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104 Cards in this Set
- Front
- Back
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COPD refers to
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a group of 3 disorders
1. asthma 2. chronic bronchitis 3. emphysema |
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define what happens in COPD
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An increase in airway resistance 2' bronchiole edema (CB), SM contraction (A), and/or decreased elasticity of the lung (E).
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In general, a patient with COPD will have a decreased...
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decreased FVC - forced vital capacity
decreased FeV1 |
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FVC forced vital capacity
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after maximal inhalation, the volume or air that can be expelled from the lungs
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FeV1
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The amount of air expired in the first second after a maximum inhalation.
Normal is 70-75% of the air that you will expire. |
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ventilation in the V/Q ratio refers to
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the amount of air getting to the lungs
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perfusion in the V/Q ratio refers to
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the amount of blood getting to the lungs
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normal V/Q ratio
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0.5
if increased, V>Q |
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define chronic bronchitis
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a disease of the large airways marked by inflammation of the bronchi
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3 main characteristics of chronic bronchitis
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-increase in size and # of submucosal glands in large bronchi (->increase mucus production)
-increase goblet cells (->increase mucus production) -impaired ciliary function (-> decreased ability to clear mucus) |
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the 3 main char of CB lead to...(2)
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decrease ventilation
increased risk of infection |
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signs and symptoms of CHRONIC BRONCHITIS
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cough
mucus production pursed lip breathing cyanosis distended neck veins overly developed neck and thorax muscles barrel chest (2' CO2 retention) clubbing digits pulsus paradoxus prolonged expiration decrease BS adventitious BS enlarged liver enlarged heart 2' increased workload cor pulmonale fatigue decreased O2, increased CO2 levels increase MCV |
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In chronic bronchitis, the bronchiole walls are usually _______, and this leads to an increase in the risk for _______.
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swollen and edematous
-leads to increase risk of -obstruction -airway collapse |
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why does MCV increase in patients with CB
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increase in size of the RBCs is to try to get more O2 to the tissues
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complications with chronic bronchitis?
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-infection**
-ARF -sleep dyspnea -hypoventilation -V/Q mismatch |
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Define emphysema
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loss of elasticity of alveolar walls and subsequent overdistention
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etiology of emphysema
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The patients have the presence of the enzyme protease, which attacks the alveolar walls. They develop pockets of air in between the alveoli called "blebs." "Bullae" are pockets that can form anywhere in the lung tissue. Blebs and bullae are dead space, so viable lung tissue is lost.
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protease, blebs, and bullae are associated with
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emphysema
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What are the 3 types of emphysema?
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1. centrilobular emphysema
2. paraseptal emphysema 3. panlobular emphysema |
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About centrilobular emphysema
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-most common
-associated with smoking -affects upper half of lungs as well as alveoli |
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About paraseptal emphysema
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-destroys the alveoli
-usually have bullae throughout the lungs -more common in elderly, and pts have a deficiency in AAT |
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AAT - alpha1 anti-trypsin
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-an enzyme that helps protect the lungs
-genetic deficiency of AAT associated with paraseptal emphysema |
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About panlobular emphysema
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-affects the bronchioles and alveoli
-usually affects lower half of the lungs |
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usually age of onset of chronic bronchitis
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40-50
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usually age of onset of emphysema
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50-75
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What are some signs and symptoms between chronic bronchitis and emphysema?
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-weight loss
-SOB -accessory muscle use -decreased BS -decreased FeV1 -decreased diffusion capacity -low PaO2 -tachypnea -increased residual volume -increased PCO2 -COUGH AND SPUTUM ARE RARE!!!! THEY ARE MORE ASSOCIATED WITH CHRONIC BRONCHITIS |
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treatments for both CB and emphysema
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-ventilation
-CMV -O2 (1-3L, no more) -bronchodilators -chest PT/nebulizers -pulmonary vest -smoking cessation -decrease exposure to irritants -avoid ppl c infection -diet change |
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diet for people with CB and emphysema and why
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-small meals (bc large meals increase workload of breathing)
-increased protein, decreased carbs (because carbs tend to make a person retain CO2) |
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Why should people with COPD be given minimal O2 of 1-3 L?
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Because they are driven to breath by a low O2 saturation, so increasing that saturation will decrease their respiratory drive.
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complications of emphysema
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similar to CB except for infection because there is not all that mucus production occuring
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Atmospheric oxygen percentage?
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21% O2
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O2 1 liter to 5 liters corresponds to what percentage O2?
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24%-40%
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if a patient is on 5 L O2, the air should definitely be
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humidified
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surgery for COPD is rare except to
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remove bullae in emphysema, because the bullae place the patient at risk for pneumothorax
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Tracheobronchitis is...
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Tracheobronchitis is an inflammatory process of the mucus membranes of the trachea.
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Tracheobronchitis usually occurs following..
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-viral or bacterial infection
-post pneumonia -post inhalation of irritating gases |
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What are the symptoms of tracheobronchitis?
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-burning over the midsternum
-cough -fever |
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What is the treatment for tracheobronchitis?
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-if bacterial - abx
-if viral - rest, bronchodilators, steroids -avoid cold (cold will exacerbate cough and increase pain |
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What is bronchiectasis?
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-a form of bronchitis with abnormal dilation of the bronchioles
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bronchiectasis typically occurs
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s/p viral or bacterial infection
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What are the symptoms of bronchiectasis?
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-cough
-sputum production |
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What is the treatment for bronchiectasis?
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same as for acute bronchitis
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define embolus
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a clot that can travel anywhere in the circulation
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define pulmonary embolism
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an occlusion of part or all of the pulmonary blood flow by an embolus
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What is the prognosis for PE's?
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high mortality
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risk factors of pulmonary embolism
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-smoking ***
-s/p sx who don't mobilize -ppl on oral contraceptives |
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most PE's originate from these veins....
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-calf
-femoral -popliteal -iliac |
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Other sources of PE's are...
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-amniotic fluid
-vegetations from heart valves -bone marrow |
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What is the pathophysiology of a pulmonary embolism?
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When an embolus travels to the lungs, it can either lodge in and completely or partially block an area of the lung, blocking pulmonary perfusion. If it lodges in a pulmonary vessel, it will increase PVR and lead to atelectasis. If it lodges in the pulmonary artery, it can lead to R-CHF because blood backs from PA to RV and RA.
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A massive PE that completely obstructs pulmonary blood flow will lead to
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respiratory arrest (if it is large enough and completely occludes pulmonary perfusion).
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What are the signs and symptoms of pulmonary embolism?
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-sometimes non specific, and sometimes may not present themselves til later
-tachypnea -chest pain -SOB, dyspnea -pleuritic pain -anxiety, apprehension -diaphoresis -sometimes pain increases with breathing |
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What is the number one diagnostic aide for pulmonary embolism?
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spiral CT
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What are the diagnostic tests for pulmonary embolism?
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-spiral CT *** Gold Standard
-ABGs show hypoxia and resp acidosis or alkalosis -D-Dimer elevated -LDH elevated |
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what is a spiral CT?
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a diagnostic, especially for pulmonary embolism, in which dye is injected into a vein to show pulmonary perfusion
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Treatments for pulmonary embolism
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-immediately - correct A/B imbal, ventilate, and IV heparin
-IV heparin for at least 3 days, maybe longer. Then you can introduce Coumadin. Do not d/c heparin until Coumadin is therapeutic AEB INR 2.0-3.0. -Usually stay on Coumadin for 6 months after discharge |
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What does IV heparin do r/t PE?
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used immediately to stabilize the clot and keep it from moving. It also prevents more clots from forming.
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How do you know if heparin is therapeutic?
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the PTT will be 2-3 times control
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antidote for heparin?
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protamine sulfate
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How do you know if Coumadin is therapeutic?
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INR will be 2.0 - 3.0
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antidote for Coumadin?
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vitamin K
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NAA and other treatments for pulmonary embolism
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-HOB elevated
-feet can be elevated but avoid flexure at the hip (b/c clots can come from there) -sometimes antiembolic stockings -CPR -analgesics -IVC/Greenfield filter -embolectomy |
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Greenfield filter
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inserted into inferior vena cava to catch any clots in the system.
-indicated if the pt has formed multiple clots or PE's |
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Atelectasis is aka
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pneumothorax
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define atelectasis
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collapse lung tissue that is not able to participate in gas exchange
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How is atelectasis diagnosed?
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-chest x-ray,
-dullness with percussion on collapsed area |
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What are some signs and symptoms of atelectasis?
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-dullness with percussion over collapsed area
-hypoxia -SOB -increased RR -decreased BS in affected lung field -if Severe - Trachea will shift toward the Affected side |
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Atelectasis may occur as a result of...
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-obstruction
-insufficient alveolar elasticity -post-op if x CDB, esp s/p abd/chest sx 2' pain -increased mucus in airway -2' lung trauma -2' lung tumor |
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What is the treatment for atelectasis?
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-tx cause
-incentive spirometry -CDB |
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3 types of atelectasis and explain them
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1. spontaneous - sudden, unknown etiology
2. secondary - known cause 3. tension - most dangerous |
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What is pneumonia?
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An inflammatory process in response to either a bacteria virus, or fungus. The lungs are not able to adequately respond. Therefore fluid accumulates within the lobe/s of the lung and within the alveoli. Then there is an impairment in O2/Co2 exchange.
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What are risk factors for pneumonia?
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-smoking**
-untreated URI -altered LOC who cannot clear secretions -immobility -dehydration -malnourishment |
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CAP is typically bacterial or viral?
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viral
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HAP is typically bacterial or viral?
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bacterial
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What are the overall signs and symptoms of pneumonia?
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-fever (but not w/ elderly)
-chills -pleuritic chest pain -cough -SOB -headache -fatigue -change in mental status |
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Why don't the elderly spike temps as regularly?
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because their thermoregulatory mechanism is impaired.
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Instead of fever in the elderly, what should the nurse observe for?
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a change in mental status.
could indicate pnm or uti |
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pneumococcoal pneumonia
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-aka streptococcal
-sudden onset of chills, followed by a high temperature -tx penicillin |
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staphylococcal pneumonia
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-fever
-chills -pleuritic pain -SOB -crackles -decreased BS -cough -increased golden yellow sputum -caused by S. aureus -tx with penicillin and cephalosporins -if MRSA-type, tx with vancomycin |
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influenza pneumonia
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-apple green sputum
-caused by H. influenza -tx Cefuoxime & ampicillin (ampicillin plus one of the cephalosporins) |
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Klebsiella pneumonia
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-increased temperature
-red jelly sputum -gram negative organism -tx Bactrim and Cipro (floxins) |
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Legionairres pneumonia
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-dry cough (but sometimes blood tinged sputum production)
-headache -fever (high fever 24-48 hours after exposure) -malaise -caused by legionella pnm -tx erythromycin (if allergy, then cephalosporins) |
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myoplasma pneumonia
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-low grade fever, normal WBC
-caused by myoplasma bacteria -tx. tetracyclines |
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viral pneumonia
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-high fever
-dry cough -slight increase WBC -caused by influenza A -typically considered CAP -tx. symptomatic -bronchodilators -cough suppressants -steroids |
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fungal pneumonia
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-malaise
-fever -caused by histoplasmosis, aspergillosis, candidiasis -mostly occurs in immunocompromised pts -tx. Amphoterecin B |
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tuberculosis is caused by
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the acid fast bacillus mycobacterium tuberculosis
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How is TB acquired?
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airborne route but needs to reach alveoli
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How is a patient diagnosed?
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-Mantoux test followed by
-chest x-ray |
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Do you need to contact people that the TB infected patient has come into contact with?
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yes
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Risk factors for TB
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-immunosuppression
-medically underserved -immigrants from 3rd world countries -health care workers |
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What does primary TB infection refer to?
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The first time the patient is infected. Mycobacterium enters the lungs and focuses on the apices or bases. Bronchopneumonia develops. By the time the host activates the macrophages to fight the infection, the bacteria has already spread. The bacteria, once dead, produce cavities in the lung, made of WBC, bacteria, and dead lung tissue
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About the cavities r/t TB...
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-made of WBC, bacteria, and dead lung tissue.
-over time these liquefy and can be coughed up by the patient. -the lungs become necrotic in the affected area |
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reactivitation of TB
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-can occur at any time,
-increase risk with increase age, immunosuppression, malnourishment (heavy smokers/drinkers), malignancy |
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What does secondary TB infection refer to?
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reactivation
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People with TB should be monitored with...
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chest xrays
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What are the signs and symptoms of tuberculosis?
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-cough that doesn't resolve and is nonproductive
-fever |
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diagnostics of TB
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-Mantoux test +5 to +10 mm induration
-chest xray -sputum culture |
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Mantoux test
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-tests for exposure to mycobacterium
-a positive test does not mean you will develop TB |
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A patient with +PPD, +CxR, +sputum culture, will remain in the hospital until
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certain drug levels are therapeutic.
-negative pressure room |
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Pharmacologic regimen for tx of TB
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-initial phase - 2 months heavy dosing of izoniazid, rifampin, and pyrazinamid, followed by
-maintenance phase - 4 months of just izoniazid and rifampin |
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Why use 3 anti-TB drugs to start?
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to prevent resistance. doses are usually large and frequent to maximize kill of the acid fast bacillus
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Why is compliance with anti-tb meds so low?
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-frequency, amount, and SE
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SE of INH/isoniazide
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-increase LFT
-great weakness -great fatigue |
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SE Rifampin
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-mostly GI
-turn secretions orange -increase LFT |
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SE pyrazinamide / ethambutol
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-optic changes, usually blurred vision, that can be permanent or stop with d/c of drug
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