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Adult Health 2 > COPD/Asthma > Flashcards

COPD/Asthma Flashcards

1
Q

Chronic Obstructive Pulmonary Disorder (COPD)

A
  • a disease state that reduces airflow in the lungs, making it difficult to breathe
  • usually progressive and not fully reversible
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2
Q

What is the 4th leading cause of death in the US?

A

COPD

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3
Q

COPD is an umbrella term used to describe progressive lung diseases including what?

A
  • emphysema
  • chronic bronchitis
  • refractory (non-reversible) asthma
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4
Q

Emphysema

A
  • alveoli are damaged
  • over time the inner walls of alveoli weaken and rupture
  • larger air spaces are created making it difficult to exhale
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5
Q

Chronic Bronchitis

A
  • inflamed bronchial tubes produce excessive mucus
  • increased cough and sputum production
  • occurs in at least 3 consecutive month increments in 2 consecutive years
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6
Q

Non-reversible Asthma

A
  • inflammation and edema of the bronchial airways

- no improvement or less than 12% in pulmonary function occurs w/ bronchodilators

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7
Q

Risk Factors for COPD

A
  • tobacco smoke
  • second-hand smoke
  • heredity
  • prolonged exposure to environmental or occupational chemicals
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8
Q

S/S of COPD

A
  • Dyspnea
  • chronic cough usually in morning
  • sputum production
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9
Q

Dyspnea w/ COPD

A
  • mild to severe
  • may start initially w/ activity and progress to at rest
  • ADL’s may become difficult
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10
Q

Sputum Production w/ COPD

A

may increase in severity, thickness, and have color w/ exacerbation

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11
Q

Diagnosing COPD

A
  • history-worsening dyspnea/cough; smoke how much
  • physical examination
  • pulmonary function test
  • incentive spirometer (first choice)
  • bronchodilators after PFT
  • ABG’s
  • Chest x-ray
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12
Q

Physical Exam Findings w/ COPD

A
  • barrel chest
  • bilateral intercostal retractions
  • diminished breath sounds w/ prolonged exhalation
  • course crackles/wheezing on auscultation
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13
Q

Stages of COPD

A
  • mild
  • moderate
  • severe
  • very severe-late-palliative stage
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14
Q

Mild COPD

A

airflow is somewhat limited, but doesn’t notice much; cough w/ mucus occurs every once in a while

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15
Q

Moderate COPD

A

airflow is worse; often short of breath after doing something active
-this is the point where most people notice symptoms and get help

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16
Q

Severe COPD

A

airflow and SOB are worse; can not do normal exercise anymore
-symptoms flare up frequently, also called an exacerbation

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17
Q

Late COPD

A

airflow is limited; flares are more regular and intense and quality of life is poor

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18
Q

How is a patient w/ COPD managed?

A
  • prevent disease progression
  • relieve symptoms
  • improve exercise tolerance
  • improve health status
  • prevent/treat complications
  • prevent/treat exacerbations
  • reduce mortality
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19
Q

COPD Treatment Options

A
  • surgery
  • oxygen
  • pulmonary rehab
  • inhaled corticosteroids
  • bronchodilators
  • smoking cessation
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20
Q

Short Acting Bronchodilators

A
  • prn; works quickly within about 15 minutes
  • albuterol
  • Proventil
  • Xopenex better for heart patients
  • duoneb
  • Atrovent
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21
Q

Long Acting Bronchodilator

A
  • regularly or on maintenance basis
  • Spiriva
  • brovana
  • serevent
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22
Q

What to monitor for when using a bronchodilator?

A
  • tachycardia
  • palpations
  • increased BP
  • avoid caffeine
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23
Q

Bronchodilators may cause what?

A

anxiety
nervousness
tremors
insomnia

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24
Q

Pulmonary Rehab

A

program of exercise, education, and support to help the patient to learn to breathe and function at highest level possible

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25
Q

What does Pulmonary Rehab work on?

A
  • breathing exercises
  • pacing of activities according to level of dyspnea
  • endurance and strength training
  • nutritional counseling
  • medication education
26
Q

Inhaled Corticosteroids

A

Flovent
Advair
Symbicort

27
Q

Oral Corticosteroids

A

prednisone

28
Q

Intravenous Corticosteroids

A

Solu-cortef

-Solu-medrol

29
Q

Important Vaccine Education for Patients

A
  • pneumonia vaccine 1 dose q 12 months x 2 types
  • TDAP booster
  • flu vaccine annually
30
Q

Oxygen may be used with COPD when?

A
  • as treatment for acute exacerbations
  • long-term for severe COPD
  • with sleep/exercise
31
Q

Goals for Oxygen use w/ COPD

A
  • keep O2 sat > 90%

- aid w/ increased cardiopulmonary workload including increased SOB, tachypnea, tachycardia, HPT

32
Q

Concerns w/ using oxygen w/ COPD are?

A
  • chronic hypercapnia
  • may lead to loss of drive to breath (hypoxic drive)
  • leads to undertreatment w/ oxygen
33
Q

Uncontrolled Oxygen Use

A
  • amount of O2 received is dependent upon depth and rate of breathing
  • nasal cannula
  • best used after patient is stabilized after acute exacerbation or chronic use at home
34
Q

Controlled Oxygen Use

A
  • oxygen of a known concentration is delivered and titrated according to the patients oxygen saturation and is not dependent on patient breathing
  • Venturi mask
  • best used w/ acute exacerbation when O2 levels cannot be controlled
35
Q

Exacerbation

A

a worsening or “flare up” of symptoms

-may indicate worsening of condition and/or decline in pulmonary function

36
Q

What may cause an exacerbation?

A

infection in the lungs, but in some cases cause may never be known

  • pneumonia
  • influenza
  • exposure to pollutants
37
Q

Treatment for Exacerbations

A
  • IV/oral corticosteroids
  • increase use of bronchodilator
  • antibiotics
  • oxygen
38
Q

Chronic Dyspnea often occurs w/o what?

A

visible signs of distress

39
Q

Treatment for Chronic Dyspnea

A
  • administer bronchodilator
  • assist w/ ADL’s to decrease over-exertion
  • administer O2 prn
  • education to relieve SOB
40
Q

Educations to Relieve SOB

A
  • pursed-lip breathing
  • cool air
  • diaphragmatic breathing
  • altering activity that increases SOB
41
Q

What should be done for Impaired Gas Exchange?

A
  • monitor O2 and ABG results
  • administer supplemental O2 and educate on home use
  • monitor neurological status
42
Q

Cough/ Ineffective Airway Clearance

A
  • remove or reduce irritants
  • chest physiotherapy
  • suctioning
  • educate on controlled coughing
  • controlled coughing spasms
43
Q

Exercising for patient w/ decreased tolerance

A
  • early, frequent ambulation short distances
  • deep breathing q hour WA
  • turn q 2 hours
  • leg lifts, ankle flexation
  • arm raises
  • up to chair at least 3 times daily
  • walking aids
  • physical therapy
44
Q

Nutrition

A
  • may need increased caloric intake
  • increase protein
  • weight reduction if overweight
  • nutritional supplements
  • vitamins
  • dietary consult
45
Q

Tips for id SOB occurs while eating or right after meals

A
  • clear airway at least one hour before eating
  • eat slowly
  • choose easy to chew foods
  • five or six small meals
  • drink liquids at the end of meals
  • eat while sitting up
  • pursed lip breathing
46
Q

-Improving Self-care/Coping Skills

A
  • realistic goals/expectations
  • stress management
  • recognize limitations
  • recognize s/s depression
  • provide support
47
Q

What to asses for S/S of impending respiratory failure?

A
  • unresponsive dyspnea
  • alternating tachypnea/bradypnea
  • anxiety
  • mental status changes
  • unresponsive hypoxemia/increasing hypercapnia
  • increasing use of accessory muscles
48
Q

Asthma

A

chronic inflammation of the airways that is worsened with certain triggers

  • allergens
  • irritants
  • no cure but reversible w/ treatment
49
Q

What happens w/ asthma attack?

A

as airway swells muscles around them tighten increasing mucus production and makes breathing more difficult

50
Q

Diagnosing Asthma

A
  • patient history
  • physical exam/symptoms
  • spirometry findings
51
Q

Physical Exam findings w/ Asthma

A
  • symptoms occur most often at night or early morning
  • may occur suddenly or over several days
  • recurrent cough
  • wheezing
  • chest tightness/dyspnea
  • worsening of symptoms w/ exposure to triggers
  • excessive mucus production
52
Q

Goals for Asthma Treatment

A
  • reduce impairment
  • freedom from symptoms
  • decreased need for short acting meds
  • reduce risk of complications
  • prevent recurrences
53
Q

Peak Flow Monitoring

A

blow a fast hard blast rather than slow breathing emptying your lungs

54
Q

What is peak flow monitoring used for?

A
  • diagnose asthma in patient w/ normal spirometry

- assist in treatment for those who have trouble recognizing exacerbation

55
Q

How to establish personal best w/ peak flow monitoring?

A

use peak flow meter at the same time every day for 2 weeks

56
Q

Asthma exacerbations may lead to what?

A
  • worsening disease
  • status asthmaticus
  • respiratory failure
  • death
57
Q

Status Asthmaticus

A

severe attack that is resistant to treatment

  • rapid initiation of symptoms
  • chest tightness
  • wheezing
  • dry cough
  • SOB
58
Q

Treatment for Status Asthmaticus

A
  • ED/ICU monitoring
  • O2
  • IV fluids
  • antibiotics if needed
  • short acting bronchodilator
  • theophylline-oral bronchodilator
59
Q

Theophylline

A

oral bronchodilator

-take on empty stomach 1-2 hours before meals improves absorption/minimizes

60
Q

Studies have shown that long acting bronchodilators should only be used in combination with what?

A

Used in combination w/ inhaled corticosteroids to prevent increased exacerbations and/or death

61
Q

Nursing Care for Asthma

A
  • keep calm/reassure
  • assess exposure to triggers, hx, symptoms, self management, response to treatment
  • administer meds/monitor response

Adult Health 2 (5 decks)

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