Flashcards in 1.2 Chronic Obstructive Respiratory Disease Deck (31)
Define what COPD is.
A chronic long term narrowing of the airways that lead to an obstruction of the normal airflow function of the lungs.
What is COPD.
COPD is a collection of three main diseases:
1. Chronic broncitis.
3. Chronic asthma.
What are two main types of COPD?
Emphysema and Bronchitis
True or False - patients with COPD are typically over 50 years, long term smokers and are not symptom free between attacks?
What causes emphysema to develop?
Smoking or a toxic environment.
Narrowing of the lower airway's.
Loss of elasticity in aveolar walls, causing air trapping.
Distended aveolar walls that then breakdown.
Less lung surface area in contact with capillaries.
Less gas exchange.
Lower O2 & higher Co2 levels.
What are the features of a CORD patient with emphysema?
They are nick named Pink puffers, they can have:
Restricted air movement.
Thin barrel shaped chest.
Complexion usually a pink colour.
Pursed lip breathing.
Dyspnoeic on exertion.
Diminished breath sounds.
Emphysema reduces the effectiveness of the alveoli - explain what happens to the alveoli?
The alveoli are destroyed/fused together which results in less surface area for gas exchange to take place.
Typically, what does a patient with chronic emphysema look like?
Fast Respiration rate (> 20 per minute)
Cough but little sputum
Diminished breath sounds
Wheeze and rattles on auscultation.
What causes chronic bronchitis to develop?
Inflammation of the bronchial tubes or bronchi.
Oedema & thickening of the linings of the bronchioles.
Excessive mucous production in the bronchioles & bronchi.
Restricted air movement.
Compromised gas exchange.
Wheeze produced by air being forced past blocked airway's.
What are the features of a patient with chronic bronchitis?
They are nick named Blue bloaters, they can have:
Cyanosis of the face & lips.
Excess weight usually.
Vigorous productive cough.
History of chronic persistent pulmonary infections.
Typically, what does a patient with chronic bronchitis look like?
Vigorous cough with sputum
Course snoring/rattling on auscultation
Wheezes and possibly crackles at base of lungs.
What is the clinical symptoms a patient must have to be diagnosed as having bronchitis?
A persistent cough that produces sputum for 3 months in 2 consecutive years.
What does bronchitis cause to happen to the bronchi and bronchioles?
Causes them to get inflamed, swollen and thicken and excess mucus production.
Are the alveoli affected when a patient has chronic bronchitis?
No - the bronchi and bronchioles are.
What is your management plan for a patient with CORD?
Oxygen if required to maintain a SpO2 of 88-92%
Nebulised bronchodilators, alternated 5 min. with the mask on & 5 min. with the mask off if SpO2 is > than 92% during nebulised delivery.
Call for ALS backup if the patient has moderate to severe respiratory distress.
What are two more common examples of breathing problems that can sound like cord?
Cardiogenic Pulmonary Odema
Is exhaling active of passive with patients suffering from chronic emphysema?
Becomes active - need to work to push air out.
According to CPG guidelines, what is the ideal oxygen saturation for CORD patients to maintain?
True or False - Some patient's require being slightly hypoxia to get rid of carbon monoxide?
True - excess oxygen can cause hypercarbic respiratory failure.
Why are ambulance staff instructed to treat CORD patients 5 minutes on and 5 minutes off when using the nebuliser mask?
To limit oxygen exposure while delivering nebulised drugs.
What are signs and symptoms of a rising carbon dioxide level?
True or False - patients with CORD always have a wheeze present?
False - they may not move enough air to create a wheeze.
Do you give adrenaline to a patient suffering CORD?
Yes - can be given, but is not on the indications list for the drug.
IM adrenaline 0.3mg - 0.5mg if status one and not improving
IV adrenaline if status one and deteriorating despite IM adrenaline.
What dose and what drugs can you give to a CORD patient to help with breathing at a BLS level?
5 mg salbutamol with 0.5mg ipratropium by nebuliser.
What are the reasons why excess oxygen administration can cause hypercarbic respiratory failure?
a) reversal of hypoxic pulmonary vasoconstriction causing high levels of CO2 in poorly ventilated alveoli to diffuse back into circulation
b) decrease in ventilatory drive
c) decreased CO2 buffering capacity of haemoglobin
d) absorption of CO2 from alveoli beyond obstructed aiways
e) the higher denisty of oxygen compared with air causing increased work of breathing.
If patients know that they are at risk of hypercarbic respiratory failure what can you expect them to have?
A card or letter with instructions for oxygen therapy.
What circumstances would make you consider assisting a patients ventilation early (without oxygen unless required to maintain 88-92%) using a manual ventilation bag?
a) SPO2 continues to fall below 80% despite treatment
b) the patient is becoming exhausted
c) the patient is suspected of devloping lypercarbic respiraratory failure despite lowering the oxygen flow.
What is the risk of administering adrenaline to a patient having breathing problems who also suffers from myocardial ischaemia?
How do you distinguish between CORD and Asthma?
Patients with CORD are generally over 50 years, long term smokers and are NOT symptom free between attacks.
Patients with Asthma are usually less than 50 years and symptom free between attacks.