question

What are two diseases that encompass COPD?

answer

Emphysema Chronic Bronchitis

question

Emphysema affects the __________ while Chronic Bronchitis affects the _________.

answer

Alveoli; Airway (Bronchi)

question

What characterizes Emphysema?

answer

Loss of elasticity Hyperinflation of lung tissue

question

Four functional and anatomical changes of Emphysema

answer

1. Loss of elasticity 2. Hyperinflation of the lungs 3. Diaphragm becomes weak (flattened) 4. Barrel chest

question

What results from hyperinflation of the lungs?

answer

Air is trapped → increase RR (tachypnea) → dyspnea

question

In a COPD patient, what is their main drive for breathing? What airflow would you administer oxygen?

answer

↓PaO₂; Low flow O₂ (1-2L) Giving more than this would stop their drive to breathe

question

Abnormal ABG's with COPD

answer

↓PaO₂ ↑PaCO₂ (CO₂ Retention) ↓O₂ Saturation

question

What characterizes Chronic Bronchitis

answer

Inflammation and scarring of bronchial tubes

question

What causes Chronic Bronchitis?

answer

Chronic exposure to irritants, especially tobacco smoke

question

Chronic exposure to irritants would create what?

answer

Large amount of thick mucus Thickened airway Impaired airflow

question

What occurs with a chronic airway inflammation?

answer

Vasodilation Mucosal edema Congestion Bronchospasm

question

Four pathophysiology ideas regarding Chronic Bronchitis

answer

Cilia damage Increase airway resistance Pulmonary infections from sputum production Polycythemia

question

Why does polycythemia occur in a patient with Chronic Bronchitis?

answer

It develops in response to hypoxia. Bone marrow produces more RBCs

question

What symptoms would predominately appear in a patient with Emphysema?

answer

SOB Phelgmatic cough Pursed-lip breathing

question

What symptoms would predominately appear in a patient with Chronic Bronchitis?

answer

Persistent mucus filled cough Wheezing SOB Fatigue Respiratory Infections

question

Four risk factors regarding COPD

answer

Cigarette smoking (90%) Air pollution Occupational substance (i.e. coal dust) AAT deficiency (Alpha1-Antitrypsin deficiency)

question

What does Alpha 1-antitrypsin (AAT) do?

answer

Normally prevents lung tissue breakdown

question

What are seven respiratory assessments found in a COPD patient?

answer

Exertional dyspnea → SOB Diminished breath sounds w/ prolonged exhalation Wheezes or crackles Use of accessory muscles Productive cough Respiratory infections Barrel chest

question

What are four "other" assessments found in a COPD patient?

answer

Underweight Clubbing (w/ advanced COPD) Activity intolerance Cor Pulmonale

question

What is Cor Pulmonale?

answer

Right sided heart failure

question

What are manifestations with Cor Pulmonale?

answer

Distended neck veins Dependent edema Enlarged/tender liver

question

What are five diagnostic tools of COPD?

answer

Pulmonary Function Test ABG's Chest X-ray Sputum cultures CBC, BMP

question

Give rationales for each diagnostic tool

answer

-PFT's for diagnosis and measures lung volume; an increased residual volume means trapped air -ABG's: ↓PaO₂, ↓O₂ sat, ↑ PaCO₂ -Chest X-Ray: shows hyperinflated lungs, flattened diaphragm, and ↑AP diameter (barrel chest) -Sputum cultures: for culture and sensitivity -CBC, BMP: additional tests

question

What are ten interventions to help manage COPD?

answer

Airway maintenance Assess s/s O₂ therapy (low flow 1-2L) Drug therapy Chest physiotherapy (CPT) Controlled coughing Suctioning Positioning Hydration Collaboration with RT

question

What are five drugs used for COPD?

answer

Bronchodilators Methylxanthines Corticosteroids Leukotriene Modifiers Mucomist

question

Give an example of a bonchodilator with its therapeutic & side effects

answer

short-acting albuterol; opens up the airway for rapid relief; can cause tremors/anxiety, tachycardia/palpitations

question

Give an example of a mehtylxanthine with it's therapeutic and side effects

answer

theophylline; relaxes smooth muscles of the bronchi; can cause tachycardia/palpitations, nausea, headache, and diarrhea. Be sure to monitor serum drug level for toxicity

question

Give an example of a corticosteroid with its therapeutic & side effects

answer

prednisone & fluticasone; decreases airway inflammation; serious side effects such as: immunosuppression fluid retention hyperglycemia hypokalemia poor wound healing mouth sores black, tarry stools

question

Give an example of a leukotriene modifier with its therapeutic effect

answer

montelukast; decreases airway inflammation; headache, cough, GI upset; liver contraindication

question

Give an example of a mucomist with its therapeutic effects

answer

guaifenesisn (PO), acetylcysteine (nebulizer); thins and loosen mucus to help expectorate

question

What are seven health promoting nursing interventions for a patient with COPD? (All dealing with education...)

answer

Avoid smoking Avoid irritants/cold weather Adequate nutrition Prevent/eliminate lung infections Teach breathing techniques Bronchodilator therapy and MDI Importance of pneumonia & flu vaccines

question

What are two breathing techniques for a patient with COPD?

answer

Pursed-lip breathing Diaphragmatic breathing

question

What are eight nursing diagnoses for COPD?

answer

Impaired gas exchange Ineffective breathing pattern Ineffective airway clearance Alteration in nutrition, less than body req' Anxiety Activity intolerance RC: pneumonia RC: respiratory failure

question

NCLEX test question Assessment findings are as follows: T 99.8, HR 124, RR 30 B/P 130/76, sat 91% on room air. Prioritize the following nursing interventions. ______ Administer antibiotics ______ Administer O2 therapy ______ Obtain sputum specimen ______ Administer Tylenol ______ Provide pneumococcal vaccine

answer

- 3 - 1 - 2 - 4 - 5

question

ATI CH 22 A nurse is providing discharge teaching to a client who has COPD and has a new prescription for albuterol (Proventil). which of the following statements made by the client indicates an understanding of the teaching? A. "This medication can increase my blood sugar levels." B. "This medication can decrease my immune response." C. "I can have an increase in my heart rate while taking this medication." D. "I can have mouth sores while taking this medication."

answer

C. "I can have an increase in my heart rate while taking this medication."

question

ATI CH. 22 A nurse is preparing to administer a new prescription prednisone (Deltasone) to a client who has COPD. Which of the following should the nurse monitor for? (Select all that apply.) A. Monitor the client for hypokalemia B. Monitor the client for tachycardia C. Observe the client for fluid retention D. Monitor the client for nausea E. Advise the client to report black, tarry stools

answer

A, C, E

question

ATI CH. 22 A nurse is instructing a client on the use of an incentive spirometer. Which of the following statements made by the client indicates an understanding of the teaching? A. " I will place the adapter on my finger to read my blood oxygen saturation level." B. "I will lie on my back with my knees bent." C. "I will rest my hand over my abdomen to create resistance." D. "I will take in a deep breath and hold it before exhaling."

answer

D. "I will take in a deep breath and hold it before exhaling."

question

ATI CH. 22 A nurse is discharging a client who has COPD. Upon discharge, the client is concerned that he will never be able to leave his house now that he is on continuous oxygen. Which of the following is an appropriate response by the nurse? A. "There are portable oxygen delivery systems than you can take with you." B. When you go out, you can remove the oxygen and the reapply it when you get home." C. "You probably will not be able to go out as much as you used to." D. "Home health services will come to you so you will not need to go out."

answer

A. "There are portable oxygen delivery systems than you can take with you."

question

ATI CH. 22 A nurse is planning to instruct a client on how to perform pursed-lip breathing. Which of the following should the nurse include in the plan of care? A. Take quick breaths upon inhalation. B. Place your hand over your stomach C. Take a deep breath in through your nose D. Puff your cheeks upon exhalation

answer

C. Take a deep breath in through your nose

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