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 |