COPD

Question 1

Respiratory symptoms of Cor Pulmonale

Answer 1

Hypoxia and hypoxemia, increasing dyspnea, pulmonary hypertension, fatigue

Question 2

Circulatory symptoms of Cor Pulmonale

Answer 2

Warm, cyanosis hands and feet with bounding pulses, cyanotic lips, distended neck veins, visible pulsations below the sternum, dependent edema

Question 3

Cardiovascular symptoms of Cor Pulmonale

Answer 3

Right ventricular enlargement (hypertrophy)

Question 4

GI symptoms of Cor Pulmonale

Answer 4

Enlarged and tender liver, nausea, anorexia

Question 5

Acid base imbalances related to Cor Pulmonale

Answer 5

Metabolic and respiratory acidosis

Question 6

What is the most common cause of Cor Pulmonale?

Answer 6

COPD

Question 7

The severity of Cor Pulmonale is correlated with what three factors?

Answer 7

Magnitude of hypoxemia, hypercapnia, and airflow obstruction

Question 8

Right-sided heart failure caused by pulmonary disease

Answer 8

Cor Pulmonale

Question 9

What is the initial pathophysiologic event in the production of Cor Pulmonale?

Answer 9

An elevation of pulmonary vascular resistance

Question 10

Low oxygen levels due to COPD that cause a rise in blood pressure in the arteries of the lungs

Answer 10

Pulmonary hypertension

Question 11

Nursing interventions for COPD

Answer 11

Maintain airway, breathing techniques, position patient up and forward, ensure effective coughing, supplemental oxygen (if applicable), exercise conditioning, suctioning, hydration, use vibratory positive pressure device, medications, NUTRITION, monitor weight and prealbumin levels, discuss anxiety, assess and treat lung infections

Question 12

COPD patient education

Answer 12

Avoid crowds; get pneumonia vaccine

Question 13

A _________ test measures how much and how fast you can move air into and out of your lungs

Answer 13

Spirometry

Question 14

Performing a spirometry test

Answer 14

Place clips over patient’s nose. Instruct the patient to place the mouthpiece in their mouth and form a tight seal with their lips. Have the patient breathe normally, then slowly blow out until their lungs are empty. Then, have the patient take a deep breath to fill their lungs completely and when their lungs are full, have them blow out as hard and as fast as they can until they are empty.

Question 15

What helps distinguish airway disease (obstructive diseases) from interstitial lung disease (restrictive diseases)?

Answer 15

Airflow rates and lung volume measurements

Question 16

What is performed before and after administration of bronchodilating agents to see how they work?

Answer 16

Pulmonary function tests (PFTs)

Question 17

Lung volumes measured for COPD

Answer 17

Vital capacity, residual volume, forced expiratory volume, and total lung capacity

Question 18

What lung volume is most affected in COPD with increases reflecting the trapped, stale air remaining in the lungs?

Answer 18

Residual volume

Question 19

A diagnosis of COPD is based mostly on

Answer 19

Forced expiratory volume

Question 20

Lung volume that measures how much air a person can exhale during a forced breath

Answer 20

Forced expiratory volume

Question 21

The amount of air exhaled may be measured during

Answer 21

The first FEV1, second FEV2, and/or third seconds FEV3 of the forced breath

Question 22

The total amount of air exhaled during the FEV (forced expiratory volume) test

Answer 22

Forced vital capacity (FVC)

Question 23

As COPD progresses, the ratio of the forced expiratory volume in the first second compared to the fourth becomes __________

Answer 23

Smaller

Question 24

GOLD 1: mild COPD

Answer 24

FEV1 over 80% of predicted

Question 25

GOLD 2: moderate COPD

Answer 25

FEV1 50-79% of predicted

Question 26

GOLD 3: severe COPD

Answer 26

FEV1 30-49% of predicted

Question 27

GOLD 4: very severe COPD

Answer 27

FEV1 less than 30% of predicted

Question 28

8-item test that includes severity indications (0-5 scale) based on symptom scores obtained from patient responses to COPD assessment test

Answer 28

CAT assessment

Question 29

Highest score on CAT assessment for COPD

Answer 29

40; the lower the score, the more severe the symptoms

Question 30

Assessment of symptoms/risk of COPD exacerbation

Answer 30

ABCD assessment tool

Question 31

A on ABCD assessment tool for COPD

Answer 31

Indicates low risk for exacerbation

Question 32

T or F: a patient with GOLD 4 COPD is at high risk for exacerbation

Answer 32

FALSE; GOLD simply measures severity of COPD, but severity is not correlated with risk for exacerbation (measured through ABCD tool). So a patient can be classified as GOLD 4, but have an A (low-risk for exacerbation) designation

Question 33

D on ABCD assessment tool for COPD

Answer 33

Indicated high risk for exacerbation and need for hospitalization

Question 34

Scale used to assess the degree of baseline functional disability due to dyspnea (grade 0-4)

Answer 34

Modified MRC dyspnea scale (mMRC)

Question 35

An airway clearance device used to clear airway secretions by which the patient blows air into a vibrating tube (which can be set on different resistance settings) until the they feel the need to cough and clear

Answer 35

Acapella; flutter is very similar to acapella

Question 36

What can cause hyperinflated lungs?

Answer 36

Blockages in the air passages or air sacs that are less elastic

Question 37

Hyperinflated lungs are seen in patients with

Answer 37

COPD, emphysema

Question 38

Normal chest assessment

Answer 38

Thorax has an oval shape with an anterioposterior to transverse diameter of 1-1.5 or 5-7

Question 39

Barrel chest assessment

Answer 39

Equal anterioposterior transverse diameter; ribs are horizontal to compared to the normal downward slope

Question 40

Barrel chest is associated with what conditions?

Answer 40

COPD and severe asthma

Question 41

How many lobes make up the right and left lung?

Answer 41

Right has 3, left has 2

Question 42

Branches in the lungs that supply the lobes with independent supplies of air

Answer 42

Bronchi

Question 43

Air sacs that are responsible for crucial exchange of air

Answer 43

Alveoli

Question 44

The exchange of O2 and CO2 is known as

Answer 44

Respiration

Question 45

An umbrella term for a range of progressive lung diseases

Answer 45

COPD

Question 46

Chronic bronchitis and emphysema can both result in

Answer 46

COPD (a diagnosis of COPD means that you have one of these lung damaging diseases or symptoms of both)

Question 47

Long-term inflammation of the bronchioles that leads to mucus buildup along the lining resulting in narrowing of the tubes; mucus cannot be cleared due to damaged cilia

Answer 47

Chronic bronchitis

Question 48

The breakdown of the walls of the alveoli at the end of the bronchial tubes at the bottom of the lungs

Answer 48

Emphysema

Question 49

What is the difference between asthma and COPD?

Answer 49

COPD is chronic and progressive mainly caused by smoking, while asthma is often set off by an allergy

Question 50

Blue bloater (chronic bronchitis) S/S of COPD

Answer 50

Mucous, cyanosis, increased hemoglobin, respiratory acidosis, digital clubbing of fingers

Question 51

Pink puffer (pulmonary emphysema) S/S of COPD

Answer 51

Bullae, collapsed alveoli, hyperinflation, pursed lips, barrel chest, speaking in short jerky sentences

Question 52

Noninvasive positive pressure ventilation consisting of two pressures (inspiratory [IPAP] and expiratory [EPAP]) that prevents airway collapsing and helps get rid of CO2 and improve ventilation

Answer 52

BiPAP

Question 53

How often should BiPAP be checked/monitored?

Answer 53

Every 4 hours

Question 54

The number between IPAP and EPAP values

Answer 54

Pressure support (if patient has an IPAP of 10 and EPAP of 5, the pressure support is 5)

Question 55

The amount of time it takes for BiPAP to reach its peak flow

Answer 55

Rise time (increase rise time if patient is air hungry)

Question 56

What is the purpose of setting a rate on BiPAP?

Answer 56

To give the patient a boost/remind them to breathe. Minimum rate is 4 (meaning the machine will initiate a breath 4 times per minute)

Question 57

BiPAP Inspiratory times can be up to ___ seconds

Answer 57

2

Question 58

BiPAP expiratory times should be at least ___ times more than the inspiratory time

Answer 58

2