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CSI year 2 > case 10 COPD > Flashcards

case 10 COPD Flashcards

1
Q
  • Give brief descriptions of emphysema and chronic bronchitis
A

Emphysema - damage to the air sacs in the lungs

Chronic bronchitis - long-term inflammation of the airways

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2
Q
  • What are the main symptoms of COPD?
A

Increasing breathlessness, particularly when active

Persistent chesty cough with phlegm - some people may dismiss this as just a “smoker’s cough”

Frequent chest infections

Persistent wheezing

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3
Q
  • In what case should you get medical advice?
A

See a GP if you have persistent symptoms of COPD, particularly if you’re over 35 and smoke or used to smoke

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4
Q
  • What can the GP do after asking about your symptoms and whether you smoke or have smoked in the past?
A

Organise a breathing test (spirometry) to help diagnose COPD and rule out other lung conditions such as asthma

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5
Q
  • What is the main cause of COPD and what happens to the lungs?
A

Smoking

fumes and dust at work

-air pollution

-genetics

COPD happens when the lungs have become inflamed, damaged and narrowed

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6
Q
  • What is the issue leading to COPD caused by a rare genetic problem?
A

alpha-1-antitrypsin deficiency. Alpha-1-antitrypsin is a substance that protects your lungs. The lungs are more vulnerable to damage without it

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7
Q
  • What are some of the treatments for COPD?
A

Stopping smoking - if you have COPD and you smoke, this is the most important thing you can do

Inhalers and medicines - to help make breathing easier

Pulmonary rehabilitation - a specialised programme of exercise and education

Surgery or a lung transplant - although this is only an option for a very small number of people

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8
Q
  • When is social care and support guide needed for COPD?
A

If you:

Need help with day-to-day living because of illness or disability

Care for someone regularly because they’re ill, elderly or disabled - including family members

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9
Q
  • Describe the COPD exacerbation and how this could lead to mortality
A

COPD Exacerbation → Decreased Lung Function → Decreased Physical Activity → Decreased Mental Health → Decreased QoL → Further COPD Exacerbations → Mortality

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10
Q

What are the main co morbidities in COPD

A
  • Hypertension
  • Anxiety
  • Depression
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11
Q
  • What does it mean if opacification can be seen in a chest x ray?
A

Wherever there is a cloudy white area where there should not be (opacification), this means that something has replaced the air in the alveoli in that part of the lung

This could be fluid, bacteria or immune cells that is replacing the air and so gas exchange in this part of the lung cannot occu

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12
Q
  • What is Type I Hypoxemic Respiratory Failure?
A

The failure of lungs and heart to provide adequate O2 to meet metabolic needs. Treated by CPAP. low 02 but normal c02.

  • Mainly caused by things that stop the flow of air properly like a pneumonia, aspiration, pleural effusion, asthma + pulmonary contusions.
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13
Q
  • What are the criteria for Type I Hypoxemic Respiratory Failure?
A

PaO2 < 60 mmHg or FO2≥50

Or PaO2 < 40 mmHg on any FO2 and SaO2 <90

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14
Q
  • What are the basic causes for Type I Hypoxemic Respiratory Faliure?
A

R-L Shunt

V/Q mismatch

Alveolar hypoventilation

Diffusion defect

Inadequate FI02- fraction of inspired oxygen

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15
Q
  • What is Type II Hypercapnic Respiratory Failure?
A

The failure of the lungs to eliminate adequate CO2. Low c02 and 02.

Mainly caused by things that stop breathing such as stroke, neuromuscular disorders, lesions in the respiratory centers AND COPD!​

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16
Q
  • What are the criteria for Type II Hypercapnic Respiratory Failure?
A

Acute increase in PaCO2> 50 mmHg

Or Acutely above normal baseline in COPD with concurrent decrease in pH < 7.30

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17
Q
  • What are the basic causes for Type II Hypercapnic Respiratory Failure?
A

Pump failure (drive, muscles, WOB)

Increase CO2 production

R-L Shunt

Increased deadspace

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18
Q
  • What is the enzyme responsible for converting carbon dioxide into bicarbonate and hydrogen ions?
A

Carbonic Anhydrase

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19
Q
  • If there is a respiratory acidosis, what is the compensatory mechanism?
A

Metabolic alkalosis

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20
Q
  • What are some conditions associated with Type I Respiratory Failure?
A

Pneumonia, Pulmonary Oedema, Pulmonary embolism, Pulmonary fibrosis

ARDS - Acute respiratory distress syndrome (ARDS) occurs when fluid builds up in the tiny, elastic air sacs (alveoli) in your lungs.

Aspiration- when something you swallow “goes down the wrong way” and enters your airway or lungs.

Lung collapse e.g. retained secretions

Asthma

Pneumothorax

Pulmonary contusion (blunt chest trauma) is a bruise of a lung, which causes bleeding and swelling

TYPE ONE USUALLY WITHIN LUNG

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21
Q
  • What are some conditions associated with Type II Respiratory Failure?
A

Reduced respiratory drive e.g. drug overdose, head injury

Upper airway obstruction (oedema, infection, foreign body)

Late severe acute asthma

COPD

Peripheral neuromuscular disease e.g. Guillain-Barre myasthenia graves

Flail chest injury- Flail chest injury: defined as two or more contiguous rib fractures with two or more breaks per rib

Exhaustion (includes all type 1 causes)- Any cause of respiratory failure may cause respiratory muscle fatigue.

22
Q
  • What are some of the drug treatment options for Mr Craven (infective exacerbation) ?
A

Oxygen (need to write target O2 saturation + monitor by looking at ABG), hypoxaemia will kill quicker than hypercapnia

IV Steroids/hydrocortisone

IV antibiotics- broad spectrum, then narrow

Nebulised- steroid anti inflammatory

maybe mucolytic

Look at previous sputum cultures if any

23
Q
  • What are some of the non-drug treatment options for Mr Craven (infective exacerbation)?
A

Sit up to relieve pressure on diaphragm

other lifestyle factors: like smoking cessation

Encourage activity after exarcerbation

chest physiotherapist- physiotherapy treatment techniques
to remove of secretion and improve airway clearance

pulmonary rehab- exercise training, health education, and breathing techniques

24
Q
  • Why are Mr Craven’s ankles swollen?
A

Alveolar hypoxia due to decreased gas exchange

Hypoxic pulmonary vasoconstriction move blood to areas of lung that work to increase the SA for gas exchange

Pulmonary vascular resistance due to vasoconstriction

Pulmonary hypertension

Right ventricular after load to overcome the increased pressure in the pulmonary circuit

Right ventricular failure

Peripheral oedema as blood gets backed up in veins throughout body and as fluid leaks into surrounding tissues, oedema develops

Due to effects of gravity, fluid starts to pool in the lowest parts of your body, feet, ankles and legs making them swell

25
Q

what is an ABG

A

An arterial blood gas (ABG) test measures the oxygen and carbon dioxide levels in your blood as well your blood’s pH balance.

26
Q
  • How do you interpret an ABG report?
A

Determine whether the pH is acidic, alkalotic or normal

Is the primary disturbance respiratory or metabolic?

Is there an anion gap in metabolic acidosis?

Is there any compensation?

27
Q
  • When is respiratory acidosis caused?
A

When there is too much CO2 in the blood leading to increased carbonic acid, decreasing the pH

28
Q
  • When is respiratory alkalosis caused?
A

When there is too little CO2 in the blood, reducing the amount of carbonic acid formed, increasing the pH

29
Q
  • Where does reabsorption of bicarbonate ions mainly occur?
A

Proximal Renal Tubule

30
Q
  • The excretion of what molecules allows the reabsorption of bicarbonate ions?
A

Ammonia and mono phosphate ions and hydrogen ions

31
Q
  • Between what concentrations is the bicarbonate ion a marker of homeostasis?
A

22-28mmol/L

32
Q
  • How is metabolic acidosis occurred?
A

Decreased bicarbonate ions → decreased pH

Increased acid formation (more H+) in the blood or insufficient synthesis of bicarbonate ions in the kidneys

33
Q
  • How is metabolic alkalosis occurred?
A

Increased bicarbonate ions → Increased pH

Loss of hydrogen ions or abnormal increase of bicarbonate ions

34
Q
  • What are common causes of high anion gap metabolic acidosis?
A

Lactic acidosis, Ketoacidosis, toxins and renal failure

35
Q
  • What is a high anion gap caused by?
A

Increase in unmeasured anions

Hydrogen ions reacting with bicarbonate ion

36
Q
  • Why might there be a normal anion gap metabolic acidosis?
A

Lost bicarbonate ions are replaced with chloride ions

37
Q
  • What are the most common causes of normal anion gap metabolic acidosis?
A

Diarrhoea

Renal tubular acidosis

38
Q
  • What is the respiratory compensation in metabolic acidosis?
A

Decreased pH due to increased bicarbonate ions → increased ventilation → decreased CO2 → decreased carbonic acid → increased pH

39
Q
  • When does the respiratory compensation usually begin?
A

In the first hour

40
Q
  • How is hypoventilation in metabolic alkalosis usually presented?
A

Less pronounced

Rarely retains carbon dioxide beyond 7.5kP

41
Q
  • If a patient has respiratory acidosis, what is the response of the kidneys and how long does it take?
A

Kidneys retain more bicarbonate and excrete more H+ to raise the pH and takes several days to complete

42
Q
  • How determine the cause of metabolic acidosis
A

calculate anion gap

(Na+) -(HCO3-) - (Cl-) (main anions in the blood)= anion gap (8-16mmol/l)

If K+ is added increases to 12-20mmol/l

43
Q

How do you determine if the primary disturbance is respiratory or metabolic?

A

Look at pCO2 relating to respiratory causes

Review cHCO3 looking at metabolic causes

44
Q
  • What are the mechanisms compensatory for Acidaemia and alkalaemia
A

adjustments to ventilation

kidney absorption and excretion

45
Q
  • Why is anion gap only applicable to metabolic acidosis
A

as metabolic acidosis can be caused by either an increase in H+ ions or a decrease in bicarbonate

46
Q
  • In some patients, the initial management is not adeuate to control their symtoms or correct the respiratory failure. You would then
A

consider ventilatory support

47
Q

What are the main tests done for diagnosing COPD

A

spirometry
chest x ray
blood tests- show other conditions that can cause similar symptoms to COPD, such as a low iron level (anaemia)

48
Q
  • Difference between infective exarcebation of COPD and Plural effision
A

infective exarbetation- discrete alveoli

Plural effusion- contained in plural space, space of effusion is greater.

Pleural effusion, sometimes referred to as “water on the lungs,” is the build-up of excess fluid between the layers of the pleura outside the lungs

49
Q

non drug treatments of COPD

A

Non – Pharmacological (always done)

Stop smoking (every patient must be advised to do this)​
Nutritional support​
Flu vaccinations​

Pulmonary rehabilitation

50
Q

Pharamcological treatments of COPD

A

Pharmacological ​

Step 1: Starting with a Short acting B2 agonist (SABA)/ short acting muscarinic antagonist (SAMA). ​

Step 2: Add a long acting B2 agonist (LABA) AND a long acting muscarinic antagonist (LAMA).​

Step 3: IF daily symptoms affect their activities of daily living then a 3 month trial of LAMA + LABA + ICS should be considered.

CSI year 2 (8 decks)

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