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Disease COPD

Chronric Bronchitis & COPD

Define COPD in terms of component diseases and effect on airflow: Component diseases: 1.Chronic bronchitis 2.Asthma 3. Emphysema 4.Bronchectasis 5. CF
What is the Effect on airflow in terms of COPD: obstruction/limitation that is not completely reversible
What are the Causes of COPD: •Chronic inflammatory responses, noxious particles, gases
Discuss the progressive nature of COPD and relate it to the need for establishing a baseline and follow up: COPD will get worse over progressive period of time. We should establish a baseline so we know when to start treatment and follow-up to make sure track the progressive of disease.
Explain the etiology of COPD and lung damage risk factors: -Smoking -Genes -Age&gender -Lung growth and development -Exposure to particles -Social status
Describe the general pathophysiology of COPD: 1. Airflow limitation & air trapping 2. Traps air in exhalation leading to hyperinflation3. Break down of the alveolar walls, excess mucus inflamed lining and bronchial
List the general symptoms of COPD: dyspnea, cough, sputum, fever, wheezing, chest tightness, fatigue
Differentiate the major symptomatic difference between chronic bronchitis and emphysema: Chronic bronchitis: excessive sputum production for at least 3 months for a year and 2x in a row Emphysema: destruction of the gas exchange surfaces
Describe the 2 major ways to diagnose COPD: Clinical assessment/history, Spirometer•volumes•capacities•flow
What are Other tools besides the two most common ways to diagnose COPD: Lab values,EKG,ABG,CXR
List the COPD severity staging guidelines: Gold standards-Stages:1 (mild)-FEV1<80% of predicted 2(moderate)-FEV1=50-80% predicted 3 (severe)-FEV1=30-50%pred 4 (very severe)-<30% pred
Explain the main “intervention” for managing COPD: Remove irritant =smoking cessation, Pharmacology agents Pulmonary rehabilitation Surgical options
Explain the effect of bronchodilators on the decline in lung function: Drugs don't change the progressive decline in lung function. They will only help dilate the bronchotrachael tree to help aide air movement and mucus movement
Explain the main goals of pharmacological COPD management: Improve symptoms & improve quality of life
Describe which medications are used in the management of COPD and in what order they should be used: Racemic epinephrine/micronefrin-vaponefrine, Albuterol/Proventil, ventilin, Levalbuterol/xopenex,Salmeterol/serevent, Formoterol/foradil, Arformoterol/brovana, Ipratropium/atrovent,Tiotropium/sprivia, Budesonide/pulimcort, Mometasone/asmanex
Describe which medications are used in the management of COPD and in what order they Mometasone/asmanex Fluticasone/Flovent Beclomethasone/QVAR, Acetylcysteine/mucomyst, Dornase alpha/rhDNAse Cormide/intal Nedocromil/tilade
Explain the preferred long term steroid administration route and why it is preferred: Inhaled because they don't have the side effects of systemic steroids
Discuss when it is appropriate to use systemic steroids: Symptom/airflow limitation despite maximal therapy with other drugs.•IV,•shot,•orally, When nothing else works
List the criteria for home oxygen use: 1. PaO2<55% or SaO2 <88% on room air -taken 2 times over 3 weeks period in stable pt 2. PaO2 55-60% if evidence of pulmonary HTN, CHF, or polycythemia
Definition of CB: Chronic ↑↑ production of mucus from bronchi, Not from a specific disease,Cough and ↑ sputum 3 consecutive months Each year for 2 years
Three causes Of CB: •Smoking!!!, •Recurring pulmonary infections as a child may increases susceptibility, •Air pollution
Pathophysiology of CB: Inhale irritant, Bronchial walls inflame, Bronchial mucous glands enlarge,
Advance stages of CB: Larger airways plug, V/Q mismatch, Pulmonary arteries constrict, Polycythemia
CBC for Advance stage of CB CBC-RBC 4.6-6.2 million/UL for M, 4.2-5.4 for F, Hgb 13-18 gm/dl for M, 12-16 gm/dl for F., Cor Pulmonale (hypertrophy R. Ven), Respiratory Failure
Clinical Manifestations of CB:Include: signs, symptoms, observation, percussion, palpation & auscultation- Frequent cough w/mucous expectorate,Slight ↑ RR, Slight ↑ HR, CO, BP, Dyspnea only with lung infection, Breathsounds: no significant changes, Xray – no significant changes, ABG’s slight Resp. Alkalosis with mild hypoxemia (↑PH, ↓PaCO2, ↓HCO3 ↓PaO2)
Advanced signs of CB: Chronic cough with increased mucus,Increased RR, HR, CO, BP, Dyspnea esp. with exertion, Increased WOB – prolonged expiration, Diagnostic palpation/percussion, Decreased tactile & vocal fremitus Hyperresonant percussion note Breathsounds,Decreased, Cr
Diagnostic test and result of CB CXR, Hyperinflation (air trapping), Translucent (very dark), Increased A-P diameter(barrel chest),Flattened Diaphragm-< or blunted costophrenic angle, Spider like projection in the bronchogram, Enlarged heart
Pulmonary function testing of CB: Decreased Expiratory maneuver – Flows, FVC-Lung Volume & Capacity-Increased – Vt, RV,-RV/TLC, FRC-Decreased – VC, IRV, ERV, Normal FEV1/FVC 78 – 83% if less than 50% significant disease
Treatment – medical & respiratory of CB: Stop smoking–eliminate irritant, Avoid other lung infections, Avoid Dry, cold air, Bronchial hygiene, Humidified O2 – PRN,Dilate airway to help cough – Bronchodilator- sympathomimetic, Beta 2-Parasympatholytic, Xanthines (theophylline) –
Treatment -medical and respiratory of CB ,Dilate airway to help cough – Bronchodilator- sympathomimetic, Beta 2-Parasympatholytic, Xanthines (theophylline) – aid bronchial dilation,Thin the thick mucous –Mucolytic–P & PD–USN–Heated Aerosol•Antibiotics – bacterial
What are the Breath sounds in early CB No significant changes
What would an ABG look like if a pt was diagnosed with early stages of CB ABG’s slight Resp. Alkalosis with mild hypoxemia (↑PH, ↓PaCO2, ↓HCO3 ↓PaO2)
What would the breath sounds be in advanced CB Crackles- wet secretions wheezes- bronchoconstriction (mucus plug) Rhonchi- inflammed airways
What would an ABG look like if a pt was diagnosed with the advance stage of CB pH normal,↓ PaO2 (cyanosis & clubbing),↑ PaCO2, ↑ HCO3 Compensated Respiratory Acidosis
Why do the pulmonary vessel constrict during chronic bronchitis because of the hypoxemia leads to PVR
Created by: laney21882
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