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5COPD
Alterations in Oxygenation r/t Obstructive Disorders MS1 exam2
| Question | Answer |
|---|---|
| The #1 RF for COPD? | tobacco smoking |
| other RF for COPD? | secondhand smoke, environmental smoke, chemical irritants in workplace, recurrent resp infections, aging process, asthma, alpha-antirtypsin (AAT) deficiency |
| COPD | CHRONICObstructivepulmonaryDisease epmhysema & bronchitis; *irreversible airflow inflammation; not curable but can be managed; age onset 40-50yr, long smoking hx(>10-20packs), slowly progressive persistent worsening with exacerbations (L635T29-17) |
| What is Alpha-Antitrypsin? | genetic component, autosomal recessive produced in liver/found in lungs; inhibits lysis of lung tissues; ZZ homozygous for deficient gene (Sx: COPD by age 40, <smoking hx, family hx of emphysema, chronic liver disease, northEuropena) (L632) |
| patho of Emphysema | inflammatory response destroy elastin=<surface area/<elastic recoil=airway collapse=air trapping SWISS CHEESE/BIGGER GRAPES |
| main characteristic of COPD | irreversible airflow=air trapping, cant expire CO2 |
| FYI: nicotine | not carcinogen but have >deleterious effects *stimulates SNS (>HR/BP/cardiac workload, vasoconstriction); <functional hgb, >platelet aggregation (L631) |
| FYI: cigarette smoke | has irritating effects=<ciliary activity/alveolar walls destruction; goblet cells hyperplasia=>mucus (L631) |
| FYI: tobacco smoke | contains carbon monoxide (CO)-has > affinity for hgb, combines more readily than O2 = <O2capacity = >HR/cardiac workload (L631) |
| patho of Chronic Bronchitis | productive cough x3mos in 2yr, no other cause *<airway and >secretions |
| S/S of COPD | productive cough, progressive dyspnea, barrel chest, tripod/accessory muscles, JVD, clubbingfingers, >expiratory, <breath sounds, wheezing/chest tightness, wtloss/anorexia, HYPOXEMIA with HYPERCAPNIA later, ruddy/cyanosis |
| describe a productive cough/sputum | usually=white frothy thick exacerbation from URIs/LRIs=greenyellow |
| describe a progressive dyspnea | r/t activity level/ADLs tolerance, then dyspnea on rest to lying down |
| what does a diminished breath sound mean? | air trapping |
| describe wt loss r/t COPD | 20-30lbs loss over 1-2yrs, there is >metabolic needs; <appetite due to feeling of fullness from hyperinflation, variety of meds altering tastebuds |
| describe a ruddy/cyanosis appearance | reddish/polycythemia = >RBC production from compensation with peripheral cyanosis = <O2 |
| classic sign of COPD/chronic HYPOXIA | clubbing of fingers/bloating |
| diagnostic tests for COPD | spirometry/pulmonary function tests, plsax, CXR, serumAATlevels, ABGs, sputum C&S/gram stain, 6min walk test, set of exercises |
| ABGs findings for COPD during exacerbations | pH= N-> 7.35< ChronicRespAcidosis PaCO2= N-> 45> normal for them PaO2= N-> 80< or 70< drive to breath *compensation will not bring levels WNL |
| CXR findings for COPD | hyperinflation, cardiac enlargement, flattened diaphragm (L635) |
| lung volumes/Spirometry,PFTs findings | never normalizes due to trapped air ChronicRespAcidosis TLC= > RV= > FEV= < FEV1/FCV = <70% (L635) |
| complications of COPD | CorPulmonale/RtSidedHF, acute exacerbations, pneumonia, RespFailure, GERD, depression, chronicRespAcidosis |
| FYI: CHF | starts at the left side of heart |
| Cor Pulmonale | RtSided HF,hypertrophy; goes hand in hand with RespFailure *in response to <O2 compensation=polycythemia and pulmoVasoconstriction = pulmo HTN = corPulmonale = RtsideHF |
| drug therapy for depression | common: SSRIs (selective serotonin reuptake inhibitors) avoid: benzodiazapines-SE resp depression, habit forming |
| classification of severity of COPD based on FEV1% | stage0=at risk stageI=mild, <80% stageII=moderate;50-80% stageIII=severe; 30-50% stageIV=very severe; <30 or <50% chronic resp failure (L635T29-18) |
| FEV1% | severity of obstruction determines the stage, provides general guideline for type of interventions (L6 |
| therapy at each stage | stage0=avoid RF, flu vac stageI= +shortacting broncho prn stageII= +regular treatment/longacting broncho, rehab stageIII= +inh corticosteroids stageIV= +longtermO2, surgery (L639T29-21) |
| diagnosing severity of COPD based on lung function test | FEV1/FVC = <70% |
| S/S RTsided HF | peripheral edema esp sacral area, ascites/pregnant man, hepatomegaly, bounding pulse, JVD, wt gain (1L=2.2lbs), S3/S4 heart sounds, polycythemia, pulmovasoconstriction |
| most impt intervention/prevention/delay of progression of COPD | #1 smoking CESSATION |
| collaborative therapy/nurs interventions | smoking cessation, treatment of exacerbations/respInfections, drug/O2/nutritional therapies, chest physiotherapy, exercise, vaccines, surgery, pulmo rehab |
| smoking cessation teachings/alternatives | meds (nicotine patch, gums, pills), e-cig *pills (Walbutrin, Zantex?) = caution SE:hallucinations *e-cig = antifreeze, FDA unapproved -they are not breaking addiction rather substituting |
| dyspnea management/pulmo Rehab | breathing techniques (pursedlip, diaphragmatic), airway clearance (acapella, flutter mucus, vest), effective coughing/huff cough, position changes, rest/assist ADLs, fans, relaxation, meds |
| pursed lip breathing | prolong exhalation, blow off CO2 - |
| use of airway clearance techniques/devices | 1hr before and 1-3hr after meals, broncho 15min prior |
| effective coughing/huff cough | (L646T29-25) |
| why is there a need for a fan? | cools and circulates air |
| drug therapy for COPD | broncho=shortact-Albuterol, IpratropiumSE dry mouth; longact-salmeterol corticosteroids=inh mod to severe, PO longterm, comb fluticasone/salmeterol (Advair) longact cholinergic=tiotropium(Spiriva) theophylline=PO, uncommon due to SE, <therapeutic range |
| corticosteroids methods of administration | IV/IVPB-Solu-Cortef,Solu-Medrol, inh-Advair, PO-Prednisone <dose |
| nutritional/hydration therapy | >protein, >cal, <CHO diet, appetite stimulant (Megace 200-400mg), >clearfluids unless contra, oral care help with altered tastebuds, smallfrequent meals, broncho 30min prior, no fluid with meals, no gas producing(brocholi, peppers)/carb drinks, <dairy |
| why should pt <dairy intake? | milk and milk products are said to thicken mucus/secretions |
| psychosocial needs | lifestyle changes, guilt, depression, social isolation/body image, sexuality |
| O2 therapy/pt-family teaching | least amnt possible, low flow=nasal cannula; reading of empty tank, avoid smoking |
| what does low flow oxygen mean? | the % of O2 mixed with air as delivery system, nasal cannula, not the L/min |
| pneumococcal re vaccination | >65y/o, had one >5yrs, primary vac <65y/o |
| why a <CHO diet? | the by-product of carb/CHO is CO2 |
| pt,family teaching | disease process, infection control, correct use of MDI/DPI, home O2 therapy, when to contact MD |
| rationale for teaching disease process to pt | may actively participate if knowledgeable and diligently follow treatment/prevention, based on studies |
| when to contact MD? | CHANGES in usual breathing rate/pattern, coughing, wt gain, awakens at night, edema, <gradetemp |
| correct use of MDI | Albuterol; slowly deep breathing, 1-2in between mouth and mouthpiece, hold; if 2puffs wait 1min |
| correct use of DPI | Advair/Spiriva?quick deep breath, hold, rinse mouth if steroids |
| why is rinsing the mouth necessary after taking a corticosteroid? | risk for developing thrush/candidiasis? |
| end of life care | hospice: dyspnea management; meds-morphine sulfate (MSO4)liquid, neb, SL/IV in hosp; anticholinergic=thin/<secretions; antianxiety=<doseAtivan 0.25-0.5g |
| what is the drug of choice for end of life care dyspnea management? | morphine sulfate (MSO4) <RR/resp depression, alleviate >RR |
| advantage of a spacer | . |
| COPD dx in chart | Bronchitis or Emphysema or both, but one may predominates one in terms of pathophysiology |
Created by:
sarahjqs
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