COPD

Question 1

broadly describe COPD

Answer 1

• chronic obstructive pulmonary disorder
• progressive disorder that gets worse
• risk is cigarette smoking
• either chronic bronchitis or emphysema

Question 2

path of COPD

Answer 2

progressive failure of lungs to be able to ventilate/perfuse

end stage is the same for both

Question 3

what does COPD lead to in both

Answer 3

• abnormal ventilation, perfusion ratio (V/Q)
• hypoxemia
• hypoventilation
• cor pulmonate (R heart failure)

Question 4

describe chronic bronchitis

Answer 4

• BLUE-bloater
• airway problem (air trapping)
• compromised airway, healthy alveoli but air does NOT reach them
• *V/Q Mismatch
• hypercapnea

Question 5

what is V/Q mismatch in chronic bronchitis

Answer 5

perfusion is fine but CANNOT ventilate

Question 6

describe emphysema

Answer 6

• PINK-puffer
• alveolar problem (alveolar hyperinflation)
• ineffective alveoli (bad air trapping, cant push air back out)
• V/Q Matched (perfusion AND ventilation are bad)

Question 7

what are the COPD stages

Answer 7

0-normalish
to
4-severe

Question 8

chronic bronchitis s/s

Answer 8

• airway flow problem
• recurrent cough/sputum
• hypoxia
• respiratory acidosis
• increased Hgb
• increased RR
• cardiac enlargement
• blue bloater

Question 9

emphysema s/s

Answer 9

• alveoli (diffusion) problem
• CO2 retention
• pursed lip breathing
• barrel chest (use muscles not normally used)
• prolonged expiatory time
• THIN (use energy all the time)
• pink puffer
• severe dyspnea at rest
• sit up and lean forward

Question 10

diagnose COPD

Answer 10

• chest x ray
• pulmonary function test (how well can you force air out of lungs?)
• ABG

Question 11

what s/s of hypoxemia (lack of oxygen)

Answer 11

restlessness or confusion

Question 12

assessment indications of COPD or resp problems

Answer 12

• pt with difficulty sleeping (need many pillow or sits up)
• wt loss d/t expenditure of energy to breathe (emphysema)
• ABGs show compensation
• dyspnea
• barrel chest

Question 13

diagnose chronic bronchitis

Answer 13

s/s and history

Question 14

diagnose emphysema

Answer 14

physical change in alveoli

Question 15

treatment goal of COPD

Answer 15

slow progression

smoking cessation

Question 16

meds for COPD

Answer 16

• mucolytic: break up secretions
• pnumococcal and flu vaccine: decrease risk of resp infection
• bronchodilator: improve airflow and reduce air trapping
• theophylline: stimulates resp drive, strengthens diaphramatic contractions, improves cardiac output

Question 17

systemic or inhaled agents for COPD

Answer 17

systemic

Question 18

what are pulmonary hygeine measure

Answer 18

breathing exercise, pursed lip breathing
hydration
coughing, percussion, drainage

Question 19

nursing interventions for COPD

Answer 19

**high fowlers: easiest position to breathe in
oxygen
encourage exercise but rest when needed: walk 2-3 times per week, expand lung capacity, combat muscle wasting

Question 20

who should NOT get a flu shot

Answer 20

allergies to eggs
hx of Gullian Barre
acute illness/fever

Question 21

s/s of flu shot

Answer 21

site soreness, fever, aches

will NOT increase asthma attacks

Question 22

flu can lead to _____

Answer 22

pneumonia

Question 23

what is important when helping COPD pt

Answer 23

ensure they maintain adequate perfusion and ventilation

Question 24

most common indicators of pulmonary embolism

Answer 24

tachypnea (decrease CO2)
hypoxia (decrease O2)
dyspnea

Question 25

risk for pulmonary embolism

Answer 25

immobility, obesity, DVT, post op, post partum, oral contraceptive

Question 26

effects of pulmonary embolism

Answer 26

large pulmonary artery occlusion that can result in sudden death

Question 27

s/s of pulmonary embolism

Answer 27

dyspnea, SOB, chest pain, anxiety, cough, tachycardia, tachypnea, crackles(rales), low grade fever

Question 28

diagnosis of pulmonary embolism

Answer 28

* *d dimer level - CT chest with contrast - lung scans

Question 29

important to remember about d dimer

Answer 29

specific to clot ANYWHERE in body | does not tell where clot is

Question 30

meds for pulmonary embolism

Answer 30

``` anticoagulants (heparin and warfarin) thrombolytic therapy (streptokinase, urokinase) ```

Question 31

describe pulmonary HTN

Answer 31

HIGH pressure system in lungs