Busy. Please wait.

show password
Forgot Password?

Don't have an account?  Sign up 

Username is available taken
show password


Make sure to remember your password. If you forget it there is no way for StudyStack to send you a reset link. You would need to create a new account.
We do not share your email address with others. It is only used to allow you to reset your password. For details read our Privacy Policy and Terms of Service.

Already a StudyStack user? Log In

Reset Password
Enter the associated with your account, and we'll email you a link to reset your password.

Remove ads
Don't know
remaining cards
To flip the current card, click it or press the Spacebar key.  To move the current card to one of the three colored boxes, click on the box.  You may also press the UP ARROW key to move the card to the "Know" box, the DOWN ARROW key to move the card to the "Don't know" box, or the RIGHT ARROW key to move the card to the Remaining box.  You may also click on the card displayed in any of the three boxes to bring that card back to the center.

Pass complete!

"Know" box contains:
Time elapsed:
restart all cards

Embed Code - If you would like this activity on your web page, copy the script below and paste it into your web page.

  Normal Size     Small Size show me how


Alterations in Oxygenation r/t Obstructive Disorders MS1 exam2

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