Chronic Obstructive Pulmonary Disease (COPD) – Flashcards
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What are two diseases that encompass COPD?
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Emphysema Chronic Bronchitis
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Emphysema affects the __________ while Chronic Bronchitis affects the _________.
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Alveoli; Airway (Bronchi)
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What characterizes Emphysema?
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Loss of elasticity Hyperinflation of lung tissue
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Four functional and anatomical changes of Emphysema
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1. Loss of elasticity 2. Hyperinflation of the lungs 3. Diaphragm becomes weak (flattened) 4. Barrel chest
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What results from hyperinflation of the lungs?
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Air is trapped → increase RR (tachypnea) → dyspnea
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In a COPD patient, what is their main drive for breathing? What airflow would you administer oxygen?
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↓PaO₂; Low flow O₂ (1-2L) Giving more than this would stop their drive to breathe
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Abnormal ABG's with COPD
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↓PaO₂ ↑PaCO₂ (CO₂ Retention) ↓O₂ Saturation
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What characterizes Chronic Bronchitis
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Inflammation and scarring of bronchial tubes
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What causes Chronic Bronchitis?
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Chronic exposure to irritants, especially tobacco smoke
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Chronic exposure to irritants would create what?
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Large amount of thick mucus Thickened airway Impaired airflow
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What occurs with a chronic airway inflammation?
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Vasodilation Mucosal edema Congestion Bronchospasm
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Four pathophysiology ideas regarding Chronic Bronchitis
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Cilia damage Increase airway resistance Pulmonary infections from sputum production Polycythemia
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Why does polycythemia occur in a patient with Chronic Bronchitis?
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It develops in response to hypoxia. Bone marrow produces more RBCs
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What symptoms would predominately appear in a patient with Emphysema?
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SOB Phelgmatic cough Pursed-lip breathing
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What symptoms would predominately appear in a patient with Chronic Bronchitis?
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Persistent mucus filled cough Wheezing SOB Fatigue Respiratory Infections
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Four risk factors regarding COPD
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Cigarette smoking (90%) Air pollution Occupational substance (i.e. coal dust) AAT deficiency (Alpha1-Antitrypsin deficiency)
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What does Alpha 1-antitrypsin (AAT) do?
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Normally prevents lung tissue breakdown
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What are seven respiratory assessments found in a COPD patient?
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Exertional dyspnea → SOB Diminished breath sounds w/ prolonged exhalation Wheezes or crackles Use of accessory muscles Productive cough Respiratory infections Barrel chest
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What are four "other" assessments found in a COPD patient?
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Underweight Clubbing (w/ advanced COPD) Activity intolerance Cor Pulmonale
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What is Cor Pulmonale?
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Right sided heart failure
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What are manifestations with Cor Pulmonale?
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Distended neck veins Dependent edema Enlarged/tender liver
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What are five diagnostic tools of COPD?
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Pulmonary Function Test ABG's Chest X-ray Sputum cultures CBC, BMP
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Give rationales for each diagnostic tool
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-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
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What are ten interventions to help manage COPD?
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Airway maintenance Assess s/s O₂ therapy (low flow 1-2L) Drug therapy Chest physiotherapy (CPT) Controlled coughing Suctioning Positioning Hydration Collaboration with RT
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What are five drugs used for COPD?
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Bronchodilators Methylxanthines Corticosteroids Leukotriene Modifiers Mucomist
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Give an example of a bonchodilator with its therapeutic & side effects
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short-acting albuterol; opens up the airway for rapid relief; can cause tremors/anxiety, tachycardia/palpitations
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Give an example of a mehtylxanthine with it's therapeutic and side effects
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theophylline; relaxes smooth muscles of the bronchi; can cause tachycardia/palpitations, nausea, headache, and diarrhea. Be sure to monitor serum drug level for toxicity
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Give an example of a corticosteroid with its therapeutic & side effects
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prednisone & fluticasone; decreases airway inflammation; serious side effects such as: immunosuppression fluid retention hyperglycemia hypokalemia poor wound healing mouth sores black, tarry stools
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Give an example of a leukotriene modifier with its therapeutic effect
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montelukast; decreases airway inflammation; headache, cough, GI upset; liver contraindication
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Give an example of a mucomist with its therapeutic effects
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guaifenesisn (PO), acetylcysteine (nebulizer); thins and loosen mucus to help expectorate
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What are seven health promoting nursing interventions for a patient with COPD? (All dealing with education...)
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Avoid smoking Avoid irritants/cold weather Adequate nutrition Prevent/eliminate lung infections Teach breathing techniques Bronchodilator therapy and MDI Importance of pneumonia & flu vaccines
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What are two breathing techniques for a patient with COPD?
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Pursed-lip breathing Diaphragmatic breathing
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What are eight nursing diagnoses for COPD?
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Impaired gas exchange Ineffective breathing pattern Ineffective airway clearance Alteration in nutrition, less than body req' Anxiety Activity intolerance RC: pneumonia RC: respiratory failure
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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
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- 3 - 1 - 2 - 4 - 5
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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."
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C. "I can have an increase in my heart rate while taking this medication."
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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
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A, C, E
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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."
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D. "I will take in a deep breath and hold it before exhaling."
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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."
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A. "There are portable oxygen delivery systems than you can take with you."
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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
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C. Take a deep breath in through your nose
