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39 Cards in this Set
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- Back
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Chronic Respiratory Illness: prevalence, differential diagnosis, types of lung diseases |
Prevalence • COPD rates higher in smaller communities (decreased health access, more smoking, less income, less education) • Increased rate of COPD in indigenous populations (lower SES, more poverty, less healthcare access) o Indigenous populations smoke more • Climate change (wildfire smoke, heat waves, dust storms) Differential diagnosis • Bronchodilators have less effect on COPD than asthma • FEV/FVC <70% = COPD Types of lung diseases • Obstructive – increased airway resistance • Restrictive – loss of airway compliance (stretch/expand) • Parenchymal – destruction of alveoli or air sacs • Infectious – caused by bacteria invading the lungs |
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Asthma: causes, risk factors, patho, types of responses |
Patho • Chronic inflammatory disorder of the airways o Causing airway restriction • Paroxysmal (fit/attack) or persistent • Symptoms present early morning and night Causes/risk factors • In children o Common chronic disease in children and is a leading cause of childhood morbidity o Atopy present asthma over 3 year old o Allergy specific sensitization risk factor o History allergic rhinitis and wheezing from o colds Pathophysiology • Phenotypes o Allergic (especially in children, associated with allergic history, eczema, rhinitis) o Non-allergic (no allergy association) o Adult-onset asthma (requires higher doses inhaled GCC aka ICS, work related) o Asthma with persistent airflow limitation (long standing asthma -> airway limits) o Asthma with obesity (obesity cause asthma S&S) • Early Response o Bronchospasm triggered by allergy o Irritant attach IgE on mast cell in basement membrane bronchial wall releasing inflammatory factors o Intense inflammation, bronchiole smooth muscle constriction, vasodilation and permeability and epithelial damage o Effects of bronchospasm, increase mucus secretion, edema, tenacious sputum o Response peaks at 30-60 min after exposure to trigger and subsides in 30-90 min • Late Response o 5-12 hr after exposure o More inflammation present as increased airway reactivity lowers threshold for symptoms to worsen o Hyperresponsive to allergens o Lead to hypertrophy bronchial smooth muscles o Increase work of breathing o Result alteration respiratory function o If airway not managed lead to long term damage lungs |
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Asthma: assessment and ongoing monitoring |
Physical assessment o Vital signs o O2 Saturation (pulse oximetry) & ABGs o Resp assessment: Auscultation, wheezing, crackles, ↓ breath sounds, hyper-resonance, sputum, use of accessory muscles, retractions, tachypnea, prolonged expiration o Restlessness/exhaustion, confusion, tripod position o Eczema, diaphoresis, cyanosis (circumoral, nails) o Tachycardia, pulsus paradoxus, JVD, HTN/Hypo
Ongoing monitoring • GOAL: risk reduction and symptom control. o Assess Current asthma control – e.g. asthma control questionnaire o Risk of future exacerbations • Assess the current level of asthma control (past 4 weeks) for following criteria: o Need for a fast-acting beta2-agonist < 4 doses/week (including for exercise); o Daytime symptoms < 4 days/week; o Nighttime symptoms < 1 night/week; o Normal physical activity levels; o Mild, infrequent exacerbations; o No absences from work or school; o Forced expiratory volume in first second (FEV1) or peak expiratory flow (PEF) ≥ 90% of personal best*‡; o Diurnal PEF variation < 10–15%*‡; and o Sputum eosinophils < 2–3%*‡ . • Risk of future asthma exacerbations o Current control of asthma o Co-morbidities (ex. obesity, lung fibrosis, etc.) o Severe exacerbations experienced (ex. requiring systemic corticosteroids) o Use of emergency care or hospitalisation |
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Conditions associated with asthma |
o Obesity – hard time breathing – slight collapsed lungs = wheezing o Chronic sinus infections – will have a cough = seems poorly controlled asthma (but it’s nose) o GERD – cough o Pregnancy – 1/3 de better, 1/3 do worse & 1/3 don’t change o Sleep disordered breathing – sleep apnea (if not well treated, asthma is not well controlled) |
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Respiratory diagnostic studies |
Forced Expiratory Volume over 1 second (FEV1) o Amount of air forcibly expired after one second o Distinguishes obstructive or restrictive lung disease o Special considerations Unreliable in children <5 years old ICS/SABA/LABA increase FEV1Forced Vital Capacity (FVC) o Amount of air forcibly expired o Distinguishes obstructive or restrictive lung disease o Special considerations FEV1 > FVC => chest wall deformities & idiopathic lung fibrosis Reduced FEV1 to FVC ratio => expiratory airflow limitation Assess change in value/reversibility after SABA use Peak Expiratory Flow (PEF or PEFR) PFM (peak flow measurement) o Assess response treatment (use before/after medication administration) o Compare personal best PEF from two reading daily averaged 2 weeks o Peak flow amount and rate air forcibly exhaled o Determine when attack coming on and provide information how open airway are o Measure at home over time o Green good optimal asthma control o Yellow colour -> less control -> may need medication o Patient teaching Move the marker to the bottom of the numbered scale. Stand up straight. Take a deep breath and fill your lungs all the way. Hold your breath while you place the mouthpiece in your mouth, between your teeth. Close your lips around it. Do not put your tongue against or inside the hole. Blow out as hard and fast as you can in a single blow. Your first burst of air is the most important. So blowing for a longer time will not affect your result. Write down the number you get. But, if you coughed or did not do the steps right, do not write down the number. Instead, do the steps over again. Move the marker back to the bottom and repeat all these steps 2 more times. The highest of the 3 numbers is your peak flow number. Write it down in your log chart. |
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Respiratory differential diagnosis |
• FEV1/FVC ratio distinguishes obstructive or restrictive lung disease o Normal/restrictive -> FEV1/FVC value >0.70 o Obstructive -> FEV1/FVC value <0.70 • Give SABA/bronchodilator for patient o Asthma Dx -> if FEV1 increases/is reversible o COPD Dx -> if FEV1 stays the same/is not reversible • Asthma o Intermittent and variable S&S, infrequent sputum production, often related to allergies, spirometry findings often normalize, characterized as stable with exacerbations • COPD o Persistent S&S, often sputum production, infrequently related to allergies, spirometry findings may improve but never normalize, characterized as progressive worsening with exacerbations |
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Asthma levels of severity: GINA guidelines |
• No need for rescue inhaler, only for sudden/acute • Treatment focus on controlling symptoms and management of modifiable risk factors • Mild Asthma o Well controlled low-intensity treatment (Step 1 treatment – as need or prior to strenuous activity) • Moderate asthma o Well controlled step 3 to 4 treatment • (use for SABA and ICS) • Severe asthma o Uncontrolled despite optimized treatment o LABA-ICS • Controlled Asthma o Absence symptoms o Normal pulmonary function o Can have mild or severe asthma well-controlled o Severity determined level of medication treatment o Severity can alter through the life span |
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Triggers of asthma |
• Allergens (one of reason It affects children more) • Tobacco and marijuana (smoke in general) • Exercise (airway narrowing, bronchospasm causing S&S, cold air also bad) o Manage by warming up, • Respiratory infections (increase inflammation of mucous membrane and airways) • Medications (NSAIDs -> bronchoconstriction, beta-blockers can trigger asthma S&S) • Rhinitis • GERD • Weight • Air pollution -> climate change |
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Manifestations of asthma |
• Wheezing o Audible/on auscultation o Expiratory first, then inspiratory as asthma worsens o If wheezing stops = silent chest’ in a patient is a medical emergency, and is a sign of impending respiratory failure o After bronchodilator, wheezing gets louder in asthma patients • Cough o Often at night/in the morning o Some pt “only” have coughing • Dyspnea o Varies in extent, can lead to anxiety o Pt should sit in tripod position • Chest tightening o Subjective symptom due to airway restriction • Prolonged expiration o Inspiratory-expiratory ration 1:3 or 1:4 (vs. normal 1:2) • Other o Tachycardia, decreased BP o Restlessness, anxiety, exhaustion o Pulsus paradoxus (lying down reduces systolic pressure and increase intrathoracic pressure) o Hypoxemia, accessory muscle use o Resp. alkalosis → Resp. acidosis (Acidosis from CO2 trapping) |
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Asthma exacerbation: medical and nursing management |
• Monitor Airway, Breathing, Circulation & Neuro • Oxygen administration (as ordered – sat 93%-95% adults) • Intubation/Critical care (as ordered) • Medication Administration (as ordered) • Discharge Planning o Focus on patient GOALS o Plan at home (resources) o Engagement with family • Comfort, Rest & Ambulation • Patient Education o Triggers o Medications (how/when to use inhalers) o Follow-up appointments o Asthma Action Plan • Difficult to Treat Asthma/Severe Asthma: o Uncontrolled despite medium or high dose ICS-LABA treatment o Or requires high dose ICS-LABA to maintain symptoms control o In many cases due to suboptimal management of modifiable risk factors |
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Asthma exacerbation: medical and nursing management |
• Monitor Airway, Breathing, Circulation & Neuro • Oxygen administration (as ordered – sat 93%-95% adults) • Intubation/Critical care (as ordered) • Medication Administration (as ordered) • Discharge Planning o Focus on patient GOALS o Plan at home (resources) o Engagement with family • Comfort, Rest & Ambulation • Patient Education o Triggers o Medications (how/when to use inhalers) o Follow-up appointments o Asthma Action Plan • Difficult to Treat Asthma/Severe Asthma: o Uncontrolled despite medium or high dose ICS-LABA treatment o Or requires high dose ICS-LABA to maintain symptoms control o In many cases due to suboptimal management of modifiable risk factors |
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Asthma textbook interventions: ineffective airway clearance |
related to excessive mucus, retained secretions as evidenced by ineffective cough, adventitious breath sounds • GOAL: Maintains open airway. Has normal breath sounds and respiratory rate. Has normal or personal best objective lung function measurements (PEFR, FEV1, FEV1/FVC). Participates in normal life activities, including exercise and physical activity (identifying activity that is meaningful to the patient is helpful). • Nursing Interventions and Rationales o Position patient to maximize ventilation potential allowing for adequate chest expansion. o Monitor respiratory (including spirometry) and oxygenation status to determine need for intervention or to note improvement. o Administer medications (e.g., bronchodilators, corticosteroids), as per MD/NP, to improve respiratory function. o Teach patient proper use of prescribed inhalers (see Table 31-8) to deliver adequate medication to the lungs. o Auscultate lung sounds after treatments to note improvement. o Regulate fluid intake to optimize fluid balance and liquefy secretions to facilitate removal. o Provide asthma education to help patient understand condition and avoid triggers, when possible. o Establish a written asthma action plan with patient to manage exacerbations, and educating the patient about it to ensure that patient is prepared for emergency situations. |
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Asthma exacerbation: medical and nursing management |
• Monitor Airway, Breathing, Circulation & Neuro • Oxygen administration (as ordered – sat 93%-95% adults) • Intubation/Critical care (as ordered) • Medication Administration (as ordered) • Discharge Planning o Focus on patient GOALS o Plan at home (resources) o Engagement with family • Comfort, Rest & Ambulation • Patient Education o Triggers o Medications (how/when to use inhalers) o Follow-up appointments o Asthma Action Plan • Difficult to Treat Asthma/Severe Asthma: o Uncontrolled despite medium or high dose ICS-LABA treatment o Or requires high dose ICS-LABA to maintain symptoms control o In many cases due to suboptimal management of modifiable risk factors |
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Asthma textbook interventions: ineffective airway clearance |
related to excessive mucus, retained secretions as evidenced by ineffective cough, adventitious breath sounds • GOAL: Maintains open airway. Has normal breath sounds and respiratory rate. Has normal or personal best objective lung function measurements (PEFR, FEV1, FEV1/FVC). Participates in normal life activities, including exercise and physical activity (identifying activity that is meaningful to the patient is helpful). • Nursing Interventions and Rationales o Position patient to maximize ventilation potential allowing for adequate chest expansion. o Monitor respiratory (including spirometry) and oxygenation status to determine need for intervention or to note improvement. o Administer medications (e.g., bronchodilators, corticosteroids), as per MD/NP, to improve respiratory function. o Teach patient proper use of prescribed inhalers (see Table 31-8) to deliver adequate medication to the lungs. o Auscultate lung sounds after treatments to note improvement. o Regulate fluid intake to optimize fluid balance and liquefy secretions to facilitate removal. o Provide asthma education to help patient understand condition and avoid triggers, when possible. o Establish a written asthma action plan with patient to manage exacerbations, and educating the patient about it to ensure that patient is prepared for emergency situations. |
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Status asthmaticus: causes, manifestations |
• Causes: viral illness, environmental pollutant, allergen exposure, poor medication adherence, or from underlying condition and age. Ex. older adult and CAD • Extreme acute asthma attack – life threatening situation o Can lead to cor pulmonal (late sign of COPD) and even death |
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Asthma exacerbation: medical and nursing management |
• Monitor Airway, Breathing, Circulation & Neuro • Oxygen administration (as ordered – sat 93%-95% adults) • Intubation/Critical care (as ordered) • Medication Administration (as ordered) • Discharge Planning o Focus on patient GOALS o Plan at home (resources) o Engagement with family • Comfort, Rest & Ambulation • Patient Education o Triggers o Medications (how/when to use inhalers) o Follow-up appointments o Asthma Action Plan • Difficult to Treat Asthma/Severe Asthma: o Uncontrolled despite medium or high dose ICS-LABA treatment o Or requires high dose ICS-LABA to maintain symptoms control o In many cases due to suboptimal management of modifiable risk factors |
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Asthma textbook interventions: ineffective airway clearance |
related to excessive mucus, retained secretions as evidenced by ineffective cough, adventitious breath sounds • GOAL: Maintains open airway. Has normal breath sounds and respiratory rate. Has normal or personal best objective lung function measurements (PEFR, FEV1, FEV1/FVC). Participates in normal life activities, including exercise and physical activity (identifying activity that is meaningful to the patient is helpful). • Nursing Interventions and Rationales o Position patient to maximize ventilation potential allowing for adequate chest expansion. o Monitor respiratory (including spirometry) and oxygenation status to determine need for intervention or to note improvement. o Administer medications (e.g., bronchodilators, corticosteroids), as per MD/NP, to improve respiratory function. o Teach patient proper use of prescribed inhalers (see Table 31-8) to deliver adequate medication to the lungs. o Auscultate lung sounds after treatments to note improvement. o Regulate fluid intake to optimize fluid balance and liquefy secretions to facilitate removal. o Provide asthma education to help patient understand condition and avoid triggers, when possible. o Establish a written asthma action plan with patient to manage exacerbations, and educating the patient about it to ensure that patient is prepared for emergency situations. |
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Status asthmaticus: causes, manifestations |
• Causes: viral illness, environmental pollutant, allergen exposure, poor medication adherence, or from underlying condition and age. Ex. older adult and CAD • Extreme acute asthma attack – life threatening situation o Can lead to cor pulmonal (late sign of COPD) and even death |
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Cor Pulmonale: Patho, causes, manifestations, mangement |
Causes: late sign of COPD, asthma exacerbation • Cor pulmonal = structure & function alteration of right ventricle typically caused by pulmonary hypertension • Sinus tachycardia right side pulmonary vasoconstriction pulmonary hypertension further develop to cor pulmonal right-side heart failure • Cor Pulmonal Pathophysiology: o Description: Hypertrophy of right-side heart resulting from pulmonary hypertension o Alveolar hypoxia leads to constriction of pulmonary vessels, and acidosis potentiates vasoconstriction o Chronic alveolar hypoxia leads to Pulmonary arteriolar muscle hypertrophy Erythropoiesis -> polycythemia, increases blood viscosity o Manifestation: JVD, hepatomegaly, ascites peripheral edema, weight gain, ascites o Management: low flow oxygen, diuretics |
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Asthma exacerbation: manifestations, management, collaborative care |
• Manifestation: o Severe and prolonged wheezing, or silent breath sounds d/t obstruction o Extreme anxiety, fear of suffocation o Increased of work breathing (muscle retraction in sternocleidomastoid, intercostal and supraclavicular muscles) o Diaphoresis common (no diaphoresis indicate dehydration) • Not responsive to traditional treatment • Management: 3-5% require ventilatory assistance ICU collaborative care • Goals of care for asthma diagnosis o Achieve good symptom control o Minimise asthma-related mortality, exacerbation, persistent airflow limitation and side-effects of treatment o Get to where the patient ‘wants to be’ • Setting goals for home o Returning to normal activities. o Engaging in activity of daily living o Achieve control over symptoms o Minimize attacks and symptoms |
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Asthma exacerbation: manifestations, management, collaborative care |
• Manifestation: o Severe and prolonged wheezing, or silent breath sounds d/t obstruction o Extreme anxiety, fear of suffocation o Increased of work breathing (muscle retraction in sternocleidomastoid, intercostal and supraclavicular muscles) o Diaphoresis common (no diaphoresis indicate dehydration) • Not responsive to traditional treatment • Management: 3-5% require ventilatory assistance ICU collaborative care • Goals of care for asthma diagnosis o Achieve good symptom control o Minimise asthma-related mortality, exacerbation, persistent airflow limitation and side-effects of treatment o Get to where the patient ‘wants to be’ • Setting goals for home o Returning to normal activities. o Engaging in activity of daily living o Achieve control over symptoms o Minimize attacks and symptoms |
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Asthma: non pharm interventions |
• Smoking cessation & reducing exposure to second-hand smoke • Promote physical activity & Weight reduction • Avoid indoor/outdoor allergens & pollution • Healthy diet (sulphites, a food additive, can be a trigger) • Breathing exercises (deep breathing, pursed lips, diaphragmic breathing) • Psychosocial support • Avoid occupational exposures • Avoid medication if they make their asthma worse (NSAID, aspirin, oral/ ophthalmic beta-blockers), case-by-case basis |
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Asthma pharm management general info: long terms goals, two types of treatments |
• Long term goals: o Achieve good symptom control o Decrease risk of death, exacerbation, airflow limitation, side effects o FIRST STEP: SABA with ICS reduces severe exacerbation risk • Two types of treatment o Controller meds: for prevention of S&S, used regularly (best = inhaled glucocorticoids) o Reliever meds: for management of acute S&S, used PRN, ex. exercise-induced (best = short-acting beta2-agonist, SABA) |
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Asthma pharm management general info: long terms goals, two types of treatments |
• Long term goals: o Achieve good symptom control o Decrease risk of death, exacerbation, airflow limitation, side effects o FIRST STEP: SABA with ICS reduces severe exacerbation risk • Two types of treatment o Controller meds: for prevention of S&S, used regularly (best = inhaled glucocorticoids) o Reliever meds: for management of acute S&S, used PRN, ex. exercise-induced (best = short-acting beta2-agonist, SABA) |
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Asthma pharm medications |
• SABA: short-acting beta2-agonist; o SABA alone increased risk death and need emergency care o Onset is 10-20 minss • LABA: long-acting beta2-agonist; (second line therapy) o Takes several hours to kick in and gives relief for 12-24 hours (taken regular) • SAMA: short-acting muscarinic antagonist; o Works within 5-15 minutes, lasts 4-6 hours (breakthroughs) o Indirect bronchodilators (not 1st line treatment) • LAMA: long-acting muscarinic antagonist; ICS: inhaled corticosteroids o Indirect bronchodilators (not 1st line treatment) • When bronchodilators not enough, add: o Formoterol – short and long-acting bronchodilator. Starts quickly but lasts 12 hours. • Anti-inflammatories – ones available in Montreal. • Access to rescue medication: fast acting B2 agonist or reliever ie. SABA • Corticosteroids use in combination for best outcomes o Control of hyperresponsive response blocking late phase reaction o Therapeutic effects in 24 h some meds o Fixed schedule o Side effects: oropharyngeal candidiasis, hoarseness, and dry cough (Monitor I&O -> d/t fluid retention) o Use spacer better outcome o Rinse mouth after administration • Antileukotrienes (third line therapy) o Montelukast block leukotrienes bronchoconstriction and cause edema and airway inflammation o Not as potent as ICS |
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COPD: general info, causes/risk factors, patho, |
COPD • Prevalence: ≥ 35 years of age • Associated with enhanced chronic inflammatory response of the airway and lungs • Abnormality alveoli cause persistent often progressive airflow obstruction • Chronic respiratory symptoms • COPD persist or fixed • Also harbor multiple co-morbidities Causes/risk factors • Smoking is a huge factor, noxious particles, and gases, but not exclusive o Any exposure to smoking o Effect inflation in lungs, hyperplasia of goblet cells o Reduce ciliary activity and damaged alveoli o Carbon monoxide effect hemoglobin oxygen carrying capacity o Overall decrease oxygen function o GOLD standard review research show trend of decrease smoking but not equivalent to decrease COPD rate meaning…. o Only 50% heavy smoker develop COPD therefor other pathological factors come into play • Noxious particles and gases o Harmful existing lung condition can lead to exacerbation or causative factors o Workplace fumes, exposure to dust, vapours o Coal burning o Pollution in air o Exposure pesticides o Exposure PM2.5 and nitrogen dioxides effect lung function and development • Recurrent respiratory infections o Recurrent rep infection aggravates and progresses COPD o Reduce lung function o Increase respiratory symptoms • Climate change -> wildfires, smoke • Genetics – AAT deficiency (alpha1 anti-trypsin deficiency) o Results in lack of elastin in lungs (fights infections) o AAT prevents the body from being attacked by its own enzymes • Older age o Respiratory muscles gradually lose elastic recoil o Changes thoracic cage shape d/t osteoporosis and calcification (Osteoporosis highly prevalent with COPD patients. Inflammation role osteoporosis effects bone metabolism) o Fewer capillaries available for gas exchange Pathophysiology • Defined: persist and progressive airflow limitation o Bronchitis (chronic productive cough 3 month in 2 successive years) Primarily mucous production Earlier sign develop by 35 years of age for chronic smokers o Emphysema (destruction of alveoli) Destruction of walls hyperinflates leading to airspace enlargement • Air trapped inside lungs • Difficult exhaling air trapped in alveoli Can occur without airflow limitation but more common with patient that have airflow limitation Increase inflammation reduces surface area gas exchange • Airflow limitation exhalation caused by loss of elastic recoil • Airflow obstruction d/t mucus hypersecretion, edema and bronchospasm • Air trapped in lungs, chest hyper expanded • Difficult breathing when overinflated leads to dyspnea • Leads to hypercapnia and hypoxemia over time |
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COPD assessment (interview & physical) |
• Patient Interview: o Exposure to risk factors (ex. smoking, premature, low birth weight, maternal smoking, exposure to smoke during infancy) o Medical history (ex. S&S, complications, hospitalization frequency) o Family history (ex. AAT deficiency) o Smoking history (ex. how many packs per day) o Comorbidities o Severity of disease o Severity of symptoms o Assessment complication o Frequency of hospitalizations • Physical assessment o Vital signs o O2 Saturation & ABGs o Resp assessment: wheezing, crackles, ↓ breath sounds, hyper-resonance, sputum, use of accessory muscles, retractions, tachypnea, work of breathing o Cardiac assess: 3rd heart sound (gallop) o Restlessness/exhaustion, confusion, tripod position o Pedal edema, ascites, JVD o Cyanosis (oral, nail beds, etc.) |
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COPD diagnostic studies |
Tests • CBC (think polycythemia) • ABGs (think hypoxemia &/or hypercapnia) • Cardiac Echo (PAP & right-sided hypertrophy) • Forced Expiratory Volume over 1 second (FEV1) o For determining severity (Ex. pre, early, mild, complicated COPD) • Forced Vital Capacity (FVC) • Chest X-ray • AADT testing (genetics) • 6-minute walking test (with oximetry) • Sputum specimen (C&S) • Evidence of airflow obstruction: FEV1/FCV ration ≤0.7 unrelieved with bronchodilator o For differential diagnosis from asthma (FCV isn’t good for COPD because pt can cough, feel fatigued -> not capable to force all air out d/t • ABG Measuring dyspnea o Grade 0: breathless with strenuous exercise o Grade 1: SOB when hurrying, walking up hill o Grade 2: walk slower d/t SOB, have to catch breath when walking at normal pace o Grade 3: stops for breath after walking 100m o Grade 4: too SOB to leave house, SOB from dressing CAT score (measuring symptoms) o 30 high condition stops them from doing everything they want o 10-20 medium problem and room for improvement Cough time to time Have some good days and weeks Get breathless certain activities o <10 low few problem stop person from doing some activities |
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COPD stages |
mild - SOB from hurrying on flat surface, walking up slight hill moderate - SOB causing pt to stop walking after 100 m severe - SOB, too breathless to leave house, breathless from dressing/undressing |
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GOLD classifications post-bronchodilator |
GOLD 1 - mild - FEV1 greater/equal to 80% GOLD 2 - moderate - less than 80% GOLD 3 - severe - less than 50% GOLD 4 - very severe - less than 30% |
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COPD Classification Groups (alphabetical letters) |
o Group A few symptoms better lung function o Group B more symptoms better lung function o Group C few symptoms poor lung function o Group D more symptoms poor lung function |
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COPD Classification Groups (alphabetical letters) |
o Group A few symptoms better lung function o Group B more symptoms better lung function o Group C few symptoms poor lung function o Group D more symptoms poor lung function |
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COPD manifestations |
• Cough early in the morning, With or without sputum, dyspnea, difficulty breathing, SOB, fatigue, chest tightness, accessory muscle breathing use • Diaphragm flattens overtime from reply intercostal and accessory muscles (concern for ribs fixed in inspiratory position) o Barrel chest appearance (advanced emphysema, flattened diaphragm) • Edema in ankle sign cor pulmonal • Bluish colour polycythemia o Increase production RBC body attempt to compensate for hypoxia • Thin difficulty breathing and workload causing increase metabolic rate • Chronic symptoms dyspnea, cough, sputum production and or exacerbation due to abnormalities of airways (bronchitis) • Cachexia: loss of muscle mass weaking from exacerbation or decondition of COPD o Hypermetabolic state increases energy requirement |
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COPD Classification Groups (alphabetical letters) |
o Group A few symptoms better lung function o Group B more symptoms better lung function o Group C few symptoms poor lung function o Group D more symptoms poor lung function |
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COPD manifestations |
• Cough early in the morning, With or without sputum, dyspnea, difficulty breathing, SOB, fatigue, chest tightness, accessory muscle breathing use • Diaphragm flattens overtime from reply intercostal and accessory muscles (concern for ribs fixed in inspiratory position) o Barrel chest appearance (advanced emphysema, flattened diaphragm) • Edema in ankle sign cor pulmonal • Bluish colour polycythemia o Increase production RBC body attempt to compensate for hypoxia • Thin difficulty breathing and workload causing increase metabolic rate • Chronic symptoms dyspnea, cough, sputum production and or exacerbation due to abnormalities of airways (bronchitis) • Cachexia: loss of muscle mass weaking from exacerbation or decondition of COPD o Hypermetabolic state increases energy requirement |
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COPD exacerbation: medical & nursing management |
• Acute worsening of respiratory symptoms that results in additional therapy • Most common cause is viral respiratory tract infections • Goal of treatment o Minimize negative health impacts of the current exacerbation o Prevent subsequent events Nursing management of acute COPD exacerbation in the hospital • Ventilation assistance d/t ineffective breathing pattern: o Monitor resp. status (auscultation) & O2 status (SpO2 & SaO2) o Encourage slow/deep breathing (turning and coughing) o Position to min resp effort – elevate head and provide table for tripod o Monitor resp. muscle fatigue to id need for ventilator assistance o Ensure adequate hydration o Administer Oxygen as ordered • Medication Administration (as ordered) • Sleep o Monitor sleep pattern and apnea o Provide education for good sleep hygiene: daytime activities, nightie routine, relaxation techniques, avoiding stimulants or screens o Sleeping position (pillows to prop) • Comfort, rest & ambulation • Patient education • Discharge planning o Focus on patient GOALS o Plan at home (resources) o Engagement with family |
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Asthma pt education |
• Pathophysiology of asthma (basics & link to symptoms) • Medications and device techniques (difference between controllers & relievers, establish schedule, indication for relievers, indications for medical visit) • Self-monitoring • Triggers (identification and avoidance) • Measuring peak expiratory flow (how) • Smoking cessation (as required) • Breathing techniques/exercises • Follow-up care |
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Asthma pt education |
• Pathophysiology of asthma (basics & link to symptoms) • Medications and device techniques (difference between controllers & relievers, establish schedule, indication for relievers, indications for medical visit) • Self-monitoring • Triggers (identification and avoidance) • Measuring peak expiratory flow (how) • Smoking cessation (as required) • Breathing techniques/exercises • Follow-up care |
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COPD patient |
• What is COPD? o Basic pathophysiology o S&S of exacerbations (cold, flu pneumonia) o Tests used to assess breathing (spirometry) • Healthy Nutrition (see previous slides) o Strategies to lose weight if overweight o Strategies to gain weight if underweight • Non-Pharmacological Therapy o Breathing & relax. exercises o Rescue breathing techniques and positioning o Energy conservation o Regular exercise o Smoking cessation Prevents worsening and later pulmonary function improves • Medication & correct use of inhalers o Types & uses o Written list o Medication schedule • Breathing & relaxation exercises • Rescue breathing techniques • Energy conservation • Regular exercise • Smoking Cessation o MOST significant risk factor for COPD o Can improve pulmonary function (& avoid further decline) o Treatment: Nicotine replacement therapy (patch) • Long action nicotine delivery • Gum and lozenge • Inhaler short acting • Puffs without inhaling too deeply repeat until craving subsides • Breathing, airway clearance & O2 o Pursed lip & belly breathing o Hydration (3L/day unless contraindicated) o Coughing and airway clearance techniques o Long-Term O2 therapy o NIPPV • Nutrition, Energy Conservation & Exercise o Severe COPD spend 30-50% more energy breathing than average people. Oxygen consumption increased. Eating becomes a high effort activity. Consultation with registered dietician is critical. BMI goal = 21-25 Decreased food intake (inability to prepare, access, etc.) and effect of certain drugs, systemic inflammation (feeling bloated), dyspnea, dyspepsia, depression, anxiety, physical limitations, decreased sense of smell, financial considerations (not working), etc. Low BMI is associated with worse outcomes in people with COPD. In malnourished people, nutritional supplementation promotes significant weight gain and leads to significant improvement in respiratory muscle strength and overall health-related QOL. Nutritional antioxidant supplementation (Vitamin C & E, Zinc and selenium) has been shown to improve antioxidant deficits, quadricep strength and total serum protein. o Nutritional supplementation In malnourished individuals, nutritional supplementation improves the 6-minute walk test, resp. muscle strength and health status. o Pacing & planning activities o Relaxation techniques o Progressive exercise (walking & upper body) Mild aerobic exercise that does not stress the cardiorespiratory system. Walk for 15–20 minutes/day, keeping the pulse rate <75% to 80% of maximum heart rate (220—client’s age). o Rest for 30 min. before eating o Use bronchodilator before meals o Select foods that can be prepared in advance o Eat –6 small meals/day Large meals -> full stomach -> impedes ability of diaphragm to descend during inspiration -> increased WOB High protein & high calorie diet (and/or supplements) Avoid foods requiring a lot of chewing Avoid high carbs food -> produces CO2 -> metabolic acidosis Avoid ‘gassy foods’ (e.g., cabbage, beans, etc.) Cold foods (produce less ‘fullness’) o Get help with food preparation (meals on wheels, frozen foods, etc.) o Avoid exercise X 1 hour before/after meals • Sexual activity o (a) have sexual activity during the part of the day when breathing is best, o (b) use slow pursed-lip breathing, o (c) refrain from sexual activity after eating or other strenuous activity, o (d) do not assume a dominant position, and o (e) do not prolong foreplay. |
