MedSurg Mod 6: Nursing Care in COPD Flashcards Preview

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Flashcards in MedSurg Mod 6: Nursing Care in COPD Deck (62)
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1

___ is the primary risk of COPD

smoking (85-90%)

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

2

COPD is the ___ leading cause of death in America

3rd

3

COPD includes __ and __

bronchitis and emphysema

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

4

S/S of Bronchitis

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

5

S/S of EmPhysema

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

6

Blue Bloater

Bronchitis

7

Pink Puffer

Emphysema

8

What occurs in COPD starting with chronic airway obstruction

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

9

With COPD what basically occurs with air

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

10

Risk factors for COPD

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

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

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

11

___ is the leading preventable cause of death in the US

smoking

12

Smoking causes more deaths each year than what combined

HIV

illegal drug use

alcohol use

motor vehicle injuries

firearm accidents/incidents

13

__% of all deaths from COPD are due to smoking

80%

14

What occurs if you quit smoking

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

15

What is as equally dangerous as smoking?

Second Hand Smoke

16

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

smoking and vaping

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

17

How does nicotine addiction activate reward pathways

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

18

Nicotine withdrawal is not ___ and no __ __

pleasant and well understood

19

What is the strong behavioral component of nicotine addiction

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

20

Strategies for Smoking Cessation

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

21

EVALI: E Cigarette or Vaping Product Associated Lung Injury

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

22

Triad of COPD symptoms

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

23

Diagnostic Tests and Results for Bronchitis

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

24

Diagnostic tests and Results for Emphysema

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

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