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Mar2018drmccreary
studyguideCOPD
| Question | Answer |
|---|---|
| COPD Diseases = CBABE | Cystic Fibrosis, Bronchitis (chronic), asthma, Bronchiectasis, emphysema |
| Cause Cystic Fibrosis | Genetic; caused by mutations in a pair of genes on chromosome 7 |
| Cause Bronchitis (Chronic) | Smoking, Atmospheric pollutants, Chronic Infections, GERD |
| Cause Asthma | Extrinsic = allergic or atopic asthma ; Intrinsic = not allergic/usually activity induced |
| Cause Bronchiectasis | Acquired = recurring infections or bronchial obstruction Congenital = Kartagener's syndrome, hypogammaglobulinemia, CF |
| Cause Emphesema | Smoking, genetic (alpha1 protease inhibitor), occupational exposure to chemicals, exposure to pollutants (atmosphere) |
| 2 types of Asthma | Extrinsic and Intrinsic |
| Extrinsic Asthma | allergic or atopic; airway highly reactive to airborne particles |
| Intrinsic Asthma | Nonallergic or non atopic; airway responds to organism but not allergic; usually activity induced |
| 2 types bronchiectasis | Acquired or Congenital |
| Acquired bronchiectasis | Recurring infections, bronchial obstruction (inoperable tumor) |
| Congenital bronchiectasis | Born with it; kartagener's syndrome, hypogammaglobulinemia, CF |
| Hypogammaglobulinemia | immune disorder characterized by a reduction in all types of gamma globulins, including antibodies that help fight infection. |
| 7 Signs and symptoms during COPD assessment | 1)accessory muscle usage, 2)pursed-lip breathing, 3)barrel chest, 4)cyanosis, 5)digital clubbing, 6)cough w/sputum production, 7)substernal intercostal retraction (skin is sucked in to the space between the ribs) |
| 4 vital signs and affect during exacerbation of COPD | 1) ↑RR, ↑HR, ↑CO, ↑BP |
| 6 manifestations during chest assessment COPD | 1) Hyperresonant percussion, 2) ↓ breath sounds, 3)↓ heart sounds, 4) ↓ tactile & vocal fremitus (sound thru chest wall), 5) crackles, rhonchi, wheezing, 6) expiratory prolongation |
| COPD=Peripheral edema & venous distension | Pitting edema, enlarged, tender liver, and distended neck veins |
| 5 findings on CPX for COPD | 1)translucent (dark) lung fields, 2)depressed/flattened diaphragm, 3)long, narrow heart, 4)enlarged heart, 5)↑ AP diameter |
| 5 anatomic alterations that cause clinical manifestations in COPD | 1)excessive bronchial secretions, 2)bronchospasm, 3)atelectasis, 4)consolidation, 5)distal airway & alveolar weakening |
| How do lung alterations affect V/Q ratio in COPD? | V/Q ratio ↓ ; Not ventilating enough (V ↓) |
| How does ↓ v/q ratio affect tissue perfusion? | impaired gas exchange, hypoxemia and hypocapnia |
| Secondary condition in v/q mismatch? | Small airway narrowing; stimulation of O2 receptors |
| How do excessive secretions & bronchospasms affect RAW? Why? | ↑ RAW; because diameter of tube is smaller |
| Bronchospasms breath sounds | Wheezing, diminished & hyperresonant percussion |
| Treatment bronchospasms | O2 therapy, bronchial hygiene therapy, anti inflammatories, steroids, bronchodilator & mech vent protocol |
| Excessive bronchial secretions breath sounds | Ronchi & wheezing, diminished, hyperresonant percussion |
| Treatment excessive bronchial secretions | O2 therapy, bronchial hygiene, hyperinflation; give xanthines, expectorants, antibiotics, bronchodilators; mech vent protocol |
| Atelectasis breath sounds | Diminished |
| Treatment atelectasis | Hyperinflation therapy |
| Consolidation breath sounds | Crackles, dull percussion |
| Treatment consolidation | antibiotics for infection, O2 therapy, mech vent protocol |
| Clinical manifestations for consolidation | Fever |
| Secondary mechanism due to ↑ RAW for consolidation | Stimulation of O2 receptors, air trapping |
| Expiratory flow values on PFT's in COPD | ↓FVC, ↓FEVr, ↓FEF25-75, ↓FEF200-1200, ↓PEFR, ↓MVV, ↓FEF50, ↓FEV; so ALL are decreased |
| Effect on RV, FRC, & TLC in COPD on PFT's | ↑RV, ↑FRC, ↑ OR NORMAL TLC |
| Affect on Total O2 Delivery in COPD | Decreased due to ↓ V/Q mismatch |
| Affect on C(a-v)O2 difference in COPD | Normal |
| Affect on O2 consumption in COPD | Normal |
| Affect on O2 ER in COPD | Increased; because increased carbon dioxide retention |
| Affect on SvO2 in COPD | Decreased |
| Affect on Pulmonary Shunting in COPD | Increased |
| hemodynamic indices in COPD | ↑CVP, ↑RAP, ↑PA(mean), ↑ RVSWi, ↑ PVR. PCWP, CO, SV, SVi, Ci, LVSWi, SVR are all Normal. |
| Manage care for Cystic Fibrosis | Pt/Family education, O2 therapy, Bronchial hygiene, aerosol meds (xanthines, expectorants, antibiotics), mech vent protocol |
| Manage care for (Chronic) Bronchitis | Pt/Family education, behavioral mgmt (no smoking, avoid infection), O2 therapy, bronchial hygiene, aerosol meds, mech vent protocol |
| Manage care for Asthma | Pt/Family education, environmental control, O2 therapy. bronchial hygiene, aerosol meds (xanthines, steroids, anti-inflammatories, leukotriene inhibitor), mech vent protocol |
| Manage care for Bronchiectasis | Pt/Family Education, control infections, control secretions, prevent complication, O2 therapy, bronchial hygiene, hyperinflation, aerosol meds (xanthines, expectorants, antibiotics), mech vent protocol |
| Manage care for Emphysema | Pt/Family education, O2 therapy, bronchial hygiene, aerosol meds, mech vent protocol |
| Additional care for emphysema | Antibiotics with infection, Antitrypsin therapy (genetic only), Lung volume reduction surgery, lung transplant |
| Behavior management for emphysema | No smoking, no irritants, avoid infections by taking flu & pneumonia shots, proper nutrition |
| What obstructive diseases may present alone or in combination? | Asthma, Bronchitis, Emphysema |
| Specific Anatomic Alterations of Lung = Cystic Fibrosis | Thick, tenacious sputum, atelectasis |
| Specific Anatomic Alterations of Lung = Bronchitis | Chronic inflammation & swelling of peripheral airways |
| Specific Anatomic Alterations of Lung = Bronchiectasis | Dilation & distortion of bronchial airways, foul sputum, atelectasis, consolidation, fibrosis, hemorrhage |
| Specific Anatomic Alterations of Lung = Asthma | Thick, whitish, tenacious sputum, atelectasis (severe) |
| Specific Anatomic Alterations of Lung = Emphysema | Permanent enlargement & weakening of distal airways, destruction of pulmonary capillaries, Cor Pulmonale |
| Most common mutation of CF | ▲ F508 |
| CF Etiology | Genetic disease; chromosomal in nature, comes from BOTH parents |
| Bronchitis Etiology | Inflammation is key; something from outside going in; alcohol makes it worse |
| Asthma Etiology | Condition that exists because airway is highly reactive to airborne particles |
| Bronchiectasis Etiology | Has a dramatic long term effect on the lungs & can't be repaired; most of these pts are terminal |
| Emphysema Etiology | Important to remember there are two kinds; acquired & genetic; also important--occupational exposure to chemical irritants |
| Pts with peripheral edema & venous distention | This pt issue is COPD that has gone on a long time. |
| Treatment for Excessive Bronchial Secretions | O2 Therapy, bronchial hygiene therapy, hyperinflation, aerosol meds, mech vent protocol. |
| Common Anatomic Alterations in pts with COPD | Excessive mucus, partial or total mucus plugging, hyperinflation (air trapping), bronchospasms |
| Effect of COPD on tissue perfusion | NORMAL; perfusion usually not affected |
| Correction of lung alterations due to ↓ V/Q ratio | Ventilate more; if on vent ↑ RR, if not on vent, give O2 therapy |
| COPD Oxygenation Indices | QS/QT ↑ ; O2ER ↑ ; DO2 ↓ ; SvO2 ↓ ; VO2 Normal ; C(a-v)O2 Normal. |
| Abnormal lab procedures in COPD | ↑ hct & hgb ; ↓ Cl ; ↑ CO2 & HCO3 ; ↑ WBC (infection) ; if shows streptococcus pneumoniae, give antibiotic; if shows haemophilus influenzae, give antiviral |
| Abbreviations for CVP, RAP, PA(mean), PCWP, SVi, Ci, RVSWi, LVSWi, PVR, SVR | central venous press., right atrial press., "mean" pulm. artery press., pulmonary-capillary wedge press (rt side heart), stroke volume index, cardiac index, right ventricular stroke work idex, left vswi, Pulmonary vascular resistance, Systemic VR. |
| Hemodianamic | Means moving blood or blood in motion; this is what we want to know about volumes and/or pressures |
| Additional Risk Factors in Asthma | If live in urban area, 2nd hand smoke, parent has asthma, resp. infections as child, low birth weight, & obesity |
| ABG's in status asthmaticus | (acute vent failure w/hypoxemia) ↓ pH, ↓ PaCO2, ↓ HCO3 (significant), ↓ PaO2 |
| Color Zones for Asthma | Green = 80-100% PEFR; Yellow = 50-80% PEFR; Red = <50% PEFR |
| Pulsus Paradoxus in Asthma | ↓ BP during inspiration; ↑ BP during expiration |
| What causes the vitamin deficiency in CF? | Mucus blocks passageways in pancreas; this decreases digestion & leads to vitamin deficiency. |
| What is an additional CFX finding that only occurs in CF? | Pneumothorax (spontaneous)***** Only with CF--this is key! |
| What is another key assessment that occurs in CF only? | Nasal polyps & sinusitis***** Only with CF--this is key! |
Created by:
Beccaboop
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