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Mar2018drmccreary

studyguideCOPD

QuestionAnswer
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