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OA Exam 2 > COPD > Flashcards

COPD Flashcards

1
Q

COPD results from…

A

repeated exposure to respiratory irritants that begin to damage the structures of the respiratory system

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2
Q

Damage to the large and small airways cause…

A

increased mucus production, causing arrest in cilia action

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3
Q

Increased mucus production leads to…

A

excessive fluid accumulates with lung mucosal cells or edema

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4
Q

Edema leads to…

A

narrowing of airway passages which leads to airflow limitation

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5
Q

Airflow limitation

A
  1. air trapping

2. hyperinflation of the lungs

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6
Q

air trapping

A

decreased airflow with exhalation

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7
Q

bronchitis

A

inflammation of the mucous membranes of the bronchial tubes

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8
Q

chronic bronchitis

A
  • disorder of excessive bronchial mucous secretion

- productive cough for 3 or more months in 2 consecutive years

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9
Q

Major risk factor for chronic bronchitis

A

smoking

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10
Q

emphysema

A

destruction of the walls of the alveoli resulting with enlargement of abnormal air spaces

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11
Q

What deficiency is there with emphysema?

A

a1-antitrypsin

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12
Q

a1-antitrypsin

A

enzyme that normally inhibits the activity of proteolytic enzymes and destruction in the lungs

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13
Q

Describe progression of emphysema

A
  1. inflammatory cells collect in distal airway lead to destruction of elastic fibers in the respiratory bronchioles and alveolar ducts
  2. which causes alveoli and air spaces to enlarge with loss of corresponding portions of pulmonary capillary beds
  3. which leads to surface area of alveolar-capillary diffusion is reduced which affects gas exchange
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14
Q

Risk factors for COPD

A
  • smoking (greatest)
  • frequent exposure to smoke
  • long term exposure to chemical irritants in workplace or hobby
  • asthma
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15
Q

Short term exposure to smoke or irritants

A

normally does not pose risk for COPD

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16
Q

The key to preventing COPD

A

not engaging in behaviors that have been linked with etiology of disease

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17
Q

Prevention Methods for COPD

A
  • not smoke or quit
  • decrease exposure to secondhand smoke
  • decrease occupational respiratory irritants
  • decrease air pollutants
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18
Q

Culture that has a higher risk of developing COPD

A

Hispanic population due to acculturation, education levels, alcohol, and substance abuse

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19
Q

Clinical manifestations of COPD

A

varies from simple chronic bronchitis without disability to chronic respiratory failure and severe disability

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20
Q

FEV1

A

forced expiratory volume in 1 second measure by spirometer

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21
Q

How to measure severity of COPD

A

FEV1 and symptom manifestations determine the level of COPD

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22
Q

Clinical manifestations typically…

A

absent or minor early in the disease

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23
Q

Initial symptoms of COPD

A

-chronic cough and sputum production

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24
Q

initial symptoms tend to begin….

A

long before changes in pulmonary function

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25
Q

When do patients typically seek medical help for COPD symptoms?

A

after 10 yrs of initial symptoms

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26
Q

When does dyspnea occur initially?

A

Dyspnea initially occurs on extreme exertion and progresses over time

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27
Q

Manifestations of chronic bronchitis

A
  • cough with copious amounts of thick, tenacious sputum
  • cyanosis
  • evidence of right-sided heart failure
  • adventitious lung sounds
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28
Q

evidence of right-sided heart failure

A
  • distended neck veins
  • edema
  • liver engorgement
  • enlarged heart
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29
Q

adventitious lung sounds

A
  • loud rhonchi

- possible wheezes

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30
Q

Manifestations of emphysema

A
  • dyspnea (1st symptom)
  • cough is minimal or absent
  • barrel chest
  • client is usually thin
  • tachypneic
  • uses accessory muscles
  • tripod position
  • pursed-lip breathing
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31
Q

tripod position

A
  • used with emphysema patients

- sitting and leaning forward

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32
Q

pursed-lip breathing

A

prolong expiratory phase in an effort to promote more alveolar emptying while maintaining open alveoli

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33
Q

prolonged impairment of gas exchange as a result of COPD leads to…

A

cardiac dysfunction

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34
Q

cardiac function

A

heart having to work harder to provide oxygen through the bloodstream

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35
Q

earliest manifestations

A

chest pain and HTN

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36
Q

caloric demand increases as…

A

the effort to breathe increases

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37
Q

Eating becomes more difficult with…

A

tachypnea

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38
Q

Increase in caloric demand with decreased caloric intake often occurs…

A

in latter stages of COPD resulting in weight loss and possible anemia

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39
Q

Anxiety due to periods of dyspnea occurs

A

with exacerbations in moderate and severe COPD

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40
Q

Severe COPD leads to

A

impairment of other body systems due to insufficient airflow further restricting quality of life

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41
Q

Stages of COPD

A
  1. Mild
  2. Moderate
  3. Severe
  4. Very Severe
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42
Q

Stage 1: Mild

A
  • usually chronic cough and sputum production
  • mild airflow limitation
  • FEV1 > 80% predicted
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43
Q

Stage 2: Moderate

A

-usually worsen symptoms with SOB on exertion

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44
Q

Stage 3: Severe

A

-worsen symptoms w/ noticeable SOB

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45
Q

Stage 4: Very Severe

A

-severe symptoms

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46
Q

Spirometry

A

common office test used to assess how well your lungs work by measuring how much air you inhale, how much you inhale, and how quickly you exhale

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47
Q

Serum alpha1-antitrypsin levels

A

screen for deficiency if:

  • fam hx
  • early COPD onset
  • female
  • does not smoke
48
Q

Normal serum alpha1-antitrypsin levels

A

80-260 mg/dL

fasting not require

49
Q

alpha1-antitrypsin

A

protects the lungs from injury

50
Q

CBC w/ WBC differential

A

shows increased RBC and hematocrit

51
Q

polycythemia

A

increased # of blood cells

52
Q

increased WBC and increased % of immature WBCs indicate…

A

bacterial infection

53
Q

ABGs

A

Arterial blood gas

-evaluate gas exchange especially during acute COPD exacerbations

54
Q

emphysema pts

A
  • mild hypoxemia
  • normal or low carbon dioxide tension
  • respiratory may be present as a result of increased RR
55
Q

chronic bronchitis & airway obstruction pts

A
  • marked hypoxemia and hypercapnia with respiratory acidosis

- SpO2 decreased because of marked hypoxemia

56
Q

chest x-ray result for emphysema

A

small white patches indicative of hyperinflated alveolar sacs filled with secretions that are common in emphysema

57
Q

chest x-ray result for more advanced bronchitis

A

long fields with larger areas of white, indicating secretions

58
Q

chest x-ray may show flattening of the diaphragm because of…

A

hyperinflation and evidence of pulmonary infection if present

59
Q

Ventilation Perfusion Scanning

A
  • determine extent lung tissue is ventilated but not perfused
  • determine extent lung tissue is perfused but not adequately ventilated
  • radiosotope injected or inhaled to illustrate areas of shunting and absent capillaries
60
Q

Pulse Oximetry

A
  • monitored to assess the need for supplemental oxygen
  • often less than 95% due to marked airway obstruction and hypoxemia
  • used to monitor oxygen saturation of the blood
61
Q

Exhaled Carbon Dioxide

A

ETCO2

-may be measured to evaluate alveolar ventilation

62
Q

Normal value for exhaled carbon dioxide

A

35-45mmHg

63
Q

When would exhaled carbon dioxide levels be elevated?

A

when ventilation is inadequate and decreased when pulmonary perfusion is impaired

64
Q

ETCO2 monitoring leads to

A

reduced frequency of ABGs

65
Q

Periodic exacerbations

A

period of increased symptoms:

  • dyspnea and cough
  • sputum from lungs
  • decline in activity
  • lead to change in meds
  • lung tissues have progressive destructive changes
66
Q

Possible causes of periodic exacerbations

A
  • respiratory infection
  • air pollution
  • temp change
  • unknown cause
67
Q

Oxygen management goals

A
  • slow disease progression
  • ease symptoms
  • improve health status and exercise tolerance
  • prevent and treat exacerbations and complications
  • reduce mortality risk
68
Q

Pharmacologic Therapy for COPD

A
  • immunizations
  • broad spectrum antibiotics
  • bronchodilators
  • statins
69
Q

Non-pharmacologic Therapy for COPD

A
  • postural drainage
  • pulmonary rehab
  • dietary measures
  • herbal teas
  • acupuncture
  • guided imagery
  • surgical interventions
70
Q

immunizations for COPD

A
  • pneumococcal vaccine
  • pneumococcal revaccination if 65 or older and previous vaccine was 5+ yrs ago
  • yearly flu vaccine
71
Q

broad spectrum antibiotics

A
  • for infections with patients with purulent sputum with dyspnea
  • exacerbations 4+ per year
72
Q

Bronchodilators

A
  • improve airflow
  • reduce air trapping
  • relax bronchial smooth muscle
  • widen airway
73
Q

albuterol

A

short acting

74
Q

ipratropium bromide

A

longer duration

-anticholinergic agent by MDI

75
Q

salmeterol

A

long acting

-beta 2 agonist, can be given with a corticosteroid (fluticasone) to reduce risks of cardiac side effects

76
Q

theophylline (oral)

A

-weak bronchodilator with a narrow TR

77
Q

statins

A

new research shows significant improvement for the client with COPD

78
Q

statins are associated with a decrease in…

A

all-cause mortality as well as a reduction in the rate of respiratory-related emergency care

79
Q

In addition to targeting systemic inflammation…

A

statins may also target airway inflammation

80
Q

What medications are not recommended for COPD patients

A
  • cough suppressants: usually ineffective

- sedatives: generally avoided, may cause secretion retention, decreased respirations

81
Q

postural drainage

A

drainage by gravity of secretions from various lung segments

82
Q

secretions that remain in the lungs or respiratory airways…

A

promote bacterial growth and subsequent infection

83
Q

before postural drainage…

A

bronchodilator or nebulizer therapy to loosen secretions

84
Q

sequence for postural drainage

A
  1. positioning
  2. percussion
  3. vibration
  4. removal of secretions by coughing or suction
85
Q

how long does the patient hold each position in the postural drainage

A

10-15 minutes

-may be shorter in the beginning and gradually increases to 10-15 minutes

86
Q

after postural drainage

A
  • listen to lungs
  • compare findings to baseline
  • document amount
  • document color
  • document character
87
Q

Pulmonary Rehab

A
  • assessment
  • exercise training
  • aerobic exercise program
  • nutrition counseling
  • smoking cessation
  • education
  • hydration with humidifiers
88
Q

aerobic exercise program

A
  • improves exercise tolerance
  • enhance ability to perform ADLs
  • prevent deterioration of physical condition
89
Q

education for pulmonary rehab

A

-avoid exposure to other airways irritants and allergens

90
Q

how long is pulmonary rehab performed?

A

at least 6 wks

91
Q

What does pulmonary rehab achieve?

A
  • reduces dyspnea and fatigue
  • improve exercise tolerance
  • improve quality of life
  • benefit patients at all disease stages
92
Q

dietary measures

A
  • reduce dairy products and salt to reduce production and thin secretions
  • need protein and calcium
  • diet high in fat and low carbs
93
Q

enteral formulas for dietary measures

A
  • high calorie
  • modified carb and fat
  • helps reduce diet-induced carbon dioxide production
94
Q

what beverage relieves chest congestion

A

hot herbal teas with peppermint

95
Q

hypnotherapy

A

insufficient evidence of effectiveness

96
Q

bullectomy

A

reduces dyspnea and allows re-expansion of compressed lung region

97
Q

bullae

A

enlarged alveolar air spaces, do not contribute to gas exchange, compress lung tissue

98
Q

lung reduction surgery

A

removes nonfunctional lung areas with hyperinflation

-improves survival > 50 months

99
Q

lung transplant

A

single and bilateral transplants

-increases survival 75 % to 2 yrs

100
Q

Nursing plan of care

A
  • client will adapt breathing patterns to meet oxygenation demands adequately
  • client will experience ease of respirations with the use of positioning and pursed-lip breathing
  • client will maintain patent airway, allowing adequate oxygenation
  • client will maintain SpO2 levels >90%
  • client will tolerate activity levels, allowing completion of ADLs
101
Q

Priorities for nursing

A
  • focused on promoting oxygenation
  • airway clearance
  • effective breathing patterns
102
Q

5 R’s for smoking cessation

A
  • Relevance to quit
  • Risks of using tobacco
  • Rewards of quitting
  • Roadblocks to quitting
  • Repetition with each new encounter with the patient
103
Q

STAR

A

S: set a date within 2 wks
T: tell fam, friends, coworkers
A: anticipate challenges to quit especially in first few weeks
R: remove all tobacco products

104
Q

Evaluation/Outcomes

A
  • pt consistently maintained SpO2 >90%
  • pt modified ADLs to reduce fatigue related to activity intolerance
  • pt demonstrated appropriate use of medications
105
Q

When to initiate long term oxygen therapy

A

severe and progressive hypoxemia

106
Q

goal of oxygen therapy

A

SpO2 > 90% (varies per patient)

107
Q

Different ways to administer oxygen therapy

A

intermittently, at night, or continuously

108
Q

giving too much oxygen to COPD patients…

A

takes away the drive to breathe

-max 2 L/min

109
Q

drive to breathe for healthy patients

A

occurs with hypercapnia

110
Q

drive to breathe for COPD patients

A

low O2 levels

111
Q

hypercapnia

A

interferes with body’s ability to respond to increased COPD

112
Q

Types of inhaler

A
  • MDI
  • MDI with spacer
  • DPI
  • SMI
113
Q

DPI

A

dry powder

close mouth tightly around mouth piece of the inhaler and inhale rapidly

114
Q

spacer/holding inhaler

A

-recommended for young children and corticosteroid

115
Q

In the mouth inhaler not recommended for…

A

corticosteroid

OA Exam 2 (6 decks)

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