COPD

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Is the following statement true or false?

The primary oxygen administration method for a patient with COPD is a nasal cannula
False

The primary oxygen administration method for a patient with COPD is a Venturi mask, not a nasal cannula.
What is oxygen toxicity?
Oxygen toxicity: O2 concentrations of greater than 50% for extended periods of time (longer than 48 hours) can cause an overproduction of free radicals, which can severely damage cells
What are symptoms of oxygen toxicity?
Symptoms include substernal discomfort, paresthesias, dyspnea, restlessness, fatigue, malaise, progressive respiratory difficulty, refractory hypoxemia, alveolar atelectasis, and alveolar infiltrates on x-ray
How can you avoid oxygen toxicity?
Prevention:
Use lowest effective concentrations of oxygen
PEEP or CPAP prevent or reverse atelectasis and allow lower oxygen percentages to be used
Incentive Spirometry
-Two types: volume or flow
-Device encourages patient to inhale slowly and deeply to maximize lung inflation and alveoli expansion
-Used to prevent or treat atelectasis
Nursing care:
-Positioning of patient, encourage use, set realistic goals, and record outcomes.
Is the following statement true or false?

The patient should be encouraged to use an incentive spirometer approximately 10 breaths per hour between treatments while awake
True

The patient should be encouraged to use an incentive spirometer approximately 10 breaths per hour between treatments while awake
What is a nebulizer treatment
Handheld apparatus that disperses a moisturizing agent or medication into the lungs, make a visible mist
What are nursing interventions for nebulizer treatments?
Nursing care:
-Slow, deep breathes through mouth and hold a few seconds at the end of inspiration
-Coughing exercises to mobilize secretions
-Assess patent before treatment and evaluate patient response after treatment
What is Chest PT (Physiotherapy)?
Includes postural drainage, chest percussion and vibration, breathing retraining, and effective coughing
What are the goals of chest PT?
Goals: remove secretions, improve ventilation, and increased efficiency of respiratory muscles
Patient Teaching: Home Oxygen
-Safety
-Flow rate and adjustment
-Maintenance of equipment
-Identification of malfunction
-Airway obstruction
-Humidification
-Ordering of supplies and oxygen
-Signs and symptoms
-Diet, activity, travel
-Electrical outlets
Noninvasive Positive-Pressure Ventilation
-Use of mask or other device to maintain a seal and permit ventilation

-Continuous positive airway pressure (CPAP)
-Bilevel positive airway pressure (BiPAP)
Weaning
-Process of withdrawal of dependence upon the ventilator
-Successful weaning is a collaborative process
_________ includes diseases that cause airflow obstruction (emphysema, chronic bronchitis) or a combination of these disorders.
COPD
Patho of COPD
-Airflow limitation is progressive and is associated with abnormal inflammatory response of the lungs to noxious agents.
-Inflammatory response occurs throughout the airways, lungs, and pulmonary vasculature.
-Scar tissue and narrowing occurs in airways.
-Chronic inflammation damages the lungs
Chronic Bronchitis
-The presence of a cough and sputum production for at least 3 months in each of 2 consecutive years
-Irritation of airways results in inflammation and hypersecretion of mucus.
-Mucus-secreting glands and goblet cells increase in number.
-Ciliary function is reduced, bronchial walls thicken, bronchial airways narrow, and mucus may plug airways.
-Alveoli become damaged and fibrosed, and alveolar macrophage function diminishes.
The patient is more susceptible to respiratory infections.
Is the following statement True or False?

For patients with chronic bronchitis, the nurse expects to see the major clinical symptoms of tachypnea and tachycardia.
False

For patients with chronic bronchitis, the nurse expects to see the major clinical symptoms of sputum and productive cough, not tachypnea and tachycardia.
Emphysema
-Abnormal distention of air spaces beyond the terminal bronchioles with destruction of the walls of the alveoli
-Decreased alveolar surface area causes an increase in "dead space" and impaired oxygen diffusion.
-Reduction of the pulmonary capillary bed increases pulmonary vascular resistance and pulmonary artery pressures.
-Hypoxemia is the result of these pathologic changes.
-Increased pulmonary artery pressure may cause right-sided heart failure (cor pulmonale).
What is the primary clinical symptom of emphysema?
A. Chest pain
B. Productive cough
C. Sputum
D. Wheezing
D

The primary symptom of emphysema is wheezing. Sputum and productive cough are the primary symptoms of chronic bronchitis.
Risk factors for COPD
-Smoking (80-90% of all cases)
-Passive smoking
-Occupational exposure
-Air pollution
-Genetic abnormalities
-Deficiency of alpha1-antitrypsin (an enzyme inhibitor that normally counteracts the destruction of lung tissue by certain other enzymes)
In COPD there is a change in ________ for the drive to breathe
stimulus
Normal Stimulus to breathe is
Normal Stimulus: high CO2
In COPD the stimulus to breathe is
In COPD: low O2; drive to breathe is hypoxemia
Clinical presentation of COPD
-Three primary symptoms: chronic cough, sputum production, and dyspnea on exertion
-Weight loss
-"Barrel chest"
-Abdominal breathing
COPD Assessment
-Exposure to risk factors
-Smoking and passive smoke
-Air pollution
-Alpha 1 anti-trypsin deficiency
-Past medical history (Respiratory diseases/problems)
-Family history of COPD/Respiratory
-Pattern of symptom development
-History of exacerbations or previous hospitalizations
-Presence of co-morbidities
-Impact on quality of life
-Social and family support
-Potential for reducing cause of risk factors
-Effectiveness and appropriateness of treatment
Diagnostic Tests for COPD
-*Pulmonary Function Tests (PFTs)
-Spirometry to evaluate airflow obstruction
-FEV1 compared to FVC
-An FEV1 ration of less than 70% is diagnostic of COPD
-Provider may use bronchodilator reversibility test after spirometry to rule out asthma
-ABGs
-Chest X-ray
-SVO2 - shows exhausted supplies
Nursing Considerations with COPD- Planning
-Smoking cessation
-Improved activity tolerance
-Maximal self-management
-Improved coping ability
-Adherence to therapeutic regimen and home care
-Absence of complications
Improving Gas Exchange
-Proper administration of bronchodilators and -corticosteroids
-Reduction of pulmonary irritants
-Directed coughing, "huff" coughing
-Chest physiotherapy
-Breathing exercises to reduce air trapping
-diaphragmatic breathing
-pursed lip breathing
-Use of supplemental oxygen
Bronchiectasis
-Chronic, abnormal dilation of one or more large bronchi
-Reduced ability to clear mucus
-Decreased expiratory airflow
-Classified as obstructive airway disease
Bronchiectasis is a chronic, irreversible dilation of the bronchi and bronchioles.
Caused by:
Bronchiectasis is a chronic, irreversible dilation of the bronchi and bronchioles.
Caused by:
Airway obstruction
Diffuse airway injury
Pulmonary infections and obstruction of the bronchus or complications of long-term pulmonary infections
Genetic disorders such as cystic fibrosis
Abnormal host defense (immunodeficiency)
Idiopathic causes
Bronchiectasis: Clinical Manifestations
-Chronic cough
-Purulent sputum in copious amounts
-Clubbing of the fingers
Bronchiectasis: Diagnosis
-Chest x-ray
-High-resolution CT (gold standard)
-Sputum culture (Frequently colonized with H. influenzae or P. aeruginioa)
-FEV1and FEV1/FVC
Bronchiectasis: Medical management
-Postural drainage
-Chest physiotherapy
-Smoking cessation
-Antimicrobial therapy
Bronchiectasis: Nursing management
Focuses on alleviating symptoms and clearing pulmonary secretions
Most common chronic disease in childhood
is
asthma
Asthma
-Chronic inflammatory disease of the airways that causes hyperresponsiveness, mucosal edema, and mucus production
-Inflammation leads to cough, chest tightness, wheezing, and dyspnea.
-The most common chronic disease of childhood-can occur at any age
-May range from mild to severe & life-threatening
-Allergy is the strongest predisposing factor
-Dust, pollen, pet dander, mold, cockroaches, food
-IgE the antibody behind asthma
Asthma S&S
-Cough (may be only symptom)
-Dyspnea
-Wheezing
-Often occur at night or early morning
-Chest tightness
-Diaphoresis
-Tachycardia >120
-Widened pulse pressure
-Cyanosis (late sign)
-Hypoxemia (relatively uncommon)
-Exercise induced-asthma
-Choking sensation during exercise
-Nocturnal symptoms do not occur
Complications of Asthma
-Status Asthmatics
-Respiratory Failure
-Pneumonia
-Atelectasis
-Airway Obstruction-emergent
Indications for Immediate Medical Care
-Dyspnea @ rest
-Inability to speak in sentences
-Loud or absent wheeze
-Pulse rate > 120/minute
-Peak expiratory flow rate > 50% of predicted personal best even after treatment
Medications for Chronic Airway Obstruction
-Bronchodilators
-Short-acting
-Long-acting
-Anticholinergics
-Corticosteroids
-Leukotriene Modifiers
-Zanthine Derivatives
Effective use of inhalers
-Administer bronchodilator before inhaled steroid
-Take a sip of water to moisten throat
-Shake canister for 5-10 seconds
-Tilt head back slightly & exhale normally
-Administer medication @ beginning of next inhalation using a spacer
-Hold breath for up to 10 seconds
-Exhale through pursed lips
-Wait 30-60 seconds before next puff
-Rinse & gargle with warm water. Do not swallow (especially important with inhaled steroids to prevent oropharyngeal thrush)
Patient Teaching
-The nature of asthma as a chronic inflammatory disease
-Definition of inflammation and bronchoconstriction
-Purpose and action of each medication
-Identification of triggers and how to avoid them
-Proper inhalation techniques
-How to perform peak flow monitoring
-How to implement an action plan
-When and how to seek assistance
Asthma Implications
-Complete history
-Obtain a hx of allergic reactions to
medications
-Identify medications currently taken
-Administer medications & monitor response to medications
-Antibiotic if underlying respiratory infection
-Administer fluids if dehydration
-Monitor VS, Pulse ox,
-Sputum culture
-ABG's
-Lab work (CBC elevated eosinophils)
Status Asthmaticus
-Severe & persistent asthma but does not respond to conventional therapy
-Inflammation of bronchial mucosa, constriction of the bronchiolar smooth muscle, & thickened secretions
-Severe bronchospasm with mucus plugging leading to asphyxia
-Ventilation-perfusion abnormality results in hypoxemia & respiratory acidosis
-Initially Respiratory Alkalosis (⇪pH & ⇩CO2). As it worsens, CO2 ⇪ & pH⇩ results in Respiratory acidosis
S&S Status Asthmaticus
-Same as seen with severe asthma
-Labored breathing
-Prolonged exhalation
-Engorged neck veins
-Wheezing
-Does not indicate the severity of the attack
-May disappear; a sign of impending respiratory failure
Status Asthmaticus Diagnostics & Management
-Pulmonary Function Studies (PFT) (most accurate)
-ABG
-Obtained if unable to perform PFT
-Short-acting inhaled beta2-adrenergics
-Corticosteroids
-Solu-Medrol
-Supplemental oxygen
-Partial or complete non- rebreather mask
-IV fluids
-Magnesium Sulfate
-Shown to improve symptoms in clinical trials. Can relax smooth muscle & cause bronchodilation
Mechanical ventilation
Cystic Fibrosis
-The most common fatal autosomal recessive disease among the Caucasian population.
-Genetic screening is able to detect carriers of this disease.
-Genetic counseling for couples at risk.
-A mutation of a gene causes changes in chloride transport which leads to thick, viscous secretions in the lungs, pancreas, liver, intestines, and reproductive tract.
-Pulmonary problems are the leading cause of morbidity and mortality.