N353: Nursing Care of the patient with COPD – Flashcards
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3rd leading cause of death in america
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COPD
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primary risk factor for COPD
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smoking
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bronchitis skin and
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- Bluish-red skin tones - Blue (Cyanosis - Good lung perfusion/Bad ventilation) - Red (Polycythemia)
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respiratory system with bronchitis
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Frequent cough Foul smelling sputum (d/t bacteria) Frequent pulmonary infections
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weight for bronchitis
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Tendency for oBesity
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if you have bronchitis, what are you are risk for and why?
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DVT d/t H&H increases
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Emphysema respiratory system
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- Pursed lip breathing - Obvious use of accessory muscles - Barrel chest - Progressive DOE - Diminished breath sounds
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emphysema weight
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Underweight
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what is persistent in emphysema and why?
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Persistent tachycardia d/t inadequate oxygenation
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explain COPD
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chronic airway pbstruction -> they can't get air out and then the airway collapses due to inflammation resulting in bronchospasm, swelling, excess mucus, and barrel chest
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risk factors for COPD
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- Repeated lung damage from infections/pollution (15%) - Genetics (5%) - Direct and second-hand cigarette smoke (80%!)
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examples of pollutants that cause COPD
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- Indoor air pollution from cooking stoves - Occupational pollutants
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genetics that lead to COPD
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Alpha-1 antitrypsin deficiency Cystic Fibrosis
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leading preventable cause of death in the US
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smoking
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what does smoking increase the risk of?
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- coronary heart disease - stroke - developing lung cancer
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Within 2 to 5 years after quitting smoking, your risk for stroke could fall to about
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the same as a nonsmoker's.
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besides heart disease and cancer deaths being caused by smoking, what else can smoking cause?
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- lung infections - number and severity of asthma attacks - middle ear infections - low-birth weight baby
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smoking allows the rapid distribution of....
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nicotine
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explain rapid nicotine distribution
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- Increases its "addiction index" - Peaks and dissipates quickly
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how does nicotine addiction work?
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it activates the reward pathway increasing the level of dopamine
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what happens to the brain when you have a nicotine addiction?
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the brain physical changed resulting in a continued addiction
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what is a strong component of a nicotine addiction?
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strong behavioral component
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how to combat smoking cessation
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- counseling - meds
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what meds help smoking cessation
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- Nicotine-replacement therapies (gum, inhaler, nasal spray, and patch) - varenicline (Chantix) - bupropion (Zyban)
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how does bupropion work?
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Appears to act on pathways in the brain that are involved in nicotine addiction
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interventions for smoking (3)
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- biofeedback - emotional support - counseling
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biofeedback
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people learn to calm themselves instead fo reaching for a cigarette to calm themselves
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triad s/s of COPD
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- Increased sputum production - Cough (Bronchitis) - Dyspnea on exertion (Emphysema)
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explain the cough in bronchitis
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Intermittent, usually in AM, expectorate small amounts of sticky mucus
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explain the doe in emphysema
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Gradually worsens and interferes with ADL's
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chest xray for bronchitis
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- Enlarged heart - Congested lung fields - Normal or flattened diaphragm (d/t to chronically over inflated lung to try and breath)
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pulmonary function test for bronchitis & emphysema
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increased residual air volume, decreased vital capacity, decreased FEV1 and FVC ratio
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ABGs, pulse ox in bronchitis & emphysema
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decreased PO2
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what is a dx test for bronchitis
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elevated rbc because it's the body's attempt to try and get oxygen by producing a higher amount of oxygen carrying guys
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chest X-ray of someone with emphysema
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Hyper-inflated lungs Flattened diaphragm
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lab test for empysema
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6MWT Walk, level surface, at own rate, for 6 minutes Measure the distant traveled
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complications/consequences of COPD
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- Chronic reduced PaO2 levels - Pneumonia and other pulmonary infections - Pneumothorax - Atelectasis - Pulmonary hypertension - Lung cancer - Peptic Ulcer Disease - Severe weight loss and malnutrition - Right-sided heart failure - Respiratory failure - Increased risk of DVTs Fatigue - Altered mobility - Depression - Limited socialization - Socio-economic consequences - Shortened lifespan - Mechanical ventilator
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right side heart failure caused by lung disease
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Cor Pulmonale
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general goals in COPD
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- Early diagnosis - Prevent further deterioration - Alleviate symptoms - Improve ability for ADL's/quality of life issues
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general strategies in COPD
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- Medication as appropriate for symptoms (Inhalers, etc.) - Regular oxygenation PRN - Early intervention for infections (Antibiotics) - Chest PT - Adequate fluid intake - Oral care - Vaccinations - Pulmonary rehab
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two huge vaccinations for the pt with COpD
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Pneumonia Influenza
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4 main nursing goals for the patient with COPD
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- SMOKING CESSATION - Managing symptoms - Maximizing functions - Decrease knowledge deficit
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managing symptoms
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- Maintain patent airway - Promote adequate ventilation with appropriate respiratory rate - Remain free from or with a reduced rate of respiratory infections
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how to maximize function of the COPD
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- maintain performanc elf daily living activities - decrease anxiety
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if the patient has SOB, what are some nursing Dx
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- Impaired Gas Exchange - Impaired Airway Clearance - Ineffective Breathing Pattern
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if the patient has depression, what are some nursing Dx
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ineffective coping
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if the patient has anxiety, what are some nursing Dx
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knowledge deficient
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respiratory assessment
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- lung sounds - symmetry of chest wall - airway clearance - resp effort - flaring of nares - accessory muscles - pursed lip breathing
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signs of hypoxemia
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- Confusion - SpO2
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interventions for the copd pt
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- Vital signs - note pulse - Labs - H&H, WBCs - O2 at prescribed flow rate - Position for optimal respirations - Consider O2 use during meals - Allow adequate time for meals - Position properly for eating
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why note pulse?
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b/c if you're over exerting yourself... your pulse is going to increase significantly
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education ideas for the COPD pt
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- Avoid pulmonary irritants & extremes of temperature - Humidifier at night to mobilize secretions - Encourage smoking cessation - Encourage pursed lip breathing - Easily prepared foods - lightweight cookware - Encourage well-balanced diet - Encourage fluids, unless contraindicated by a co-morbidity
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SpO2
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official oxygenation o the peripherals (pulse ox
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why not use humidifier
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potential for humidifier
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what does pursed lip breathing reduce and how?
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hyperventilation by increases the Co2 in the alveoli with relaxes/dulates smooth muscles of airways to keep them open for a long amount of time
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net result of pursed lip breathing
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- Decreases work of breathing - Conserves oxygen - Releases trapped air
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assessments that need to be done
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weight I/O
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t or f: A person with COPD can burn 10 times as many calories breathing as a healthy person does.
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true
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activity level assessment
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- self care - activity tolerance
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activity level interventions
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- Pulmonary rehab - Maintain a level of physical activity - Encourage self care - Allow for adequate rest
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skin assessments
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- redness - sponginess
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skin interventions
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- Moisturize - Reposition - Monitor for breakdown (Cheeks/ears if using O2)
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coping assessments
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- Behavior changes - Mood swings
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coping interventions
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- Provide emotional support - Allow/encourage autonomy - Encourage verbalization of feelings, perceptions, and fears - Encourage identification of own strengths and abilities - Provide education: Disease, Treatment, Medications
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general education
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- Personal infection control strategies - Maintain high resistance - Early recognition/treatment of respiratory infection - Monitor sputum - Develop energy-conserving strategies - Research treatment(s) - importance of immunizations - maintian adequare nutrition - teach safety with home O2 use - admin meds the right way & know the details regarding them
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two ways to control personal infection
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- Avoid large groups/people with URIs. - Good oral hygiene to reduce migrating infection.
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maintaing high resistance by
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- Adequate rest - Balanced diet - Limiting stress - Avoid exposure to dampness, cold, drafts
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early recognition/tx of resp. infection
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Increased dyspnea Increased fatigue Chest tightness Increased sputum
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energy-conserving strategies
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Tripod sitting Adequate rest periods
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tripod sitting
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you try to balance using three points.. It taes care of balance and opens up chest... two feet on floow and elbows on a table
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research tx
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NIH web site Stem cells New medications
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how often do you get a pneumococcal immunizaiton
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once every 10 years
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how often do you get a influenza immunizaiton
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annually
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how to maintain adequate nutrition
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- Balanced diet with adequate calories to compensate for breathing - Adequate fluid within limits of right sided failure
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S/S of Co2 narcosis
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- Drowsiness - Confusion - increased respirations/pulse - Diaphoresis
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safety of O2 home use
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- maintian flow rate - know s/s of co narcosis - keep nasal passages moist with non-petroleum products
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why not use petroleum based products?
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the oil blobs are getting into people's airways
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bronchodilators
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relax muscles surrounding smaller airways
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how to use MDI
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- remove cap - shake well - breathe out ALL the WAY - mouthpiece b/n teeth and seal lips - press down as you start to breath in - keep breathing in slowly and deeply - hold breath for 10 seconds - repeat for each puff prescribed
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when do you use a spacer?
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if MDI is a corticosteroid
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beta-agonist
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- Effect of adrenaline without unwanted side effects - Relax muscles surrounding smaller airways
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what is the rescue drug
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short-acting beta-agonist
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how long do long-acting beta-agonists last
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12 hours
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anticholinergics
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Blocks acetylcholine Prevent airways from narrowing
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corticosteroids
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Interfere with the inflammatory process to open airways Long-term usage has serious side effects
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other medications
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- Anxiolytics - Ab - Steroids - Diuretics - Calcium channel blockers - Anti-coagulation therapy - Coumadin
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MRC breathlessness scale
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degree of breathlessness r/t activities
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do you want a higher or lower score for the MRC breathlessness scale
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lower
