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5COPD

Alterations in Oxygenation r/t Obstructive Disorders MS1 exam2

QuestionAnswer
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