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COPD (CB & Emph)
cardiopulmonary disease test 1
| Question | Answer |
|---|---|
| Define COPD | Chronic Obstructive Pulmonary Disease is a preventable and treatable disease state characterized by airflow limitation that is not fully reversible. |
| Describe the clinical definition of Chronic Bronchitis | Chronic Bronchitis is defines clinically as chronic productive cough for 3 months in each of 2 successive years in a patient in whom other causes of productive chronic cough have been excluded. |
| Identify the most important or primary cause of Chronic Bronchitis | cigarette smoking |
| Chronic Bronchitis | The conducting airways (particularly the bronchi)are the primary structures that undergo change in chronic bronchitis. |
| Clinical manifestations of Chronic Bronchitis | Chronic inflammation and swelling of the wall of the peripheral airways.Excessive mucous production and accumulation. Partial or total mucous plugging of the airways. Smooth muscle constriction of bronchial airways(bronchospasm).Airtrapping/hyperinflatio |
| Etiology of Chronic Bronchitis | that inhalation of cigarette smoke is the most important factor that generates chronic bronchitis. Other noxious agents about which there are still controversial opinions, are air pollution and occupational inhalants. |
| Pathology of Chronic Bronchitis | The pathology of chronic bronchitis includes an inflammatory mononuclear cell infiltrate in the airway wall and a neutrophil influx into the airway lumen. |
| Treatment of Chronic Bronchitis | bronchodilator medications, steroids, antibiotics, oxygen therapy, vaccines, surgery, and pulmonary rehabilitation. |
| Etiology of Acute Bronchitis | Influenza,Parainfluenza, coronavirus, rhinovirus, RSV, human metapneumovirus |
| Clinical manisfestation of acute bronchitis | Cough with sputum production Typically lasts 10-20 days 50% will have purulent sputum, Bronchospasm (improves in 5-6 weeks)FEV1 reduced in 40% of patients |
| Give the medical term for an increase in tissue volume with the addition of new cells | Hyperplasia |
| Medical term for an increased term for an increased in tissue volume as a result of enlargement but not increased the number of new cells | Hypertrophy |
| Define emphysema | Presence of permenant enlargement of the airspaces distal to the terminal bronchials accompanied by distraction of the walls and without obvious fibrosis |
| Indentify the genetic deficiency of a serum compound that can lead to emphysema | Alpha1 Antitrypsin Deficiency |
| Etiology of emphysema | Cigarette smoking, inhaled irritants, Infection, hereditary and age |
| Clinical manifestations of emphysema | Barrel Chested pursed-Lip Breathing Use of Accessory Muscles Hyperresonant to percussion Breathsounds -Diminished Crackles or wheezing |
| Radiographic changes of emphysema | Translucent - Dark Depressed flatteningof diaphragms Hyperinflation Increased Retrosternal air spaces separation of the aorta and sternum the heart often appears long and narrow as a result of being drawn downward by the descending diaphragm |
| Pathology of emphysema | Loss of lung recoil due to loss of elastic tissues Increased lung compliance Decreased expiratory flows Instability of small airways due to loss of nearby support tissue Air trapping; Increased FRC, RV & TLC |
| What is GOLD? | Global Initiative for Chronic Obstructive Lung Disease; is recognized as a worldwide leading authority for the diagnosis,management, and prevention on COPD |
| Pathologic or Structural changes with Emphysema | Permanent enlargement and deterioration of airspace's distal to the terminal bronchioles. Destruction of elastic fibers Destruction of pulmonary capillaries. Airflow obstruction from loss of airway tethering and radial traction. |
| Give the medical term for an increase in tissue volume with the addition of new cells | hyperplasia |
| Give the medical term for an increase in tissue volume with a result of ENLARGEMENT but NOT increase in the number of new cells | hypertrophy |
| Describe the changes seen in a patients ABGs that have Emphysema | The DLCO (diffusion capacity) is decreased |
| Describe the changes seen in a patients ABGs that have Chronic Bronchitis | |
| Give the first and most common change in the patients ABGs in Emphysema | increased CO2 |
| List 3 categories of Bronchodialators used in treatment for COPD | Beta2-Agonists Anticholinergics |
| List 2 drugs used with obstructive lung disease that are NOT bronchodilators | oxygen therapy corticosteroids antibiotics |
| The key indicators for considering a COPD diagnosis are | Dyspnea chronic cough chronic sputum production history of exposure to risk factors such as tobacco smoke |
| 3 main spirometry test used to identify COPD | Forced Vital Capacity (FVC) Forced Expiratory Volume in 1 second (FEV1) Forced exp. vol. in 1 sec/forced vital capacity ratio (FEV1/FVC ratio) aka (FEV1%) |
| Describe the changes seen in a patients ABGs that have Emphysema or Chronic Bronchitis from stage I to IV | Stage I alkalotic pH, CO2 acidic, HCO3 acidic, PaO2 is decreased (someone who is hyperventilating) Stage IV pH is within normal range, CO2 acidic, HCO3 alkalotic, PaO2 decreased (hypoxic) |
| Describe the management of the patient with Emphysema with the ABGs, pH 7.36 PaCO2 65 PaO2 50 | leave them alone because they are COPD and the pH is within normal range....??? give him O2 therapy and treat the underlying cause maybe give a bronchodilator to get the PaO2 up to 60 |
| Loss of tractional support | Emphysema |
| Alveolar destruction | Emphysema |
| Inflammation | Chronic Bronchitis |
| Mucous plugs | Chronic Bronchitis |
| Smooth muscle spasm | Chronic Bronchitis |
| Elastic Recoil in Emphysema | decreased |
| Residual Volume in Emphysema | increased |
| total lung capacity in emphysema | increased |
| FEV1 in emphysema | decreased |
| FVC in emphysema | decreased |
| FEV1/FVC% in emphysema | decreased |
| DLCO (diffusion capacity) in emphysema | decreased |
| Elastic recoil in Chronic Bronchitis | normal |
| Residual volume in Chronic Bronchitis | increased |
| Total Lung Capacity in Chronic Bronchitis | increases |
| FEV1 in Chronic Bronchitis | decrease |
| FVC in Chronic Bronchitis | decrease |
| FEV1/FVC% in Chronic Bronchitis | decrease |
| DLCO (diffusion capacity) in Chronic Bronchitis | often normal |
| The barrel chest is a physical sign of what? | emphysema |
| In chronic bronchitis what airways are affected first? | large airways (bronchi) |
| Term used to describe right sided heart failure secondary to pulmonary disease | cor pulmonae |
| The patient with chronic bronchitis is susceptible to what? | respiratory infections |
| Pink Puffer | Type A COPD; derived from the reddish complexion and the "puffing" (pursed-lip breathing) commonly seen in patients with Emphysema. Pts usually thin. Marked dyspnea. |
| Blue Bloater | Type B COPD;the term is derived from the cyanosis commonly seen in patients with Chronic Bronchitis. Pts tend to be stocky and overweight. HYPOventilation common. secondary polycythemia, CO2 retention,pulmonary hypertension, and cor pulmonale |
| Auscultation in Emphysema | decreased breath sounds decreased heart sounds prolonged expiration |
| Auscultation in Chronic Bronchitis | wheezing crackles rhonchi,depending on severity of disease |
| Percussion in Emphysema | Hyperresonance |
| Percussion in Chronic Bronchitis | Normal |
| What are the two types of emphysema? | centrilobular and panlobular |
| centrilobular emphysema | this type of emphysema is associated primarily with cigarette smoking and affects mainly the respiratory bronchioles |
| panlobular emphysema | cause more often by a hereditary deficiency of the enzyme inhibitor alpha - antitrypsin,affects the respiratory bronchioles and the alveoli. |
| Pockets of air located between the alveolar spaces | bullae |
| What percentage of all cases of COPD is caused by an A1-antitrypsin deficiency? | 2%-3% |
| According to the GOLD report, which of the following is the greatest worldwide risk factor for COPD | tobacco smoke |
| Which of the following are anatomic alterations found with chronic bronchitis | Increased size of submucosal bronchial glands Chronic bronchial wall inflammation Bronchospasm |
| Which of the following are anatomic alterations found with emphysema? | Weakened distal airways Decreased surface area for gas exchange Hyperinflation |
| Which of the following medications is indicated for REGULAR use in patients with stable COPD | B2-agonists |
| A patient with chronic bronchitis will have which of the following clinical manifestations | Cough Stocky, overweight build Cor pulmonale Rhonchi |
| What treatment below for patients with COPD has been shown to improve long-term survival | oxygen |
| Chronic obstructive pulmonary disease (COPD) includes which of the following conditions | Chronic Bronchitis Emphysema |
| A patient is experiencing an exacerbation of COPD. He is 65 years old, fairly slim, and in notable distress with tachypnea, tachycardia, and an arterial blood pH of 7.20. Which of the following therapies would be most indicated? | noninvasive ventilation |
| Emphysema | -is most closely associated with Chronic Bronchitis -leads to the destruction of alveolar walls |
| Which of the following would indicate a diagnosis of advanced COPD | -Arterial blood gases show low O2 and high CO2 -Pulmonary function tests show low flow of air on expiration |
| Emphysema is probably caused by all of the following EXCEPT: | inhaling asbestos fibers |
| At which stage of COPD does the patient usually first seek medical attention because of worsening symptoms? | Stage IIMost patients will seek medical attention when they begin to feel serious symptoms such as shortness of breath or chronic cough during Stage II of COPD. Stage I symptoms are not bad enough for most patients to see a physician. |
| Which form of Obstructive Lung Disease is most common | Chronic Bronchitis |
| Which of the following is true of the diffusing capacity test (DLCO) findings in a patient with COPD | decreased in emphysema |
| Chronic bronchitis is defined as | -daily productive cough for 3 months -for 2 years in a row |
| What is the benefit of pulmonary rehabilitation in patients with moderate to severe COPD | improves exercise tolerance |
| What are the primary structures affected by chronic bronchitis | conducting airways (The conducting airways (bronchi) are primarily affected by chronic bronchitis. The alveoli, pulmonary capillaries, and goblet cells are affected to a lesser extent) |
| Which of the following terms is/are commonly applied to a patient with emphysema | Type A COPD Pink Puffer |
| It is not clear whether your patient has COPD or asthma. Which of the following characteristics is most closely associated with the diagnosis of asthma? | normalization of the FEV1 after use on a bronchodilator |
| A patient with emphysema will often have the following clinical manifestations | Barrel Chest pursed-lip breathing |
| The management of chronic obstructive pulmonary disease (COPD) includes: | bronchopulmonary hygiene procedures smoking cessation lung volume-reduction surgery annual influenza immunization |
| Which of the following are associated with chronic bronchitis | right heart failure purulent sputum elevated CO2 levels cyanosis |
| “I coughed hard all night long.” “My chest feels very tight.” “I feel very short of breath.” | Subjective information presented by the patient |
| Objective information that can be measured, factually described, or obtained from other professional reports or test results. | Heart rate Respiratory rate Blood pressure Temperature Breath sounds Cough effort |
| Professional conclusion about the cause of the subjective and objective data. | The assessment of bronchospasm can be concluded from wheezes. Or, acute ventilatory failure with moderate hypoxemia can be inferred from the following ABGs pH:7.18 • PaCO2 80 mm Hg • HCO3 29 mEq/L • PaO2 54 mm Hg |
| Plan is the therapeutic procedure(s) selected to remedy the cause identified in the assessment. For example: | An assessment of bronchial smooth muscle constriction justifies the administration of a bronchodilator The assessment of acute ventilatory failure justifies mechanical ventilation |
| common cause of Respiratory acidosis | *abnormalities in pulmonary ventilation leading to CO2 retention. *Halted or hindered gas exchange *Obsructions preventing exhalation of CO2 *Impaired neuromuscular function or integerity of chest wall *Depressed Respiratory center in medulla |
| Etiology of Respiratory acidosis | ARDS, Pneumonia, Atelectasis, COPD, emphysema, asthma, bronchial burns, chest trauma, Guillain-Barre, MS, Mysathenia gravi, Drug overdoses, anesthesia, acute alcoholism |
| Compensatory mechanisms that take place within 24 hours of Respiratory Acidosis | Kidneys conserve HCO3 and excrete more hydrogen ions into urine Urine becomes more acidotic |
| Clinical manisfestations or signs of respiratory acidosis | Drowsiness, unconsciousness, disorientation, rapid, shallow respirations, tachycardia, dizziness, decreased BP, headache, Tachycardia, seizures |
| s/s of hypoxemia | • tachypnea • tachycardia (1st sign of hypoxemia) • cyanosis • accessory muscles |
| normal ranges for adult respirations? | 12-20 breaths/min |
| normal range for adult pulse rate? | 60-100 bpm |
| normal range for adult systolic bp | 110-140 |
| normal range for adult diastolic bp | 60-90 |
| SpO2 for severe hypoxemia | less than 85% |
| treatment for severe hypoxemia? | admin of O2 and/or ventilatory support |
| wheezing is a sign of | airway obstrruction |
| coarse crackles indicate | CHF, pulmonary edema, pneumonia with severe congestion and COPD |
| pulmonary edema | the collection of fluid in the alveoli, particularly dangerous because it impedes gas exchange. common causes of pulmonary edema are increased pulmonary blood pressure or infection of the respiratory system. |
| Congestive Heart Failure | failure of the left ventricle to pump an adequate amount of blood to meet the demands of the body, resulting in a "bottleneck" of congestion in the lungs that may extend to the veins, causing edema in lower portions of the body |
| during the advanced stages of emphysema what does the PaO2 and PaCO2 show | chronically low PaO2 and high PaCO2 |
| hypoxemia | a decreased arterial oxygen level |
| type of pulmonary shunting associated with CB and Emphysema? | Relative or Shuntlike effect |
| Peripheral Edema is commonly seen in patients with | CHF, Cor Pulmonale, hepatic cirrhosis |
| Repeated expectoration of blood-streaked sputum is seen in | CB,bronchiectasis, CF, embolism, lung cancer, TB and fungal diseases |
| common causes of non productive cough | tumors, irriation of the airways, mucous accumulation, irritation of the pleura |
| normal tidal volume for an adult | 400-500 ml |
| restrictive lung disease | tumor, pulmonary fibrosis, scarring, neumonia, chest wall stifness, respiratory muscle weakness and central nervous system diseases, musculoskeletal, sarcoidosis, inhaling toxic fumes, decrease in lung compliance, decreased lon volumes tlc, vc irv tv erv |
| normal acid base balance? | 1:20 |
| Sa02 normal values | 96-100% |
| DLCO | test how well gases(oxygen) move through the lungs and into the blood stream |
| CXR for Chronic Bronchitis | hyperinflation |
| Expected Sa02 and PaO2 | 90 : 60 80 : 50 70 : 40 *PaO2 100 SaO2 98 |
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