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NRSG 227 > Week 1 > Flashcards

Week 1 Flashcards

1
Q

COPD

A

A preventable disease characterized by persistent airflow limitation that is usually progressive

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2
Q

COPD Characteristics

A

Difficulty breathing
SOB
Activity limitations
Skeletal muscle dysfunction
RHF
Secondary polycythemia
Depression
Altered nutrition

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3
Q

COPD Common in Canada?

A

Population 35 and older - 9.4% (2 million Canadians)

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4
Q

What causes COPD?

A
  1. Tobacco Smoke
  2. Occupational chemicals and dusts
  3. Infection
  4. Heredity
  5. Aging
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5
Q

Physiological changes with COPD

A
  • Chronic inflammation in airways, lung bronchi/alevoli
  • Airflow obstruction from mucus and secretion build up
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6
Q

Bullae

A

Large air spaces in the parenchyma

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7
Q

Blebs

A

air spaces adjacent to pleurae

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8
Q

Why do ppl with COPD develop pulmonary hypertension?

A

Pulmonary arteries vasoconstrict from hypoxemia, and thickening of vascular smooth muscle occurs. From loss of alveolar walls surrounding capillaries, pulmonary circulation pressure increases

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9
Q

Systemic changes from COPD

A

Cachexia (loss of skeletal muscle mass - sarcopenia)
Muscle weakness
Anemia
Anxiety
Depression
C-reactive protein increase

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10
Q

Clinical manifestations with COPD

A

Cough
Sputum
Dyspnea
Diminished breath sounds
Hypoxemia

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11
Q

Clinical manifestations of asthma

A

<40 years
Not casual smoking but can be a trigger
Intermittent and variable symptoms
Infrequent sputum
Allergies often
Stable disease course with exacerbations

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12
Q

What FEV1/FVC ratio establishes the diagnosis of COPD?

A

Less than 70%

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13
Q

How are pulmonary function tests (PFTs) conducted?

A

Spirometer is used
Age, sex, height, and weight are entered into the PFT computer to calculate the predicted values
Patient takes deep breath and exhales hard and fast as long as possible
Computer calculates achieved vs wanted

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14
Q

FVC

A

Amount of air that can be quickly and forcefully exhaled after maximum inspiration

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15
Q

FEV1

A

Amount of air exhaled in the first second of FVC; valuable clue to severity of airway obstruction

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16
Q

FEV1/FVC

A

Ratio of value for FEC1 to value for FVC; useful in differentiating obstructive and restrictive pulmonary dysfunction

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17
Q

PEFR

A

Maximum airflow rate during forced expiration; aids in monitoring bronchoconstriction in asthma

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18
Q

Cor pulmonale

A

Hypertrophy of the right side of the heart, with or without HF, that results from pulmonary hypertension
Pulmonary hypertension is caused primarily by constriction of pulmonary vessels in response to alveolar hypoxia in COPD

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19
Q

Why is it important to identify whether a client has a purulent or nonpurulent exacerbation of COPD?

A

Because this assists in determining the need for antibiotic therapy (purulent needs)

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20
Q

What causes AECOPD?

A

Airflow obstruction
Exposure to allergens
Cold air
Pollutants
H influenza, S pneumoniae

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21
Q

What vaccinations should be recommended for people with COPD?

A

Annual influenza and pneumococcal vaccinations

22
Q

How can COPD lead to acute respiratory failure?

A

An acute exacerbation of COPD can cause this, many people wait too long to seek help

23
Q

How is depression, anxiety, and panic related to COPD?

A

Depression from isolation, hopelessness or grief that accompany the disease
Anxiety with dyspnea
Panic causes faster breathing which affects the oxygenation status

24
Q

What assessments should a nurse perform on a client with COPD?

A

Thorough history (smoking, pack years, symptoms, SOB
Physical examination for swelling, weight loss, airflow obstruction
Chest radiographic studies to rule out comorbid conditions

25
Q

How are “pack-years” calculated for people with a history of cigarette smoking?

A

By multiplying the number of cigarette smoked daily by the number of years smoking

26
Q

What are the 7 primary COPD management goals?

A

Prevent disease progression (smoking cessation)
Reduce frequency and severity of exacerbations
Alleviate breathlessness and other respiratory symptoms
Improve exercise tolerance
Treat exacerbations and complications of the disease
Improve the health status and quality of life
Reduce associated mortality and morbidity

27
Q

How does smoking cessation slow the progression of COPD?

A

The accelerate decline in pulmonary function stops and usually improves

28
Q

Why are bronchodilators the mainstay of treatment for COPD?

A

Relaxes smooth muscles in the airway, reduces airway resistance and dynamic hyperinflation of lungs thus decreasing breathlessness

29
Q

What are the most commonly medications used to treat COPD?

A

B2 adrenergic agonists
Muscarinic meds
Methylxanthines
SABDs
SABA
SAMA

30
Q

Why are inhaled corticosteroids (ICS) and long-acting β2 adrenergic agonists (LABAs) often combined in the treatment of COPD?

A

They both have b2 adrenergic agonist that prevent exacerbations in patients who have higher peripheral eosinophilia counts with previous acute exacerbations

31
Q

Why are oral or parenteral corticosteroids used in the treatment of COPD?

A

To speed recovery time, reduce relapse rates, reduce need for hospitalization, and improve FEV1 and partial pressure of oxygen

32
Q

Which three surgical procedures have been used to manage severe COPD? (and how do they help?)

A

Lung volume reduction surgery to reduce the size of the hyperinflated emphysematous lungs, airway obstruction is decreased and room for remaining normal alveoli
Bullectomy removes bulla to decompress adjacent lung parenchyma
Lung transplantation when all else fails to achieve substantial improvements in their exercise capacity

33
Q

What are the components of an effective pulmonary rehabilitation program?

A

Exercise conditioning, breathing exercises, energy conservation, nutrition, smoking cessation, environmental factors, health promotion, patient education, self management, psychological support, psychological counseling, vocational rehabilitation

34
Q

How much fluid should a client with COPD take in daily?

A

2-3L

35
Q

What is pneumonia?

A

An acute inflammation of the lung parenchyma caused by a microbial agent

36
Q

What are all of the things that can cause pneumonia?

A

Decreased LOC, trach intubation obstruction, air pollution, cig smoke, viral URI, aging changes, malnutrition, certain diseases, immobility, HIV, altered flora

37
Q

Why is it helpful to classify pneumonia as community-acquired or hospital-acquired?

A

Community is before or within first 2 days of hospitalization whereas hospital acquired is after 48 hours in the hospital

38
Q

What are the characteristics of community-acquired pneumonia (CAP)?

A

Congestion, red hepatization, grey hepattization, resolution

39
Q

Which factors increase the risk of a person developing aspiration pneumonia?

A

HX of LOC, tube feedings

40
Q

What are the 3 types of aspiration pneumonia?

A

Chemical, mechanical, bacterial

41
Q

Tidal volume

A

volume of air inhaled and exhaled with each breath; only a small proportion of total capacity of lungs

42
Q

Minute volume(MV)

A

total amount of air inhaled and exhaled per minute

43
Q

Expiratory Reserve Volume (ERV)

A

Additional air that can be forcefully exhaled after normal exhalation is complete

44
Q

Residual volume

A

amount of air remaining in lungs after a forced expiration; air available in lungs for gas exchange between breaths

45
Q

Inspiratory Reserve Volume

A

maximum volume of air that can be inhaled forcefully after normal inspiration

46
Q

Total lung capacity (TLC)

A

max value of air that lungs can contain

47
Q

Functional residual capacity

A

volume of air that can be exhaled after maximum inspiration

48
Q

Inspiratory capacity

A

max volume of air that can be inhaled after normal expiration

49
Q

Maximal midexpiratory flow rate

A

measurement of airflow are in middle half of forced expiration; early indicator of disease of small airway

50
Q

Maximal voluntary ventilation

A

deep breathing as rapidly as possible for specified period; test for airflow, muscle strength, coordination, airway resistance; important factor for exercise tolerance

51
Q

Maximum inspiratory pressure or negative inspiratory force

A

amount of negative pressure generated on inspirations indication of ability to breathe deeply and cough

NRSG 227 (5 decks)

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