CHRONIC PULMONARY DISEASE

Question 1

CHRONIC OBSTRUCTIVE PULMONARY DISEASE AND ASSOCIATED RESPIRATORY DISEASES

Answer 1

• COPD IS A SLOWLY PROGRESSIVE RESPIRATORY DISEASE OF AIRFLOW OBSTRUCTION
  — INVOLVING THE AIRWAYS, PULMONARY PARENCHYMA, OR BOTH

Question 2

PATHOPHYSIOLOGY OF COPD

Answer 2

• AIRFLOW LIMITATION IS PROGRESSIVE, ASSOCIATED WITH ABNORMAL INFLAMMATORY RESPONSE TO NOXIOUS PARTICLES OR GASES
• CHRONIC INFLAMMATION DAMAGES TISSUE
• SCAR TISSUE IN AIRWAYS RESULTS IN NARROWING
• SCAR TISSUE IN THE PARENCHYMA DECREASES ELASTIC RECOIL (COMPLIANCE)
• SCAR TISSUE IN PULMONARY VASCULATURE CAUSES THICKENED VESSEL LINING AND HYPERTROPHY OF SMOOTH

Question 3

CHRONIC BRONCHITIS

Answer 3

• COUGH AND SPUTUM PRODUCTION FOR AT LEAST 3 MONTHS IN EACH OF 2 CONSECUTIVE YEARS
• CILIARY FUNCTION IS REDUCED, BRONCHIAL WALLS THICKEN, BRONCHIAL AIRWAYS NARROW, AND MUCOUS MAY PLUG AIRWAYS
• ALVEOLI BECOME DAMAGED, FIBROSED, AND ALVEOLAR MACROPHAGE FUNCTION DIMINISHES
• THE PATIENT IS MORE SUSCEPTIBLE TO RESPIRATORY INFECTIONS

Question 4

PATHOPHYSIOLOGY OF CHRONIC BRONCHITIS

Answer 4

Question 5

EMPHYSEMA

Answer 5

• ABNORMAL DISTENTION OF AIR SPACES BEYOND THE TERMINAL BRONCHIOLES WITH DESTRUCTION OF THE WALLS OF THE ALVEOLI
• DECREASED ALVEOLAR SURFACE AREA INCREASES IN “DEAD SPACE,” IMPAIRED OXYGEN DIFFUSION
• HYPOXEMIA RESULTS
• INCREASED PULMONARY ARTERY PRESSURE MAY CAUSE RIGHT-SIDED HEART FAILURE (COR PULMONALE)
• CHANGES IN ALVEOLAR STRUCTURE

Question 6

NORMAL CHEST VS. BARREL-SHAPED CHEST

Answer 6

Question 7

TYPICAL POSTURE OF A PERSON WITH COPD

Answer 7

Question 8

WHAT IS THE PRIMARY CLINICAL SYMPTOM OF EMPHYSEMA?

Answer 8

D. WHEEZING

Question 9

ASSESSMENT AND DIAGNOSIS OF COPD

Answer 9

• HEALTH HISTORY
• PULMONARY FUNCTION TESTS
  — SPIROMETRY
• ARTERIAL BLOOD GAS
• CHEST X-RAY

Question 10

COMPLICATIONS OF COPD

Answer 10

• RESPIRATORY INSUFFICIENCY AND FAILURE
• PNEUMONIA
• CHRONIC ATELECTASIS
• PNEUMOTHORAX
• COR PULMONALE

Question 11

COPD MEDICAL MANAGEMENT

Answer 11

• PROMOTE SMOKING CESSATION
• REDUCING RISK FACTORS
• MANAGING EXACERBATIONS
• PROVIDING SUPPLEMENTAL OXYGEN THERAPY
• PNEUMOCOCCAL VACCINE
• INFLUENZA VACCINE
• PULMONARY REHABILITATION

Question 12

COPD SURGICAL MANAGEMENT

Answer 12

• BULLECTOMY
• LUNG VOLUME REDUCTION
• LUNG TRANSPLANT

Question 13

MEDICATIONS TO TREAT COPD

Answer 13

• BRONCHODILATORS, MDIs
• BETA-ADRENERGIC AGONISTS
  — Albuterol
• MUSCARINIC ANTAGONISTS (ANTICHOLINERGICS)
  — Ipratropium bromide
• COMBINATION AGENTS
  — combivent/ Methylxanthine??
  — Theophylline
• CORTICOSTEROIDS
• ANTIBIOTICS
• MUCOLYTICS:
  — acetylcysteine
• ANTITUSSIVES

Question 14

COPD NURSING MANAGEMENT

Answer 14

• OBTAIN HISTORY
• REVIEW OF DIAGNOSTIC TESTS
• ACHIEVING AIRWAY CLEARANCE
• IMPROVING BREATHING PATTERN
• IMPROVING ACTIVITY TOLERANCE
• MDI PATIENT EDUCATION

Question 15

Which statement by the client with chronic obstructive pulmonary disease (COPD) indicates the need for additional follow-up instruction?

Answer 15

• B. “I don’t need to get the flu shot.”

Question 16

For relief of hypoxemia in the newly admitted client with chronic obstructive pulmonary disease (COPD), what does the client most likely need?

Answer 16

• A. Oxygen flow rate of 1 to 2 L/min via nasal cannula

Question 17

Your client has been diagnosed with chronic bronchitis and started on a mucolytic. What is the rationale for ordering a mucolytic for this client?

Answer 17

• D.Mucolytics thin secretions, making them easier to expectorate.

Question 18

ASTHMA

Answer 18

• CHRONIC INFLAMMATORY DISEASE OF THE AIRWAYS THAT CAUSES HYPERRESPONSIVENESS, MUCOSAL EDEMA, AND MUCUS PRODUCTION
• INFLAMMATION LEADS TO COUGH, CHEST TIGHTNESS, WHEEZING, AND DYSPNEA (FIG. 24-6)
• ASTHMA IS LARGELY REVERSIBLE; SPONTANEOUSLY OR WITH TREATMENT
• ALLERGY IS THE STRONGEST PREDISPOSING FACTOR

Question 19

ASTHMA CLINICAL MANIFESTATIONS

Answer 19

• COUGH, DYSPNEA, WHEEZING
• EXACERBATIONS
• COUGH, PRODUCTIVE OR NOT
• GENERALIZED WHEEZING
• CHEST TIGHTNESS AND DYSPNEA
• DIAPHORESIS
• TACHYCARDIA
• HYPOXEMIA AND CENTRAL CYANOSIS

Question 20

MEDICATIONS MANAGEMENT FOR ASTHMA

Answer 20

• QUICK-RELIEF MEDICATIONS
  — BETA2-ADRENERGIC AGONISTS
  — ANTICHOLINERGICS
• LONG-ACTING MEDICATIONS
  — CORTICOSTEROIDS
  — LONG-ACTING BETA2-ADRENERGIC AGONISTS
  — LEUKOTRIENE MODIFIERS
  —- montelukast

Question 21

ASTHMA PATIENT TEACHING

Answer 21

• HOW TO IDENTIFY AND AVOID TRIGGERS
• PROPER INHALATION TECHNIQUES
• HOW TO PERFORM PEAK FLOW MONITORING
• HOW TO IMPLEMENT AN ACTION PLAN
• WHEN AND HOW TO SEEK ASSISTANCE

Question 22

USING A PEAK FLOW METER

Answer 22

Question 23

CLINICAL MANIFESTATIONS OF COPD

Answer 23

THREE PRIMARY SYMPTOMS
- CHRONIC COUGH
- SPUTUM PRODUCTION
- DYSPNEA
WEIGHT LOSS DUE TO DYSPNEA
“BARREL CHEST”