x Resp: COPD (Ms. Ci) Flashcards
1
Q
COPD is 3rd leading cause of death in US
A
COPD is 3rd leading cause of death in US
2
Q
COPD (Chronic Obstructive Pulmonary Disorder)
A
-group of pulmonary disorders
-progressive, inflammatory disease
-irreversible airflow limitations
NO CURE, CAN NOT REVERSE Lung Damage
3
Q
COPD: several disease..
A
- Chronic Bronchitis
- Emphysema
- Chronic Asthma
- Bronchiectasis
4
Q
COPD Def
A
permanent blockage of the pulmonary system and interfere w gas exchange (i.e. one bronchi or alveoli become completely obstructed)
5
Q
Lung
A
Trachea
Bronchi
Bronchioles
Alveoli`
6
Q
COPD several disorders
A
Chronic Bronchitis - affects bronchi
Emphysema - affect alveoli
7
Q
Less air flow d/t:
A
- Bronchi / Bronchioles, loose elastic quality
- walls btw alveoli destroyed
- airway walls thick and inflamed
- excess mucus obstructs airways
8
Q
COPD: Causes
A
- Smoking
- exp to pollution, fumes, dust
- Gx, alpha1 antitrypsin deficiency (protein protects lung tissue fro enzymes of inflammatory cells. LO levels lead to lung damage/COPD if exposed to pollution, fumes, dust)
9
Q
EMPHYSEMA
A
- Alveolar disease
- abnormal perm enlarge of alveoli will destroy alveolar walls.
- many small alveolar provide maximum surface area.
10
Q
Emphysema: Pathos
A
- Bronchiole lumen narros —> traps air during expiration
- trapped air –> alveolar distention and hyperinflate
- hyperinflation –> several alveoli rupture and make 1 large alveoli
- larger less elastic sacs CAN NOT completely force air our
- less alveolar = less surface area
- must breath harder
- Expiration becomes ACTIVE process. burn more calories. (thats why they are thin)
11
Q
Inspiration - Active
A
Expiration - Passive
12
Q
Emphysema:SS
A
aka Pink Puffer
- Polycythemia (Skin tone Pink d/t hypoxia. body UP RBCs to UP O2 carrying capacity
- Barrel chest (d/t inflated alveolar)
- Dyspnea
- UP resting resp rate
- initially little sputum ==>copious sputum
- Clubbing (d/t chronic hypoxia)
- LO breath sounds
- rales
- thin appearance
- retain CO2 (respiratory acidosis)
- pursed lip breathing
- frequent URI
- use of accessory muscles
- Cor Pulmonae (Rt sided heart failure)
13
Q
Emphysema: Dx Tests
A
- Med Hx (smoker, WTC worker)
- PFTs
- ABG
- Blood test: alpa1-antitrypsin, cbc
14
Q
Emphysema: MM
A
- Broncho dilators
- Chest PT (loosen mucus, i.e. cupping)
- O2 1-2L/min
- Abx
- Diuretics
- Anti Inflam Agents/Steroids
- Pul Rehab
15
Q
Emphysema: NI
A
-semi/hi fowlers
-O2 1-2L/min
-pt education
-Diet: UP protein, calorie
Fluid: encourage 2-3L/day to loosen secretions, unless contraindicated..renal, heart probs)
-STOP SMOKING
-Avoid respiratory Depp?
-Vaccine )flu/pna)
-pursed lip breathing
16
Q
CHRONIC BRONCHITIS
A
- presence of a productive cough for at least 3 mos - year over 2 consecutive years
- inflam of bronchi which lead to UP mucous
17
Q
Chronic Bronchitis: Pathos
A
- bronchi inflam –> DEC in bronchi diameter
- less air flowing thru
- bronchi inflam –> UP mucous production –> airway obstruction
18
Q
Chronic Bronchitis: Causes
A
- smoking/2nd hand smoke
- repeated acute bronchitis attacks
- Envt pollution
19
Q
Chronic Bronchitis: Dx Tests
A
- PFTs
- ABG
- CxR
- CBC
20
Q
Chronic Bronchitis: SS
A
- productive cough
- LO breath sounds, wheezes, raunchy
- Cyanosis, “Blue Bloaters”
- Hypoxia
- Acidosis
- edematous
- UP resp rate
- Dyspnea
- Cor Pulmonea
- heart enlargement
- use accessory muscles to breath
21
Q
Chronic Bronchitis: MM
A
- Bronchodilators (open airway)
- Steroids (LO inflam)
- Mucolytics (loosen mucous)
22
Q
Chronic Bronchitis: NIs
A
- MEd education (steroids, taper off)
- PO fluids
- suctioning
- monitor change in sputum
- STOP SMOKING
- nutrition assessed
23
Q
ASTHMA
A
chronic inflame disease of airways characterized by airway hyper responsiveness to variety of stimuli
- resolves spontaneously or w meds
- reversible
24
Q
Asthma: Types
A
- Extrinisic
- Intrinsic
25
Asthma: Types: Extrinisic
Caused by external factors
| -dust, pollen, mold, feathers, food, animal dander, roach droppings
26
Asthma: Types: Intrinsic
Caused by unknown internal factors triggered by respiratory factors
- Strenuous Phys Activity
- Stress
27
Asthma: Pathos
- trigger bronchospasms
- airway inflam --> constriction (wheeze)
- Excessive mucous production
28
Asthma: SS
- Dyspnea
- Tachypnea
- Tachycardia
- Chest tightness
- cough
- wheezing
- use of accessory muscles
- anxiety
29
Asthma: Dx Tests
- PFT
- Abx
- Chest Xray
- Sputum Culture
30
Asthma: Rx
- Bronchiodilators
- Steroids
- Mucolytics
- Abx
- O2
31
Asthma: MEDS
```
-to prevent and minimize SS
MEDS:
-SEREVENT: long acting bronchodilator
-FLOVENT: corticosteroid
-THEOPHYLLINE: bronchodilator
-SINGULAIR: bronchodilator, Anti inflam effects, Leukotrine receptor antagonist
```
32
Asthma: Acute Therapy
- immediately relieve SS of accute asthma attack
- MED: Albuterol (short acting)
- MED: Corticosteroid
- MED: Ephinepherine
- O2
33
Peak Flow Meter
normal 80-100%
- portable hand held device
- measures how fast air flows out of lungs w 1 fast exhale
- monitors lung fx by measuring: Peak Expiratory flow rate
- 60% LOWER = SEVERE ASTHMA
- 50% LOWER = LIFE THREATENING
34
Asthma: NI
- ABCs
- Recognize asthma triggers, avoid
- Med education
- peak flow monitoring
35
Pursed Lip Breathing
- improves ventilation
- releases trapped air in lungs
- keeps airways open longer to decrease work of breathing
- prolongs exhalation to slow respiration
- improves breath pattern
- relieves SOB
- causes relaxation
- Inhale (2 sec), Exhale (4 sec)
36
BRONCHIECTASIS
A condition in which the lungs' airways become damaged, making it hard to clear mucus.
-chronic dilation of bronchi --> destruction of bronchial elasticity + musculature
37
Bronchiectasis: Causes
Repeated pulmonary infections
38
Bronchiectasis: SS
- Dyspnea
- Disabling cough w hemoptysis
- Cyanosis
- Clubbing of fingers
39
Bronchiectasis: Dx
- Chest xray
- Sputum C&S
- PFTs
40
Bronchiectasis: Rx
- Bronchodilators
- Mucolytics
- Abx
- Lobectomy
41
Progression of COPD
- mucous hypersecretions -->
- ciliary dysfunction -->
- airflow limitation -->
- pulmonary hyperinflation -->
- gas exchange abnormalities -->
- pulmonary HTN
- Cor pulmonale (rt sided heart failure)
42
Cor Pulmonale
- Rt Sided hear failure
- Change in structure and Fx of R ventricle caused by primary disorder of respiratory system.
- abnormal enlargement of RT side heart d/t bad lunch not working, cause backup back down pulmonary artery to RT atria.
43
Cor Pulmonale: SS
- low ext edema
| - distended jugular veins
44
Path of Blood to heart
see pic
45
PLEURISY (Pleuritis)
-inflammation of pleura
46
Pleurisy: Causes
- TB
- PNA
- Influenza
- Neoplasm
- PE
- Autoimmune condition
47
Pleurisy: SS
- sharp inspiratory chest pain
- shallow breath
- pleural friction rub
48
Pleurisy: Dx Tests
- SS
- Pleural friction rub
- C Xray
- Thoracentesis
49
Pleurisy: Rx
```
-Rx underlying condition (flu, CA...)
PAIN Mgmt:
-MED: ** NSAID's (reduce inflam)
-MED: cough syrup w CODEINE
???-lying on bad side (so bad lung won't expand)????
-
```
50
Pleural Effusion
-Excess fluid collection in pleural space
-Normal Fluid - 1-15ml
-Abnormal Fluid - 25ml - L
-Fluid: TRANSUDATE(clear, LO protein, fluid from cappilaries)
or
EXUDATE, cloudy, WBC, protein, result of inflam process
51
Pleural Effusion: Exudate vs Transudate
In a pleural effusion, different fluids can enter the pleural cavity. Transudate is fluid pushed through the capillary due to high pressure within the capillary. Exudate is fluid that leaks around the cells of the capillaries caused by inflammation. Learn why transudative fluid does not contain proteins, why exudate does contain proteins, and how health professionals can differentiate between the two using Light’s criteria.
52
Pleural Effusion
-Associated w other diseases (lung CA, TB, PNA, Pancreatitis, Cirrhosis)
53
Pleural Effusion: SS
- SOB
- cough
- tachypnea
- LO or absent breath sounds
- Pleuritic chest pain (on inspiration, not continuous. clue that not an MI, because not continuous)
54
Pleural Effusion: Rx
- Cxray
- Thoracentesis (one time, not continuous, if chronic, chest tube used)
- Chest tube
- Rx underlying cause
55
EMPYEMA
- pus in plural space
- Cause: Infection (TB, PNA)
- Rx: Abx, Chest tube
56
PULMONARY EMBOLISM (PE)
- blockage of pulmonary artery or branches by a:
- blood clot
- fat (w Sx)
- air (IVs)
- tumor cells
- amniotic fluid embolus
57
PE: SS
- dyspnea
- chest pain
- cough w hemoptysis
- anxiety
- hypotension
- tachycardia
- hypoxia
- rales/wheeze
58
PE: Risks
- recent Sx
- Immobilization
- Pregnancy/birth
- Dysrythmias
- birth control (BCP)
- smoking
- polycythemia vera (disorder of RBC, too many
- Hypercoagulability (tendency to clot)
- Travel (sitting long)
59
PE: Dx
- VQ Scan (Ventilation perfusion test)
- Pulmonary Angiongram
- D-Dimer (UP D-Dimer is clue of PE, blood test for breakdown of fibrinogen levels )
60
PE: Rx
Anti Coag:
- MED: Heparin Drip (iv) (immediate)
- MED: Coumadin (to therapeutic level, INR 2-3, takes about 5 days)
OTHER
- Thrombolytic Agents
- Embolectomy
61
PE: Prevention
- MED: Lovenox (subq, prevent/tx)
- MED: Heparin (subq)
- SCDs
- DVT --> IVC filter
