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Flashcards

453: Test 1 COPD & Cor Pulmonale

Kristi Breese Nursing 453 English 67 cards

Cards in this deck (67)

  1. 1-Preventable -Treatable -Chronic air flow limitation that is fully reversible -Progressive -Inflammatory response to noxious particles, usually smokingCOPD
  2. 2COPD is the _____ leading cause of death in the US3rd
  3. 3More than _____% die within 10 years of a COPD diagnosis50
  4. 4COPD is characterized by __________, ____________, and _____________.Airflow limitation, breathlessness, exacerbations
  5. 5COPD includes:Emphysema
    Chronic Bronchitis
  6. 61. Abnormal permanent enlargement of the air space distal to the terminal bronchioles. 2. Destruction of bronchioles without obvious fibrosis 3. Only 10% of patients have the pure form of thisEmphysema
  7. 71. Presence of chronic productive cough for 3 or more months in each of 2 consecutive years. 2. Other cause of chronic cough must be excludedChronic bronchitis
  8. 8COPD risk factors1. Cigarette smoking
    2. Air pollution
    3. Chronic infection
    4. Heredity (AAT deficiency)
    5. Aging
    6. Occupational chemicals and dust
  9. 9Smoking cessation can both __________ and _________ progression of COPDPrevent and slow
  10. 10Occupation and environmental factors have a _______ risk compared to smokingSmall
  11. 11COPD can develop with intense or prolonged exposure to:1. Dusts, vapors, irritants, or fumes
    2. High levels of air pollution
    3. Fumes from indoor heating or cooking with fossil fuels
  12. 12Severe, recurring __________ in childhood (and adulthood) have been associated with decreased lung function and increased respiratory symptoms in adulthoodInfections
  13. 13The genetic risk factor for COPDα-Antitrypsin (AAT) deficiency
  14. 14AAT ___________ lysis of the lung tissueInhibits
  15. 15Aging1. Some degree of emphysema is common due to physiological changes of aging lung tissue, even in a non smoker
    2. Gradual loss of elastic recoil
    3. Thoracic cage changes & lungs become rounded and smaller
    4. Decreased total # of alveoli & loss of alveolar supporting structures.
  16. 16Inflammation1. Complex, but primary process of COPD
    2. Inhaled noxious particles→release of inflammatory mediators→causes damage to lung tissue→excess mucus→ongoing injury and repair→structural remodeling occurs→increased scar tissue→resulting fibrosis
  17. 17COPD early interventions1. Oral medications
    2. Inhaled medications
  18. 18Oral and inhaled medications are used for patients with stable COPD to __________, ___________, & _____________.1. Reduce dyspnea
    2. Improve exercise
    3. Prevent complications
  19. 19Most of the maintenance medications used in COPD treatment are directed at:The potentially reversible mechanisms of airflow limitation
  20. 20Onset of clinical manifestations1. Develops slowly, usually age 40-50ish
    2. and usually with 20 pack-years of smoking
  21. 21Diagnosis of COPD is considered with1. Cough
    2. Sputum production
    3. Dyspnea
    4. Exposure to risk factors
  22. 22The earliest sx of COPD isIntermittent cough, usually in the AM
  23. 23Patient will usually seek medical attention whenDyspnea occurs or with infection
  24. 24Clinical manifestions1. Barrel-chested
    2. Characteristically underweight with adequate caloric intake
    3. Chronic fatigue
    4. Prolonged expiratory phases, wheezes, decreased breath sounds
    5. Bluish-red color of skin (polycythemia and cyanosis)
  25. 25PolycythemiaAn abnormal condition with excessive levels of red blood cells
  26. 26CyanosisBluish discoloration of skin and mucous membranes
  27. 27COPD Exacerbations1. Signaled by change/worsening; different than daily patterns
    2. Increases in: dyspnea, cough, sputum
    3. Flare ups require changes in management
    4. The more severe the COPD, the poorer the outcomes of exacerbations
  28. 28Depression may be _______ times more likely for COPD patientsFour
  29. 29Anxiety complications1. Respiratory compromise
    2. Dyspnea
    3. Hyperventilation
  30. 30Diagnosis of COPD is confirmed byPulmonary function tests
  31. 31True or False: 1. H & P is important in the diagnostic workup 2. The chest x-ray is not a very good indicator of the severity of disease early on. It may show hyperinflation but this is only one piece of the puzzleTRUE
  32. 32The most significant findings of pulmonary functions tests areThe increased resistance to expiratory airflow
  33. 3310 signs of COPD exacerbation (first 5 on this flashcard)1. Shortness of breath
    2. Noisy breathing
    3. Worry (anxiety)
    4. Irregular (uneven) breathing
    5. Cough
  34. 3410 signs of COPD exacerbation (last 5 on this flashcard)6. Changes in skin or nail color
    7. Trouble sleeping or eating
    8. Can't talk
    9. Early morning headache
    10. Swollen ankles or belly pain
  35. 35Indications for ICU admit1. Severe dyspnea that responds inadequately to emergency treatment
    2. Confusion, lethargy, coma
    3. Persistence of: worsening hypoxemia, increasing hypercapnia, severe or worsening respiratory acidosis
  36. 36Other COPD diagnostic studiesCBC, electrolytes, coagulation studies, troponins, inflammatory markers, blood culture, ABGs, AAT levels, 12 lead ECG, CXR, Spiral CT
  37. 37Typical ABG findings in exacerbations1. Low PaO2 and saturations
    2. Increased PaCO2
    3. Normal or decreased pH as exacerbation progresses
    4. Increased bicarbonate level found in late stages or exacerbations of COPD
  38. 38What is good to look at on a CBC?1. H&H (higher in COPD patient)
    2. WBC (infection?)
  39. 39How do we care for a COPD patient?1. Assess, assess, assess
    2. Establish severity
    3. Positioning (tripod, elevate HOB)
    4. Administer meds, focus on inhaled if possible
    5. Diagnostics
    6. Long term care goals
    7. End-of-life planning
  40. 40Acute airway management in a COPD patient1. Oxygen therapy
    2. First things first... AD? DPA?
    3. Underlying issue - can this be fixed? Can patient return to baseline?
    4. CPAP/BiPAP
    5. Endotracheal intubation (nasal v. oral)
    6. Tracheostomy
  41. 41COPD Drug Therapy1. Bronchodilators
    2. Inhaled corticosteroid therapy
    3. Oxygen
    4. Oral corticosteroids - usually prednisone
    5. Methylxanthines (theophylline)
    6. Mucolytics
    7. Beta blockers
    8. Antibiotics
  42. 42Bronchodilators1. Relaxes smooth muscle in the airway
    2. Improves ventilation of the lungs
    3. Inhaled route is preferred
    4. Both beta agonists & anticholinergics
    5. Both short acting & long acting
  43. 43Inhaled corticosteroid therapyUsed for moderate to severe cases
  44. 44Antibiotics in COPD care1. Oral - 2nd & 3rd generation cephalosporin, macrolides, doxycycline, flouroquinolone
    2. IV - same as oral AND beta lactam antibiotic + beta lactamase inhibitor
  45. 45COPD Collaborative Care1. Smoking cessation
    2. Oxygen therapy
    3. Respiratory & physical therapy
    4. Effective coughing
  46. 46Oxygen therapy1. Oxygen is considered a drug
    2. Medicare will cover if Pt's O2 saturation is less than 88%
    3. Goals are to reduce the work of breathing, decrease the workload of the heart, keeping sats above 90%
    4. Can have low flow O2 or high flow O2 depending on Pt's needs
  47. 47Respiratory and Physical therapyBreathing retraining - pursed lip to prolong exhalation and diaphragmatic breathing to focus on using the diaphragm to achieve max inhalation instead of accessory muscles
  48. 48Main goals of effective coughing1. Conserve energy
    2. Reduce fatigue
    3. Facilitate removal of secretions
  49. 49COPD Health Promotion1. Vaccinate (Pneumonia & Flu)
    2. Adequate rest
    3. Avoid exposure to viral URI
    4. Pulmonary rehab
    5. Nutrition & hydration to support metabolic needs
  50. 50COPD Nursing Diagnoses1. Ineffective airway clearance
    2. Impaired gas exchange
    3. Imbalanced nutrition: less than body requirements
    4. Risk for infection
    5. Insomnia
    6. Anxiety and/or depression
    7. Others: Self-esteem, dependence
  51. 51Elevated pulmonary artery (PA) pressure from an increase in resistance to blood flow through the PA (usually low resistance, low pressure)Pulmonary Hypertension
  52. 52Common manifestations of pulmonary hypertension1. Dyspnea
    2. Exertion & fatigue
  53. 53Pulmonary hypertension1. Can be primary (idiopathic) or a secondary complication
    2. Incurable
  54. 54#1 Cause of secondary pulmonary HTNCOPD
  55. 55Other causes of secondary pulmonary HTN1. PE
    2. Obstructive sleep apnea
    3. Autoimmune diseases; RA, scleroderma
    4. Medications
    5. Heart valve disease
    6. Congenital heart
    7. Left heart failure
  56. 56Definitive test to diagnose pulmonary HTNRight sided heart catheterization
  57. 57In pulmonary HTN, dyspnea on exertion (DOE) is related toInability of cardiac output to increase in response to oxygen demand
  58. 58Pulmonary HTN ________ workload of right ventricle and causes right ventricle ________ and can lead to ___________1. increases
    2. hypertrophy
    3. cor pulmonale
  59. 59Clinical manifestations of pulmonary HTN1. Dyspnea, fatigue, lethargy, chest pain
    2. Increased pulmonic heart sound
    3. RV hypertrophy on ECG
    4. If leading to cor pulmonale will also see: peripheral edema, JVD, enlarged liver & spleen
    5. Polycythemia
  60. 60Enlargement of the right ventricle secondary to diseases of the lung, thorax, or pulmonary circulation.Cor pulmonale
  61. 61Causes of cor pulmonale1. COPD (most common)
    2. Pulmonary HTN
    3. Cardiac failure
  62. 62Cor pulmonale clinical manifestations1. Dyspnea
    2. Chronic productive cough
    3. Wheezing
    4. Retro/substernal pain
    4. Fatigue
    5. Potential for chronic hypoxemia → Polycythemia, Increased total blood volume & viscosity
  63. 63Cor pulmonale clinical manifestations with right heart failure1. Peripheral edema 3+
    2. Weight gain
    3. JVD
    4. Full, bounding pulse
    5. Enlarged liver
  64. 64Cor pulmonale plan of care1. Treat underlying pulmonary problem
    2. Long term O2 therapy
    3. Monitor fluid, electrolyte & acid-base imbalance
    4. End-stage surgical procedures include atrial septostomy (palliative) and lung transplantation
  65. 65Goal of pharm management of pulmonary HTN and cor pulmonalePromote vasodilation of pulmonary vasculature, reduce right ventricle overload, and reverse remodeling
  66. 66Pharm management of pulmonary HTN and cor pulmonale1. CCBs - high doses, not in right sided heart failure
    2. Phosphodiesterase enzyme inhibitors - given orally, contraindicated if on NGT
    3. Vasodilators - both parenteral and inhaled, not for hypotensive patient
    4. Endothelial receptor antagonists - oral, binds to endothelin-1 receptors with a decrease in PA pressures and increase in cardiac index
  67. 67Pharm management of pulmonary HTN and cor pulmonale (continued)5. Oxygen - hypoxia is potent vasoconstrictor. Goal is to maintain sats over 90%
    6. Diuretics - to manage peripheral edema
    7. Anticoagulants - sx r/t thrombus
    8. Inotropic agents - digoxin & sometimes theophylline

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Nursing 453 Flashcards on 453: Test 1 COPD & Cor Pulmonale, created by Kristi Breese on 25/01/2017.
Created by
Kristi Breese · Jan 2017
Updated
Jan 30, 2017
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