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173 Cards in this Set

  • Front
  • Back
Chronic Obstructive Pulmonary Disease (COPD) is a group of diseases including
Chronic Bronchitis
Emphysema
Asthma
_____ million Americans have COPD
35 million

*Most common lung disorder
80- 90% of COPD is associated with
Smoking
Harmful effects of smoking leading to COPD
smoking rapidly accelerates lung deterioration leading to COPD
Chronic Bronchitis
(def)
the presence of a productive cough that lasts 3 months a year for 2 consecutive years
Chronic Bronchitis is primarily associated with
1. Cigarette smoking
2. Air pollution
The decline of lung function with Chronic Bronchitis is caused by
Chronic irritation of the airway causing an inflammatory response in the airway initiating a hypersecretion of mucous and kills ciliary
Patients with Chronic Bronchitis are often referred to as
Blue Bloaters- skin appears swollen and bluish due to an increase in RBC
Polycythemia
(def)
Increased level of Red Blood Cells circulating in the blood stream
Polycythemia occurs with Chronic Bronchitis as an attempt to compensate for
hypoxia
*Starts in the kidneys
Hemoglobin values
Males 13.5 - 18

Females 12- 16
Polycythemia Hemoglobin Value
20 g/dl or more
Respiration Rate Changes with Chronic Bronchitis
Increase rate
Shallow respirations
Increase cough
Expected breath sounds associated with Chronic Bronchitis
-Diminished in peripheral regions
-Crackles with congestion
-Wheezing
S/S of Chronic Bronchitis
1. Change in respiratory rate and breath sounds
2. Use of accessory muscles
3. Dyspnea
4. Orthopnea
Pulmonary Function Test
(PFT)
- Measure lung volumes and airflow by a spirometer
-Calculates a % based on an average
PFT's are used to
-diagnose pulmonary disease
-monitor disease progression
-evaluate disability
-evaluate response to bronchodilators
Normal PFT range
80-100%
Normal PFT values are based on
Age
Gender
Race
Height
Vital Capacity (VC)
(def)
Maximum volume of air that can be exhaled after maximum inspiration
VC is typically (increased/decreased) with chronic bronchitis
decreased
_________ may be ordered after administration of a bronchodilator to determine the degree of response
spirometry (pulmonary function test)
A positive response to a bronchodilator is
> 200 ml increase or a 12% increase
Forced Vital Capacity (FVC)
(def)
Amount of air that can be quickly and forcefully exhaled after maximum inspiration
Forced Expiatory Volume (FEV1)
(def)
Amount of air exhaled in first second of FVC
Grades severity of airway obstruction
FEV1
Normal value for FVC and FEV1
Over 80%
_______ have been shown to have a higher FVC and FEV1 than _________ and _________
Whites

Mexican Americans and African Americans
Increased CO2 levels with Chronic Bronchitis will result in
CNS sedation
CNS sedation caused by an increase in CO2 will cause
Restlessness
Irritability
Confusion
Somnolence
Late S/S of Chronic Bronchitis
Dusky, Cyanotic skin
Clinical manifestations of the Heart related to Chronic Bronchitis
1. Heart pumps thick blood through narrowed (vesoconstricted) vessels
2. Right ventricle enlarges
3. Right sided heart failure
Classic Symptom of Right side heart failure
JVD
Chronic Bronchitis causes right ventricular enlargement because
it is working so hard to pump into the narrowed pulmonary vessels
Right sided heart failure associated with Chronic Bronchitis may also lead to
1. Hepatomegla
2. Splenomegla
3. Intestinal backflw (n/v)
4. Edema
Blood tends to be thicker in patient's with Chronic Bronchitis r/t
increased RBC
Weight typically (increases/decreases) with Chronic Bronchitis
Increases- caused by edema
Activity level typically (increases/decreases) with Chronic Bronchitis
Decreases- caused by SOB and dyspnea
Emphysema
(def)
Chronic obstruction of inflow and outflow of air from the lungs
*Increase in airway resistance
The leading cause of emphysema
smoking
Characteristics of Emphysema
1-hyperexpansion of the lungs
2- Breakdown of alveolar and supporting tissue (air stays in the lungs)
3- Inflammation of the bronchioles
4- Excessive mucous
5- Loss of elastic recoil of airways
Hyperexpansion of the lungs associated with emphysema
-Lungs stay inflated and stiff reducing the ability to exhale effortlessly
___________ and __________ are destroyed with emphysema causing the loss of lung recoil
elastin and collagen
Inflammation of the bronchioles, excessive mucous and loss of elastic recoil may lead to
infections
*stimulating neutrophils and macrophages causing protelytic enzyme to be released
By the time S/S of Emphysema occur
Damage to the tissues is done and cant be repaired
Proteolytic enzymes
-Break down of proteins
-Destroy alveolar tissue causing:
*Increase of air trapped in alveoli
*Increase in dead space
*Decrease O2 diffusion
Proteolytic enzymes are released in response to
recurrent infections related to emphysema
Due to hyperexpansion of the lungs, emphysema causes
barrel chest and respiratory changes
Alpha 1 Antitrypsin (AA1)
(def)
a glycoprotein that has an inhibitory effect on proteolytic enzymes
*Genetic cause of COPD
Patients with Emphysema have __________ AA1 levels
deficient
____________ inactivates AA1
smoking
Deficient AAT causes
lysis of lung tissue
____% of emphysema is caused by genetic AA1
3%
*Majority caused by smoking
The emphysemic is often called
"pink puffer"
"pink puffer" refers to the predominant symptom of emphysema
dyspnea
*Can be present at rest and become worse with exertion
(True/False)
It is not until late in Emphysema that a person becomes hypoxic
True
The earliest sign of emphysema
dyspnea
*Takes a lot of nrg to breath just sitting still
Barrel Chest associated with emphysema is caused by
increased air trapping flattens ithe diaphragm and increases the anteroposterior diameter of the chest
Emphysema typically causes a __________ cough
non-productive
*minimal sputum
Respiratory rate with emphysema typically (increases/decreases)
Increases
*18-24 (use of accessory muscles)
_______ and _______ often occur with emphysema sue to an increase in metabolic rate and lack of nrg
Anorexia and weight loss
*loss of muscle mass and fat
(True/False) Patients with emphysema typically have an increase in nrg
False-
emphysema causes weakness due to muscle wasting
Asthma
(def)
Chronic inflammatory disorder of the airways
Inflammation related to asthma causes airway
obstruction
Asthma causes episodes of
wheezing
breathlessness
chest tightness
cough
Asthma results in a complex _________ response that causes an increase in airway ________
inflammatory

resistance
Constant inflammation and airway resistance associated with asthma eventually leads to
airway damage
______ million people per year are hospitalized with asthma
1/2 million
Asthma causes ______ and _______ of the tracheobronchial tree
hyperirritability
hyperresponsiveness
Hyperirritability and hyperresponsiveness of the tracheobroncial tree causes
-constriction of bronchial smooth muscle
-hypersecretion of mucous and mucosal inflammation
-Edema (inside the lungs)
Inflammation r/t asthma is caused by
1. Allergens
2. Air pollution
3. RTI
4. Exercise
5. Cold Air
6. Stress
7. Medications
8. GERD
IGE receptors on Mast cells in response to allergens release
Mediators:
histamine
bradykinin
prostoglandins
Leukotrienes
Mediators released by mast cells initiate an inflammatory response causing
vascular permeability
*causing fluid to leak into the interstitial spaces
Common allergens that trigger asthma
sinusitis
animals
dust mites
pollen
To prevent an asthma attach while exercising be sure to
warm to to promote O2 exchange
Cold air can cause asthma attacks by
causing bronchospasms
Medications that can trigger asthma attacks
Aspirin
Anti inflammatory
GERD can cause asthma attacks by
allowing gastric contents to get into the esophagus
S/S of Asthma
1. Respiratory changes
2. Wheezing
3. Nonproductive cough
4. ABG's
5. PERF
6. Epsinophilia
Wheezing occurring with asthma
Starts off with expiratory wheezing and progresses to expiratory and inspiratory wheezing
(True/False) Asthma typically presents a nonproductive cough
True
*Secretions associated with asthma are thick and often cant be coughed up
ABG values with Asthma
Acute asthma attacks will cause Respiratory Alkalosis b/c excessive blowing off of CO2
Peak Expiratory Flow Rate (PEFR) (def)
Maximum airflow rate during forced expiration
*Aids in monitoring bronchoconstriction
PEFR is measured with
Peak flow meter (PFM)
*Determines how well asthma is being controlled
PEFR Normal Value
80-100% of personal best
Steps to use a peak flow meter (PFM)
1-Slide red indicator to start position
2-Sit or stand
3-Inhale filling lungs completely
4-Place lips tightly over the PFM
5-Exhale forcefully into PFM
6-Location of red indicator will determine results
7-Repeat results 2 more times
*If you cough, must repeat the test
PFM should be taken each day for
2 to 3 weeks
PFM should be taken
-Between noon and 2pm each day
-Each time quick relief medicine is taken (after taking)
-At HCP suggestion
Peak Flow Zones
Green: 80-100% (good control)
Yellow: 50-79% (caution: ashtma getting worse)
Red: below 50% (Medical Alert)
Interventions for Green Zone Reading
Keep taking long-term medication as prescribed
Interventions for Yellow Zone Reading
-Keep taking long-term medications as prescribed
-Add quick relief medications
-Consult MD to determine if additional dosages are required
Interventions for Red Zone Reading
Add or increase quick relief medication and call HCP NOW!
PEFR Normal Value
80-100% of personal best
Eosinophilia
(def)
-Elevated eosinophil count
Above 4%
Normal Eosinophil Value
1-4%
An increase in eosinophils may be related to
an increase in allergens
Leukotriene Modifier medications have what (2) effects
1. Bronchodilator
2. Anti-inflammatory
Action of Leukotriene Modifiers
Interfere or block the action of leukotrienes, which cause airway edema, bronchoconstriction and inflammation
Examples of Leukotriene Modifiers
1. Zafirlukast (Accolate)
2. Montelukast (Singulair)
3. Zileuton (Zylfo)
Treatment for an Acute Asthma Attack
Maintain airway and help calm anxiety
Chronic Management of Asthma
Determine what is causing the attacks
Assessment for Asthma
*If they are currently having an attack, get important info only then perform a complete assessment later
Smoking history for asthma is determined by
Pack/year history
(one pack year= one pack per day for 1 year)
Serious lung complications typically begin once a smoker reaches
20 pack/year history
COPD Assessment should include:
-History
-Physical Exam
-Respiratory:PFT
-Skin
-Cardiac: monitor for HF
-Fluid: deficit or overload
-Nutrition
Nursing Diagnosis R/T COPD
1. Ineffective airway clearance
2. Imbalanced Nutrition: less than body requirements
3. Risk for infection
4. Impaired gas exchange
5. Anxiety
6. Decreased ADL Tolerance
7. Decreased Tissue Perfusion
8. Sleep Disturbance Pattern
Nursing Interventions R/T COPD
1. Prevention and health maintenance
2. Teach/Demonstrate/Encourage
3. Monitor O2 therapy and ABG's
4. Position in Semi Fowlers
5. Control Anxiety
6. Fluid Balance
7. Respiratory Treatments (require MD order)
8. Monitor Cardiac Status
9. Activities
10. Improve Respiratory Function
Intervention for COPD prevention and health maintenance
Smoking Cessation
Medications for smoking cessation
-Chantix: disrupts brain messages, pt's may become hostile- watch for suicide
-Wellbutrin: depression medication has shown to be helpful
Teaching Interventions for COPD
1. Effective Coughing
2. Breathing Techniques (pursed lips)
Pursed Lip Breathing
-Improves O2 transport
-Encourages slow controlled breathing
-Lengthens exhalation reducing airway collapse
Steps for Pursed Lip Breathing
1. Inhale slowly for 3 seconds
2. Exhale thru pursed lips for 7 seconds while tightening abdominal muscles
O2 Therapy Administration for Patients with COPD
-Low dose O2
-0.5-3 Liters/ minute with nasal cannula
__________ drives a COPD patient to breathe
Hypoxemia
*COPD Pt's used to increased CO2 levels, if high levels of 02 levels are administered, hypoxemia drive to breathe will diminish
Drug Therapy for COPD
1-Bronchodilators
2-Corticosteroids
3-Mast Cell Stabilizers
4-Mucolytics
5-Expectorants
6-Antibiotics
Bronchodilator Examples
1. Methylxantines
(IV form: Aminophylline)
(Oral form: Theophylline)
2. Beta-Adrenergic Agonists
3. Anti-Cholinergics
Action of Methylxanthines
Reverse airway obstruction by relaxation of bronchial smooth muscles and improve contractility of diaphragm
Side effects of Methyxanthines
Cause GI symptoms:
Nausea/Vomiting
GI irritation
___________ tends to produce many side effects and is not prescribed often
Aminophylline
Therapeutic levels of Methylxanthines should range between
10-20 mcg/ml
*Above 20 mcg/ml Toxic
Side effects of toxic methylxanthine levels effect
CV and CNS
Beta- Adrenergic Agonist Examples
Alupent
Albuterol
Proventil
Brethaire
Action of Beta-Adrenergic Agonists
-Relax smooth muscle of all airways (trachea to terminal bronchioles)
-Increase mucociliary clearance
-Mimic SNS (Increase HR and BP)
It is desired to take Beta-Adrenergic Blockers that block only Beta (1/2) receptors
2
*Beta 2 receptors affect bronchial smooth muscles
Methylxanthines and Beta-Adrenergic Blockers can be given
Orally or by inhalation and should be spaced out equally throughout the day
Anti-cholinergic Examples
-Atrovent
-Spiriva
Action of Anti-cholinergic
Opens airways by blocking vagal (parasympathetic) nerve impulses resulting in:
-bronchodilation
-decreased mucus secretions
Anti-cholinergic inhalants have (few/many) side effects
Few
*inhalants have few side effects because they are poorly absorbed
The first line drug of treatment for Chronic COPD
Corticosteroids
Corticosteroid Examples
-(IV forms): Solu-Cortef; Solu-Medrol
-(oral forms): Prednisone; Medrol
-(Inhaled forms): Becovent; Flovent; Aerobid
Effects of Corticosteroids
1. Anti-inflammatory
2. Immunosuppressive effects
Affects of corticosteroids on the Lungs
-Decreased bronchial airway edema
-Act synergistically with beta-2 agonists
-Decrease mucus secretions
Side effects of Corticosteroids
-Increase glucose levels
-Increase Na+ (Increases BP)
-Increases appetite
-Decreases K+
-Mood swings
-Ulcers
Mast Cell Stabilizer Example
Cromolyn sodium ( Aarane and Initial)
Aarane and Initial are both
inhalants
Action of Mast Cell Stabilizers
-Prophylactic
-Inhibits the release of histamine,
-Inhibits mast cell degranulation
-Inhibits release of bronchospastic agents
(True/False) Mast Cell Stabilizers are used before asthma attacks occur
True
*Mast Cell Stabilizers are used as a prophylactic. They PREVENT asthma attacks but have little effect once an attack begins
Mucolytic Example
Mucomyst
Mucomyst is administered
by nebulizer
Action of Mucolytics
-decrease viscosity of mucus
-enhance mobilization of secretions
Expectorant Example
-Mucinex (Guaifenesin)
Action of Mucinex
Thins secretions to expel easier
What should be given at the first sign of respiratory infection
Antibiotics
S/S of respiratory infection
-Purulent sputum
-Fever
-Increased WBC count
-Increased cough
Nebulization Action
-Converts drug solutions into mist
-Delivers particulate water mist (aerosols) with nearly 100% humidity
Aeroslization Action
Dispensing particles in a fine mist of saline
Nebulizers are usually used for
-severe asthmatics
-people who have trouble with MDI's
Inhalation of nebulizers can be done through
-face mask
-mouth piece held between the teeth
(MDI) Metered Dose Inhaler Action
Small, handheld, pressurized device that delivers a measured dose of drug with each activation
MDI dosing is usually accomplished with
1 to 2 puffs
PT's with poor coordination can add a _____ to an MDI
spacer
*improves inhalation of the drug
MDI should be cleaned by
Removing dust cap and rinsing with water 2x per week
Steps to properly use an MDI
1. Take off the cap and shake the inhaler
2. Breathe out all the way
3. Hold the inhaler appropriately
4. Press down the inhaler one time while breathing in SLOWLY
5. KEep breathing slowly and deeply
6. Hold your breath while counting to 10 if possible
Inhalation with a holding chamber on an MDI
first press down the inhaler then begin breathing in slowly within 5 seconds
For inhaled quick release medications like B2 Agonists wait ____ _______ between each puff
1 minute
*It is not necessary to wait between puffs with other medicines
(True/False) Instruct pt not to place in haler in mouth when inhaling steroids
True
*Inhaler should be placed 1 to 2 inches in front of the pt's mouth
Teachings for using DPI
1. Remove mouthpiece, check for dust/dirt, count # doses remaining
2. Load medication in the inhaler
3. Do NOT shake medicine
4. Tilt head back slightly and breathe out (not into inhaler)
5. Close lips tightly around inhaler
6. Breathe in deeply and quickly
7. Hold breath for 10 seconds
8. Note the # doses remaining (should be 1 less than before)
9. Don't store in humid environment
Guidelines of MDI
-Shake well before using
-Inspire Slow
-Spacer can be used (esp with steroids)
-No external counting device
-Often 2 inhalations per dose
-Use water to clean
Guidelines of DPI
-Don't shake
-Inspire rapidly
-No spacer permitted
-Counter present
-Often 1 inhalation per dose
-Avoid any moisture
Problems encountered with MDI's
1. Failing to coordinate activation and inspiration
2. Activating MDI in mouth while breathing thru nose
3. Inspiring too rapidly
4. Not holding breath for 10 seconds
5. Holding MDI upside down or sideways
6. Inhaling more than 1 puff
7. Not shaking
8. Not waiting long enough between puffs
9. Not opening mouth wide enough (medication bounces off teeth or tongue)
10. Not having adequate strength to activate MDI
11. Unable to understand directions
When giving 2 inhalants with an MDI, always give ______ first
bronchodilators
*wait 1 minute between each puff
Commonly ordered DPI
Advair (Fluticasone/Salmeterol)
steroid and beta-adrenergic agonist
Flutter Mucus Clearance Device
-Hand held device shaped like a small pipe
-Provides (PEP) Positive Expiratory Pressure
-Helps to move mucus up thru the airways so it can be expectorated
Dietary suggestions for improving respiratory function
Eat small meals throughout the day
Common supplement for Pulmonary Patients
Pulmocare:
-less CHO and more PROT to prevent and increase in CO2 from CHO breakdown
COPD Discharge Planning & Teachings
1. S/S of hypoxia
2. S/S of hypercapnia (depresses CNS causing vasodilation and headaches)
3. Breathing techniques
4. Medications
5. Stress Management
6. OTC medications
7. Vaccines (flu/Pneumonia)
8. Home O2 (fire hazard)
Cor Pulmonale
(def)
Hypertrophy of right ventricle secondary to pulmonary disease (i.e. pulmonary hypertension, COPD)
Cor Pulmonale leads to
Right sided heart failure then both (full blown HF)
CO2 Necrosis/ Respiratory Failure
Increased PCO2 (50 - 60 Range)
Decreased PO2 (55 and Below)
Increased RBC associated with COPD causes and increase in blood viscosity possibly leading to
Thromboembolism or DVT
Status Asthmaticus
(def)
Severe, life threatening asthma attack that is refractory to usual treatment and places the patient at risk for respiratory failure
Characteristics of Status Asthmaticus
-Symptoms are severe and prolonged
-Attack lasts longer than 24 hours
-Don't respond to treatments
-May cause respiratory acidosis
Grave S/S of Status Astmaticus
Increased HR and everything deterioration of everything else due to Respiratory Acidosis