COPD Flashcards Preview

chronic > COPD > Flashcards

Flashcards in COPD Deck (52):
1

ventilation

movement of air in and out of the lungs

2

perfusion

exchange of oxygen and carbon dioxide at alveolar-capillary level

3

Ventilation/perfusion must be matched so that

adequate O2 and CO2 exchange can occur

4

examples of v/q mismatches

Pneumonia: ventilation problem
P.E.: (pulmonary embolism-clot) perfusion problem

5

respiratory control center is located in the

medulla oblongata

6

central chemoreceptors COPD

Found near the medulla
Are stimulated by an increase in CO2 or a decrease in pH

7

peripheral chemoreceptors

Located in the carotids and aortic arch
Are stimulated by an increase in CO2, a decrease in pH, or by hypoxia

8

respiratory assessment diagnostics

Percutaneous Biox (Pulse Oximetry) Capnography
X-Ray
CT Scan – Helical / Spiral
MRI: Magnetic Resonance Imaging
V/Q scan
Sputum
ABG
PFT
Bronchoscopy
Thoracentesis
Lung Biopsy

9

pulse oximetry COPD

Measures: oxygen saturation
Non invasive
False results: Increased bilirubin, Dark nail polish/fake nails
CO poisoning

10

capnography COPD

Measures: exhaled CO2
Normal pCO2: 35-45
Non invasive
Usually in ventilated patients

11

purpose of CXR COPD

Detect alterations
Determine position of tubes, catheters (chest tube, PICC line, endotracheal tube, ports)
Evaluate progress of disease, etc. (pneumonias)

12

CT scan helical/spiral

3D scan

13

MRI

Preparation: no metals, remove jewelry
Contraindication: any form of metal that cannot be removed

14

V/Q scan or lung scan

Inhalation or IV injection of radiopaque iodine to detect alterations in patterns of ventilation or perfusion; blank spaces indicates (ventilation) blockage in the airways, (perfusion) blood clot
V/Q mismatch ventilation but not perfusion
V: ventilation Q: perfusion (IV)

15

C&S for COPD

Gram-stain results 24 hours; Culture results 72 hours

16

AFB acid fast bacillus

For TB

17

purpose of cytology

Identify abnormal cells (usually malignancies)

18

Collection of 1st sputum in AM is best

this is when it is Most concentrated

19

purpose of ABGs

Identify acid-base imbalances
Identify hypoxia
Drawn from radial or femoral artery

20

purpose of pulmonary function tests (PFT)

Assess functional capacity of the lungs; helps evaluate pulmonary disease and response to treatments; volume, force

21

tidal volume

(Normal male: 400-500 cc): volume inspired or expired during spontaneous breath

22

inspiratory reserve volume (IRV)

volume that can be inspired at the end of normal inspiration

23

Expiratory reserve volume (ERV)

volume that can be expired at the end of normal expiration

24

residual volume (RV)

volume of air remaining in lungs after maximal expiration

25

vital capacity

TV + IRV + ERV

26

total lung capacity

Vital Capacity + Residual Volume

27

prep for bronchoscopy

NPO 8 hrs. prior (may vary) for risk for aspiration
Consent form (conscious sedation)

28

post bronchoscopy

NPO until return of gag esp if received Versed
Assess resp. effort/rate

29

Thoracocentesis: Insertion of needle into pleural space (between parietal & visceral pleura) to:

Remove fluid (from cancer or infection)
Instill meds
Facilitate breathing

30

COPD

Lower airway disorder resulting in irreversible changes that are chronic and progressive
Includes: Emphysema and Chronic Bronchitis

31

asthma

unlike emphysema and bronchitis, is a condition of intermittent, reversible airflow obstruction

32

etiology of chronic bronchitis

Inhalation of physical or chemical irritants, with cigarette smoking most common
Also implicated: pollutants, chronic resp. infections, genetic predisposition

33

patho chronic bronchitis

1. Inflammation
2. hyperplasia of mucus-producing glands
3. excessive mucus production
4.decreased ciliary action
5. Airway obstruction
6. Hypoxia, hypercapnea, resp acidosis
7. PaO2 dec, PaCO2 inc
8. polycythemia
9. “blue bloater”

34

cor pulmonale

Rt. Sided cardiac hypertrophy as the heart pumps against increased pulmonary vascular resistance; backflow into the vena cava and the periphery/tissues causing edema

35

assessment findings chronic bronchitis

Early: Productive cough on awakening (smoker’s cough)
Dyspnea, wheezing
Decreased activity (often subconscious)
Cyanosis (“Blue Bloater”) or dusky color
Distended neck veins due to backflow of the rt sided failure
Increased edema due to backflow of the rt sided failure
Appear stout or overweight
Late: Right sided cardiac failure and respiratory failure

36

diagnostic results COPD

Chronic Hypercapnia (CO2)
Chronic hypoxia
PFTs: Increased Residual Volume, Decreased Forced Expiratory Volume- cant get CO2 out (air trapping)

37

emphysema patho

1. Alveolar walls destroyed
2. “Air trapping” in alveolar spaces
3. Increased dead spaces
4. Hyperventilation
5. Increased work of breathing
6. Weight loss
7. PaO2, PaCO2 Normal/Low
8. “Pink puffer”

38

emphysema assessment findings

Dyspnea on exertion (DOE) that progresses to dyspnea at rest
Cyanosis around lips
Clubbing of fingers

39

emphysema diagnostics

ABGS normal until late (compensated resp. acidosis in late stages)
Decreased Forced Expiratory Flow and Volume

40

characteristics of chronic bronchitis

1. Barrel Chest
2.Stout, stocky appearance
3. Cyanosis
4. Persistent cough
5. copious sputum

41

characteristics of emphysema

1. Cachectic
2. Accessory Muscle use
3. Tachypnea, hyperventilation
4. Skin pink
5. SOB
6. Exertional dyspnea DOE
7. Hyper-resonance

42

common nursing diagnoses for chronic bronchitis and emyphsema

1. Impaired gas exchange
2. Ineffective airway clearance
3. Anxiety
4. Activity Intolerance
5. Imbalanced Nutrition – less than body requirements
6. Risk of Infection
7. Decisional conflict r/t smoking cessation
8. Interrupted family process
9. Sexual dysfunction
10. Disturbed sleep pattern

43

medical management for chronic bronchitis and emphysema

improve ventilation (CPAP, meds)
remove secretions (pulmonary hygiene)
slow progression (aerobic and breathing exercises)
prevent complications (treat edema- digoxin, diuretics)
promote health maintenance (stop smoking, nutrition, avoid allergens, oxygen therapy)

44

COPD medications (classes)

bronchodilators
anticholinergics
MDI
anti-inflmmatory (corticosteroids)
leukotriene inhibitors

45

bronchodilators

(Sympathomimetics/ß2 agonists)
Stimulate beta2 receptors in lungs to cause smooth muscle relaxation with bronchodilation

46

examples of bronchodilators

-Albuterol (Proventil) – inhaler
-Salmeterol (Serevent)-long acting (for long term control; never used alone or as a 1st choice agent) due to increased severity of asthma attacks
-Metaproterenol (Alupent) - inhaler

47

anticholinergics

Block choinergic receptors located in large airways, producing bronchodilation
Fewer side effects than that Beta2 agonists

48

MDI metered dose inhaler

Clean Mouth piece after use
Spacer allows large drops to land on walls of spacer as opposed to mouth & vocal chords, while smaller drops disperse more fully into deeper airways

49

anti-inflammatory meds (corticosteroids)

-Reserved for severe cases
-Given IV, po, or by inhalation
-Use with spacer for inhalation (reduce drug disposition in oropharynx increasing risk of candidiasis)

50

examples of anti-inflammatory meds (corticosteroids)

Inhaled examples:
-Azmacort (triamcinolone acetonide)-MDI
-Flovent (fluticasone proprionate)- MDI, DPI (dry powder inhaler)
Other examples:
-Decadron (dexamethasone)
-Methylprednisolone (Prednisone)
-Hydrocortisone (Cortisone)

51

leukotriene inhibitors

Also referred to as Leukasts: constrict airways secondary to inflammation
Less effective than steroids

52

exaplmes of leukotriene inhibitors

Example: Singulair (montelukast)