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Level III - NCM 112: MEDICAL SURGICAL NURSING > OXYGENATION - COPD > Flashcards

OXYGENATION - COPD Flashcards

1
Q

What is COPD?

A

An obstruction of the airway which narrows over time causing an airflow obstruction and an abnormal response of the lungs to gases.

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2
Q

True or False: COPD is reversible.

A

False.

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3
Q

What does progressive means?

A

Damage advances slowly, and that it cannot be reverted to the
normal state, even with medical management (irreversible).

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4
Q

What are the structures affected by the COPD?

A 
Proximal airways (trachea and
bronchi > 2 mm in diameter)
Peripheral airways (bronchioles
< 2 mm diameter)

Alveoli ducts and alveoli

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5
Q

What happens in the proximal airways in COPD?

A

Increased numbers of goblet cells

and enlarged submucosal glands which results to increased mucus secretion.

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6
Q

What happens in the peripheral airways in COPD?

A

Thickening of the airway wall, peribronchial fibrosis and

exudates in the airway leading to airway narrowing.

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7
Q

What happens in the alveoli ducts and alveoli in COPD?

A

Damage and enlargement of
alveolar wall and
loss of elastic recoil

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8
Q

True or False: The ongoing injury-and-repair process causes scar tissue formation and narrowing of the airway lumen.

A

True.

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9
Q

What are the disease associated with COPD?

A

Chronic Bronchitis

Emphysema

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10
Q

Is asthma considered as under COPD? Why?

A

No. AZTH is reversible.

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11
Q

What is the characteristic of chronic bronchitis?

A

Inflammation of bronchi resulting to large amount of mucus secretion and obstruction.

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12
Q

What is the characteristic of emphysema?

A

Abnormal enlargement of alveoli with the

destruction of alveolar walls.

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13
Q

True or False: High lung compliance results to

destruction of alveolar walls and hyperinflation of the alveoli

A

True.

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14
Q

What are the sequence of assessment?

A

a) History taking
b) Physical Examination
c) Diagnostic Examination

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15
Q

What should you determine in the history taking?

A

Determine the etiology or the cause of the health problem

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16
Q

Define the sx of COPD.

A

Dyspnea
Sputum production
Cough
These occur for at least 3 months in each of 2 consecutive year

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17
Q

How is sputum produced?

A

produced when the goblet cells are irritated by smoke, causing an increase in sputum production.

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18
Q

How does smoking affect the cilia?

A

Smoke paralyzes
the cilia, it the cilia cannot perform its role of filtering the gasses that
enters the upper respiratory tract. C

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19
Q

What is the defense mechanism of the RT for increased mucus secretion?

A

Cough.

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20
Q

What is cough?

A

Cough is a reflex that protects the lungs from accumulation

of secretions or inhalation of foreign bodies.

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21
Q

If the cough is not managed, what would happen?

A

Dyspnea

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22
Q

Dyspnea on exertion (DOE) results from

A

Inadequate
oxygen that enters during inspiration and the accumulation
of carbon dioxide (CO2).

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23
Q

As the COPD progresses, what are its other sx?

A

Weight loss
Risk for respiratory insufficiency and respiratory infections
Barrel chest in emphysema

24
Q

Barrel chest is caused by _____.

A

chronic hyperinflation leads to Barrel chest” thorax configuration. The chronic hyperinflation of
the alveoli and loss of lung elasticity leads to a more fixed position of the ribs in the inspiratory position.

25
Q

True or false: In assessing the past history, one should use retrospective approach.

A

True.

26
Q

What is the purpose of assessing the past history?

A

Determine the risks/etiology of COPD.

27
Q

What are the risk factor of COPD?

A

Environmental factors (External)
 Tobacco Smoke- active and passive smoking (80-90% of COPD cases)
 Occupational exposure (dust, chemicals)
 Air pollution

Genetic - alpha 1 antitrypsin deficiency

28
Q

Where is the alpha 1 antitrypsin produced?

A

Liver

29
Q

What is the function of alpha 1 antitrypsin?

A

protects the lungs from neutrophil
elastase (enzyme that digests damaged
or aging cells and bacteria to promote
healing).

30
Q

What happens when there is a deficiency in AAT?

A

Neutrophil elastase enzyme to attack the healthy lung tissue

31
Q

AAT testing is recommended for _____.

A

Pt with a diagnosis of COPD or adult-onset asthma (WHO)

32
Q

True or False: Subjective and objective data is needed for initial dx.

A

True.

33
Q

What is the characteristic of cough and sputum that the nurse must observe?

A

Color and consistency of sputum and amount

34
Q

What is the characteristic of other body parts during dyspnea that the nurse must observe?

A 
Rapid and shallow breathing
Increase RR
Use of accessory muscles
 Flaring of alai nasi
 a rise in sternocleidomastoid muscles
 intercostal retraction
Cyanosis-late sign
35
Q

What is PE technique to identify emphysema and bronchitis?

A

Auscultation

36
Q

During auscultation, _____ in emphysema can be heard.

A

Faint and inaudible breath sounds

37
Q

During auscultation, _____ in bronchitis can be heard.

A

Wheezes, crackles

38
Q

Define the role of dx exam.

A

Confirm the impression or initial dx

39
Q

What is the The GOLD international advise for dx COPD?

A

Spirometry is he gold standard for accurate

and repeatable measurement of lung function.

40
Q

How is bronchodilator reversibility test performed?

A

Spirometry is initially performed

The patient is given an inhaled bronchodilator treatment

Spirometry is repeated.

41
Q

What is the abnormal result of bronchodilator reversibility test?

A

FEV1/FVC ratio of < 70% means that there is the presence of airflow limitation after an
inhaled bronchodilator, showing a degree of irreversibility.

42
Q

Whys is ABG is obtained?

A

Arterial blood gas (ABG) is obtained to assess baseline oxygenation and gas exchange

43
Q

Whys is chest X-ray is obtained?

A

to exclude alternative diagnoses.

Contraindicated in pregnant women

44
Q

Screening for alpha1-antitrypsin deficiency may be performed for patients ________?

A

Younger than 45

years of age and those with a strong family history of COPD

45
Q

What is the first step in the management of patients with COPD?

A

correct diagnosis

46
Q

What are the general management for COPD?

A

smoking cessation
prescribing medications
oxygen therapy

47
Q

What is the action of bronchodilators?

A

relieve bronchospasm and reduced airway obstruction

48
Q

What is the action of corticosteroids?

A

anti inflammatory

49
Q

What is the action of antibiotics?

A

infection/anti microbial

50
Q

Mucolytic and antitussive

A

liquefies secretion and cough suppressant

51
Q

Antitussives aluminum nitroxide – prevents side effects of corticosteroid – ranitidine.

A

True. If oral corticosteroid, antitussive should also be oral

52
Q

Side effects of corticosteroids

A

Increase blood sugar
Weight gain
Gastric irritation – medication given after eating

53
Q

What happens when pt is in prolonged inhaler?

A

dryness of the oral mucosa and irritation of the throat: advise patient to gargle

54
Q

Impaired gas exchange can be used if

A

the oxygen saturation is low or there is data from arterial blood g

55
Q

Ineffective breathing pattern

A

used if RR, abnormality In breathing, accessory muscles

56
Q

Ineffective airway clearance

A

client is unable to remove the secretion

Level III - NCM 112: MEDICAL SURGICAL NURSING (4 decks)

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