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kol- Med Surg 320 Spring > COPD > Flashcards

COPD Flashcards

1
Q

What is COPD? divided into what 2 things?

A

Chronic Obstructive Pulmonary Disease
Chronic = Not going away, Not getting better
Not reversible
-Includes Emphysema and Chronic Bronchitis

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2
Q

describe the patho of emphysema?

A

Increased proteases breakdown elastin causing damage to alveoli and small airways

  • ->Loss of elasticity in lungs
  • ->Hyperinflation of lungs
  • ->Collapsed small airway
  • -> Alveoli drop in number, some become large and flabby

=Reduced gas exchange

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3
Q

What is air trapping? what does it lead to?

A

Elastic recoil dysfunction

  • ->Hyperinflation of lungs causes flattening of diaphragm
  • ->Use of accessory muscles to breathe
  • ->Increased work of breathing (actually uses more oxygen)
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4
Q

what does air trapping result in?

A
  • Air hunger
  • Uncoordinated breathing pattern
  • Needs additional oxygen due to demand from work of breathing
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5
Q

what is chronic bronchitis? most common cause?

A

Inflammation of the bronchi and bronchioles: Caused by irritants

  • Most common cause is smoking
  • Irritant causes inflammation, vasodilation, mucosal edema, congestion and bronchospasm
  • Increased mucous production –> Infection

=Results in: Impaired Airflow & gas exchange

(smaller lumen + build up of gas unexchanged)

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6
Q

what is alpha 1 antitrypsin deficiency? how do you get it?

A

Risk factor for COPD

  • AAT inhibits excessive protease activity (so that protease doesn’t cause airway damage)
  • Having low levels of AAT (or no AAT) may allow the lungs to become damaged.
  • This allows neutrophil elastase (normally kept at bay by AAT) to destroy lung tissue, causing lung disease

AAT gene is recessive

  • If one allele is affected and the other is normal- Carrier-
  • If both alleles are affected – Disease (young age)
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7
Q

signs of COPD

A

Impaired Gas Exchange

  • ->Decreased PaO2 in blood
  • ->Increased PaCO2 in blood
  • Hypoxemia (low oxygen in tissue level)
  • Acidosis
  • Respiratory Infections
  • Respiratory Failure
  • Dysrhythmias
  • Cor Pulmonale (right sided heart failure)
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8
Q

sxs of COPD

A 
SHOB
	Breathing Problems
	Wheezing
	Coughing
	Mucous Production Increase
	Orthopnea
	Sexual Activity Decrease
	Basic ADL’s Difficulty 
	Progression of symptoms
	Changes in weight Decrease
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9
Q

risk for copd

A 
Age (older)
Gender (females more at risk)
Occupational History
Family History 
History of Smoking (Pack Year)
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10
Q

general appearance of someone with COPD

A 
Neglect of basic hygiene
	Weight distribution: Enlarged Neck Muscles, Thin Arms
	Position : Orthopneic/ Tripod
	Barrel Chest
	Fatigue
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11
Q

COPD respiratory assessment

A

-Increased Breathing Rate
-Breathing Pattern: Shallow, Uncoordinated
-Use of accessory muscles
-Retractions
-Clubbing
-ANXIETY
-Adventitious breath sounds (may be normal)
Wheezing
Rhonchi
Diminished

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12
Q

cardiac assessment copd?

A 
Edema
Pallor
Cyanosis
Tachycardia
Arrhythmias
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13
Q

pink puffer=

A

emphysema

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14
Q

blue bloaters =

A

chronic bronchitis

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15
Q

labs for copd?

A

-ABG’s
-Establish Baseline
-“CO2 Retainers” : compensatory metabolic
alkalosis
-PaO2 low, PaCO2 high, HCO3 high
(compensatory)
-Sputum Cultures
-WBC Count
-Serum Alpha1 Antitrypsin
-H & H - create more RBC to carry more /o2
-Electrolytes

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16
Q

COPD ABG

A
  • “CO2 Retainers” : compensatory metabolic alkalosis
    • PaO2 low, PaCO2 high, HCO3 high

-Chronic respiratory acidosis is compensating metabolically

17
Q

what is gold classification? what tool are we using to determine the results?

A
  • At Risk, Mild, Moderate, Severe, Very Severe (I, II, III, IV)
  • Forced Expiratory Volume (Airflow in first second of exhale) determines classification
    - as you get worse, the FEV gets less
18
Q

diagnostics for copd

A
  • Lung Volume & Airflow Rates
  • Able to distinguish Obstructive Disease from Restrictive Disease
  • Vital Capacity (Max. amount of air that can be exhaled after a full inspiration)
  • *Residual Volume (Air Trapping)
  • Total Lung Capacity (Max amount of air that your lungs can hold)
  • chest x ray
19
Q

I: Milds

A

80% normal lung function

20
Q

II: Moderate

A

50-80% lung function

21
Q

III: Severe

A

30-50% lung function, typically involved severe restraint of respirations, tininess of breath and frequent COPD exacerbations

22
Q

IV: Very Severe

A

<30% lung function

23
Q

Interventions for COPD

A
  • Maintain airway
  • Assess
  • Oxygen
  • Breathing techniques
  • Positioning
  • Exercise conditioning
  • Effective coughing
  • Suctioning
  • Hydration
  • Vibratory Positive Pressure Device (flutter valve)
  • Adherence to pharmacology regimen
  • Monitor patient’s breathing and disease progression
24
Q

2 types of breathing technique for COPD

A

Diaphragmatic breathing: place hand over abdomen as resistance- encourage engaging muscle
Pursed lip breathing: creates resistance to help push air out (emphysema)

25
Q

positioning for COPD

A

upright

in a chair

26
Q

”Hypoxic Drive to Breath”

A
  • Normal drive to breath controlled by CO2 changes
    • COPD loses CO2 drive and gets O2 drive
    • Hypoxic drive to breath controlled by O2 levels
    • Change in threshold: Maintain SpO2 at 88-92%
      ex: if on 15 L @ 94% turn them down to get to 92%
  • Know your patient’s home O2 level- try to keep them there
  • Know your patient’s baseline ABG
27
Q

-Positive Pressure Ventilation-

A

9expands alveoli to increase ventilation (BIPAP)

28
Q

exercise conditioning for copd?

A

May be formal or informal
Start slow, rest periods and slowly increase overtime (as tolerated)
May require use of oxygen
2-3 X’s per week

goal: keeps muscles strong to help with breathing

29
Q

suctioning for copd?

A

Only as needed

Nasotracheal Suctioning

30
Q

Hydration for copd?

A

2-3 L per day

Humidity

31
Q

Vibratory Positive Pressure Devices

A

Flutter Valve: Helps to remove secretions

32
Q

anxiety management for copd?

A 
Positioning
	Breathing techniques
	Support groups
	Therapeutic communication *****
	Rest
	Anti-anxiety medication
33
Q

nutrition for copd?

A

Increased protein and calorie needs
High calorie
High Protein

Malnutrition can worsen disease
Small & frequent meals
Food selection
Pre-medicate before meals- give albuterol before meals
34
Q

Care Coordination

A 
Home health care
	Oxygen
	Equipment
	Understanding long term health challenges & management
	Goal setting- palliative care
35
Q

normal ranges for ABG

A

pH: 7.35-7.45.
(PaO2): 80 to 100 mmHg.
(PaCO2): 35-45 mmHg.
Bicarbonate (HCO3): 22-26 mEq/L.

ROME
High CO2= acidosis
High Bicarb = alkalosis

kol- Med Surg 320 Spring (43 decks)

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