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NURS353 - Practice of Nursing 2 > MedSurg Mod 6: Nursing Care in COPD > Flashcards

MedSurg Mod 6: Nursing Care in COPD Flashcards

(62 cards)

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1
Q

___ is the primary risk of COPD

A

smoking (85-90%)

male smokers 12x and women 13x more likely to die from COPD as men who have never smoked

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2
Q

COPD is the ___ leading cause of death in America

A

3rd

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3
Q

COPD includes __ and __

A

bronchitis and emphysema

usually it is mixed but many have a predominance of one as well

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4
Q

S/S of Bronchitis

A

BLuish-red skin tones (blue from cyanosis with good lung perfusion/Bad ventilation; Red from polycythemia)

Tendency for oBesity

frequent cough

foul smelling sputum

frequent pulmonary infections

INCREASED RISK FOR DVT d/t H&H INCREASES

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5
Q

S/S of EmPhysema

A

Pursed lip breathing

obvious use of accessory muscles

barrel chest

underweight

progressive DOE (dyspnea on exertion)

Diminished breath sounds

PERSISTENT TACHYCARDIA D/T INADEQUATE OXYGENATION

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6
Q

Blue Bloater

A

Bronchitis

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7
Q

Pink Puffer

A

Emphysema

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8
Q

What occurs in COPD starting with chronic airway obstruction

A

Chronic airway obstruction –> airway collapse or inflammation –> bronchospasm, swelling, and excess mucus

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9
Q

With COPD what basically occurs with air

A

AIR GETS IN BUT CANNOT GET OUT (because exhaling is usually passive so its harder to work when things are obstructed)

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10
Q

Risk factors for COPD

A

1 - Direct and Second Hand Cigarette smoke (80%)

repeated lung damage from infections/pollution - indoor pollution and occupational; pollutants (15%)

Genetics (5%) - alpha 1 antitrypsin deficiency - rapid damage; cystic fibrosis

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11
Q

___ is the leading preventable cause of death in the US

A

smoking

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12
Q

Smoking causes more deaths each year than what combined

A

HIV

illegal drug use

alcohol use

motor vehicle injuries

firearm accidents/incidents

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13
Q

__% of all deaths from COPD are due to smoking

A

80%

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14
Q

What occurs if you quit smoking

A

within 2-5 years your risk for stroke can fall to that of a nonsmokers and cancer risk all drops by half in 5 years

within 10 years after your risk for lung cancer drops by half

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15
Q

What is as equally dangerous as smoking?

A

Second Hand Smoke

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16
Q

What allows for rapid nicotine distribution and what occurs when used?

A

smoking and vaping

it increases the addiction index and peaks and dissipates quickly meaning they want a lot fast - Sharp peak and sharp dissipation

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17
Q

How does nicotine addiction activate reward pathways

A

increases the level of dopamine

for many tobacco users, long term brain changes induced by continued nicotine exposure results in addiction - a physiologic reason for not stopping occurs

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18
Q

Nicotine withdrawal is not ___ and no __ __

A

pleasant and well understood

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19
Q

What is the strong behavioral component of nicotine addiction

A

the smoking may be associated with something you doe very day or some pattern so there may be a gap in the day when quitting that needs to be filled

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20
Q

Strategies for Smoking Cessation

A

Counseling - social support and problem solving approach

Medications - nicotine replacement therapies, E Cigs (not FDA approved), chantix, Zyban (acts on nicotine pathways)

Biofeedback

emotional support

counseling

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21
Q

EVALI: E Cigarette or Vaping Product Associated Lung Injury

A

An ACUTE lung injury involving the heating of a liquid and then inhaling the resulting aerosol

these liquids can have nicotine, THC, CBD, oils, flavoring, and other additives - not certified

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22
Q

Triad of COPD symptoms

A
  1. Increased sputum production
  2. Cough (bronchitis) - intermittent, usually in AM< expectorate small amounts of STICKY mucus
  3. dyspnea on exertion (emphysema) - gradually worsens and interferes with ADLs
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23
Q

Diagnostic Tests and Results for Bronchitis

A

CXR - enlarged heart, congested lung fields, normal or flat diaphragm

Pulmonary function test - incr residual air volume, decreased vital capacity, decreased FEV1/FVC ratio (<70%)

ABGs/pulse ox: Decreased PO2

Elevated RBC - elevated H&H in later stages

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24
Q

Diagnostic tests and Results for Emphysema

A

CXR - hyper inflated lungs and flat diaphragm

Pulmonary function test - incr residual air volume, decreased vital capacity, decreased FEV1/FVC ratio (<70%)

ABGs/pulse ox: decreased PO2

6MWT

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25
6MWT
6 minute walk test walk for 6 minutes and measure the distance to get functional measure of how well the COPD patient is doing (emphysema) it is walking not jogging and is simple and effective
26
Complications and Consequences of COPD
Chronic reduced PaO2 levels Pneumonia and other pulmonary infections Pneumothorax Atelectasis Pulmonary hypertension Lung cancer Peptic Ulcer Disease Severe weight loss and malnutrition Right-sided heart failure Respiratory failure Increased risk of DVTs Fatigue Altered mobility Depression Limited socialization Socio-economic consequences Shortened lifespan Mechanical ventilator
27
General Goals for COPD Medical Treatment
Early diagnosis prevent further deterioration alleviate symptoms improve ability for ADLs and QOL issues
28
general Strategies for COPD Medical treatment
meds as appropriate for symptoms regular oxygenation PRN early intervention for infections - antibiotics chest PT adequate fluid intake oral care vaccinations for pneumonia and influenza pulmonary rehabilitation
29
Nursing Goals for COPD
SMOKING CESSATION Managing symptoms - maintain patent airway, promote adequate ventilation w/ appropriate resp rate, remain free from or with a reduced rate of resp infections Maximizing functions - maintain performance of daily living activities, decrease anxiety Decrease knowledge deficit - disease, treatment, medications
30
Nursing Diagnosis for the SOB of COPD
impaired gas exchange impaired airway clearance ineffective breathing pattern
31
Nursing Diagnosis for the depression of COPD
ineffective coping
32
Nursing Diagnosis for the weight loss of COPD
imbalanced nutrition: less than body requirements
33
Nursing diagnosis for the anxiety of COPD
knowledge deficit
34
What to assess for with COPD regarding respiratory status
Respiratory Status - Lungs, respiratory effort, signs of hypoxemia like confusion or spO2 VS - note pulse Labs like H&H and WBC O2 at prescribed flow rate position for optimal respirations assess education need
35
Education Ideas for COPD patients
avoid pulmonary irritants and extremes of temperature humidifier at night to mobilize secretions encourage smoking cessation encourage pursed lip breathing
36
Pursed Lip Breathing
Reduces hyperventilation Increased CO2 level in the alveoli which relaxes/dilates smooth muscles of airways Keeps the airways open longer Overall makes breathing more effective by increasing CO2 to encourage relaxation and allow more open airways longer and more efficient gas exchange
37
Net Result of Pursed Lip Breathing
decreases work of breathing conserves oxygen releases trapped air
38
Assessments and Interventions for Nutritional Status of COPD patients
Assess weight and I&O encourage well balanced diet and fluids unless contraindicated consider O2 during meals (nasal canulla) allow adequate times for meals position properly for eating educate on easily prepared foods and lightweight cookware
39
A person with COPD can burn __x as many calories breathing as a healthy person does
10x
40
Assessments and Interventions for the Activity level of a COPD patient
assess self care and activity tolerance pulmonary rehabilitation maintain a level of physical activity encourage self care allow for adequate rest
41
Assessments and interventions for the skin of a COPD patient
assess redness and sponginess moisturize reposition monitor for breakdown - cheeks and ears if using O2
42
Assessments and interventions for the coping of a COPD patient
assess behavior changes and mood swings provide emotional support allow and encourage autonomy encourage verbalization of feelings, perceptions and fears encourages identification of own strengths and abilities provide education on disease, treatment, and medications
43
General Education points for COPD Patients
Personal infection control strategies maintain high resistance early recognition and treatment of respiratory infection monitor sputum develop energy conserving strategies research treatment(s) importance of immunizations maintain adequate nutrition teach safety with home O2 use administer meds approp know details of medications
44
What to educate COPD regarding personal infection control strategies
avoid large groups and peoples with URIs good oral hygiene to reduce migrating infection
45
What to educate COPD regarding maintain high resistance
adequate rest balanced diet limiting stress avoid exposure to dampness, cold, drafts
46
What to educate COPD regarding early recognition/treatment of respiratory infection
increased dyspnea increased fatigue chest tightness increased sputum
47
What to educate COPD regarding developing energy conserving strategies
tripod sitting (sitting forward to open chest up and allow expansion) adequate rest periods
48
What to educate COPD regarding importance of immunization
pneumOcoccal ( Once in a decade) influenzA (Annually)
49
What to educate COPD regarding maintain adequate nutrition
balanced diet with adequate calories to compensate for breathing adequate fluid within limits of right sided failure less carbs since they metabolize to CO2 but a balanced diet is needed
50
What to educate COPD regarding safety with home O2 use?
maintain flow at prescribed rate s/s of CO2 narcosis like drowsiness, confusion, increased respirations and pulse, diaphoresis keep nasal passages moist with NON PETROLEUM (FAT) PRODUCTS - USE WATER SOLUBLE PRODUCTS
51
What is the point of giving bronchodilators to COPD patients
Relaxes muscles surround smaller airways a hallmark treatment
52
What to educate about Bronchodilator use?
MDI and Spacer use (Metered dose inhaler) floating inhalers no longer used - so MDIs do not float when empty and are less intense jetting on the back of the throat
53
How to correctly use a metered dose inhaler
Remove the cap from the MDI and shake well. Breathe out all the way. Place the mouthpiece of the inhaler between your teeth and seal your lips tightly around it. As you start to breathe in slowly, press down on the canister one time. Keep breathing in as slowly and deeply as you can. (It should take about 5 to 7 seconds for you to completely breathe in.) Hold your breath for 10 seconds (count to 10 slowly) to allow the medication to reach the airways of the lung. Repeat the above steps for each puff ordered by your doctor. Wait about 1 minute between puffs. Replace the cap on the MDI when finished. If you are using a corticosteroid MDI, you should use a spacer. *Shake, Exhale fully, Put in mouth, 1 puff breathed in slowly - use spacer if using corticosteroids*
54
Why should you NOT do 2 immediate puffs with inhalers and bronchodilators
the second one is basically wasted so take a break inbetween
55
Why is it important to use a spacer with an inhaler using corticosteroids
steroids can develop around the mouth and cause thrush or yeast infection - so use a spacer
56
Benefit of spacer
can take mult breaths in spacer so you dont have to coordinate press down and breath in
57
Beta Agonist (-erol) Bronchodilators
Effect od adrenaline without unwanted SE relaxes muscles surrounding small airways short acting as a rescue drug like albuterol or long acting routine like Formoterol
58
Anticholinergic Bronchodilators
Atrovent and Spiriva blocks acetylcholine to prevent airways from narrowing
59
Corticosteroid Bronchodilators
interfere with the inflammatory process to open airways long term usage has serious SE though
60
Beta Agonist, Anti Cholinergic, Corticosteroids Bronchodilators all cause...
airway opening with the difference being how fast it occurs
61
Other medications for COPD
anxiolytics antibiotics steroids diuretics calcium channel blockers anti coagulants
62
MRC Breathlessness Scale
Quantifies breathlessness related to activities 1 means not troubled and 5 means breathlessness underused but can quantify how someone is doing

NURS353 - Practice of Nursing 2 (14 decks)

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