COPD exacerbation Flashcards
S/S of a COPD exacerbation
increased cough, sputum
worsening dyspnea
wheezing, tachypnea
increased work of breathing-can’t finish sentences, tripoding, use of accessory muscles
hypoxia
management for COPD exacerbation (6 things)
nasal cannula
vapotherm
possitive pressure ventilation systems (PPV)
intubation & mechanical ventilation
inhalants
steroids
we can put the nasal cannula up to ____ L
up to 6 L
what is vapotherm?
high flow nasal O2 + positive pressure
it “washes out” upper airway expired CO2 replacing it with highly oxygenated O2
what is positive pressure ventilation?
BIPAP/CPAP
it forces good O2 rich air in and CO2 laden air out
can be used PRN
when do we use intubation/mechanical ventilation?
as a last resort
very difficult to wean
what do beta adrenergic agonists do?
produces bronchodilation
what do anticholinergic agents do?
relaxes smooth muscle enhancing the dilation effects of beta adrenergic agonists
how often do we give ipratropium?
tiotropium?
ipratropium (DuoNeb) → every 4-6 hours
tiotropium (Spiriva) → once daily
no benefit to using both, just use one or the other
parenteral steroids for COPD exacerbation?
PO steroids for COPD exacerbation?
parenteral- methylprednisolone for the first day or two
PO- prednisone tapered over a max of 2 weeks
what is the average length of stay for a COPD exacerbation?
~ 5 days
what do we do for the management of a COPD exacerbation on days 2-3 (midway during their stay)?
change to PO steroids (Prednisone)
continue inhalants
start to wean O2
encourage patient to ambulate
what do we need to do the day before discharging a patient with a COPD exacerbation?
make sure all IV meds have been converted to PO
ambulate the patient & check a formal overnight O2 desaturation study as well as a hallway ambulatory study
we need to make sure all patients have good _____ when we discharge them
good follow-up
