COPD Mary

Question 1

What is COPD

Answer 1

• Chronic inflammatory lung disease that causes obstructed airflow from lungs

Question 2

Mary Risk factors for COPD

Answer 2

• Smoking
  -exposure to chemicals
• Possibly genetics

Question 3

What genetic condition leads to COPD

Answer 3

• Alpha-1 anti-trypsin deficiency (AAT)

Question 4

General S+S COPD

Answer 4

• Barrel chest
• chronic cough
• Blue tinged lips
• Finger clubbing
• Pursing lips when breathing
• shortness of breath
• accessory muscle use when breathing
• labored breathing

Question 5

Mary S+S COPD

Answer 5

• pursed lip breathing
• shortness of breath
• barrel chest
• labored breathing
  accessory muscle use
• purple tinged lips

Question 6

Emphysema patho

Answer 6

• Exposure to irritants
  = inflammation in alveoli
  = increase proteases and decrease anti-proteases
  = oxidative stress
  = alveolar tissue destruction + decrease tissue healing
  = decrease alveolar walls
  = decrease capillaries
  = decrease elastin
  = decrease alveolar surface area for gas exchange + enlarged air spaces + lose recoil
  = bronchiole expiratory collapse
  = decrease gas exchange
  = air trapping and hyperventilation

Question 7

Chronic bronchitis path

Answer 7

• Bronchial inflammation and oedema
• increase mucous production
• decrease cilia action
  = increase airway resistance
  = decrease gas exchange

Question 8

Medication COPD management

Answer 8

1. Beta-agonists
   - bind to beta2 adrenergic receptors on bronchiole smooth muscle, stimulating bronchodilation
2. Anticholinergics
   - blocks muscarinic acetylcholine receptors on bronchiole smooth muscle
   - preventing bronchoconstriction
   = bronchodilation
3. corticosteroids
   - anti-inflammatory agents used to decrease the inflammatory response
4. Oxygen
   - low-level oxygen therapy may be used to maintain oxygen saturation

Question 9

Mary management before hospital COPD

Answer 9

• inhaler
• oxygen

Question 10

Mary COPD medications after hospital

Answer 10

1. Salbutamol
   - short acting beta-agonist bronchodilator
2. seretide
   - long acting beta-agonist bronchodilator and corticosteroid
3. Spiriva
   - anticholinergic for bronchodilation
4. oxygen therapy

Question 11

General COPD complications

Answer 11

• Respiratory acidosis
• metabolic acidosis
  Tissue wasting
• pulmonary hypertension
• respiratory failure
• cyanosis (purple tinged lips )

Question 12

Mary COPD complications

Answer 12

• purple tinged lips (cyanosis)
• weight loss
• occasional ankle oedema (sign of right heart failure)
• acute respiratory failure

Question 13

COPD patho

Answer 13

• hyperinflation flattens diaphragm, expands chest and increase thoracic volume
  = respiratory muscles work harder and accessory muscles facilitate ventilation
  = expanded rib cage
  = difficult to reduce intrathoracic pressure during inspiration and increase airway resistance
  = energy expenditure increases and fatigue occurs

Question 14

Physical evaluation of Mary COPD

Answer 14

• weight loss
• dusky colour
• lips blue tinge
• breathing quiet but labored
• barrel chest
• RR 20 breaths/min
• accessory inspiratory muscles
• coarse crackles

Question 15

other evaluation of COPD

Answer 15

• blood tests
• spirometry

Question 16

Mary COPD spirometry results

Answer 16

• pulmonary function test
• indicates she has progressive COPD
• increased residual volume
• increased functional residul capacity
• reduced forced vital capacity
  = lung volume increased and air flow decreased
  = more air trapped in lunges
  = harder to move air in and out of lungs

Question 17

Lab tests for COPD

Answer 17

• Blood gases and PH
• sputum sample

Question 18

investigations for COPD

Answer 18

• chest x-ray
• pulmonary function tests
• ECG

Question 19

Mary chronic bronchitis element of COPD

Answer 19

causes mucus secretion, narrowing and obstruction of airway
= mary airway resistance increase and reduce airflow and lengthening her expiration time
- mary unable to expire air
= air trapped
= increase residual volume and increased functional residual capacity

Question 20

Mary emphysema element of COPD

Answer 20

• Associated with loss of lung elasticity
• without elastic recoil
  = harder for mary to generate pressure required to drive expiration
• airway prone to collapse during expiration
• results in trapped air increase residual volume
  = decrease vital capacity

Question 21

what is emphysema

Answer 21

• Type of COPD in which the alveoli are damaged

Question 22

Compare Chronic Bronchitis and Emphysema

Answer 22

Chronic bronchitis
- inflammation occurs in bronchioles leading to branchial oedema
- increasing mucous production
- decrease Hilary action
- increase airway resistance
- decrease gas exchange

Emphysema
- inflammatory destruction of alveoli and capillaries.
- decrease alveolar surface area for gas exchange
- decrease airflow
- air trapping