NURS 3512 - Class 1-6 > Week 2 - COPD > Flashcards

Week 2 - COPD Flashcards

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1
Q

what is COPD

A
  • respiratory disorder characterized by progressive, partially reversible airflow obstruction, systemic manifestations & increasing frequency and severity of exacerbations
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2
Q

what are causes of COPD (5)

A
  • smoking
  • occupational chemicals and dusts
  • infection
  • heredity
  • aging
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3
Q

what does COPD cause

A
  • airflow obstruction

- limited airflow

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4
Q

why is there limited airflow in COPD? what does this cause? what is this called?

A
  • loss of elasticity of the alveoli sacs from damage (emphysema)
    = inability to fully exhale
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5
Q

why is there airflow obstruction in COPD (4)? what is this called?

A

caused by:

  • inflammation
  • mucus hypersecretion
  • mucosal edema
  • bronchospasm

= bronchitis

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6
Q

what does COPD lead to? (6)

A
  • inability to expire air = hyperinflation
  • abnormal gas exchange = hypoxemia & hypercapnia
  • V/Q mismatch
  • excess mucus production
  • pulmonary HTN
  • hypertrophy of the right ventricle of the heart –> right sided heart failure
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7
Q

how does COPD cause pulmonary HTN

A
  • small pulmonary arteries undergo vasoconstriction in response to hypoxemia
  • changes in structure
  • body tries to compensate by increasing RBC production
  • -> thickening of vascular sm. m
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8
Q

how does pulmonary HTN lead to hypertrophy of the right ventricle & right sided heart failure?

A
  • the pressure in the pulmonary arteries leads to blood backflowing into the right side of the heart
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9
Q

when should a diagnosis of COPD considered (5)

A

if the pt:

  • has cough
  • sputum production
  • dyspnea
  • history of smoking
  • exposure to risk factors
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10
Q

what effect does COPD have on the resp. system (9)

A
  • chronic dyspnea
  • chronic cough
  • sputum (esp. w bronchitis)
  • accessory muscle breathing
  • pursed lip breathing
  • prolonger expiratory time
  • abnormal lung sounds
  • orthopneic
  • bluish-red color (cyanosis r/t hypoxia & erythema r/t polycythemia)
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11
Q

what effect does COPD have on body comp. (3)

A
  • barrel chest (due to hyperinflation)
  • thin in appearance (weight loss)
  • digital clubbing
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12
Q

what effect does COPD have on energy (3)

A
  • fatigue
  • lack of energy
  • unable to tolerate activity (SOB)
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13
Q

what effect does COPD have on ABGs`

A
  • low O2 (hypoxemia)
  • high CO2 (hypercapnia)
  • resp. acidosis
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14
Q

why might a person w COPD lose weight

A
  • pt spends a lot of energy breathing & in hypermetabolic state
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15
Q

what lung sounds might you hear in COPD (3)

A
  • wheezing
  • crackless (d/t mucus)
  • decreased breath sounds
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16
Q

what effect does mild COPD have on lung function?

A
  • SOB when hurrying on the level or walking up a slight hill
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17
Q

what effect does moderate COPD have on lung function & daily actvities

A
  • SOB causing the pt to stop after walking approx 100 m or a few min on the lvl
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18
Q

what effect does severe COPD have on lung function (SOB) (4)

A
  • SOB resulting in the pt being to breatheless to leave the house
  • breathless when dressing or undressing
  • presence of chronic resp failure
  • signs of right sided HF
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19
Q

what position helps a pt with COPD breathe better

A

tripod position

- pt stands upright with arms on a fixed surface & is kinda bent over the surface

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20
Q

what are complications of COPD (4)

A
  • cor pulmonae
  • acute exacerbations
  • acute resp. failure
  • depression, anxiety, and panic
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21
Q

what is cor pulmonae

A
  • hypertrophy of the right side of the heart, with or without heart failure
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22
Q

what causes cor pulmonae

A
  • pulmonary HTN
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23
Q

what causes pulmonary HTN (2)

A
  • constriction of pulm vessels r/t alveolar hypoxia

- erythropoiesis = increased viscosity of blood

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24
Q

how does pulmonary HTN lead to cor pulmonae

A
  • the increase pressure in the pulmonary arteries causes the right side of the heart to have to increase its work to push blood into the lungs
  • eventually leads to heart failure
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25
what are signs of cor pulmonale (9)
- dyspnea - distension of neck veins - hepatomegly - peripheral edema - weight gain - ascites - epigastric distress - lung sounds normal or w crackers at bases - changes to heart sounds
26
what is the treatment for cor pulmonale (5)
- continuous admin of low-flow O2 - diuretics - low-sodium diet - bronchodilator therapy - calcium channel blockers and vasodilators
27
what must be monitored during treatment for cor pulmonale (2)
- electrolytes (esp. hypokalemia r/t arythmias) | - serum creatinine & BUN (diuretics can cause volume depletion)
28
what is the treatment for cor pulmonale is medical treatment fails
- lung transplantation
29
what is the most frequent cause of medical visit, hospitalizations, and death among people w COPD
- acute exacerbations
30
what is an acute exacerbation of COPD
- sustained worsening of dyspnea, cough, or sputum production - where sustained = change from baseline that lasts 48 hr or longer
31
what can cause acute exacerbations of COPD (6)
- infection - allergens - irritants - cold air - fires - air pollution
32
what is important to note when treating an acute exacerbation of COPD
- is the sputum purulent or nonpurulent (infection??) | - if an infection, given antibiotics for 7-10 das
33
what is treatment for an acute exacerbation of COPD (4)
- a/b if infection - increase inhaled bronchodilators - oral systemic steroids - O2 therapy
34
what can be used to diagnose an acute exacerbation of COPD (5)
- history - physical exam - ABGs - SaO2 - chest xray
35
what is a frequent complication of COPD
- pneumonia
36
what can lead to acute resp failure in a pt w COPD (4)
- acute exacerbation - exacerbation of cor pulmonale - discontinuing of bronchodilators or corticosteroids - surgery or severe, painful illness involving the chest or abdomen (leads to splinting, ineffective ventilation, resp. failure)
37
what can exacerbate acute resp failure (3)
- beta blockers (ex. propanolo) - sedatives - narcotics
38
what can be done to avoid exacerbation of resp failure, if a pt has both cardio and pulmonary conditions
- use of cardioselective beta blockers
39
how do sedatives and narcotics exacerbate or cause resp. failure? when is this imp. to remember/consider
- suppress ventilatory drive | - imp. if post-op
40
what does acute resp. failure require
- hospitalization | - specialized care
41
why do high rates of people w COPD experience dperession, anxiety, and panic (3)
- feelings of loss (ex. of hobbies, social activities, work) & grief associated w the progressive course of disease - heightened dyspnea --> anxiety --> trying to breathe faster - guilt of smoking
42
what are the main goals of collaborative care for someone w COPD (6)
- prevent disease progression - reduce frequency and severity of exacerbations - alleviate breathlessness & other symptoms - improve exercise tolerance - improve health status and quality of life - reduce risk of mortality
43
what is the most significant factor in slowing the progression of COPD
- smoking cessation
44
what is the benefit of smoking cessation r/t COPD (2)
- after a pt stops smoking, the accelerated decline in function slows and improve - sooner the pt stops smoking, the less pulmonary function is lost & sooner symptoms decrease
45
what is the mainstay of pharmacological therapy for COPD
- bronchodilators
46
what do bronchodilators do (3)
- relax smooth muscles in the airway - reduces airway resistance & hyperinflation - improves ventilation of the lungs = reduce the degree of breathlessness
47
what are 4 categories of bronchodilators often used for COPD
- SABA - LABA - anticholinergics - steroidal anti-inflammatorys
48
what is a type of SABA
- salbutamol (ventolin)
49
what do SABA do (3)
- improve pulm function - improve symptoms - improve exercise fnxn
50
what two meds are often used together to produce superior bronchodilation
- SABAs and anticholinergics
51
what is a type of anticholinergic for COPD
- ipatropium bromide (atrovent)
52
what is the function of anticholinergic (2)
- bronchodilates | - decreases mucus
53
how is bronchodilator therapy usually used for pts w COPD
- as maintenance therapy , 3-4 times/day | - with extra puffs as needed for breakthrough symptoms
54
who are LABAs usually indicated for
- pts w more severe COPD & who experience more persistent symptoms
55
what is the fnxn of LABAs
- relax smooth muscle in the airway = bronchodilation | - sustained improvements in pulm. function, activity-related dyspnea, quality of life
56
what is a type of LABA
- salmeterol (serevent)
57
what are oral/parental corticosteroids used for r/t COPD
- acute exacerbations
58
what is the benefit of corticosteroids for COPD (3)
- speed recovery time - reduce relapse rates - reduce need for hospitalization
59
how long are people typically on corticosteroids for COPD? why?
- 7-14 days | - continuous use can lead to side effects
60
what effects for corticosteroids have (2)
- anti-inflammatory | - immunosuppressive
61
what is a type of corticosteroid used for COPD
- hydrocortisone
62
what are different types of treatment for COPD (7)
- smoking cessation - meds - O2 therapy - surgery - nutritional therapy - breathing exercises - health promotion
63
what is O2 therapy used to do? (2)
- reduce work of breathing | - maintain PaO2 to reduce workload on the heart
64
what should O2 sats be for a pt on O2 therapy for COPD
- should be >90% or as prescribed
65
O2 from cylinder or wall systems are dry. what indication does this have
- the O2 must be humidified when administered, eitehr via humidification or nebulization - imp. bc dry O2 has irritating effect on mucus members & dries secretions
66
what are some complications of O2 therapy (5)
- combustion - O2 toxicity - carbon dioxide narcosis - infection - absorption atelectasis
67
what is carbon dioxide narcosis
- CO2 usually drives us to breath - the constant high lvls of CO2 during COPD makes the resp. center lose its sensitivity to COPD - so now the drive to breath is hypoxemia = administered O2 weakens their drive to breath
68
what type of breathing exercise is used for a pt w COPD
- pursed lip breathing
69
what is the benefit of pursed lip breathing
- prolongs exhalation - prevents bronchiolar collapse & air trapping - assist w dyspnea
70
explain how pursed lip breathing is done
1. relax neck and shoulder muscles 2. inhale thru the nose to count of 2 3. pucker lips as if whisling 4. exhale slowly & gently thru lips while counting to 6 5. always exhale longer then inhale
71
why is effective coughing imp. for pt w COPD
- many pts have developed ineffective coughing patterns that do not adequately clear the airways of sputum
72
what is huff coughing? how is it done?
- effective technique that the pt can be taught easily - before the pt coughs, take deep breath & lean forward - cough 3-4 times of exhalation
73
what are the main goals of huff coughing?
- conserve energy - reduce fatigue - facilitate removal of secretions
74
what things r/t to nutrition are common among people w COPD
- weight loss | - mlanutrition
75
why is weight loss and malnutrition common in COPD (4)
- increased WOB = increased energy expenditure - eating become an effort d/t dyspnea - difficulty breathing while eating = inadequate comsumption - pressure on diaphragm from a full stomach causes dyspnea
76
what can pts with COPD do to decrease dyspnea and conserve energy r/t nutrition (3)
- rest at leasr 30 min before eating - use bronchodilator before meals - prepare foods in advance
77
what other nutritional therapy is done for pts w COPD? (6)
- 2-3 L of fluid per day (unless contraindicated for other medical conditions like HF) - sodium restriction if has HF - corticosteroid use can lead to osteoporosis = calcium and vitamin D intake imp. - avoid foods that form intestinal gas - high cal - high protein
78
what is the best prevention for COPD
- cessation of smoking
79
what are important preventive measures to maintain healthy lungs (4)
- avoid or control occupational & enviro pollutants & irritants - influenze & pneumococcal vaccines - avoid large crowds during peak influenza times - hygeine
80
what education should be given to a pt w COPD (9)
- breathing exercises - energy conserving strategies - sleep - psychosocial consideration - meds & how to use an inhaler - need for home O2 - smoking cessation - pulmonary rehab --> walk 20 min/day - nutrition
81
what are some energy conserving strategies to teach a pt with COPD (6)
- using a tripod position - use O2 therapy during activities of hygeine - exhale when pushing, pulling, or exerting effort - sit as much as possible when doing activities - exercise training of upper extremities reduce dyspnea - alternative energy saving practices for ADLs
82
what is important to teach a pt with COPD r/t sleep (3)
- adequate sleep is v important - LABA may help with coughing during the night - postnasal drip can be treated w nasal saline sprays, rinses, or steroids
83
what are some psychosocial considerations during teaching of a pt w COPD
- use of relaxation techniques for dyspnea - emotional support for feelings of guilt, anxiety, depression, etc. - use of support groups - understanding the difficulty of the lifestyle changes, decreased ability to do ADLs, social activities, etc. they are experiencing
84
what are some relaxation techniques to teach a pt with COPD
- progressive muscle relaxation - positive thinking - visualization - music - massage - use of humour
85
what should you teach a pt regarding acute exacerbations (3)
- S&S - prompt treatment of acute exacerbations & infections are important - aware of and avoid triggers
86
why is digital clubbing a sign of COPD
- clubbing occurs r/t prolonged hypoxemia
87
what effect does COPD have on the hematological system? why?
- causes polycythemia | - the body attempts to make more RBC to carry O2 to compensate for hypoxemia
88
how is COPD diagnosed
- spirometry is done after bronchodilator treatment --> certain lvls correlate to COPD stages - also look at severity of symptoms
89
why are calcium channel blockers and vasodilators used as tx for COPD
- relax sm. muscle | - decrease pulmonary vascular resistance
90
why are diuretics and low sodium diets given for tx of COPD? what is imp to monitor for a pt on diuretics
- decrease workload on heart by getting rid of fluid | - monitor electrolytes
91
what is the effect of acute exacerbations of a pt with COPD
- more often they happen= increase in damage & further progression of the disease
92
what are nursing care interventions for a pt with COPD experiencing depression, anxiety, and panic
- monitor for depression - refer to help - meds if needed - covery understanding - encourage relaxation , esp. when anxious (ex. meditation)
93
what route of meds is most preferred for COPD
- inhaled
94
what is the goal of O2 therapy for a pt with COPD? why is this imp?
- raise the PaO2 with just enough O2 | - otherwise it could reduce ventilatory drive r/t carbon dioxide narcosis
95
at what amt of O2, is it especially imp to humifiy the O2?
>4L
96
what are some signs that a pt with COPD/an acute exacerbation is doing better? (4)``
- increased oxygenation - better mental status - decreased CO2 lvl - more productive cough
97
a nursing diagnosis r/t COPD is ineffective breathing pattern. what nursing intervention can help the pt return to baseline resp function (7)
- monitor resp and O2 status - auscultate breath sounds - encourage DB&C - encourage turning - administer meds - position to minimize resp efforts (HOB elevated, table to lean on) - monitor for resp muscle fatigue to detect need for ventilatory assistance - initiate a program of resp muscle strength and/or endurance training
98
a nursing diagnosis r/t COPD is ineffective airway clearance. what are some nursing interventions that can help improve effective coughing, clear airway, decrease dyspnea (4)
- facilitate deep breathing by sitting the pt up - ensure adequate hydration to liquefy ssecretions - teach coughing techniques - assist w inhaled bronchodilator admin
99
a nursing diagnosis r/t COPD is impaired gas exchange. what nursing interventions can help decrease CO2 lvls, increase O2 lvls, improve dyspnea & mental status? (8)
- monitor resp and O2 status - teach pursed-lip breathing to prolong expiratory phase - assist pt to position of comfort (tripod, etc.) - admin and teach how to use bronchodilators - teach S&S and consequences of hypercapnia - teach avoidance of CNS depressants (further depress resp) - admin O2 if appropriate - select O2 supply systems and devices
100
a nursing diagnosis r/t COPD is imbalanced nutrition. what nursing interventions can help this (5)
- monitor caloric intake, weight, serum albumin, protein lvls - provide menu suggestions for high protein & cal foods - give pt high protein & high cal liquid supplements - plan periods of rest before & after food intake - refer to agency for financial and nutrional assistance
101
a nursing diagnosis r/t COPD is disturbed sleep patterns. what nursing interventions can help improve sleep (8)
- identify usual sleep habits and elicit reasons for difficulty sleeping - monitor pts sleep pattern and physical circumstances - observe for S&S of sleep apnea - identify pt-specific methods of relaxaion and teach methods - encourage activity and exercise during daylight - provide pt with activitity that promotes wakefulness to limit daytime sleep - instruct pt in arranging surrounds to produce an enviro conductive to sleep - teach pt to avoid alcohol beverages, caffeine products, and other stimulants before bedtime
102
a nursing diagnosis r/t COPD is risk of infection. what nursing interventions can reduce this risk (7)
- monitor for S&S - teach pt to assess indicators of infection - teach pt good handwashing and hygeine techniques & avoid contact w people w resp infections - encourage vaccination - teach proper care and cleaning of home resp equipment - teach pt to seek medical attention for signs of infection - teach pt to follow plan of care for managing exacerbations
NURS 3512 - Class 1-6
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