week 10- COPD Flashcards Preview

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Flashcards in week 10- COPD Deck (28)
1

Characteristics

 Resistance to airflow r/t obstructed airways
 Increased mucous secretion
 Decreased inner lumen related to edema, inflammation, or bronchospasm
 Destruction of lung tissue
 Irreversible in nature

2

COPD Diseases

 Chronic Bronchitis
 Emphysema
 Asthma
• Sometimes included in umbrella group of obstructive pulmonary diseases but…
• Actually an inflammatory process
• Condition of reversible airflow limitation (at least in the early stages)
• Not truly considered COPD

3

COPD Epidemiology

 more common in whites than blacks
 affects men more than women
 4th leading cause of death in US
 Doubled in the last 25 years
 Affects middle aged & older

4

Emphysema

 destruction of the walls of the alveoli, resulting enlargement of abnormal air spaces
 Wall destruction causes alveoli & air spaces to enlarge with loss of corresponding portions of the pulmonary capillary bed

5

Manifestations of Emphysema

 Progressively worsening dyspnea
 Minimum cough with small amounts of sputum
 Barrel chest
 Hypoxemia (early), and Hypercapnea (late)
 Finger clubbing (late)
 Thin, malnourished state

6

Chronic Bronchitis

 Disorder of excessive bronchial mucus secretion
 Characterized by a productive cough lasting 3 or more months in 2 consecutive years
 Inhaled irritants lead to a chronic inflammatory process with vasodilatation, congestion, and edema of the bronchial mucosa

7

Manifestations of Chronic Bronchitis

 Productive cough – copious amounts of thick tenacious sputum, worse in AM & winter, “smokers cough”
 Frequent respiratory infections
 Dyspnea upon exertion
 Hypoxemia/ hypercapnea
 Cyanosis
 Normal to husky weight
 Evidence of Right-sided HF – distended neck veins, edema, enlarged heart
 Adventitious sounds – loud ronchi & possible wheezes are prominent on auscultation

8

Effects of Cigarette Smoke

 Hyperplasia of cells
 Goblet cells produce more mucous
 Narrowing of inner lumen of airways
 Reduced ciliary activity, and proliferation
 Destruction of alveolar walls
 inhibit the function of alveolar macrophages

9

Cor pulmonale

 Right sided ventricular failure caused by pulmonary disease
 Enlargement of right side of heart r/t pulmonary hypertension
 Air trapping, airway collapse and inelastic alveolar walls cause it to be more difficult for blood to flow through the lung vessels.

10

More Complications

 Pneumonia
 Acute respiratory failure
 Be careful with β blockers and narcotics
 Respiratory drive changes to O2
 Elevated CO2 no longer triggers respiration
 Elevated O2 could stop respirations altogether

11

Assessment

 Respiratory assessment
 Cardiovascular assessment
 Clubbed fingers
 Barrel chest
 Dyspnea assessment **sixth vital sign
Subjective feeling of breathlessness
Most disabling symptom
Do not confuse with changes in RR or depth

12

Presenting Symptoms: Acute Exacerbations

 Worsening:
dyspnea
sputum production
cough
 Increasing use of medications
 Elevated HR and RR

13

Incapacitating dyspnea is the most common presenting symptom of AECOPD.

People living with COPD experience 2-3 AECOPD per year.

14

As the dyspnea worsens individuals are less able to complete a full sentence and experience
alterations in the level of consciousness

.

15

Assessment Findings

 Accessory muscle use
 RR > 30/min
 DBP less than 60, SBP less than 90
 Increased temperature
 O2 saturation less than 90% on room air (RA)
 Change in volume, colour or viscosity of sputum
 Less able to complete a full sentence*
 Changing LOC

16

Goals OF TREATMENT

 Improve ventilation
 Promote removal of secretions
 Prevent complications, delay progression
 Promote comfort & participation
 Improve quality of life

17

Smoking Cessation

Ask, advise, assess, assist, & arrange
Quitting slows progression of disease
Most common cause of COPD

18

Drug therapy

 Βeta 2 agonist (Ventolin)
 Inhaled Anticholenergics (Atrovent) eg: Spiriva
 Oxygen
 Corticosteroids
 Antibiotics prn
 Psychotropics for anxiety

19

CO2 Narcosis/Oxygen Therapy

 High CO2 retainers will obtain respiratory drive from O2 instead of CO2 thus high % FIO2 can depress respirations similar to narcotics
 Maintain lowest FiO2 to yield goal O2 sat 88-92% (individualized)
 Frequent ABGs used to confirm Pa O2%
 Monitor V/S and mental status

20

O2 Therapy: Complications

Combustion
 Promotes combustion but is not itself combustible
 Watch those smokers!

21

Infection

Humidified air or O2 and/or dirty equipment increases risk

22

Breathing Retraining

Diaphragmatic breathing*
Pursed lip breathing*
Positioning
--Sitting: tripod position improves oxygenation
--Standing
Controlled coughing
*Describe and demonstrate 

23

Breath Retraining

• Pursed lip breathing
o Prolongs expiratory phase
o Prevents brochiolar collapse and air trapping
o Inhale through nose and slowly exhale through pursed lips (similar to whistling)
• Cascade/ Huff coughing
o Decreases ineffective coughing patterns, and helps clear secretions
o From sitting position, have pt take deep pursed lip breaths as they lean forward, then have pt sit upright again. Repeat 4x, then have pt take deep breath, lean forward and give 3-4 coughs per exhalation

24

Hydration

Drink 2-3 liters/day to liquefy secretions
Humidifiers (but must be cleaned daily to prevent growth the mold spores).

25

Nutrition

food intolerance
nausea
early satiety
Anorexia
meal-related dypsnea
Peppermint herbal tea may act as an expectorant
Licorice root – expectorant & anti-inflammatory properties

26

Interventions

Monitor nutrition status
Serve several small meals
Teach to use pursed lip and abdominal breathing to reduce dypsnea
Bronchodilator 30 min before eating
Choose foods that are easy to chew and not gas forming.
Avoid dry foods –cause coughing
Avoid milk & salt – increased thickness of secretions
Encourage to eat high protein and high calorie foods.
Dietary supplements
If early satiety- avoid drinking fluids before and during meals
Offer oral hygiene before meals

27

Interventions

• Relaxation Techniques
o Progressive muscular relaxation
o Yoga
o Music
o Positioning (tripod-leaning forward)
o Use of fresh air or fan
• Energy Conservation
o Pacing activity
o Using a wheeled walker

28

Vaccinations

Annual influenza vaccine in Fall
Pneumoccal vaccine at least once in their lives (q 5-10 years in very high risk individuals)