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173 Cards in this Set
- Front
- Back
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Chronic Obstructive Pulmonary Disease (COPD) is a group of diseases including
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Chronic Bronchitis
Emphysema Asthma |
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_____ million Americans have COPD
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35 million
*Most common lung disorder |
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80- 90% of COPD is associated with
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Smoking
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Harmful effects of smoking leading to COPD
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smoking rapidly accelerates lung deterioration leading to COPD
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Chronic Bronchitis
(def) |
the presence of a productive cough that lasts 3 months a year for 2 consecutive years
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Chronic Bronchitis is primarily associated with
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1. Cigarette smoking
2. Air pollution |
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The decline of lung function with Chronic Bronchitis is caused by
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Chronic irritation of the airway causing an inflammatory response in the airway initiating a hypersecretion of mucous and kills ciliary
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Patients with Chronic Bronchitis are often referred to as
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Blue Bloaters- skin appears swollen and bluish due to an increase in RBC
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Polycythemia
(def) |
Increased level of Red Blood Cells circulating in the blood stream
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Polycythemia occurs with Chronic Bronchitis as an attempt to compensate for
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hypoxia
*Starts in the kidneys |
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Hemoglobin values
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Males 13.5 - 18
Females 12- 16 |
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Polycythemia Hemoglobin Value
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20 g/dl or more
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Respiration Rate Changes with Chronic Bronchitis
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Increase rate
Shallow respirations Increase cough |
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Expected breath sounds associated with Chronic Bronchitis
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-Diminished in peripheral regions
-Crackles with congestion -Wheezing |
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S/S of Chronic Bronchitis
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1. Change in respiratory rate and breath sounds
2. Use of accessory muscles 3. Dyspnea 4. Orthopnea |
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Pulmonary Function Test
(PFT) |
- Measure lung volumes and airflow by a spirometer
-Calculates a % based on an average |
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PFT's are used to
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-diagnose pulmonary disease
-monitor disease progression -evaluate disability -evaluate response to bronchodilators |
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Normal PFT range
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80-100%
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Normal PFT values are based on
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Age
Gender Race Height |
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Vital Capacity (VC)
(def) |
Maximum volume of air that can be exhaled after maximum inspiration
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VC is typically (increased/decreased) with chronic bronchitis
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decreased
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_________ may be ordered after administration of a bronchodilator to determine the degree of response
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spirometry (pulmonary function test)
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A positive response to a bronchodilator is
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> 200 ml increase or a 12% increase
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Forced Vital Capacity (FVC)
(def) |
Amount of air that can be quickly and forcefully exhaled after maximum inspiration
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Forced Expiatory Volume (FEV1)
(def) |
Amount of air exhaled in first second of FVC
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Grades severity of airway obstruction
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FEV1
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Normal value for FVC and FEV1
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Over 80%
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_______ have been shown to have a higher FVC and FEV1 than _________ and _________
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Whites
Mexican Americans and African Americans |
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Increased CO2 levels with Chronic Bronchitis will result in
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CNS sedation
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CNS sedation caused by an increase in CO2 will cause
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Restlessness
Irritability Confusion Somnolence |
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Late S/S of Chronic Bronchitis
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Dusky, Cyanotic skin
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Clinical manifestations of the Heart related to Chronic Bronchitis
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1. Heart pumps thick blood through narrowed (vesoconstricted) vessels
2. Right ventricle enlarges 3. Right sided heart failure |
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Classic Symptom of Right side heart failure
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JVD
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Chronic Bronchitis causes right ventricular enlargement because
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it is working so hard to pump into the narrowed pulmonary vessels
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Right sided heart failure associated with Chronic Bronchitis may also lead to
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1. Hepatomegla
2. Splenomegla 3. Intestinal backflw (n/v) 4. Edema |
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Blood tends to be thicker in patient's with Chronic Bronchitis r/t
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increased RBC
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Weight typically (increases/decreases) with Chronic Bronchitis
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Increases- caused by edema
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Activity level typically (increases/decreases) with Chronic Bronchitis
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Decreases- caused by SOB and dyspnea
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Emphysema
(def) |
Chronic obstruction of inflow and outflow of air from the lungs
*Increase in airway resistance |
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The leading cause of emphysema
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smoking
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Characteristics of Emphysema
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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 |
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Hyperexpansion of the lungs associated with emphysema
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-Lungs stay inflated and stiff reducing the ability to exhale effortlessly
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___________ and __________ are destroyed with emphysema causing the loss of lung recoil
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elastin and collagen
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Inflammation of the bronchioles, excessive mucous and loss of elastic recoil may lead to
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infections
*stimulating neutrophils and macrophages causing protelytic enzyme to be released |
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By the time S/S of Emphysema occur
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Damage to the tissues is done and cant be repaired
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Proteolytic enzymes
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-Break down of proteins
-Destroy alveolar tissue causing: *Increase of air trapped in alveoli *Increase in dead space *Decrease O2 diffusion |
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Proteolytic enzymes are released in response to
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recurrent infections related to emphysema
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Due to hyperexpansion of the lungs, emphysema causes
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barrel chest and respiratory changes
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Alpha 1 Antitrypsin (AA1)
(def) |
a glycoprotein that has an inhibitory effect on proteolytic enzymes
*Genetic cause of COPD |
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Patients with Emphysema have __________ AA1 levels
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deficient
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____________ inactivates AA1
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smoking
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Deficient AAT causes
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lysis of lung tissue
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____% of emphysema is caused by genetic AA1
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3%
*Majority caused by smoking |
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The emphysemic is often called
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"pink puffer"
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"pink puffer" refers to the predominant symptom of emphysema
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dyspnea
*Can be present at rest and become worse with exertion |
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(True/False)
It is not until late in Emphysema that a person becomes hypoxic |
True
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The earliest sign of emphysema
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dyspnea
*Takes a lot of nrg to breath just sitting still |
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Barrel Chest associated with emphysema is caused by
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increased air trapping flattens ithe diaphragm and increases the anteroposterior diameter of the chest
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Emphysema typically causes a __________ cough
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non-productive
*minimal sputum |
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Respiratory rate with emphysema typically (increases/decreases)
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Increases
*18-24 (use of accessory muscles) |
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_______ and _______ often occur with emphysema sue to an increase in metabolic rate and lack of nrg
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Anorexia and weight loss
*loss of muscle mass and fat |
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(True/False) Patients with emphysema typically have an increase in nrg
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False-
emphysema causes weakness due to muscle wasting |
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Asthma
(def) |
Chronic inflammatory disorder of the airways
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Inflammation related to asthma causes airway
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obstruction
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Asthma causes episodes of
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wheezing
breathlessness chest tightness cough |
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Asthma results in a complex _________ response that causes an increase in airway ________
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inflammatory
resistance |
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Constant inflammation and airway resistance associated with asthma eventually leads to
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airway damage
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______ million people per year are hospitalized with asthma
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1/2 million
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Asthma causes ______ and _______ of the tracheobronchial tree
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hyperirritability
hyperresponsiveness |
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Hyperirritability and hyperresponsiveness of the tracheobroncial tree causes
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-constriction of bronchial smooth muscle
-hypersecretion of mucous and mucosal inflammation -Edema (inside the lungs) |
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Inflammation r/t asthma is caused by
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1. Allergens
2. Air pollution 3. RTI 4. Exercise 5. Cold Air 6. Stress 7. Medications 8. GERD |
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IGE receptors on Mast cells in response to allergens release
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Mediators:
histamine bradykinin prostoglandins Leukotrienes |
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Mediators released by mast cells initiate an inflammatory response causing
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vascular permeability
*causing fluid to leak into the interstitial spaces |
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Common allergens that trigger asthma
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sinusitis
animals dust mites pollen |
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To prevent an asthma attach while exercising be sure to
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warm to to promote O2 exchange
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Cold air can cause asthma attacks by
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causing bronchospasms
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Medications that can trigger asthma attacks
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Aspirin
Anti inflammatory |
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GERD can cause asthma attacks by
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allowing gastric contents to get into the esophagus
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S/S of Asthma
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1. Respiratory changes
2. Wheezing 3. Nonproductive cough 4. ABG's 5. PERF 6. Epsinophilia |
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Wheezing occurring with asthma
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Starts off with expiratory wheezing and progresses to expiratory and inspiratory wheezing
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(True/False) Asthma typically presents a nonproductive cough
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True
*Secretions associated with asthma are thick and often cant be coughed up |
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ABG values with Asthma
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Acute asthma attacks will cause Respiratory Alkalosis b/c excessive blowing off of CO2
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Peak Expiratory Flow Rate (PEFR) (def)
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Maximum airflow rate during forced expiration
*Aids in monitoring bronchoconstriction |
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PEFR is measured with
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Peak flow meter (PFM)
*Determines how well asthma is being controlled |
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PEFR Normal Value
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80-100% of personal best
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Steps to use a peak flow meter (PFM)
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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 |
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PFM should be taken each day for
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2 to 3 weeks
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PFM should be taken
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-Between noon and 2pm each day
-Each time quick relief medicine is taken (after taking) -At HCP suggestion |
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Peak Flow Zones
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Green: 80-100% (good control)
Yellow: 50-79% (caution: ashtma getting worse) Red: below 50% (Medical Alert) |
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Interventions for Green Zone Reading
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Keep taking long-term medication as prescribed
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Interventions for Yellow Zone Reading
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-Keep taking long-term medications as prescribed
-Add quick relief medications -Consult MD to determine if additional dosages are required |
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Interventions for Red Zone Reading
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Add or increase quick relief medication and call HCP NOW!
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PEFR Normal Value
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80-100% of personal best
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Eosinophilia
(def) |
-Elevated eosinophil count
Above 4% |
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Normal Eosinophil Value
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1-4%
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An increase in eosinophils may be related to
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an increase in allergens
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Leukotriene Modifier medications have what (2) effects
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1. Bronchodilator
2. Anti-inflammatory |
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Action of Leukotriene Modifiers
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Interfere or block the action of leukotrienes, which cause airway edema, bronchoconstriction and inflammation
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Examples of Leukotriene Modifiers
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1. Zafirlukast (Accolate)
2. Montelukast (Singulair) 3. Zileuton (Zylfo) |
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Treatment for an Acute Asthma Attack
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Maintain airway and help calm anxiety
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Chronic Management of Asthma
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Determine what is causing the attacks
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Assessment for Asthma
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*If they are currently having an attack, get important info only then perform a complete assessment later
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Smoking history for asthma is determined by
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Pack/year history
(one pack year= one pack per day for 1 year) |
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Serious lung complications typically begin once a smoker reaches
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20 pack/year history
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COPD Assessment should include:
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-History
-Physical Exam -Respiratory:PFT -Skin -Cardiac: monitor for HF -Fluid: deficit or overload -Nutrition |
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Nursing Diagnosis R/T COPD
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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 |
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Nursing Interventions R/T COPD
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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 |
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Intervention for COPD prevention and health maintenance
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Smoking Cessation
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Medications for smoking cessation
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-Chantix: disrupts brain messages, pt's may become hostile- watch for suicide
-Wellbutrin: depression medication has shown to be helpful |
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Teaching Interventions for COPD
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1. Effective Coughing
2. Breathing Techniques (pursed lips) |
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Pursed Lip Breathing
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-Improves O2 transport
-Encourages slow controlled breathing -Lengthens exhalation reducing airway collapse |
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Steps for Pursed Lip Breathing
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1. Inhale slowly for 3 seconds
2. Exhale thru pursed lips for 7 seconds while tightening abdominal muscles |
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O2 Therapy Administration for Patients with COPD
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-Low dose O2
-0.5-3 Liters/ minute with nasal cannula |
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__________ drives a COPD patient to breathe
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Hypoxemia
*COPD Pt's used to increased CO2 levels, if high levels of 02 levels are administered, hypoxemia drive to breathe will diminish |
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Drug Therapy for COPD
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1-Bronchodilators
2-Corticosteroids 3-Mast Cell Stabilizers 4-Mucolytics 5-Expectorants 6-Antibiotics |
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Bronchodilator Examples
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1. Methylxantines
(IV form: Aminophylline) (Oral form: Theophylline) 2. Beta-Adrenergic Agonists 3. Anti-Cholinergics |
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Action of Methylxanthines
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Reverse airway obstruction by relaxation of bronchial smooth muscles and improve contractility of diaphragm
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Side effects of Methyxanthines
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Cause GI symptoms:
Nausea/Vomiting GI irritation |
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___________ tends to produce many side effects and is not prescribed often
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Aminophylline
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Therapeutic levels of Methylxanthines should range between
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10-20 mcg/ml
*Above 20 mcg/ml Toxic |
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Side effects of toxic methylxanthine levels effect
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CV and CNS
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Beta- Adrenergic Agonist Examples
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Alupent
Albuterol Proventil Brethaire |
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Action of Beta-Adrenergic Agonists
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-Relax smooth muscle of all airways (trachea to terminal bronchioles)
-Increase mucociliary clearance -Mimic SNS (Increase HR and BP) |
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It is desired to take Beta-Adrenergic Blockers that block only Beta (1/2) receptors
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2
*Beta 2 receptors affect bronchial smooth muscles |
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Methylxanthines and Beta-Adrenergic Blockers can be given
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Orally or by inhalation and should be spaced out equally throughout the day
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Anti-cholinergic Examples
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-Atrovent
-Spiriva |
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Action of Anti-cholinergic
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Opens airways by blocking vagal (parasympathetic) nerve impulses resulting in:
-bronchodilation -decreased mucus secretions |
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Anti-cholinergic inhalants have (few/many) side effects
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Few
*inhalants have few side effects because they are poorly absorbed |
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The first line drug of treatment for Chronic COPD
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Corticosteroids
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Corticosteroid Examples
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-(IV forms): Solu-Cortef; Solu-Medrol
-(oral forms): Prednisone; Medrol -(Inhaled forms): Becovent; Flovent; Aerobid |
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Effects of Corticosteroids
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1. Anti-inflammatory
2. Immunosuppressive effects |
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Affects of corticosteroids on the Lungs
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-Decreased bronchial airway edema
-Act synergistically with beta-2 agonists -Decrease mucus secretions |
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Side effects of Corticosteroids
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-Increase glucose levels
-Increase Na+ (Increases BP) -Increases appetite -Decreases K+ -Mood swings -Ulcers |
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Mast Cell Stabilizer Example
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Cromolyn sodium ( Aarane and Initial)
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Aarane and Initial are both
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inhalants
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Action of Mast Cell Stabilizers
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-Prophylactic
-Inhibits the release of histamine, -Inhibits mast cell degranulation -Inhibits release of bronchospastic agents |
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(True/False) Mast Cell Stabilizers are used before asthma attacks occur
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True
*Mast Cell Stabilizers are used as a prophylactic. They PREVENT asthma attacks but have little effect once an attack begins |
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Mucolytic Example
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Mucomyst
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Mucomyst is administered
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by nebulizer
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Action of Mucolytics
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-decrease viscosity of mucus
-enhance mobilization of secretions |
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Expectorant Example
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-Mucinex (Guaifenesin)
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Action of Mucinex
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Thins secretions to expel easier
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What should be given at the first sign of respiratory infection
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Antibiotics
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S/S of respiratory infection
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-Purulent sputum
-Fever -Increased WBC count -Increased cough |
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Nebulization Action
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-Converts drug solutions into mist
-Delivers particulate water mist (aerosols) with nearly 100% humidity |
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Aeroslization Action
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Dispensing particles in a fine mist of saline
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Nebulizers are usually used for
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-severe asthmatics
-people who have trouble with MDI's |
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Inhalation of nebulizers can be done through
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-face mask
-mouth piece held between the teeth |
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(MDI) Metered Dose Inhaler Action
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Small, handheld, pressurized device that delivers a measured dose of drug with each activation
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MDI dosing is usually accomplished with
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1 to 2 puffs
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PT's with poor coordination can add a _____ to an MDI
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spacer
*improves inhalation of the drug |
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MDI should be cleaned by
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Removing dust cap and rinsing with water 2x per week
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Steps to properly use an MDI
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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 |
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Inhalation with a holding chamber on an MDI
|
first press down the inhaler then begin breathing in slowly within 5 seconds
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For inhaled quick release medications like B2 Agonists wait ____ _______ between each puff
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1 minute
*It is not necessary to wait between puffs with other medicines |
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(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 |
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Teachings for using DPI
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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 |
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Guidelines of MDI
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-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 |
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Guidelines of DPI
|
-Don't shake
-Inspire rapidly -No spacer permitted -Counter present -Often 1 inhalation per dose -Avoid any moisture |
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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 |
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When giving 2 inhalants with an MDI, always give ______ first
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bronchodilators
*wait 1 minute between each puff |
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Commonly ordered DPI
|
Advair (Fluticasone/Salmeterol)
steroid and beta-adrenergic agonist |
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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 |
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Dietary suggestions for improving respiratory function
|
Eat small meals throughout the day
|
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Common supplement for Pulmonary Patients
|
Pulmocare:
-less CHO and more PROT to prevent and increase in CO2 from CHO breakdown |
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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) |
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Cor Pulmonale
(def) |
Hypertrophy of right ventricle secondary to pulmonary disease (i.e. pulmonary hypertension, COPD)
|
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Cor Pulmonale leads to
|
Right sided heart failure then both (full blown HF)
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CO2 Necrosis/ Respiratory Failure
|
Increased PCO2 (50 - 60 Range)
Decreased PO2 (55 and Below) |
|
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Increased RBC associated with COPD causes and increase in blood viscosity possibly leading to
|
Thromboembolism or DVT
|
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Status Asthmaticus
(def) |
Severe, life threatening asthma attack that is refractory to usual treatment and places the patient at risk for respiratory failure
|
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Characteristics of Status Asthmaticus
|
-Symptoms are severe and prolonged
-Attack lasts longer than 24 hours -Don't respond to treatments -May cause respiratory acidosis |
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Grave S/S of Status Astmaticus
|
Increased HR and everything deterioration of everything else due to Respiratory Acidosis
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