321 -Exam 1- P. 39-47

Front 1

Pulmonary Emphysema

2 major changes are

Back 1

loss of lung elasticity and hyperinflation of the lung


which result in??



dyspnea and the need for an increased RR

Front 2

Pulmonary Emphysema

• in a healthy lung, enzymes called proteases are present to destroy and eliminate organisms inhaled during breathing.
--if these protease levels are high, what happens

Back 2

, they damage the alveoli and the small airways by breaking down elastin.

high protease levels cause the alveolar sacs to lose their elasticity and the small airways to collapse or narrow.

some alveoli are destroyed, others become large and flabby, with a decreased area for effective gas exchange


an increased amount of air becomes trapped in the lungs and the work of breathing is increased

Front 3

Pulmonary Emphysema

the hyper inflated lung does what?

Back 3

flattens the diaphragm, weakening the effect of the muscle so the pt needs to use accessory muscle in the neck, chest, and abdomen to inhale and exhale. this increased effort increases the need for O2

Front 4

Pulmonary Emphysema

what happens to CO2

what acid base imabalance is seen

Back 4

carbon dioxide retention and respiratory acidosis are seen

Front 5

Pulmonary Emphysema

what is significant in their appearance?

Back 5

barrel chest appearance

Front 6

Pulmonary Emphysema

hyperventilation keeps PaO2 WNL


why are they called pink puffers?

Back 6

"pink puffer” (as a result of air becoming trapped they have hyperventilation, they breathe faster trying to get the air out but that breathing helps them maintain their PaO2 and that’s why they are called pink puffers, they are pink. they can get oxygen in, but they have problem blowing it out)

Front 7

what disease? excessive mucous production obstructs the small airways

Back 7

Chronic Bronchitis

Front 8

•what disease? it is an inflammation of the bronchi and bronchioles caused by chronic exposure to irritants. the irritants trigger inflammation with vasodilation, congestion, mucosal edema, and bronchospasms.

Back 8

Chronic Bronchitis

Front 9

Chronic Bronchitis

-does it affect the airways or the alveoli?

Back 9

only the airways rather than the alveoli (emphysema affects alveoli)

Front 10

Chronic Bronchitis

• chronic inflammation causes an increase in the # and size of mucous glands, which produce thick mucous

Back 10

• the bronchial walls thicken and impair airflow

Front 11

Chronic Bronchitis

•chronic bronchitis hinders airflow and gas exchange because of mucous plugs and infection narrowing the airways

--as a result, what happens to the PaO2 and the PaCO2?

Back 11

the PaO2 decrease (hypoxemia) and the PaCO2 level increases (respiratory acidosis)

Front 12

Chronic Bronchitis

why are they called the blue bloater?

Back 12

unable to increase breathing effort to maintain PaO2 -> blue bloater

Front 13

Chronic Bronchitis

chronic hypoxemia causes the kidneys to do what?

Back 13

kidneys increase production of RBC to increase oxygen (polycythemia)

Front 14

Chronic Bronchitis

CO2?
O2?

Back 14

hypercapnia (high CO2)


hypoxia (low O2)

Front 15

Chronic Bronchitis

chronic hypoxia s/s

Back 15

clubbing (angle > 160)

Front 16

teach the patient to sit in what position during a dyspneic episode?

Back 16

sitting on het side of the bed and leaning on an overbed table will enhance the effectiveness of breathing

Front 17

COPD risk factors
•___________ is an important risk factor for COPD

Back 17

cigarette smoking

(tobacco triggers the release of excessive amounts of proteases from cells in the lungs)

Front 18

COPD complications

-COPD affects oxygenation and tissue perfusion to all tissues. major problems are

Back 18

hypoxemia,
acidosis,
respiratory infection,
cardiac failure
dysrhythmias

Front 19

COPD complications

cor pulmonale is what

Back 19

right sided heart failure

oair trapping, airway collapse, and stiff alveolar walls make blood flow through lung vessels more difficult

the increased pressures makes the workload heavy on the right side of the heart, which pumps blood into the lungs

as the disease progresses, the amount of O2 in the blood decreases, causing major blood vessels in the lung to constrict

to pump blood through these narrowed vessels, the right side of the heart must generate high pressures.

Front 20

COPD complications

cor pulmonale

--in response to this heavy work load, the right chambers of the heart enlarge and thicken, causing right sided heart failure with back up into the general venous system:

S/S

Back 20

(enlarged liver,
distended neck veins,
dependent edema,
pulmonary hypertension,
cyanotic lips,
tachypnea)

Front 21

Health Promotion & Maintenance for COPD

-quit _____
-avoid ______
-often seen in what population
- what is the most important intervention to improve gas exchange?

Back 21

•quit smoking
•avoid inhalation irritants (when working in areas use masks)
•COPD is seen more often in older men


•airway maintenance is the most important intervention to improve gas exchange

Front 22

chronic bronchitis vs pulmonary emphysema

referred to as “pink puffers”

Back 22

-Emphysemia

Front 23

chronic bronchitis vs pulmonary emphysema

referred to as “blue bloaters”

Back 23

chronic bronchitis

Front 24

chronic bronchitis vs pulmonary emphysema

body build: thin with weight loss

Back 24

-Emphysemia (because the work of breathing is so hard and it takes so much energy for them to breathe)

Front 25

chronic bronchitis vs pulmonary emphysema

30-40 onset
60-70 disabling

Back 25

-Emphysemia

Front 26

chronic bronchitis vs pulmonary emphysema

Dyspnea: slow and progressive

Back 26

-Emphysemia

Front 27

chronic bronchitis vs pulmonary emphysema

Sputum: scanty, mucoid

Back 27

-Emphysemia

scanty b/c the alveoli are expanding. they can get air in, they have trouble getting air out. the alveoli are like balloons that stay inflated

Front 28

chronic bronchitis vs pulmonary emphysema

Cough: negligible

Back 28

-Emphysemia


(small)

Front 29

chronic bronchitis vs pulmonary emphysema

increase in AP diameter

Back 29

-Emphysemia

-alveoli are overstretched and overinflated so their chest becomes barrel shaped

Front 30

chronic bronchitis vs pulmonary emphysema

quite or diminished breath sounds

Back 30

-Emphysemia

Front 31

chronic bronchitis vs pulmonary emphysema

Cor pulmonale is rare except terminally

Back 31

emphysemia

Front 32

chronic bronchitis vs pulmonary emphysema

ABGs: near normal.
-mild decrease in PaO2
-normal or increased PaCO2

Back 32

emphysemia

Front 33

chronic bronchitis vs pulmonary emphysema

chest xray shows hyperinflation

Back 33

emphysemia

Front 34

chronic bronchitis vs pulmonary emphysema

tendency toward obesity

Back 34

chronic bronchitis

Front 35

chronic bronchitis vs pulmonary emphysema

onset 20-30
disabling 40-50

Back 35

chronic bronchitis

Front 36

chronic bronchitis vs pulmonary emphysema

dyspnea: variable, relatively late

Back 36

chronic bronchitis

Front 37

chronic bronchitis vs pulmonary emphysema

sputum: copious, mucopurulent

Back 37

chronic bronchitis

Front 38

chronic bronchitis vs pulmonary emphysema

cough: considerable

Back 38

chronic bronchitis

Front 39

chronic bronchitis vs pulmonary emphysema

chest: slight to marked increase to AP diameter

Back 39

chronic bronchitis

Front 40

chronic bronchitis vs pulmonary emphysema

scattered crackles, rhonci, wheezing

Back 40

chronic bronchitis

Front 41

chronic bronchitis vs pulmonary emphysema

cor pulmonale: frequent with many episodes

Back 41

chronic bronchitis

Front 42

chronic bronchitis vs pulmonary emphysema

ABGs:

decrease in PaO2
increase in PaCO2

Back 42

chronic bronchitis

Front 43

chronic bronchitis vs pulmonary emphysema

chest xray shows cardiac enlargement

Back 43

chronic bronchitis

the heart has to enlarge and work harder to pump the blood

Front 44

chronic bronchitis vs pulmonary emphysema

H/H

normal till late in disease

Back 44

emphysemia

Front 45

chronic bronchitis vs pulmonary emphysema

H/H

increased

Back 45

chronic bronchitis

-body is compensating by increasing erthrocyties and therefore hemoglobin --polycythemia

Front 46

when collecting a sputum specimen, when should you collect it?

what should they do before you collect it

Back 46

in the morning


brush their teeth because you want the organismsf rom their lungs, not their mouth