is a disease state characterized by chronic airflow limitation that is not fully reversibleit is usually progressive and is associated with an inflammatory response of the lungsincludes bronchitis and/or emphysema
what is chronic obstructive pulmonary disease (COPD)
describes an abnormal enlargement of the airspaces beyond the terminal bronchioles with destruction of the walls of the alveoli (parenchymal destruction) and impairs gas exchange; results in diminished breath sounds
what is emphysema?
a disease of thickened, impaired airways, is defined as the presence of cough and sputum production for at least 3 months in each of 2 consecutive years
describe chronic bronchitis
smoking, occupational dust and chemicals, infections, pollution, Alpha1- antitrypsin deficiency(genetic disorder that leads to lung/liver disease)
what are some risk factors for COPD
a genetic disorder that leads to lung and liver disease. the body's WBC release an enzyme that protects the lung from injury and a deficiency can cause lung damage
What is alpha1-antitrypsin deficiency?
dyspnea, chronic cough, and sputum production
what are the 3 most common manifestations of COPD
pulmonary function test (PFT), arterial blood gas (ABG), chest x-ray, CT scan, EKG/Telemetry, CBC with differential, or BNP
what are some diagnostic tests for COPD
barrel chest
what might a physical exam of someone with COPD find?
the lower the forced expiratory volume, FEV1, (the amount of air you can force from your lungs in 1 second) the more severe the condition is. Less the 80% is obstructive lung disease. Less than 50% is severe
how can a pulmonary function test help diagnose the severity of COPD
to assess baseline oxygenation and gas exchange
what is the purpose of getting a patient's ABG?
increased workload on the right ventricle
pulomonary artery constriction leads to________
it enlarges and dialates resulting right ventricular hypertrophy
what happens over time to the right ventricle when it is being overworked?
pulmonary hypertension, ventricular hypertrophy, hypercapnia, respiratory acidosis, chronic respiratory failure, chronic hypoxemia, lack of tissue profusion, can also effect skeletal muscles, neurologic/cognitive functions; psychiatric and endocrine functions
complications of COPD
(least severe) smoking cessation, bronchodilators, inhaled corticosteroids, pulmonary rehabilitation, oxygen, surgery (most severe)
management of COPD
increased frequencies of exacerbations and weight loss
what two things are most likely to indicate a poor prognosis for a patient with COPD?
tripod position, in which the patient sits or stands leaning forward with the arms supported, forces the diaphragm down and forward and stabilizes the chest while reducing the work of breathing.
what position is the patient demonstrating?
cor pulmonale, right ventricular failure
what is this patient demonstrating?
anti-inflammatories that achieve longer-term control of COPD symptoms-they are not emergency medications
what is the purpose of corticosteroids?
assessment; education of breathing exercises, ways of preforming ADLS, nutrition; physical reconditioning; psycological support
what does pulmonary rehabilitation include?
reduce symptoms, optimize functional ability, and improve the quality of life
what are the goals of pulmonary rehabilitation?
decreases breathlessness; reduces pulmonary arterial pressure and dyspnea->improves sleep/quality of life
Purpose of oxygen therapy
relieve bronchospasms, reduce airway obstruction, and aid in secretion clearance
bronchodilators
-long-acting sympathomimetics (also known as LABAs or long-acting beta adrenergics) -anticholinergic bronchodilators (also known as LAMAs or long-acting muscarinic antagonists)
what are examples of maintenance medications and usually given on a regular basis
short-acting sympathomimetics (also known as SABAs or short-acting beta adrenergics)
what is an example of a as-needed basis medication to help with dyspnea and secretion clearance?
short-acting muscarinic antagonists (SAMAs)
what is an example of a medication used for quick relief?
question the patient about dyspnea, sputum production, and cough
Taking a health history
promoting smoking cessation, managing chronic dyspnea, managing impaired gas exchange, managing cough, improving exercise tolerance, self-care, and coping, promoting nutrition, and preventing complications
nursing interventions
find the best position.control your breathing.relax.
patient education to deal with shortness of breath
venturi mask
how should you deliver oxygen in advanced COPD patients?
severe dyspnea that does not respond to treatment, tachypnea alternating with bradypnea and apnea, hyperventilation/shallow breathing, anxiety, change in mental status, worsening hypoxemia that does not respond to oxygen therapy, worsening hypercapnia, evidence of respiratory muscle fatigue
signs of impending respiratory failure
lung reaction to irritants
what is reflex bronchoconstriction?
characterized by recurring and variable symptoms, airflow obstruction, and bronchial hyper-responsiveness
describe asthma
allergic asthma, non-allergic asthma, late-onset asthma, asthma with fixed airflow limitations, asthma with obesity
what are the asthma phenotypes?
genetic atopy (predisposition/50% chance for parent-child/75% if both parents have), gender, ethnicity, obesity
risk factors of asthma
gerd, allergic rhinitis, osa, obesity, and stress
co-morbidities of asthma
based on history, physical examination, and spirometry (PFM)
How is asthma diagnosed?
cough, dyspnea, chest tightness, and wheezing in a pattern of exacerbations
most common manifestations of asthma
inflammation, airflow limitation, bronchoconstriction, hyper-responsiveness, vascular congestion, airway edema, and mucus hypersecretion
asthma pathophysiology
PFT (pulmonary function test); if a bronchodilator brings improvement > 12%
what test can the physician give to help differentiate between COPD and asthma?
symptom control (using SABA inhaler less than twice per week; waking up from it less than twice/month), maintenance of pulmonary function and activity, prevention of recurrent exacerbations, provision of optimal pharmacotherapy, and patient education
goals of management are asthma
green zone: peak flowyellow zone: may need to call doctorred zone: possible ER visit
describe the zones in an asthma action plan
1) hold in hand, breathe in as deeply as possible2) blow out into the device as hard and fast as possible3) Note the reading.4) Repeat three times and record the highest reading
patient teaching to use peak flow meter
only at the beginning; as it gets worse it is irreversible
is asthma reversible?
an acute severe asthma attack refractory (unresponsive) to treatment with broncodilators; a medical emergency; wheezing becomes less audible b/c of compromised airflow, ventilation/breathing labored; patient becomes diaphoretic (sweaty), and pulse pressure widens (normal is 40; 50 is widened)
what is status asthmaticus?
patients with frequent severe exacerbations with trips to hospital in past year; frequent use of SABAs; difficulty determining severity of reaction; low socioeconomic status; psychiatric illness drug use; comorbidities
who is more at risk for status asthmaticus?
(4-8 hours later) muscle fatigue, exhaustion, hypoventilation w/ decreased respiratory rate, no auscultated air movement; severely diminished breath sounds; nearly silent b/c airways have clamped down; respiratory acidosis; respiratory failure leading to respiratory arrest; requires intubation and ventilation
late stage of status asthmaticus
uticaria (hives), angioedema, bronchoconstriction, cough, stridor, cardiac arrhythmia, hypotension, nausea, vomiting
signs of anaphylaxsis
either inhaled or orally/IV (systemically)
how can corticosteroids (anti-inflammatory) be given?
IV corticosteroids for inflammation (faster effect);IV fluid to replace insensible fluid loss from work of breathing
when a patient comes to the hospital with an asthma attack, what may be given and why?
it is a pressurized device that should be used with a spacer chamber device that improves the coordination, inhalation and distribution of the drug
what is a metered dose inhaler and what should it be used with
breath activated, quick inhalation, less coordination, and has a visible numbered dosing; patient must take a deep breath so patient may not get full dose if poor inspiratory effort
Describe dry powder inhalers
alkalosis; asthma (which can also cause acidosis), COPD, sleep apnea
impaired gas exchange leads to respiratory (alkalosis/acidosis); can come from what disorders?
acidosis; asthma (which can also cause alkalosis); lung congestion due to heart failure; pulmonary embolism
shortness of breath can lead to respiratory (alkalosis/acidosis); can come from what disorders?
aspirin
what medication should you NOT give an asthma patient?