapy
- Pneumococcal vaccine
- Influenza vaccine
- Pulmonary rehabilitation
- Managing exacerbations

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20
Q

Medications to treat COPD

A

Bronchodilators/ MDIs
Corticosteroids
ABX
Mucolytics
Antitussives

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21
Q

Bronchodilators/MDIs include

A
  • Beta- adrenergic agonist
  • Muscarinic antagonists(anticholinergics)
  • Combination agents
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22
Q

Tx:
Rx/ Management in COPD

A

Chronic COPD
- C- Cessation smoking, steroids IF PFTs reversible
- O2 if hypoxic
- PFTs + pnemo vac, flu vac, pulmonary rehab
- Dilators (bronchodilators: B@ agonist, anticholinergic)

Acute COPD
- ABX if indicated by fever and CXR
- Corticosteroids to reduce hospital stay
- O2
- P- phlegm control- mucolytics
- Dilators

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23
Q

Name the surgical management of COPD

A

-Bullectomy
- Lung volume reduction
- Lung transplant

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24
Q

What is the nursing management of COPD?

A

Assessing the pt: obtain hx, review dx tests
- Achieving airway clearance
- Improving breathing patterns
- Improving activity tolerance
- MDI pt education

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25
Q

Nursing care of Pt with COPD

A
  • Evaluate exposure to resp. irritants
  • Nursing interventions to promote oxygenation
    –Incentive spirometry
    – Postural Drainage
    — Chest percussion and vibration
    – Breathing exercises

-Administer medications to promote gas exchange and oxygenation
-Oxygen
- Bronchodilators

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25
Q

Education plan for Pt with COPD

A

Pt education for
- Smoking cessation
- Medication administration
- Breathing exercises
- Regular exercise
- Realistic goals
- Emergency management

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26
Q

Types of breathing to help COPD includes

A

Pursed Lip breathing
Diaphragmatic Breathing

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27
Q

Name the clinical manifestations of COPD with Emphysema

A

Chronic hyperinflation of the alveolar sacs with trapped air leads to barrel chest

-Fix position of the ribs
- Loss of lung elasticity
- Retraction of the supraclavicular fossae on inspiration
- Shoulders heave upward

Advanced stages
- Use of abdominal muscles to inspire

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28
Q

Pressures in the lungs include

A

Negative pressures-(inspiration)
-Moves air into the lungs =6L

Positive pressures (expiration)
- Moves air out of the lungs

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29
Q

With Emphysema, expiration/ exhalation is …

A

NOT PASSIVE

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30
Q

What is the passive phase of respiration?

A

Exhalation

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31
Q

Patients with advanced lung disease such as COPD will often assume what?

A

Tripod positioning

When breathing difficulties occur

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32
Q

Why tripod psoitioning?

A

Provides a position that optimizes respiratory mechanics

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33
Q

Nursing Assessment of COPD includes

A

Health Hx
Inspection and examination findings
Review diagnostic tests

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34
Q

Assessment of COPD

A

H and P
Review of Dx tests
S/S of infection
- URI (changes in sputum color, consistency and amount)
S/S of hypoxemia
- Cognitive changes - memory impairment, Increase of HR and RR
- Personality and behavior changes

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35
Q

Nursing planning of COPD patients

A

Smoking cessation
Improved activity tolerance
Maximal self management
Improved coping ability
Adherence to therapeutic regimen and home care
Absence of complications

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36
Q

Ways to Improve Gas Exchange

A

-Proper administration of bronchodilators and corticosteroids
- Reduction of pulmonary irritants
- Directed coughing, huff coughing
- Breathing exercises to reduce air trapping
- Diaphragmatic breathing
- Pursed Lip breathing
-Use of supplemental O2

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37
Q

Ways to improve activity tolerance

A
  1. Focus on rehab activities to improve ADLs and promote independence
  2. Pacing of activities (AM care)
  3. Exercise training
  4. Walking aides
  5. Utilization of a collaborative approach
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38
Q

What is the priority nursing care for COPD patients?

A

-Semi Fowlers and monitor RR and tx w/ O2 and wean off O2
- Begin O2 (Pa O2 60-65%)
(O2 sat 90-92% goal)
- Drive to breath is based on low O2
- High paO2 results in low resp. drive
- Hypercapnic drive Increased CO2= Increased RR readjusted CO2 to 50
- When CO2 is 70-80 this is Increased RR
- Assess VS -careful with pulse ox
-Determine the cause of hypoxia
-Preventive URI
—-Pneumonia vaccine, HFLU vaccine, early warning signs

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39
Q

Patient teaching for COPD includes

A

-Disease process
-Medications
-Procedures
- When and how to seek help
- Prevention of infection hand washing
- Avoidance of irritants and pollutants
-Lifestyle changes
- Pursed lip and diaphragmatic breathing

40
Q

What are other interventions for COPD?

A

-Set realistic goals
- Avoid extreme temperatures
- Enhancement of coping strategies
- Monitor for and management of potential complications

41
Q

Nursing interventions for COPD include

A

ADLs
- AM challenging
- Heavy secretions in AM
-Increase participation with improved tolerance

Walking aids with periods of rest

Portable O2
-Teaching is tailored to the stage of the disease

-Environmental factors
-Continue home care/ community resources

42
Q

Retrained breathing includes

A

Pursed Lip - slow, deep, diaphragmatic breathing)

43
Q

The key and most important nursing activity is

A

Smoking cessation

44
Q

All teaching should be followed by?

A

Return demonstration of techniques and/ or verbalization
- Aggressive care tx options
- End of life care decisions

45
Q

What is the single most important intervention to reducing COPD?

A

Smoking Cessation

46
Q

Also patient education on which shot?

A

H. Flu

47
Q

Nurses must provide a ___________ ____________ then look for multiple strategies

A

strong warnings

Important to obtain a quit date

48
Q

Goals and pt outcomes/ evaluation for COPD

A

Airway clearance
Improve breathing patterns
Improved activity tolerance
Avoidance of complications, resp. failure, atelectasis, URI infections
Adequate coping mech.
Environmental Exposures
Smoking cessation achieved
Knowledge regarding complications/ pneumothorax

49
Q

Name the medical management of COPD

A

-ABGs obtain- need O2 baseline in advance stages
- CXR for exclusion
- CT- differential diagnosis must be done to r/o asthma
-A1AT 1% if younger than 45 with strong fam hx

50
Q

A1AT is produced where?

A

Liver
and one of its function is to protect the lungs from neutrophil elastase associated with liver disease

51
Q

Medical management of COPD

A

-Promote smoking cessation
- Reducing risk factors
- Managing exacerbations
- Providing supplemental O2
- Pneumococcal Vaccine
-Influenza vaccine
- Pulmonary rehab.
- Managing exacerbations

52
Q

First line therapy of COPD includes

A

Nicotine replacement
- Gum, nasal spray, transdermal patch

53
Q

Medical management of COPD includes

A

Antianxiety agents
Antidepressant- Wellbutrin SR, nortriptyline)
-Hypertensive agents :Clonodine
- Bronchodilators: via MDIs
- Corticosteroids -Improve pulmonary functions
- ABX, mucolytics, antitussives, vaccines (H flu vacs 50% deaths)
- Possible vent . support
- End of life decisions

54
Q

Pharm therapy of COPD includes

A

-Bronchodilators- Beta 2 adrenergic agonists
-Albuterol and levalbuterol
-Inhaled - short acting
-Orla- long acting : albuterol
-Therapeutic uses
- Prevention of asthma episode ( exercise induced)
- Long term control of asthma

55
Q

Formoterol and Salmeterol are

A

Long acting control of asthma
- Inhaled, long acting

56
Q

Terbutaline

A

Oral and long acting
- Long term control of asthma

57
Q

Complications of bronchos include

A

Tachycardia and angina
Tremors

58
Q

Name inhaled Anti- Cholinergic Agents (Muscarinic Agents)

A

-Ipratropium and Tiotropium (Atrovent and Spreva)

59
Q

Name the purpose of Muscarinic Agents

A

Blocks muscarinic receptors of bronchi leading to bronchodilation

60
Q

Therapeutic uses of Muscarinic Agents include

A

Relieve bronchospasm with COPD
-Complications -Dry mouth/ hoarseness

61
Q

This medication causes relaxation of bronchial smooth muscle; bronchodilation

A

Theophylline

  • Therapeutic use -Long term control of chronic asthma or COPD
  • Complications- GI Distress, restlessness
62
Q

This medication class prevents inflammation, suppress airway mucous production and promote responsiveness B2 receptors in bronchial tree

  • Reduction in airway mucosa edema
A

Glucocorticoids

63
Q

Name the therapeutic uses for glucocorticoids

A

Short term IV- status asthmaticus

-Inhaled- long term prophylaxis of asthma

  • Effects less dramatic for COPD, long term oral not recommended
64
Q

Medication Regime for COPD

A

Grade 1-mild- short acting bronchodilator

Grade 2 or 3- short acting bronchodilator and regular treatment with one or more long acting bronchodilators

Grade 3 or 4- Severe or very severe
— One or more bronchodilators and/ or inhaled corticosteroids
— Combination long term B2 agonist plus corticosteroids in one inhaler may be appropriate

65
Q

Physiologic dead space=

A

Anatomical+ alveolar

-Anatomical- person’s wt in ml
- 1/3 of the resting Tidal volume
ex: 150 ilbs man has 150 ml of dead space - Mouth and trachea

Alveolar- air in contact w/ alveolar without blood flow in adjacent pulmonary capillaries

  • Small amt in healthy individuals
66
Q

Collaborative Problems

A

-Resp. insufficiency or failure
- Pneumonia
-Pneumothorax
- Pulmonary HTN
- Cor pulmonale
- Chronic Atelectasis

67
Q

What is Emphysema?

A

-Slow, progressive, “ end stage process”

  • Overdistended of the alveoli walls beyond the terminal bronchioles resulting in decrease elastic recoil of alveoli
  • Impairs O2 and CO2 exchange (CO2 retention)
68
Q

As there are repeated resp. infections that accelerates the disease what happens

A

Decrease in elastic “recoil” of the alveoli

69
Q

This over-distention decreases the pulmonary capillary bed which causes what?

A

Increase in dead space

  • No gas exchange takes place- Hypoxemia
70
Q

The dilated sacs trap air and increase resistance to blood flow in lungs… this forces what

A

Increase in PAP may cause right sided HF

71
Q

What is chronic bronchitis?

A

Cough and sputum production for at least 3 months in each of 2 consecutive years

72
Q

Ciliary function is reduced, bronchial walls thicken, bronchial airways narrow, and mucous may plug airways

A

Chronic Bronchitis

73
Q

Alveoli may become damaged, fibrosed, and alveolar macrophage function diminishes

A

Chronic Bronchitis

74
Q

The patient is more susceptible to what with chronic bronchitis

A

Infections

Resp. infections

75
Q

Normal chronic bronchitis has

A

Inflammation
Increased number of mucous glands
Excess mucus causing chronic cough

76
Q

In 1 year of smoking cessation

A

Carbon monoxide level back to normal

77
Q

After 10 yr smoking cessation

A

Risk from dying of lung cancer is about half that of smoker

78
Q

5-15 yrs

A

Risk of stroke same as non smoker

79
Q

After 15 years

A

Risk of coronary heart disease same as nonsmoker

80
Q

E Cigarettes

A

-Juul- Delivers higher concentrations of nicotine than other e cigs
5% to 2.4%

Amount of nicotine in one juul pod is equivalent to a pack of cig

81
Q

Many of the flavoring of e cigs have not been studied

A

True

Agency deferred its authority to regulate e cig companies pre market application until 2022.

82
Q

Nicotine is

A

-Highly addictive
- Toxic to fetuses
- Impairs brain and lung development in adolescence

83
Q

Emphysema is

A

Abnormal distention of air spaces beyond the terminal bronchioles with destruction of the walls of the alveoli

Results in impaired O2/ CO2 exchange

84
Q

Decreased alveolar surface in emphysema increases what?

A

Dead Space

Impaired oxygen diffusion

Hypoxemia results

85
Q

In emphysema increased pulmonary artery pressure may cause what?

A

Cor pulmonale
Right sided heart failure

86
Q

What are the clinical manifestations of Emphysema?

A

-Congestion
- Dependent edema
- Distended neck veins
- Active, effortful respirations
- Pain in liver (with cardiac feature)
- Hypoxia/ Hypoxemia
- Hypercapnia (later stage)
-Polycythemia
Episodic RV failure (cor pulmonale)

87
Q

In barrel chest the A-P diameter and transverse diameter is

A

1:1

87
Q

Changes in alveolar structure in emphysema includes

A

Pan lobular emphysema
Centrilobular Emphysema

88
Q

PLE includes

A

Enlarged lobes
Hyperinflated chest
Severe dyspnea on exertion
weight loss

89
Q

CLE includes

A

Chronic hypoxemia
Hypercapnia
Polycythemia

Overinflated sacs compressed adjacent blood vessels

90
Q

Decrease in arterial oxygen tension in blood

A

Hypoxemia

91
Q

Decrease in oxygen supply to the tissues and cells that can also be caused by problems outside the resp. system

A

Hypoxia

Severe Hypoxia can be life threatening

92
Q

Cylinder piped in concentrator

Classified as low flow to high

A

Oxygen Administration

93
Q

Devices of O2 administration include

A
  • Nasal cannula
  • Oropharyngeal catheter
  • Masks
  • Transtracheal Catheter
94
Q

On home oxygen the nurse does what?

A

Safe methods to administer in home
- Available in gas, liquid, concentrated
- Portable devices
- Humidity must be provided
- Community resources

95
Q

Oxygen toxicity

A

May occur when too high a concentration of oxygen greater than 50% is administered for an extended period

96
Q

Symptoms of Oxygen toxicity include

A

Substernal discomfort, parathesias, dyspnea, restlessness, fatigue, malaise, progressive, resp. difficulty, refractory hypoxemia, alveolar atelectasis, and alveolar infiltrates on x ray

97
Q

Prevention of oxygen toxicity

A

Use lowest effective concentrations of oxygen

PEEP or CPAP prevent or reverse atelectasis and allow lower O2 percentages to be used

NURSADN6 Med Surg (9 decks)

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