cdunbar4's version from 2016-09-27 19:50

Patho, Etiology, etc.

Question Answer
What is COPD & is it reversible?airway obstruction resulting from chronic bronchitis OR emphysema. Obstruction is generally progressive, may be partially reversible & is accompanied by airway hyperreactivity
Cigarette smoking & irritating effects on cellscauses hyperplasia →↑ mucus production & ↓ airway diameter & ↑ difficulty in clearing secretions
How do resipratory tract infections contribute to COPD?impairs normal defense mechs., makes bronchioles & alveoli more susceptible to injury. Retained secretions provide a medium for their proliferation.
Other contributing factors to COPDUrban air pollution; occupational pollutants; genetic deficiency in a1-antitrypsin (AAT); smoking greatly exacerbates disease process; aging (decreased elasticity of lungs, thoracic cage & respiratory muscles)
What is a1-antitrypsin (AAT)normally, it inhibits breakdown of lung tissues by proteolytic enzymes from neutrophils & lymphocytes. If deficient, result allows for destruction of lung tissue.
Emphysema pathophysiologyhyperinflation of alveoli, destruction of alveolar walls, destruction of alveolar capillary walls, narrowed, small airways and loss of lung elasticity
2 types of emphysemacentrilobular (primary area of destruction is in central part of lobule) & panlobular (whole lobule is destroyed)
How does the destruction of alveoli walls ↓ O2 in circulation?less SA = less O2 diffusion into blood
Chronic bronchitis descriptionexcessive prod. of mucus in bronchi accompanied by a recurrent cough for 3m of the year for 2 consecutive years
Pathologic changes in lung d/t chronic bronchitishyperplasia of mucous-secreting glands in trachea and bronchi, increase in goblet cells, disappearance of cilia, chronic inflamm. changes, narrowing of small airways & altered function of alveolar macrophages leading to ↑ bronchial infections
How do the airways frequently get colonized with microorganisms in a patient with chronic bronchitis?excessive amounts of mucus harbor microorganisms can lead to infections
Biggest difference b/t emphysema and bronchitis in relation to alveoli?Bronchitis = scarring of alveolar walls Emphysema = destruction of alveolar walls
Clinical Manis emphysemaearly sign is dyspnea; underweight
chronic bronchitis clinical manisfreq., prod. cough during winter months (early sign); freq. resp. infections; dyspnea on exertion develops later; bluish-red color of skin; normal weight or heavyset with a ruddy appearance
Polycythemia is a mani of bronchitis; what is it and why does it develop?↑ Hgb concentration in blood; as a result of ↑ production of RBCs secondary to body's attempt to compensate for lack of O2
Complications COPDCor pulmonale d/t pulmonary HTN
Causes of pulmonary HTNconstriction of pulmonary vessels in response to alveolar hypoxia
Manis of cor pulmonalejugular vein distention, hepatomegaly w RUQ tenderness, ascites, epigastric distress, peripheral edema & wt. gain
Management of Cor Pulmonalecontinous low-flow O2. Long term O2 therapy can slow progression of PHTN in COPD
Diuretics are usually used, why with caution?tendency to deplete K & Cl & reduce intravascular volume & CO
Most common event leading to acute respiratory failure in COPDAcute resp. tract infection (usually viral) or acute bronchitis
What GI disease is increased with COPD?peptic-ucler disease, cause is unknown (perhaps LT use of bronchodilator or corticosteroid drugs or to stressful nature of disease)
COPD pt. has purulent sputum, what complication could this be?pneumonia; could also have systemic manis of pneumonia fever, chills, leukocytosis may NOT be present.

Clinical features emphysema

Question Answer
Age30-40 (onset); 40-50 (disabling)
Body buildthin
health historygenerally healthy, occasional insidious dyspnea, smoking
weight lossoften underweight
dyspneaslowly progressive & eventually disabling
sputumscanty, mucoid
chest exammarked increase in AP diameter, quiet or diminished breath sounds, limited diaphragmatic excursion
cor pulmonalerare except terminally

Diagnostic studies emphysema

Question Answer
ABGsnear normal, mild decreased PaO2, normal or decreased PaCO2
chest xrayhyperinflation, flat diaphragm, attenuated peripheral vessels, small or normal heart, widened intercostal margins
Total lung capacity (↑ or ↓)?increased
residual volume (↑ or ↓)?increased
VC (↑ or ↓)?decreased
FEV1 (↑ or ↓)?decreased
FEV1/FVC (↑ or ↓)?decreased (<70%)
Hct & HgBNormal until late disease

Clinical Features Chronic Bronchitis

Question Answer
age20-30 (onset) 60-70 (disabling)
body buildtendency towards obesity
HHrecurrent RTI, smoking
Weight lossabsent or slight
dyspneavariable, relatively late
sputumcopious, mucopurulent
chest examinationslight to marked increase in AP diameter, scattered crackles, rhonchi & wheezing

Diagnostic Studies Chronic Bronchitis

Question Answer
ABGs (oxygen & carbon dioxide)decreased PaO2, increased PaCO2
Chest xraycardiac enlargement, normal or flat diaphragm, evidence of chronic inflammation, congested lung fields
Total lung capacity (↑ or ↓)?normal or slightly increased
Residual volume (↑ or ↓)?increased
VC (↑ or ↓)?decreased
FEV1 (↑ or ↓)?decreased
FEV/FVC (↑ or ↓)?decreased (<70%)
Hct & Hgbincreased

Collaborative Care

Question Answer
primary goalsimprove ventilation, promote secretion removal, prevent complications & progression of sx, patient comfort, improve QOL
2 vaccines ppl with COPD should get every yearflu & pneumococcal
Treat RI asap; what are the best indications of a RI?purulent sputum, increased quantity and viscosity of sputum.
Cessation of smoking is key to slow disease progression, what is the non-nicotine med to help with withdrawals?buproprion/Zyban
Bronchodilator therapy can help reduce dyspnea and what other Lung Volume can increase?Forced Expiratory Volume 1
O2 therapy to maximize...oxygen-carrying ability of the blood to perfuse tissues
Respiratory care includes:breathing re-training, effective cough techniques, chest physiotherapy & aerosal-nebulization therapy.
What 3 surgical procedures have been used in severe COPD?bullectomy (removal of bullae); lung volume reduction surgery; lung transplant
how long should pt. rest before eating in order to conserve energy?30 min; eat 5-6 small, frequent meals to avoid feelings of bloating & early satiety

Nursing Management

Question Answer
Goalsbaseline respiratory function; perform ADLs; relief from dyspnea; no complications r/t COPD; knowledge and ability to implement a long-term tx regimen; overall improved QOL
Intervention (acute)t/t complications: pneumonia, cor pulmonale, acute resp. failure
Pulmonary rehabilitationPT (bronchial hygiene, exercise conditioning, breathing retraining, energy conservation); nutrition, smoking cessation, envtl nutrition, education, health promo, counseling, vocational rehabilitation
Best exercise for COPD pt?Walking-nurse should walk pt, give verbal reminders when necessary regarding breathing & steps.
How can you modify sexual activity w/o abstaining completely?do not assume dominant position or prolong foreplay; use a bronchodilator before activity to help with ventilation; pursed-lip breathing
Improve sleep hygiene:nasal saline sprays, decongestants, nasal steroid inhalers,
long-acting theophylline for sleep MOA; CI with?decreases bronchospasm and airway obstruction CI: Tagamet can cause death
expected outcomesnormal breath sounds, effective coughing, return of PaO2 to normal range for pt, improved mental status, normal body wt., normal serum PRO levels, feeling of being rested, improvement of sleep pattern,behaviors minimizing RF infection, NO INFECTIONS!!!
Chest Physotherapypostural drainage: use bronchodilator b4, work to cough & loosen up secretions, remain in postural position for 5 min (DO NOT schedule around meals)
Pursed-lip breathinghelps with expiratory phase/stress; inhale slowly through nose
What is never a solution for COPD stress?Sedation
abdominal breathinglay on back, put book on upper abdomen, get muscles to contract (push up on diaphragm)

Section 8

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