COPD

Question 1

Oxygenation Requires 2 Things

Answer 1

1. Ventilation

2. Perfusion

Question 2

Chronic Bronchitis

Answer 2

Chronic Inflammation of the bronchi and the bronchioles causing vasodilation, congestion, mucosal edema (excess mucous production).
Overall the inflammation makes the airway lumen much smaller! Trouble breathing in and out!

Question 3

Emphysema

Answer 3

Loss of E-lasticity and abnormal permanent enlargement of the alveoli. this also decreases the surface area for the exchange of gases. Trouble breathing out!

Question 4

An obstruction can be mechanical or functional, but they both have what impact on the body?

Answer 4

-Retain CO2 making the body acidotic

Question 5

What is the relationship between emphysema and chronic bronchitis?

Answer 5

• Many PT will have symptoms of both, a combination. A PT with COPD might have the flabby alveoli and the mucous
• Both caused by smoking!

Question 6

Cigarette Smoking- 6 consequences due to one main thing

Answer 6

Increase in proteases

1. decrease ciliary activity
2. possible loss of ciliated cells (protective cells)
3. cellurar hyperplasia
4. Reduction in airway diameter
5. increased difficulty in clearing secretions
6. production of mucous

Question 7

Proteases

Answer 7

• enzymes which scavenge things from the lungs and function to protect our lungs.
• RMR this is an enzyme and enzymes come from cells, when more cells are being destroyed more and more proteases are being released and they are eating more things up, including the lung itself!
• they work adaptively meaning and increase in destruction triggers more proteases.

Question 8

How does nicotine connect to the sympathetic nervous system

Answer 8

-it stimulates the SNS causing:
1. increased Heart Rate
2. Increased Blood Pressure
3. Peripheral Vasoconstriction
OVERALL INCREASED CARDIC WORKLOAD

Question 9

Wheezing vs Stridor

Answer 9

wheezing- narrowing of the lower airways

stridor- obstruction in the upper airway

Question 10

What to ask during assessment?

Answer 10

risk factors

1. age-higher risk with older people
2. gender- women and men are slowly equalizing
3. occupational hazards
4. family history

Question 11

Physical Assessment 7 things to note

Answer 11

1. abnormal breath sounds- wheezing or crackles
2. Barrel Chest
3. clubbing of the fingernails
4. cyanosis- late sign
5. Dyspnea- SUBJECTIVE ACCOUNT OF HOW SHORT OF BREATH A PERSON IS
6. trippod position
7. weight loss

Question 12

Why do people with emphysema have weight loss?

Answer 12

1. they have marked dyspnea- hard to eat

2. they have increased energy expenditure because they are breathing more and using energy to breath

Question 13

2 causes of clubbing fingernails

Answer 13

RARE

• could be idiopathic
• chronic hypoxia causing vasodilation and enlargement of the fingernails. so if someone is a smoker and they have this it is usually due to this reason and not an idiopathic cause.

Question 14

Dyspnea- How do you assess it?

Answer 14

• Ask the PT to tell how, indicate on the line how bad it is.
• Objective assessment includes observing the use of accessory muscles, hyperventilation

Question 15

Orthopneic and Tripod Positions

Answer 15

• leaning forward maximizes the thoracic cavity and decreases the resistance.
• compensatory mechanism

Question 16

Blue Bloater Symptoms

Answer 16

• chronic bronchitis
• cant get O2 in or CO2 out
• coughing alot
• fat
• cyanotic
• ronchi and wheezing
• alot of yellow/green sputum
• peripheral edema
• 3 months for at least 2 years
• elevated hemoglobin

Question 17

Pink Puffer Symptoms

Answer 17

• emphysema
• skinny
• alot of dyspnea
• older
• quiet chest- could lead to pneumo-thorax
• hyper-inflated chest seen in X-ray

Question 18

common lab tests done

Answer 18

1. ABG
2. CBC
3. Sputum analysis

Question 19

ABG

Answer 19

• pH: 7.35-7.45
• CO2- BASIC 35-45 ACDIC
• HCO3- ACID 22- 26 BASIC

Question 20

Hypercarbia

Answer 20

• also called hypercapnia
• acidosis
• low pH

Question 21

polycythemia

Answer 21

increase in RBC to help carry oxygenate throughout the body

this increases blood viscosity which increases heart’s workload and increases risk for blood clot

Question 22

Alpha 1 AntiTrypsin

Answer 22

• gene that causes emphysema in young people

- this gene increases the levels of protease which leads to tissue damage

Question 23

sputum testing

Answer 23

-to check for respiratory infection which these PT are more likely to get bc mucous is a good breeding ground for bacteria

Question 24

How do you check for oxygenation saturation

Answer 24

-pulse ox. the oxygen saturation only tells you how much oxygen binds to hemoglobin but this does not tell you how much blood or hemoglobin is in the blood. so check for normal hemoglobin levels.
For COP patients know their baseline.

Question 25

diagnostic tests

Answer 25

1. Chest X-Ray 2. Patient's presentation 3. Pulmonary Function Test

Question 26

Chest X -Ray

Answer 26

- Is not useful for early or moderate stages but useful to determine late stage disease. - in late stages the diaphragm is more inflated

Question 27

Patient Presentation Evaluation

Answer 27

-Productive cough lasting for more then 3 months for 2 years

Question 28

Pulmonary Function Test

Answer 28

- use a spirometer to test the lung volumes and can help detect lung disease

Question 29

What is spirometry

Answer 29

means to assess lung function by measuring total volume of air the patient can hold and expel after a maximal inhalation

Question 30

vital capacity

Answer 30

volume a non-forced exhale

Question 31

Residual volume

Answer 31

air left in the lungs after a max expiration

Question 32

TLC- Total lung Capacity

Answer 32

total amount of air in the lungs after taking the deepest breath possible

Question 33

FEV1 - forced expiratory volume in one second

Answer 33

-volume of air expired in 1 second

Question 34

FVC- Forced vital capacity

Answer 34

total air that can be forced out

Question 35

FEV1 / FVC Ratio

Answer 35

- fraction of air exhaled in 1 second / total volume exhaled

Question 36

what things will influence your predicted normal values for FEV1 / FVC

Answer 36

age height sex ethnic origin

Question 37

what are the normal ranges

Answer 37

-- greater then or equal to 80% for both FEV1 , FVC, and Ratio

Question 38

COPD Spirometry Reading

Answer 38

-typical findings when they are reduced to lower then 70% and they have an increased RV

Question 39

complications of COPD

Answer 39

- hypoxemia - acidosis - respiratory infections - cor pulmonale - cardiac dysrrythmias

Question 40

Cor Pulmonale - why does it happen and what is it

Answer 40

right sided heart failure, occurs often in COPD patients because the lungs are not oxygenating the blood correctly so the right side of the heart hypertrophies and works very hard to pump blood through into the lungs.

Question 41

Clinical Manifesations of Cor Pulmonale

Answer 41

- alot of dyspnea - fatigue - distended neck veins - dependent edema - enlarged and tender liver

Question 42

5 priority nursing diagnoses

Answer 42

1. hypoxemia 2. weight loss 3. anxiety 4. activity intolerance 5. risk for infection

Question 43

why is hypoxemia a priority nursing diagnoses

Answer 43

``` reduced airway size too much mucus airway obstruction diaphragm flattening loss of elasticity could all lead to low levels of oxygen in the blood and high levels of CO2 ```

Question 44

why is weight loss a concern

Answer 44

- hard for them to breath- use more energy - hard to eat bc of dyspnea - excessive secretions

Question 45

drug management therapies 3 types

Answer 45

- bronchodilators - reduce airway resistance and hyperinflation and reduce dyspnea - anti-inflammatory steroids - inhalers

Question 46

oxygen therapy for COPD

Answer 46

-LOW FLOW -central chemoreceptors which normally run based on CO2 are damaged because of chronically high CO2 levels so they began running on an hypoxia meaning really low levels of O2 will trigger the need to breath -2-4 liters a minute MAX IS 4 LITERS A MIN -give using nasal cannula or 40% on a venturi mask -humidify as needed -GOAL PaCO2 for COPD- 60-65% Normal Goal is 80-100% Saturation of Oxygen- 90% around

Question 47

chronic O2 management at home

Answer 47

- improves the health of the PT - helps better neuropsychologic function - increased exercise intolerance - reduced pulmonary hypertension

Question 48

positioning for a PT with COPD

Answer 48

-raise the head of the bed

Question 49

Exercise for PT with COPD

Answer 49

- encourage PT to remain as active as possible

Question 50

Respiratory Therapy

Answer 50

- pursed lip breathing technique - has a longer expiratory phase which helps prevent the bronchiolar collapse and air trapping - diaphragmatic breathing- focuses on using diaphragm instead of accessory muscles to breath which helps slow RR and achieve maximum inhalations and makes the diaphragm stronger

Question 51

Nutrition and Hydration management

Answer 51

- bc they have a hard time eating and breathing they might not be getting all the nutrients that they need - Avoid high CARB diets to prevent the increase in CO2 load - take dietary supplements - eat smaller meals more frequently - 5-6 small meals - fluids - intake normal 2-3 Liters of water to help liquify the mucus

Question 52

preventing infections in individuals with COPD

Answer 52

- teach them to avoid large crowds - get a pneumonia vaccine - yearly influenza vaccine