[Exam 2] Chapter 24: Management of Patients with Chronic Pulmonary Disease (Page 634-665) Flashcards
(93 cards)
1
Q
What is COPD?
A
Respiratory disease of airflow obstruction involving the airways, pulmonary parenchyma or both
2
Q
Parenchyma includes what?
A
Any form of lung tissue, including brochioles, blood vesels, alveoli
3
Q
COPD is characterized by
A
airflow limitation that is not fully reversible (chronic bronchitis and emphysema)
4
Q
What is Asthma considered to be?
A
Abnormal airway condition characterized by reversible inflammation
5
Q
COPD, what is airflow limitation?
A
Progressive, associated with abnormal inflammatory respose to noxious particles or gases
6
Q
COPD: Chronic inflammation causes
A
damage to tissues
7
Q
COPD: Scar tissue in airways results in
A
narrowing
8
Q
COPD: Scar tissue in the parenchyma decreases
A
elastic recoil (compliance)
9
Q
COPD: Scar tissue in pulmonary vasculature causes
A
thickened vessel lining and hypertrophy of smooth muscle
10
Q
COPD: Alveolar wall destruction leads to
A
loss of alveolar attachments and a decrease in elastic recoil
11
Q
Chronic Bronchitis: What is this?
A
Disease of airway defined as presence of cough and sputum production for at least 3 months in each of 2 consecutive years.
12
Q
Chronic Bronchitis: What happens to the ciliary?
A
Function is reduced, bronchial wall thicken, bronchial airway narrow and mucous may plug airways
13
Q
Chronic Bronchitis: What happens to alveoli?
A
Become damaged, fibrosed, and alveolar macrophage function diminishes leading to more infections
14
Q
Chronic Bronchitis: Patient is more susceptible to
A
respiratory infections due
15
Q
Emphysema: What is this?
A
This describes abnormal distention of air spaces beyond the terminal bronchioles with destruction of the walls of the alveoli
16
Q
Emphysema: DEcreased alveolar surface area in direct contact with capillaries decreases causing
A
an impaired oxygen diffusion which leads to hypoxemia
17
Q
Emphysema: Hypoxemia results with
A
decreased carbon dioxide elimination
18
Q
Emphysema: What is Cor Pulmonate?
A
One of the complications of emphysema, and is right-sided heart fialure brought on by long term high blood pressure in pulmonary arteries
19
Q
Emphysema: What happens in Panlobular Emphysema?
A
Destruction of respiratory bronchiole, alveolar duct.Creates an enlarged airspace , causing expiration to become active and requiring muscle effort
20
Q
Emphysema: What happens in Centrilobular Emphysema?
A
Changes take place mainly in center of seconday lobule causing a derangement of ventilation-perfusion ratios.
21
Q
COPD, Risk Factors: Most important worldwide risk factor is
A
cigarette smoking
22
Q
COPD,Clinical Manifestations: GEnerally a progressive disease characterized by what three primary symptoms?
A
Chronic Cough
Sputum Production
Dyspnea
23
Q
COPD,Clinical Manifestations: Why is weight loss common?
A
Dyspnea interferes with eating and work of breathing is energy depleting.
24
Q
COPD ,Clinical Manifestations: Why do some people deleveop “Barrel Chest”?
A
Results from more fixed position of the ribs in inspiratory positoin and from loss of lung elasticity.
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COPD, Assessment and Diagnostic Findings: Pulmonary function studies help determine
diagnosis of COPD
Disease SEverity
Monitor Disease Progression
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COPD, Assessment and Diagnostic Findings: Spirometry used to evaluate
airflow obstruction, which is determined by ratio o fFEV1 to FVC
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COPD, Assessment and Diagnostic Findings: Why would arterial blood gas measures be obtained?
To assess baseline oxygenation adn gas exchange and are especially important in advanced COPD
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COPD, Complications: What are the major life threatening complications of COPD?
Respiratory insufficiency and failure
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COPD , Complications: What are some complications?
Pneumonia, Chronic Atelectasis, Pneumothorax, and Pulmonary Arterial Hypertension (Cor Pulmonale)
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COPD , Medical Management: Therapeutic strategies include
promoting smoking cesssation, prescribing medications like bronchodilators and managing exacerbations.
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COPD , Medical Management - Risk Reduction: Major RF with COPD is
environmental exposure, and it is modifiable. Most chronic is smoking.
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COPD , Medical Management - Pharmacologic Therapy: What is use for Grade I (Mild) COPD?
Short acting bronchodilator
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COPD , Medical Management - Pharmacologic Therapy: What is used for a Grade II /III COPD?
Short acting bronchodilator and regular treatment with one or more long lasting bronchodilators
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COPD , Medical Management - Pharmacologic Therapy and Bronchodilators: Relieve bronchospasm by improving
expiratory flow through widening of the airways and promoting lungs with each breath. Alter smooth muscle tone and reduce airway obstruction.
Increases expiratory flow rate and eases dyspnea
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COPD , Medical Management - Pharmacologic Therapy and Bronchodilators: Can be delievered by
pMDI, nebulization, or via oral route
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COPD , Medical Management - Pharmacologic Therapy and Bronchodilators: What devices are available to allow medication to be inhaled
pMDI
Powder Inhalers
Spacers
Nebulizers
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COPD , Medical Management - Pharmacologic Therapy and Bronchodilators: What is a pMDI?
Pressurized device that contains an aerosolized powder of medication.
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COPD , Medical Management - Pharmacologic Therapy and Corticosteroids: Allow inhaled and systemic corticosteroids may improve symptoms of COPD, they do not slow down the decline of
lung function
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COPD , Medical Management - Pharmacologic Therapy and Corticosteroids: Long term treatment with oral corticosteroids is not recommened in COPD and can cause
steroid myopathy, leading to muscle weakness and decreased ability to function
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COPD , Medical Management - Pharmacologic Therapy and Other Medications: Vaccines are effective because they prevent
exacerbations by preventing respiratory infections
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COPD , Medical Management - Pharmacologic Therapy Corticosteroids: Why do they help?
Decrease inflammation
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COPD , Medical Management - Pharmacologic Therapy: What must you do with mucolytics?
Increase fluid intake in order to thin secretions
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COPD , Medical Management - Management of Exacerbations: Exacerbation of COPD definied as
event in the natural course of the disease characterized by acute changes in the pateints respiraotry system beyond the normal day-to-day variations
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COPD , Medical Management - Management of Exacerbations: Primary causes of acute exacerbation include
infections and air pollutions
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COPD , Medical Management - Management of Exacerbations: Treatment of exacerbation requires what?
Identifying primary cause and administering primary treamtnet
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COPD , Medical Management - Management of Exacerbations: OPtimization of bronchodilator medications is a first line therapy and involves
identifying the best medication or combinations of medications tkane on a regular schedule for a specific patient
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COPD , Medical Management - Management of Exacerbations: When patient arrives to ED< first line of treatment is
supplemental oxygen therapy and rapid assessment to determine if exacerbation is life threatening
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COPD , Medical Management - General Principles of Oxygen Therapy: Goal of oxygen supplmental therapy is to
increase the baseline resting partial pressure of arterial oxygen to at least 90%
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COPD , Medical Management - General Principles of Oxygen Therapy: Administering too much oxygen can result in the retention of
carbon dioxide.
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COPD , Medical Management - Surgical Management - Bullectomy: What is this?
Surgical option selected for patients with bullous emphysema.
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COPD , Medical Management - Surgical Management - Bullectomy: What are bullae?
Enlarged airspaces that do not contribute to ventilation but occupy space in thorax. Compress areas of the lung and may impair gas exchange.
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COPD , Medical Management - Surgical Management - Lung Volume Reduction Surgery: What is this surgery?
Removal of portion of the diseased lung parenchyma . This reduces hyperinflation
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COPD , Medical Management - Surgical Management - Lung Volume Reduction Surgery: This surgery improves
Life expectancy , decrease dyspnea, improve lung function, and exercise tolerance.
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COPD , Medical Management - Surgical Management - Lung Volume Reduction Surgery: What were Bronchoscopic lung lolvune reduction therapies designed to do?
Collapse areas of emphysematous lung and this improve aeration of the functional lung tissue. One-way valve placed to allow air and mucus to exit treated area
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COPD , Medical Management - Surgical Management - Lung Volume Reduction Surgery: What is biologic lung volume reduction?
Instillation of a sealant or gel, valves, or coils into the airway of the hyperinflated lung tissue
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COPD , Medical Management - Pulmonary Rehab Breathing Exercises: Piursed lip breathing helps do what?
Slow expiraation, prevents collapse of small airway, and helps patient control the rate and depth of respirations
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COPD , Medical Management - Nursing Management : What is Huff coughing?
One or two forced exhalations (Huffs) from low to medium lung volume with the glottis open
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Bronchiectasis: What is this
Chronic, irreversible dilation of the bronchi and bronchioles that results from destruction of muscles and elastic connective tissue. Considered separate from COPD
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Bronchiectasis: Inflammatory processed associted with pulmonary infections damages teh
inflammatory wall, causing loss of its support structure and thick sputum
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Bronchiectasis: What happens in saccular bronchiectasis?
Each dilated peribronchial tube amounts to a lung abscess
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Bronchiectasis: Retention of secretions ultimately cause teth alveoli distal to obsturction to
collapse (atelectasis)
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Bronchiectasis: What are some signs and symtpoms?
Chronic cough and production of purulent sputum .
Along with clubbing of fingers
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Bronchiectasis - Assessment adn Diagnostic Findings: Not really diagnosed because symptoms can be mistaken for
signs of chronic bronchitis
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Bronchiectasis - Assessment adn Diagnostic Findings: DEfinitive sign of this is
a prolonged history of productive, chronic cogh with sputum
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Bronchiectasis - Medical Management: Treatment objectives are to promote
bronchial drainage, to clear excessive secretions form the affected portion of the lungs.
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Bronchiectasis - Medical Management: Postural drainage is included in all treatment plans because
draining the bronchoiectatic area by gravity reduced amount of secretions
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Asthma: What is this?
chracterized by chronic airway inflammation
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Asthma: Chronic inflammatory disease of the airway causes
airway hyperresponsiveness, mucosal edema, and mucus production
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Asthma: Inflammation leads to what signs of asthma symptoms?
Cough, Chest Tightness, Wheezing, Dyspnea
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Asthma: Over time, patient may have structural changes in response to chronic inflammation that causes a
narrowing of teh airways
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Asthma: Simple definition of an acute exacerbation of asthma
bronchial smooth muscle contraction or bronchoconstriction occurs quikcly to narrow the airway
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Asthma: Acute bronchoconstriction can be due to
IgE mediated response or alpha-adrenergic receptor stimulation
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Asthma: Three common signs and symptoms are
cough, dyspnea, and wheezing
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Asthma: If the exacerbation progresses, what signs and symptoms may occur?
Diaphoresis, tachydria, and hypoxemia
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Asthma: What may happen if asthma does not get treated?
Respiratory Failure, Pneumonia, and Atelectasis
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Asthma - Medical Management: What are the two general classe of asthma medications?
Quick-relief medications for immediate treatment of asthma symptoms
Exacerbations and long-acting medication to achieve and maintain control of persistent asthma
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Asthma - Medical Management, Quick-Relief MEdications: They are used to relax
smooth muscle
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Asthma - Medical Management, Quick-Relief MEdications: What do Anticholinergics do?
Inhibit muscarinic choliergic receptors and reduce intrinsic vagal tone of airway
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Asthma - Medical Management, Long-Acting Control MedicationS: What do these do?
Alleviate symptoms
Improve airway function
Decrease peak flow variability
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Asthma - Medical Management, Long-Acting Control MedicationS: Why should you drink water after?
To prevent thrush
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Asthma: What is status asthmaticus?
Does not respond to treatment. Nurses thing pt getting better because cough/wheezing lears but this can be sign of impending respiratory failure
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Asthma: Treatment for status asthmaticus?
Oxygen, IV fluids for dehydration, beta-adrenergic agonist, corticosteroids
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Asthma: Due to patient having low respirations they will have hypocapnia (low CO2) or respiratory alkalosis (low pPaCO2 due to breathing rapidly) IF normal or high PaCO2 seen, this indicates
impending respiratory failure
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Asthma: What labs should be looked at?
Eosinophils elevated
IgE elevated if allergen present
ABG = RespiratoryAlkalosis
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Asthma - Medical Management, Peak Flow Measuring: They measure the
highest airflow during a forced expiration
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Asthma - Medical Management, Peak Flow Measuring: Daily peak flow monitoring recommended for those who have
moderate to severe asthma
Poor perception of changes in airflow
Worsening symptoms
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Asthma - Medical Management, Peak Flow Measuring: This is done for how long?
2-3 weeks, then the patients personal best value is measured
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Asthma - Assessment includes
Breath Sounds
Use of Accessory Muscles
O2 Saturation
Pulse and RR
Triggers
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Asthma - Nursing Mmanagement: What is the stepwise method?
Using short acting and long acting medications but increasing in medications and use
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Asthma - Nursing Mmanagement: What are soem quick-relief medications
Beta2 Adrenergic Agonists
Anticholinergics
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Asthma - Nursing Mmanagement: What are some Long-Acting Medications
Corticosteroids
Longacting Beta2 Adrenergic Agonists
Leukotriene Modifiers
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Asthma - Interventions: What to know about a dry pwoder inhaler?
Exhale via pursed lips
Store in a dry place
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Asthma - Interventions: What to know about a multi-dose inhaler
Inhale and exhale freely
Breathe deeply while compressing canister.
Hold 10 seconds and exhale.
rinse after administration
