Chapter 12 Chronic Obstructive Pulmonary Disease, Chronic Bronchitis, and Empysema
Terms in this set (103)
What are the 5 Obstructive Lung Diseases? (CBABE)
Cystic Fibrosis, Bronchitis, Asthma, Bronchiectasis, Emphysema.
What is the definition for Chronic Obstructive Lung Disease (COPD)?
A preventable and treatable disease state characterized by airflow limitation that is not fully reversible.
What is the primary cause of COPD?
Describe the airflow limitation with COPD.
The airflow limitation is progressive and is associated with an abnormal inflammatory response of the lungs to noxious particles or gases.
Although COPD affects the lungs, what are the other consequences?
It produces significant systemic consequences.
What is the definition for Chronic Bronchitis?
A productive cough for 3 months in each of 2 successive years in a patient whom other causes of productive couch have been excluded.
What is the definition of Emphysema?
Defined pathologically as the presence of permanent enlargement of the air spaces distal to the terminal bronchioles, accompanied by destruction of their walls and without obvious fibrosis.
Patients with COPD usually have what?
Both chronic bronchitis and emphysema.
According to the (ATS) American Thoracic Society, what is the definition for Chronic Bronchitis?
Chronic Bronchitis is based on the major "clinical manifestations" associated with the disease.
According to the (ATS) American Thoracic Society, what is the definition for Emphysema?
Emphysema is based on the pathology, or the "anatomical alterations of the lung," associated with the disorder.
What does GOLD stand for?
The Global Initiative for Chronic Obstructive Lung Disease.
COPD is ranked as the ____ leading cause of death in the U.S. .
E-cigarettes contain what chemical also found in antifreeze and fog machines?
E-cigarettes cause what type of lung disease?
What are the anatomical alternations of the lungs associated with Chronic Bronchitis?
Chronic inflammation and thickening of the wall of the peripheral airways. Excessive mucus production and accumulation. Partial and total mucus plugging of the airways. Smooth muscle constriction of bronchial airways (bronchospasm). Air trapping and hyperinflation of alveoli.
What are the anatomical alterations of the lungs associated with Emphysema?
Permanent enlargement and destruction of the air spaces distal to the terminal bronchioles. Destruction of alveolar-capillary membrane. Weakening of the distal airways, primarily the respiratory bronchioles. Air trapping and hyperinflation.
Panlobular Emphysema is associated with which parts of the acinus?
Panlobular Emphysema is associated with what deficiency?
Alpha 1- antitrypsin deficiency.
Centrilobular Emphysema is associated with which parts of the acinus?
Centrilobular Emphysema is associated with what lung disease?
Centrilobular Emphysema is caused by what action?
How many people are estimated in the U.S. to have either Chronic Bronchitis, Emphysema, or a combination of both?
True/False. Most authorities agree that COPD is under-diagnosed.
What are the risk factors according to GOLD? (GACE)
Genetic predisposition, age (COPD increases with age), conditions that affect normal lung growth, exposure to particles.
At the risk of developing COPD, individuals may be exposed to what particles?
Tobacco smoke, occupational dusts and chemicals, and indoor/outdoor pollution.
What are the risk factors according to GOLD? (SACRT)
Socioeconomic status, asthma/bronchial hyperactivity, chronic bronchitis, respiratory infections, and tuberculosis (TB).
What is Alpha 1-antitrypsin deficiency?
A lack of protein called AATD. AATD is oddly shaped and stays in the liver and does not go to the lungs to protect the individual from infection. The missing protein does not protect the tissue of the lungs.
What are some of the symptoms associated with Alpha 1-antitrypsin deficiency?
SOB on exertion, allergy-induced asthma, and recurrent respiratory infections, cough, colds, flu and pneumonia.
What is a side effect of Alpha-1 antitrypsin deficiency?
Alpha 1-antitrypsin deficiency is also known as?
A normal patient testing for Alpha 1- antitrypsin deficiency is what % and what phenotype?
A carrier of Alpha 1- antitrypsin deficiency is what % and what phenotype?
An individual who has Alpha-1 antitrypsin deficiency is what % and what phenotype?
How can you rule out Alpha-1 antitrypsin deficiency?
What is the therapy associated with Alpha 1- antitrypsin deficiency?
Weekly protein replacement.
Alpha 1- antitrypsin deficiency is under-diagnosed and patients are normally treated for what instead?
What are the primary indicators for considering COPD in patients over the age of 40?
Dyspnea, chronic cough, chronic sputum, history of exposure, and family history.
What are the 3 spirometry tests for COPD?
FEV1, FVC, FEV1/FVC ratio.
How can you tell after a spirometry test for COPD that a patient has an obstruction?
The FEV1/FVC ratio will be under 70%.
According to the lung volumes chart, which are increased and decreased due to COPD?
Increase in TLC, RV, FRC. Decrease in IC and VC.
On a (CAT) COPD Assessment Test, what score would a patient have to have in order to be considered likely to have COPD?
10 or higher.
On a (mMRC) Modified British Medical Research Council Breathlessness Scale, what test score would a patient have to have in order to be considered likely to have COPD?
2 or higher.
What is a normal FEV1?
What are the additional screening methods to diagnose COPD?
BODE index, chest radiographs, CT scans, lung volumes and diffusing capacity, oximetry and ABG, Alpha1-screen, and exercise testing.
BODE index: What does BODE stand for?
Body mass, airflow obstruction, dyspnea, and exercise.
A patient who is considered a "Pink Puffer" is?
A patient with emphysema.
A patient who is considered a "Blue Bloater" is?
A patient with chronic bronchitis.
What is the body type of a patient with emphysema?
What is the body type of a patient with chronic bronchitis?
stocky and overweight.
A patient with a barrel chest: Emphysema or Chronic Bronchitis?
Emphysema: A "Pink Puffer" is also know as?
Chronic Bronchitis: A "Blue Bloater" is also known as?
What is the respiratory pattern with Emphysema?
What is the respiratory pattern with Chronic Bronchitis?
Pursed lip breathing: Emphysema or Chronic Bronchitis?
Cough: Emphysema or Chronic Bronchitis?
Sputum: Emphysema or Chronic Bronchitis?
Cyanosis: Emphysema or Chronic Bronchitis?
Peripheral Edema: Emphysema or Chronic Bronchitis?
Reddish skin: Emphysema or Chronic Bronchitis?
Neck vein distention: Emphysema or Chronic Bronchitis?
Cor pulmonale: Emphysema or Chronic Bronchitis?
Use of accessory muscles: Emphysema or Chronic Bronchitis?
What heart sounds would you expect to hear in a patient with Emphysema?
Decreased heart sounds.
What breath sounds would you expect to hear in a patient with Emphysema?
What breath sounds would you expect to hear in a patient with Chronic Bronchitis?
Wheezes, crackles, or ronchi.
Hyperresonance: Emphysema or Chronic Bronchitis?
Hyperinflation: Emphysema or Chronic Bronchitis?
Long, vertical heart: Emphysema or Chronic Bronchitis?
Enlarged, horizontal heart: Emphysema or Chronic Bronchitis?
Polycythemia: Emphysema or Chronic Bronchitis?
Which patient gets more infections? Emphysema or Chronic Bronchitis?
Decreased diffusion: Emphysema or Chronic Bronchitis?
Pulmonary hypertension: Emphysema or Chronic Bronchitis?
What is another name for right heart failure?
What are the 3 clinical manifestations associated with Chronic Bronchitis and Emphysema?
Excessive bronchial secretions, bronchospasm, and distal airway and alveolar weakening.
Digital clubbing: Emphysema or Chronic Bronchitis?
Enlarged liver: Emphysema or Chronic Bronchitis?
Hoover's Sign: Emphysema or Chronic Bronchitis?
When RV AND FRC are increased with COPD, what does this mean?
On an (ABG) Arterial Blood Gas, what does it mean when the PaCo2 is decreased?
The patient is hyperventilating.
"V/Q" and "Qs/Qt" are related to what condition?
"Do2" stands for?
Delivery of oxygen.
"O2ER" stands for?
Oxygen extraction ratio.
"SvO2" stands for?
A patient with Chronic Bronchitis has a sputum sample done. What are the infections that could be potentials?
Strep, inflenza and respiratory tract infections.
A flattened diaphragm can be seen in patients with?
Emphysema and Chronic Bronchitis.
Bullae on CXR: Emphysema or Chronic Bronchitis?
A bullae signifies what?
Air trapping. No gas exchange occuring.
Hyperlucent means what?
What are some of the therapies to stablize COPD?
Bronchodilators, inhaled corticosteroids, oral corticosteroids, phosphodiesterase-4 inhibitors, and methylxanthines.
What are some treatment options for COPD?
Vaccines, Alpha 1- antitrypsin deficiency testing, antibiotics, mucolytics, antitussives, rehab, treatment care specialist, (LTOT) Long Term Oxygen Therpy, ventilatory support, surgery, and palliative care.
To be considered for home oxygen use, what should a patient's PaO2 be?
Below 55 mmHg.
To be considered for home oxygen use, what should a patient's SaO2 be?
GOLD recommends obtaining clinical data from what 3 assessments as the basis for developing a safe and effective treatment plan?
Severity of airflow limitation, patient symptoms, and future risk of exacerbation.
According to GOLD, what is the definition for exacerbation?
An acute event characterized by a worsening of the patient's respiratory symptoms that is beyond normal day-to-day variations and leads to a change in medication.
What is the prognosis in exacerbations with a patient who has COPD?
What is the % of patient's who will die within 3 months of admission for COPD?
What is the % of patient's who will die within 1 year if COPD is present with Co2 retention?
What is the most common cause of exacerbations?
Respiratory infection. (Viral or Bacterial)
What is the % of COPD deaths caused by smoking?
True/False: A female smoker is 13x more likely to die from COPD vs. a non-smoker.
True/False: A male smoker is 12x more likely to die from COPD vs. a non-smoker.
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