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Semester 5 PMCP Exam 2 > COPD - Aoki > Flashcards

COPD - Aoki Flashcards

1
Q

Obstructive lung disease - what is happening

A

air trapping

work of breathing is increased and you will likely end up trapping air because not all of it will come out

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2
Q

Airway diseases

A 
Upper airways
Asthma
COPD
Chronic Bronchitis
Broneictasis
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3
Q

Obstructive lung disease - categorized in what two ways

A

Reversible

Irreversible

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4
Q

Asthma is rev or irrev

A

rev

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5
Q

COPD is rev or irrev

A

irrev

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6
Q

Problem with airway - clinical presentation

A

cough - prod or non
Dyspnea
Dec ex capacity

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7
Q

How do we evaluate flow

A

Spirometry
Gold standard for obstruction
Capture volume being exhaled

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8
Q

PFT = what

A

pulmonary function test

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9
Q

What does PFT tell you

A

Spirometry
Then lung volumes - the size - changes in pressure
Then diffusing capacity - how good gas exchange is

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10
Q

FEV1 means

A

amount of air that comes out in the first second of forced expiration

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11
Q

FVC means

A

total amount of air your patient exhales

Forced vital capacity

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12
Q

What will a patient with obstruction show on the PFT lab report

A

the amount that comes out in first second is less than total exhaled
FEV1:FVC ratio is decreased!

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13
Q

PEF means

A

peak expiratory flow

when doing forced expiration what is the highest peak - often used for asthma management

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14
Q

If obstruction what happens to volume-time curve

A

It takes them longer to exhale

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15
Q

Normally we should finish exhalation in how many seconds

A

6

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16
Q

How do you determine if there is obstruction to air flow - what is the ratio

A

Yes obstruction if ratio is less than 5th percentile (less than 70%)
No if greater than 5th percentile

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17
Q

How do you know how severe the obstruction is

A

Look at FEV1 - magic number is 50%

If below 50% you are saying that there is severe obstruction

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18
Q

If they have an abnormal FEV1/FVC ratio - what is the next step

A

Want to determine if it is reversible or not

Try Inhaled Bronchodilator - and see if there is a response

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19
Q

Flow - volume loop looks like what in a normal/healthy person

A

upside down ice cream cone!

Should be smooth!

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20
Q

Flow - volume curve - what is the top? and the bottom?

A 
Top = exhalation
Bottom = inhalation
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21
Q

Flow - volume curve - what is typical of someone with obstruction

A

Concave exhalation - sometimes they may not even reach 0 line
Asthma and COPD - the concave is common

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22
Q

Upper airway obstruction - what do you see on flow - volume loop

A

Flattening of inspiratory portion - someone ate the ice cream!

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23
Q

How is upper airway obstruction tx - what is happening

A

speech therapy

when they take breath in, they have vocal cord dysfunction - closing on inspiration

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24
Q

Intrathoracic airway - asthma - define

A

Inflammatory disease of the airways with episodic and reversible airflow obstruction

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25
Asthma - characterized by whay
increased airway reactivity to various stimuli
26
Epidemiology with asthma
present at different ages - including late adulthood!
27
Prevalence of asthma
5-7% of total population
28
Clinical presentation of asthma
Wheezing (narrowing) Cough - prod or non (defensive mechanism) Dyspnea
29
Precipitating factors - asthma
``` allergens viral infection occupational exposure dust, fumes tobacco exercise gastro reflux post nasal drip medications that induce BC ```
30
Pathophysiology - asthma
- inflammatory process 1 airway hyperactivity with bronchospasm - BC 2 inflammation of bronchial mucosal 3 increased mucous production - secretions
31
Treatment medication - asthma
Bronchodilators - beta agonists (albuterol) Antiinflammatories - Steroids Antileukotriens
32
What receptor on airway smooth muscle
beta 2
33
What if symptoms persist with asthma
add an inhaled steroid!
34
what is the gold standard in patients with persistent asthma
inhaled steroid
35
What might suffice in those with intermittent asthma
beta agonist BD
36
Idea of spacer on inhaler
allows for space between mouth so this allows for better delivery - less turbulence this way so that don't lose medication
37
Inhaler vs. Nebulizer
More just about technique - the effectiveness is the same for both
38
Asthma exacerbation - define
Acute or subacute episodes of progressively worsening SOB, coughing, wheezing, and chest tightness or any combination thereof
39
What to do with asthma exacerbation
use steroids
40
Status Asthmaticus - define
Acute severe asthma attack that does not respond to usual use of inhaled BDs
41
Status Asthmaticus - associated with what
sx of potential respiratory failure | Life threatening and require immediate medical attention
42
COPD - what percent of US population
6.3% | RISK FACTOR - SMOKING
43
Pop with higher COPD prevalence
``` 65-74 yrs Non hispanic whites Women Low income Current or former smoker ```
44
Risk factors COPD
``` Smoke Occupational dust, chemicals Environmental smoke Air pollution Genes Infections SES Aging ```
45
Mechanism of COPD - impacts what
Small airway AND parenchymal destruction
46
COPD - small airway disease - what is happening
airway inflammation airway fibrosis, luminal plugs Inc airway resistance
47
COPD - parenchymal destruction - what is happening
loss of alveolar attachments | dec of elastic recoil
48
Chronic bronchitis - define
Cough that occurs every day with sputum production that lasts at least 3 months - two yrs in a row! Plus SOB
49
Chronic bronchitis - rev or irrev
irrev - remodeling is irreversible
50
Emphysema -
parenchymal destruction abnormal and permanent enlargement of airspaces End up trapping air
51
Clinical presentation - emphysema?
avg onset over 60 productive cough dyspnea
52
Clinical presentation - emphysema - later in the disease
Use of accessory mm to breath Inc AP diameter R heart failure may develop Weight loss
53
Why have hard time breathing in supine with resp. disease
Depend largely on diaphragm and normally intraabdominal pressure is higher than intrathoracic but when in supine intraabdominal pressure pushes diaphragm so we are stretching it - so it is not in the optimal place to be contracted
54
Clincial presentation chronic bronchitis
Chronic cough with sputum Cyanosis Polycythemia - inc hgb content
55
COPD is a spectrum of disease T or F
TRUE
56
COPD includes what
chronic bronchitis and emphysema
57
COPD - how will your pt present clinically
``` Accessory mm to breathe Inc AP diameter Pursed lip breathing Prolonged exp phase Tripod position Distant breath sounds ```
58
COPD - comorbidities
``` cardiovascular disease osteoporosis resp infection anx and dep diabetes lung cancer bronchiectasis ```
59
Stable COPD - goals of therapy
Reduce symptoms | Reduce risk
60
Stable COPD - goals of therapy - how do we reduce symptoms
Relieve symptoms Improve ex tolerance Improve health status
61
Stable COPD - goals of therapy - how do we reduce risk
prevent disease progression prevent and treat exacerbations reduce mortality
62
Single most important intervention to prevent disease and slow progression of disease
``` Tobacco smoking cessation Counseling Nicotine replacement therapy Bupropion Varenicline ```
63
Lung function, aging, and smoking graph
With smoking - your lung function goes downhill earlier and faster than the rest of your body With cessation - will slow down the decline! no matter when you quit it will slow down
64
Pharmacotherapy in COPD
Not to treat but moreso used to dec symptoms and complications and improve functional status
65
Long acting BDs usually last how long
12-24 hrs
66
Inhaled corticosteroid use for COPD
only in advanced, extreme cases | Stage 3 or 4 with significant sx or recurrent exacerbations
67
Which stage of COPD are we adding therapy in
Stage 2 (moderate)
68
Systemic steroids for COPD
Only for exacerbations - NOT using it daily
69
Oxygen therapy - COPD
Use of ox therapy intermittent - no impact on mortality | Continuous - does have impact
70
Vaccines imporant for COPD
Infleunza | Pneumococcal
71
Pulm Rehab - COPD - when indicated
Indicated in COPD pts with dyspnea on exertion GOLD for stage 2-4
72
Pulm rehab - COPD - what does it do
``` improves exercise capacity dec dyspnea improve QOL dec health care utilization benefits last up to 18 months ```
73
COPD acute exacerbation - define
an acute worsening of the patients respiratory symptoms that is beyond normal day-to-day variations and leads to a change in medication
74
Consequences of COPD exacerbations
``` neg impact on QOL impacts sx and lung function accelerates lung function decline inc mortality inc costs ```
75
COPD exacerbation - assessment - what do you need to determine first
baseline level of respiratory functioning
76
COPD exacerbation - assessment - what are the signs of a severe exacerbation
``` mental status changes speaks only with single words silent chest hemodynamic instability labored breathing ```
77
What do you wnat to evaluate for - COPD exacerbation - assessment -
possible concurrent conditions like pneumonia, pleural effusion, pneumothorax, CHF
78
Use of non-invasive ventilation - COPD
Improves resp acidosis Dec RR, dyspnea Dec need for intubation
79
Restrictive pathologies involve what
the layers around the lungs - onion | Limits amount of air you can contain - reflected on total lung capacity
80
First layer around lungs
visceral pleura parietal pleura in between the two you have pleural space
81
Diaphragmatic dx can present like
restrictive dysfunction
82
When would you not want to request lung function or spirometry
when patient is acutely ill
83
Restrictive process - can be due to
``` NM - myesthenia, GB, SBI Skeletal - kyphosis, scoliosis Diaphragm paralysis Pleural disease - effusion, pneumothorax Parenchymal disease - atelectasis, post surgical, interstitial lung disease, pulm edema ```
84
Restrictive can be in the __- or ___
Pulmonary (in the lungs) or in the layers (extrapulmonary)
85
Restrictive - Total lung capacity - what is standard
if you are 80-100% of your reference, you are good | Restriction less than 80%
86
Restrictive - how to decide if in the lungs or the layers
look at gas exchange If normal - think layers If abnormal - think lungs
87
Circulation - just pulmonary vasculature - can they be normal on physical exam with sounds
YES - you might hear nothing but they are short of breath and turning blue
88
Most common cause for pulmonar circulation issue
Pulmonary vascular diseases - DVT!
89
Imaging for PE
CT!
90
Is ambulation contraindication with DVT
no
91
Pulm hypertension can result from
clots
92
Groups for pulm htn
1 pulmonary arterial hptn 2 LEFT HEART DISEASE 3 chronic hypoxemia 4 thromboembolic
93
tx for pulm hptn
treat the underlying cause
94
Can people with COPD and/or restrictive dsyfunction develop pulm hptn
yes
95
who qualifies for VDs with pulm htpn
only group 1 | pulmonary arterial hptn
96
Resp failure - define
inability of the respiratory system to meet the metabolic demands of the body
97
Resp failure can be ___ or ___
acute or chronic | Early rehab is critical
98
Types of resp. failure
1 oxigenatory | 2 ventilatory
99
Resp failure - oxigenatory
gas exchange is impaired | acute vs. chronic - based on oxygen saturation
100
Resp failure - ventilatory
you are not moving air - acute vs. chronic based on ABG and blood bicarbonate level
101
Resp failure - what do you want to look at
ABG
102
Clinical presentation - acute resp failure
``` progressive dyspnea use of accessory mm paradoxical breathing tachypnea, tachycardia, nasal flaring Cyanosis agitation/lethargic ```
103
normalization of blood gas in someone who is in acute respiratory failure is
BAD sign

Semester 5 PMCP Exam 2 (6 decks)

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