1
Q
what is COPD
A
abnormal chronic inflammatory response of airways to noxious particles or gases
2
Q
past definitions of COPD
A
- chronic bronchitis
- emphysema
3
Q
cardinal symptoms of COPD
A
- dyspnea
- difficulty breathing
- SOB
- limitations in activity
4
Q
COPD significance
A
- 9.4% Canadians >35
- comparable gender prevalence
- higher among first nations
5
Q
risk factors of COPD
A
- smoking
- occupational chemicals or dust
- air pollution
- infection
- aging
6
Q
tobacco smoke and sympathetic nervous system
A
- increases HR
- peripheral vasoconstriction
- increases BP
- increases cardiac workload
7
Q
tobacco smoke and the respiratory tract
A
- increased mucus production
- hyperplasia of goblet cells
- decreased ciliary activity
8
Q
tobacco smoke and carbon monoxide
A
- decreased O2 carrying capacity
- increase HR
- impair psychomotor performance and judgement
9
Q
passive smoking (environmental tobacco smoke or secondhand smoke)
A
- decrease pulmonary function
- increase risk of lung cancer
- increase rate of mortality fro ischemic heart disease
10
Q
respiratory tract infections
A
- recurring infections impair normal defence mechanisms
- reduce lung function
- pathological destruction of lung tissue
11
Q
alpha - antitrypsin (AAT) deficiency
A
- genetic risk factor for COPD
- occurs in 1 and 5000
12
Q
aging and emphysema
A
- loss of elastic recoil in lungs
- lungs are rounded and smaller
- number of functional alveoli decreases
- peripheral airways lose support
13
Q
COPD defining features
A
- airflow limitations during forced exhalation due to loss of elastic recoil
- airflow obstruction due to mucus hyper secretion, mucosal edema and bronchospasm
14
Q
process of respiratory inflammation
A
- inhalation of noxious particles
- mediators released cause damage to lung tissue
- airways inflamed
- parenchyma destroyed
15
Q
COPD and supporting structures
A
- air goes in easy but remains in lungs
- bronchioles tend to collapse
- causes barrel-chest look
16
Q
lung changes in COPD
A
- bronchioles lose their shape and become clogged with mucus
- alveoli walls are destroyed forming fewer larger ones
17
Q
common characteristics of COPD
A
- mucus hypersecretion
- cilia dysfunction
- hyperinflation of lungs
- gas exchange abnormalities
18
Q
CM of COPD
A
- develops slowly
- cough with sputum
- dyspnea
- underweight with adequate caloric intake
- anorexia
- chronic fatigue
- use of accessory muscle for breathing
- bluish-red skin colour
19
Q
physical findings of COPD
A
- prolonged expiratory phase
- wheezes
- decreased breath sounds
- increased anterior-posterior diameter
20
Q
COPD complications
A
- car pulmonale
- acute exacerbations
- acute respiratory failure
- peptic ulcer disease
- depression
- anxiety
21
Q
car pulmonale
A
- hypertrophy of the right side of the heart
- results in pulmonary hypertension
- causes right sided HF
22
Q
acute exacerbations
A
- worsening symptoms
- change signaled by; dyspnea, cough, sputum
- purulent (require antibiotics) or nonpurulent
- associated with poorer outcomes
- causes: infections, air pollution, cold air
23
Q
acute respiratory failiure
A
- causes: exacerbations, cor pulmonale, discontinuing bronchodilator or corticosteroid meds
24
Q
COPD spirometry findings
A
- reduced FEV1/FVC ratio
- increased residual volume
25
COPD arterial blood bas findings
- low PaO2
- high PaCO2
- low pH
- high bicarbonate
26
walk test
- 6 minutes
- determines O2 desaturation in the blood with exercise
27
MRC dyspnea scale
- grades 1 to 5
- assess SOB and disability in chronic COPD
28
primary care goals for COPD
- prevent progression
- reduce exacerbations
- alleviate breathlessness
- improve exercise tolerance
- treat exacerbations
- improve health status
- reduce mortality
- smoking cessation
29
COPD medications (bronchodilators)
- relax smooth muscle in the airway
- reduce airway resistance and dynamic hyperinflation of the lungs
- improve lung ventilation
- decrease dyspnea
- increase FEV1
30
commonly used bronchodilators
- beta 2 adrenergic agonists (salbutamol, albuterol)
- muscarinic medications (ipratropium bromide)
- long acting (salmerotol)
- inhaled corticosteroids (fluticasone)
31
O2 delivery for COPD
- used to maintain PaO2 and reduce heart workload
- low flow
- humidify d/t drying effect
32
complications of O2 therapy
- combustion
- CO2 narcosis
- O2 toxicity
- absorption atelectasis
- infection
33
chronic O2 therapy at home
- reduce hematocrit and pulmonary hypertension
- re-evaluate every 30-90 days
34
COPD pulmonary rehabilitation
- pursed lip breathing
- diaphragmatic breathing
- forced expiratory technique
- huff coughing
35
pursed lip breathing
prolongs exhalation and prevents bronchiolar collapse and air trapping
36
diaphragmatic breathing
use of diaphragm instead of accessory muscles to achieve max inhalation and slow respiratory rate
37
nutritional therapy for COPD
- BMI between 21 and 25
- rest 30 min before eating
- bronchodilator before meals
- 5 to 6 small meals a day
-1.2/1.3 times normal kilocalorie intake
- 2/3 L fluids a day
38
nursing assessment COPD
- health history
- physical assessment
39
nursing diagnosis COPD
- inadequate breathing pattern
- inadequate airway clearance
- reduced gas exchange
- ineffective breathing pattern
- inadequate nutrition: less than body requirements
- disturbed sleep pattern
- potential for infection
40
nursing planning COPD
- prevent progression
- ability to perform ADLs
- relief of symptoms
- prevent exacerbations
- improved QOL
41
nursing implementation COPD
- smoking cessation
- avoid pollutants and irritants
- early detection and diagnosis of infection
- energy conserving strategies (tripod position when shaving, sit when performing activities)
