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medsurg exam 3
pulmonary conditions part 1
| Question | Answer |
|---|---|
| 2 versions of COPD | early (mild disease) late (severe dyspnea) |
| risk factors for COPD | noxious agent - tobacco smoke, air pollution, biomass fuels genetic lung development (smaller volumes) |
| biggest risk factor for COPD | cigarette smoke!! - biomass particles |
| COPD pathology | small airway inflammation - narrow alveolar destruction - collapse mucus hypersecretion - blocked by secretions |
| symptoms of COPD | dyspnea - 2degree loss of lung tissue "air trapping" |
| why does dyspnea happen with COPD | pt has inflammation and narrowing of airways so the pt looses elasticity so when exhaling, there is air trapping |
| why is COPD important | Major health problem |
| how is COPD a Major health problem | 4th leading cause death world 14.2 mil U.S. adults diagnosed with COPD in 2021 High health care costs High personal costs No therapy to reverse lung damage High symptom burden High mortality |
| key things to know about COPD | Common Preventable Not reversible |
| how do we assess severity of COPD | spirometry |
| what is spirometry | Measures volume & speed of air inhaled or exhaled as a function of time |
| spirometry values | FEV1, FVC, FEV1/FVC%, PEFR |
| FEV1 | Forced expired volume in 1st second |
| FVC | Total volume of air exhaled from maximal inhalation to maximal exhalation |
| FEV1/FVC% | The ratio of FEV1 to FVC, expressed percentage |
| PEFR | fastest flow gas from lungs |
| what is ratio used to determine severity of airflow limitation | FEV1/FVC% |
| normal percentage | >70%, if lower then there is airway obstruction |
| how can a pt manage their symptoms: pt teaching goals | Prevent progression Relieve symptoms Improve exercise tolerance Teach self-management skills |
| how to prevent progression of COPD | vaccination! |
| what vaccines are used to prevent progression of COPD | Influenza vaccine - flu has respiratory symptoms so you def don't want with COPD Pneumococcal vaccine - two types of vax |
| five A's model for | Facilitating Smoking Cessation |
| five A's model for Facilitating Smoking Cessation | ask advise assess assist arrange |
| ask | about tobacco use |
| advise | all smokers to quit |
| assess | willingness to quit: "On a scale from 0 to 10, with 0 being 'not at all motivated' and 10 being 'extremely motivated,' how motivated are you to quit smoking?“ |
| assist | the patient in his or her attempt to quit |
| arrange | follow up contact!! |
| pt tries to quit but can't, e cig? | they are liquids containing nicotine and flavorings |
| are e cig harmful | they can cause EVALI due to the vit E in them, if ingested that is fine but if breathed in then it can interfere with normal lung function |
| bronchodilators used to relieve symptoms | short acting and long acting |
| SABA | Immediate relief dyspnea work within < 1 minute last about 4-8 hours |
| SABA are known as | the rescue agent |
| how do SABA work | dilate bronchiole smooth muscle |
| LABA | Daily relief work within ~ 5 minutes last about 12-24 hours |
| how do LABA work | prevent exacerbations |
| what do bronchodilators do | Block constriction of airway by relaxing bronchial smooth muscles |
| step 1 of prescribing bronchodilators | Quick acting bronchodilator |
| what are examples of Quick acting bronchodilator | SABA and SAMA |
| how do Quick acting bronchodilator work and when are they used | dilate smooth muscle, opening the airways used in emergent situations |
| step 2 of prescribing bronchodilators | Add long acting bronchodilator |
| what are examples of long acting bronchodilator | LABA and LAMA |
| how do long acting bronchodilators work | provide 24hr relief to prevent exacerbations |
| step 3 of prescribing bronchodilators | Add 2nd long-acting bronchodilator |
| when to add 2 long acting bronchodilator | if having an attack |
| medications to relieve symptoms | rapid, short acting bronchodilators long acting bronchodilators inhalede corticosteroids (ICS) |
| rapid, short acting bronchodilators | albuterol (SABA) ipratroprium (SAMA) |
| long acting bronchodilators | Tiotropium, Aclidinium (LAMA) Salmeterol, Indacaterol (LABA) |
| ICS | fluticasone, budesonide |
| side effects of ICS | same as oral but not as severe bc not as systemic |
| pt using ICS MUST rinse mouth after to avoid | thrush, throat irritation, cough, cushings or hoarse voice |
| systemic SE of ICS | bruising, autoimmune issues, cataracts, osteoporosis |
| if pt is on SABA for quick relief what are the next steps | LABA then LAMA |
| if pt is on SAMA for quick relief what are the next steps | LAMA then LABA |
| combination inhalers | LABA + ICS LABA + LAMA LABA + LAMA + ICS |
| what is the plan for emergency relief | SAMA or SABA |
| what is the plan for long term relief | LABA or LAMA |
| what is the plan for many exacerbations | trial ICS |
| if possible use, | combination inhalers |
| pressurized inhalers (MDI) | propelled by gas |
| dry powder inhalers (DPI) | drug inhaled as powder |
| does anatomy influence drug effect | yes |
| where does the drug need to reach | lower lung area |
| your anatomy prevents unless | less than 1 micron |
| need to keep the drug | small |
| directions for inhalers | Inhale deeply Hold breath 10 sec Wait 1 min if 2 doses |
| using a DPI | Slide lever until it clicks Gently breathe out. Do not exhale into the device. Seal lips around the mouthpiece. Inhale rapidly and deeply Hold breath 10sec Remove from mouth, exhale. Check if powder gone; if not repeat. Wait 1 min between puffs |
| why do you slide lever until it clicks | because that loads medication |
| what is important to remember about DPI | do not breathe into it!! |
| using a MDI | take off cap, shake!! inhaler stand up and breathe out put inhaler in mouth or put it just in front of your mouth when you start to breathe in, push down top of inhaler and breathe in slowly hold your breath for 10 sec then breathe out!! |
| a pt says "I stopped using my medications daily because of the cost. Can you help?" | Medications are effective but costly Patients may not take as prescribed - Options exists that are less expensive, Important issue to query patients |
| what can a pt do to be less SOB | pursed lip breathing!!! |
| pursed lip breathing!!! | Inhale via nose with mouth closed Exhale over 4-6 seconds thru pursed lips Use when experience dyspnea Prevents air trapping |
| why should the pt exhale over 4-6 seconds | helps decrease air trapping |
| upper arm exercise to help decrease SOB | Respiratory muscles - Breathing + arm work Exercise - Improves muscle tone and Ability do ADL |
| how to help pt to get mucus up when coughing | Sit in chair, feet on floor 3-4 breaths in thru nose out mouth Grasp pillow with crossed hands Cough while bending forward Assists action of diaphragm, increases airflow |
| tripod position | elevates clavicle and expands lungs more, put bedside table over bed to help breathe |
| conserving energy | examples: using walker, sitting instead of standing in kitchen |
| what happens when a pt "lungs give out" | home o2 delivery |
| o2 should be used when indicated | begin in SpO2 <88% on RA |
| normal SpO2 | 98 |
| COPD SpO2 goal | 89 or higher |
| why is the COPD SpO2 goal not higher | increase O2 = decrease breathing for COPD because body doesn't think it needs to |
| how is home O2 provided | concentrator at home, portable oxygen delivery device |
| make sure to have backup O2 incase | power goes out |
| home oxygen delivery - portable | portable tanks to home, battery powered portable concentrator |
| pulmonary rehab benefits | Teaches Self-Management How to use equipment (inhaler, O2) How to exercise upper bodies, less dyspnea Stress reduction Keeps pts active |
| how often should pt exercise | 150min/week may break into smaller intervals |
| preventing COPD readmission | Patient teaching Inhaler device training COPD Action Plan Pharmacy reconciliation Follow-up call after discharge Referral to Pulmonary Rehab |
| when to do med rec | prior, during and at d/c!! |
| COPD exacerbation | respiratory distress JVD, tripod position, using accessory muscles, blue and pursed lips |
| monitoring | desired SpO2 - at least 89% or higher signs of respiratory distress vital signs LOC pt use |
| if a pt is hypoxic, what is the first sign and why | agitation because anxious of SOB |
Created by:
leh195