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N126-U3-II. COPD #2
Dobrisky-COPD
| Question | Answer |
|---|---|
| COPD is a slowly progressive disorder usually developing over | 30 years |
| COPD is characterized by stable phases and | acute exacerbations |
| what is the causative factor in 80-90% of deaths from COPD? | smoking |
| Causative factors of COPD include | cigarette smoking, 2nd hand smoke, infection, occupational exposure to toxins, genetics & aging |
| how does aging increase the risk for COPD | decreased elesticity/recoil of thorax & alveoli |
| A deficiency in what gene contributes to the risk for COPD | Alpha-antitrypsin (AAT) |
| AAT function to protect lungs from what breakdown product of WBC? | neutrophil elastase |
| WBC breakdown to | neutrophil elastase |
| Neutrophil elastase is inhibited by what gene? | AAT |
| Is 2nd hand smoke a risk factor for COPD | yes |
| Inflammation of airways leads to destruction of | lung tissue |
| Inflammation and what other condition are characteristic of COPD? | expiratory airflow limitation/obstruction or "air trapping" |
| What are the two types of COPD? | chronic bronchitis and emphysema |
| Which type of COPD is usually a combo of both? | emphysema |
| Pure _______is common, while pure ________is rare | pure chronic bronchitis-common; pure emphysema-rare |
| Which type of COPD is characterized by a productive cough & SOB that lasts about 3 mos or more each year for 2 or more years in a row? | chronic bronchitis |
| what are some of the causes of chronic bronchitis? | smoking, repeated infections |
| alveolar hypoxia as a result of chronic bronchitis can result in what end stage complications? | persistent hypoxia (polycythemia), pulmonary hypertention, cor pulmonate (R ventricle hypertrophy) and R sided heart failure |
| Polycythemia is | persistent hypoxia |
| chronic bronchitis narrows airways due to | excessive mucus production and loss of functional cilia |
| chronic inflammation from irritants can cause what type of COPD? | chronic bronchitis |
| Chronic cough, DOE, increased sputum and edema are all clinical manifestations of what type of cOPD? | chronic bronchitis |
| Cor pulmonale, cyanosis, pulmonary HTN and R sided failure are all end stage manifestations of which type of COPD? | chronic bronchitis |
| Inhaled oxidants in tobacco and pollution inhibit AAT & stimulate inflammation causing what type of COPD? | emphysema |
| alveolar destruction creates | bullae & blebs |
| bullae are | large air spaces caused by alveolar destruction in emphysema |
| blebs are | adjacent to the pleura |
| loss of elastic recoil causes difficulty in what phase of breathing? | expiration |
| air trapping leades to | hyperinflation, increased workload of breathing and hypoventilation |
| Bullae & blebs cause ineffective gas exchange, hypoxemia and what? | v/q mismatch |
| shunting is caused by | collapse, exudate, edema |
| shunting is when alveoli are not_______ but are still ______ | ventilated; perfused |
| Ventilation-Perfusion (V/Q) Mismatch is | when lungs are poorly venilated in relation to the amount of blood flow |
| when lungs are poorly ventilated in relation to the amount of blood flow this is what type of mismatch? | ventilation-perfusion (v/q) mismatch |
| V/Q mismatch leads to a condition refereed to as | shunting |
| constant dyspnea, frequent infections, weight loss, barrel chest, pulmonary HTN & R sided heart failure are clinical manifestations of which cOPD? | emphysema |
| Barrel chest, increased respiratory rate and use of accessory muscles when breathing indicates what condition? | emphysema |
| weight loss is a common in which type of copd patient? | emphysema |
| Which type of COPD is associated with hypersecretions? | chronic bronchitis |
| dyspnea and frequent infections are associated with which type of copd? | chronic bronchitis & emphysema |
| hypoxemia, hypoventilation & R sided heart failure are associated with which type of copd? | chronic bronchitis & emphysema |
| airway obstruction/air trapping is associated with | chronic bronchitis & emhysema |
| type of heart failure that develops as a result of lung disease | cor pulmonale |
| Cor Pulmonale is characterized by | R ventricle hypertrophy & R sided heart failure |
| Distended neck veins, liver engorgement, dependent edema and R ventricular gallop are clinical manifestations of which type of heart failure? | R sided |
| What type of diagnostic tests are used for COPD patients? | Pulmonary Function, ABG, CXR, sputum culture and hematology |
| spirometry measures | the amount and rate of air a person breathes |
| how is copd classified from mild to severe? | spirometry comparison of FEV to FVC |
| CXRs are not useful in what stages of COPD? | mild to moderate |
| CXR findings in late stages of COPD are? | hyperinflationl; low, flattened diaphragm |
| Which COPD diagnostic test is used to detect pneumonia? | CXR |
| In the early stage of COPD will the PaO2 be normal, increased or decreased? | normal |
| In the late stages of COPD will the PaO2 be normal, increased or decreased? | increase & decreased |
| To monitor respiratory status what diagnostic tool is done serially | ABGs |
| Late stage COPD with increase & decreased PaO2 manifests into | respiratory acidosis and cor pulmonale and respiratory failure |
| Normal ABG pH | 7.35-7.45 |
| Normal ABG PaO2 | 80-100 |
| Normal ABG PaCO2 | 35-45 |
| Normal HCO3 | 22-26 |
| With an O2 sat of 88% what can you expect the PaO2 to be? is that a normal, increased or decreased PaO2? | 55mmHg; decreased |
| Pa is ___; PaCo is _____ | pa is 80; paco is 35 |
| HCO3 normal range is | 22-26 |
| PaCO2 normal range is | 35-45 |
| what diagnostic test is done on sputum? | gram stain & culture/sensitivity |
| what are the most frequent pathogens seen in sputum cultures? | S. pneumoniae and H. influenza |
| Chronic hypoxia causes an overproduction of what type of cell? | RBC |
| the overproduction of RBCs | polycythemia |
| What types of surgery are used to treat COPD? | lung transplant or lung volume reduction surgery |
| What one modifiable risk factor slows the rate of decline in pulmonary function in all patients regardless of age? | smoking cessation |
| smoking cessation is more difficult for what age group? | older patient |
| smoking cessation success is possible when healthcare professionals are involved, nicotine replacement therapy is initiated and | the patient attends support groups |
| What is the only therapy proven to alter the course of advanced COPD? | oxygen |
| a patient will be put on oxygen if they are unable to maintain what PaO2 level? | >55 |
| the goal of oxygen therapy is to maintain what sat for how long? | >90% as close to 24 hrs a day as possible |
| because COPD patients have chronic retention of ____-they're stimulation to breath is low PaO2 | CO2 |
| purse lip breathing and flutter mucous clearance devices are therapies used for what condition? | copd |
| What is the most frequent indication for lung transplant? | copd |
| the criteria for lung transplant recipients is an age under what? | <65 |
| lung transplant criteria: FEV? | <30% |
| can a patient with pulmonary hypertension be considered for a lung transplant? | no |
| what is the 5 year survival rate for lung transplant patients? | <50% |
| abnormal assessment findings associated with COPD include? | tripod position, pursed-lip breathing, clubbing of fingers, breath sounds-distant/crackles/wheezes and edema |
| what breath sounds would you expect to hear in a pt with copd? | distant/crackles/wheezes |
| tingling in the extremities is a sign of which, hypoxemia or hypercapnia? | hypercapnia |
| vertigo is a sign of hypoxemia or hypercapnia? | hypercapnia |
| spasm is a sign of hypercapnia or hypoxemia? | hypercapnia |
| irritability is a sign of hypercapnia or hypoxemia? | hypoxemia |
| asterixis is a sign of hypoxemia or hypercapnia? | hypoxemia |
| tachycardia is a sign of ______; tachypnea is a sign of ________ | hypoxemia; hypercapnia |
| confusion, increasing somnolence and cardiac dysrhythmias are all signs of hypoxemia or hypercapnia? | hypoxemia |
| asterixis is an observed flap of what due to a brief rapid relastion of dorsiflexion? | wrist |
| muscular weakness and tingling of extremities are signs of hypercapnia or hypoxemia? | hypercapnia |
| increasing somnolence is a sign of hypoxemia or hypercapnia? | hypoxemia |
| Interventions for patients with copd should include improving airway clearance, ventilation and | oxygenation |
| list three interventions effective in improving airway clearance | Huff cough technique, 3-4 L fluid intake per day & medications/rt |
| Describe a "huff cough" | low pressure cough, which uses a series of several "mini-coughs |
| describe how to begin the huff cough technique | first have a good exhalation, and then take in that initial deep breath of air before beginning the mini-coughs |
| in pursed-lip breathing inhalation is done through which the nose or mouth and for how many counts | through nose, mouth closed, 2 counts |
| describe the exhalation in pursed-lip breathing | slowly, gently using pursed lips for 4 counts |
| PLB inhalation for how many counts? | 2 counts |
| PLB exhalations for how many counts? | 4 counts |
| should pts perform PLB with tight lips or straining? | no, increases pressure and makes breathing worse |
| the goal of PLB is to keep airways open to _______ and ______ respiration | release trapped air, slows respiration |
| What are two positions helpful for patients with dyspnea/COPD? | tripod, fowler's |
| what is the ideal humidity level for patients with COPD? | 30-40% |
| what intervention warms air to prevent bronchospasm in cold weather? | scarf over nose and mouth |
| What is the single most important aspect of rehabilatation? | exercise conditioning to improve activity tolerance |
| the most common cause of re-admissions in copd patients is | infections |
| When should a patient be instructed to call the dr? | changes in sputum, dyspnea, fatigue, weight, edema or if pt becomes argumentative |
| what might a change in behavior such as becoming argumentative indicate in a patient with copd? | an increase in PaCO2 |
Created by:
Lori Dobrisky
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