COPD Flashcards
(15 cards)
Which topics will be included when the nurse is teaching a patient with lung hyperinflation caused by severe chronic obstructive pulmonary disease (COPD)? Select all that apply.
1-Huff coughing 2-Low-calorie diet 3-Smoking cessation 4-Pursed-lip breathing 5-Diaphragmatic breathing 6-Use of airway clearance devices
1-Huff coughing
3-Smoking cessation
4-Pursed-lip breathing
6-Use of airway clearance devices
Huff coughing is an effective coughing technique that helps to clear sputum from the airways. Smoking cessation prevents the accelerated decrease in pulmonary function that leads to COPD symptoms. Pursed-lip breathing improves expiratory function and decreases air trapping. Airway clearance devices help to clear respiratory secretions. Patients with COPD are encouraged to have a high-calorie diet to help meet metabolic needs caused by the increased work of breathing. Diaphragmatic breathing is designed to increase inspiratory volumes and may increase hyperinflation and the work of breathing in the patient who already has lung hyperinflation.
Nursing assessment findings of jugular venous distention and pedal edema would be indicative of what complication of chronic obstructive pulmonary disease (COPD)?
1-Pneumonia
2-Polycythemia
3-Cor pulmonale
4-Acute respiratory failure
3-Cor pulmonale
Cor pulmonale is a right-sided heart failure caused by resistance to right-ventricular outflow resulting from lung disease; clinical manifestations include jugular venous distention and pedal edema. Respiratory infections, such as pneumonia, can occur with COPD, but clinical manifestations would be fever and hemoptysis. Polycythemia is a complication of COPD, with clinical manifestations of increased hematocrit and cyanosis. Acute respiratory failure may occur with COPD, with symptoms of increasing dyspnea, hypoxemia, and hypercapnia.
Which diagnostic test for a patient with a chronic cough will be most useful in making a diagnosis of chronic obstructive pulmonary disease (COPD)?
1-Spirometry
2-Chest x-ray
3-Complete blood count (CBC)
4-CT
1-Spirometry
Although all the tests might be used on a patient with a chronic cough and suspected COPD, spirometry is the best diagnostic test to confirm COPD. A forced expiratory volume/forced vital capacity (FEV1/FVC) ratio less than 70% (0.70) will confirm the COPD diagnosis. Chest x-rays may be used to diagnose COPD exacerbations or to assess for lung hyperinflation but are not used to confirm a COPD diagnosis. A CBC may be prescribed for a patient with COPD to diagnose polycythemia or anemia, but changes in the CBC are not diagnostic for COPD. CT scans may be used to assess for lung changes associated with COPD but are not used to make the COPD diagnosis.
Which of these is a clinical manifestation of early chronic obstructive pulmonary disease (COPD)?
1-Dyspnea at rest
2-A chronic, intermittent cough
3-The presence of chest breathing
4-Increased numbers of red blood cells
2-A chronic, intermittent cough
Clinical manifestations of COPD typically develop slowly. A chronic intermittent cough, which is often the first symptom to develop, may later be present every day as the disease progresses. Dyspnea initially occurs with exertion, and dyspnea at rest is a typical in the later stages of COPD. Use of chest muscles such as the intercostals for breathing occurs in the late stages of COPD. Polycythemia occurs in the later stages of COPD as hypoxemia develops and stimulates increased red blood cell production.
Which exercise will the nurse teach to improve expiratory effort and decrease air trapping for a patient with chronic obstructive pulmonary disease?
1-Huff coughing
2-Diaphragmatic breathing
3-Pursed lip breathing (PLB)
4-Chest physiotherapy (CPT)
3-Pursed lip breathing (PLB)
The purpose of PLB is to prolong exhalation and thereby prevent bronchiolar collapse and air trapping. Huff coughing is an airway clearance technique for improving ability to expectorate respiratory secretions. Diaphragmatic breathing techniques are taught to achieve maximal inhalation and slow breathing. Chest physiotherapy (CPT) consists of postural drainage, percussion, and vibration and is for patients who have difficulty clearing excessive bronchial secretions.
Which finding indicates that a patient with chronic obstructive pulmonary disease (COPD) requires home oxygen therapy?
1-Hemoglobin levels of 13.6 g/dL
2-Oxygen saturation (SaO2) 87% at rest
3-Red blood cell count 5 million cells/microliter
4-Partial pressure of oxygen (PaO2) 62 mm Hg
2-Oxygen saturation (SaO2) 87% at rest
A patient with an oxygen saturation less than 88% when resting requires oxygen therapy. Although polycythemia may occur with chronic hypoxemia, a hemoglobin level of 13.6 gm/dL is a normal hemoglobin level and does not require oxygen therapy. The red blood cell count of 5 million cells/microliter is normal and does not indicate polycythemia that might justify oxygen therapy. A PaO2 of 62 mm Hg is in the low normal range and would not justify home oxygen therapy.
Which finding would confirm a diagnosis of chronic obstructive pulmonary disease (COPD) in a patient with dyspnea and a history of tobacco use?
1-FEV1/FVC ratio of 65%
2-Positive sputum culture
3-Flat diaphragm upon chest x-ray
4-Oxygen saturation of 86% at rest
1-FEV1/FVC ratio of 65%
FEV1/FVC ratio is the ratio of the forced expiratory volume to the forced vital capacity of the lungs. A ratio of 70% or less supports a COPD diagnosis in patients who are suspected to have COPD. A positive sputum culture would support diagnosis of an infection such as pneumonia. A flat diaphragm can be seen on chest x-ray in some patients with COPD but does not confirm a COPD diagnosis. Oxygen saturation levels are not used to diagnose COPD as they can be indicative of a variety of pathophysiologic processes.
Which laboratory finding for a patient with chronic obstructive pulmonary disease (COPD) is most important to report to the health care provider?
1-Hemoglobin concentration is 14 g/dL.
2-Red blood cell count is 4.9 million cells/microliter.
3-Partial pressure of arterial oxygen (PaO2) is 75 mm Hg.
4-Partial pressure of carbon dioxide (PaCO2) is 55 mm Hg.
4-Partial pressure of carbon dioxide (PaCO2) is 55 mm Hg.
The normal range of PaCO2 is 35 to 45 mm Hg; the patient’s elevated PaCO2 of 55 mm Hg indicates hypercapnia and that a change in treatment may be needed. The patient’s hemoglobin of 14 g/dL is within the normal range of 13.5 to 17.5 g/dL. While a patient with COPD may develop polycythemia, this patient has a normal red blood cell count of 4.9 million cells/L. The patient’s partial pressure of arterial oxygen of 75 mm Hg is within normal parameters.
When a patient with chronic obstructive pulmonary disease has been using a beclomethasone inhaler, which assessment finding indicates a need for patient teaching?
1-White patches on pharynx
2-Oxygen saturation of 93%
3-Respiratory rate of 24 breaths/min
4-Weight increase of 1 lb (0.45 kg)
1-White patches on pharynx
The presence of white patches on the pharynx indicates oral candidiasis (thrush), a common side effect of inhaled corticosteroids. The nurse will plan to teach the patient about the need to rinse the mouth out with water after using the beclomethasone. An oxygen saturation of 93% is in the low-normal range, and no teaching is needed. A respiratory rate of 24 breaths/min is slightly above the normal range but would be acceptable for a patient with chronic lung disease. A slight weight increase or decrease is normal and not an indication of a need for patient teaching.
Which patient action when using albuterol and beclomethasone inhalers indicates a need for further teaching?
1-Rinsing the mouth following use of the inhalers
2-Administering the beclomethasone before the albuterol
3-Administering the albuterol before the beclomethasone
4-Administering the beclomethasone on a set schedule to prevent an asthma attack
2-Administering the beclomethasone before the albuterol
Albuterol, a β2-adrenergic agonist medication, should be used first to dilate the airways before administration of the corticosteroid beclomethasone. Administering the beclomethasone on a set schedule to prevent an asthma attack and rinsing the mouth following use of the inhalers are correct actions.
Which interventions may be included in the plan of care for a patient with advanced stage chronic obstructive pulmonary disease (COPD) who has experienced significant weight loss? Select all that apply.
1-Encourage rest before meals.
2-Encourage high fluid intake with food.
3-Discontinue oxygen therapy while eating.
4-Use steroids and theophylline to relieve bloating.
5-Encourage high-protein supplements between meals.
1-Encourage rest before meals.
5-Encourage high-protein supplements between meals.
Decreased appetite and weight loss occur because of systemic inflammatory processes in COPD. Resting before taking meals helps the patient reduce dyspnea and conserve energy. High-protein supplements can be taken between meals to compensate for the catabolic effects of COPD. Fluid intake should be encouraged between meals rather than with food to prevent distension of the stomach. Supplemental oxygen therapy while eating is beneficial to the patient. Steroids and theophylline cause bloating and do not relieve it.
Which intervention may improve gas exchange for a patient with chronic obstructive pulmonary disease (COPD) whose oxygen saturation is 88%?
1-Obtain an arterial blood gas (ABG).
2-Administer 6 L of oxygen via nasal cannula.
3-Sit the patient upright in a chair leaning slightly forward.
4-Place the patient in the prone position to increase postural drainage.
3-Sit the patient upright in a chair leaning slightly forward.
The patient with COPD can engage in better gas exchange in an upright position leaning slightly forward. Once the patient’s oxygen increases, the nurse may obtain an ABG if requested by the health care provider. Administering 6 L of oxygen is too much oxygen for a patient with chronic bronchitis. Placing the patient in a prone position would further impair gas exchange.
Which type of equipment will the nurse use to deliver a precise amount of oxygen to a patient experiencing an exacerbation of chronic obstructive pulmonary disease (COPD)?
1-Venturi mask
2-Simple face mask
3-Non-rebreather mask
4-Laryngeal mask airway
1-Venturi mask
The Venturi mask delivers precise concentrations of oxygen and should be selected whenever this is a priority concern. A non-rebreather and simple face mask are less precise in terms of the amount of oxygen delivered. The laryngeal mask airway is an invasive airway used for surgical procedures or emergency situations.
The nurse will suggest which intervention for the patient experiencing an acute exacerbation of chronic obstructive pulmonary disease (COPD)?
1-Walk for 30 minutes.
2-Drink more fluids at mealtime.
3-Use typed messages to communicate.
4-Speak continuously in sentences by taking deep breaths.
3-Use typed messages to communicate.
Sometimes patients with COPD or those who use oxygen (O2) therapy have difficulty speaking because of shortness of breath. These patients should be encouraged to use typed messages as an alternative to phone conversations to communicate to avoid increased dyspnea. The patient should avoid exercise or walking during the attack because severe dyspnea may lead to respiratory failure. The patient should have an adequate diet to prevent weight loss. Hence the patient should avoid consuming more fluids at mealtime. Patients with dyspnea often cannot speak in continuous sentences because of difficulty in breathing.
Which surgical option may be utilized to reduce the size of hyperinflated emphysematous lungs and decrease airway obstruction for a patient with severe chronic obstructive pulmonary disease (COPD)?
1-Bullectomy
2-Airway bypass
3-Lung transplantation
4-Lung volume reduction surgery (LVRS)
4-Lung volume reduction surgery (LVRS)
Three different surgical procedures have been used in severe COPD. One type of surgery is LVRS. The goal of this surgery is to reduce the size of the lungs by removing the most diseased lung tissue so the remaining healthy lung tissue can perform better. The rationale for LVRS is that reducing the size of the hyperinflated emphysematous lungs results in decreased airway obstruction and increased room for the remaining normal alveoli to expand and function. The procedure reduces lung volume and improves lung and chest wall mechanics. Bullectomy is for patients with emphysematous COPD who have large bullae. Airway bypass is a procedure still under evaluation. Lung transplantation would not be the first choice, because it is for carefully selected patients with advanced COPD, and this patient’s lung volume can be reduced.
