Exam 4 NUR305 Med Surg COPD

What is Chronic Bronchitis?

-cough/sputum production for at least 3months in each of 2 consecutive years -ciliary function reduced, bronchial walls thicken, airways narrow and mucous plugs with damaging alveoli

Describe the symptoms of a pt with exmphysema

-dyspnea -minimal cough -increased minute ventilation -pink skin -pursed lip breathing -accessory muscle use -cachexia -hyperinflation -barrel chest -decreased breath sounds -tachypnea

What are the medications used to treat COPD

-Bronchodilators, MDI (beta-adrenergic agonists, muscarinic antagonists(anticholinergics), and combination agents) -Corticosteroids -Antibiotics -Mucolytics -Antitussives

Surgical Management for COPD

-Bullectomy -Lung Volume reduction -Lung transplant

How do you assess for COPD

-health hx -pulmonary function tests -spirometry -arterial blood gas -chest x-ray

Cor Pulmonale causes

-is a result of pulmonary hypertension -caused by diseases that affect the pulmonary blood vessels -results from constriction of the pulmonary vessels related to hypoxia -late manifestation of COPD -poor prognosis after diagnosis *Symptom: most common in dyspnea

Describe the symptoms of a pt with chronic bronchitis

-chronic, productive cough -purulent sputum -hemoptysis -mild dyspnea initially -cyanosis (due to hypoxemia) -peripheral edema (due to cor pulmonale) -Crackles, wheezes -prolonged expiration -obese

Describe the later stages (advanced) of COPD

-Dyspnea at rest -wheezing and chest tightness -fatigue, weight loss, anorexia -prolong expiratory phases, wheezes or decreased breath sounds in all lung fields -crackles

What are the risk factors of COPD?

-Fumes 0infection -air pollution -genetic -alpha1-antitrypsin deficiency (AATD) -Aging -Gender (more common in men) -Asthma

Describe the later stages of COPD

-Hyperinflation -basilar crackles, wheezing, decreased breath sounds -barrel chest

How do you diagnose COPD

-chest x-ray to show over-inflation of lungs, flattened diaphragm and decreased lung markings. it may also show infiltrates and pneumothorax -sputum gram stain and culture- can determine if acute exacerbation is caused by an infection -WBC: 4,500-10,000 elevated -COPD assessment test (CAT) -Clinical COPD Questionare (CCQ)

What are the three primary symptoms of COPD?

-chronic cough -sputum production -dyspnea(causes weight loss) -Barrel Chest

What are some complications of a pt with emphysema

-pneumothorax due to bullae -weight lose due to work of breathing

Medical Management for COPD

-promote smoking cessation -reducing risk factors -managing exacerbations -providing supplemental oxygen therapy -pneumococcal vaccine -influenza vaccine -pulmonary rehabilitation

Acute Respiratory Failure causes

-pt diagnosed with severe COPD more prone -failure to use prescribed treatments -Bronchodilators -Corticosteroids (short term) -Use precaution when administering certain drugs -opioids -sedatives (pre/post-op) -Benzos *May depress the respiratory drive

Complications of COPD

-respiratory insufficiency and failure -pneumonia -chronic atelectasis -pneumothorax -cor pulmonale -COPD exacerbations

What are some complications of a pt with chronic bronchitis

-secondary polycythemia vera due to hypoxemia -pulmonary hypertension due to reactive vasoconstriction from hypoxemia -Cor pulmonale from chronic pulmonary hypertension

Describe the end stages of COPD

-use of accessory muscles -focred expiration through pursed lips -tripod position -cyanosis -tremors due to elevated levels of CO2 -Neck Vein Distention due to intrathoracic pressure and for pulmonate -Hypoxemia (PaO2 less than 60 or O2 sat less than 88%) -Hypercapnia (PaCO2 greater than 45 -Skin becomes bluish-red due to polycythemia and cyanosis -digital clubbing

What is COPD

A slowly progressive respiratory disease of airflow obstruction

What is Emphysema?

Abnormal distention of air spaces beyond the terminal bronchioles with destruction of the walls of the alveoli -decreased alveolar surface area increases in dead space causing impaired oxygen diffusion -Hypoxemia results -increased pulmonary artery pressure may cause right sided heart failure (cor pulmonale)

Is the following statement true or false? For patients with chronic bronchitis, the nurse expects to see the major clinical symptoms of tachypnea and tachycardia

False For patients with chronic bronchitis, the nurse expects to see the major clinical symptoms of sputum and productive cough

What is the primary clinical symptom of emphysema? A.Chest pain B.Productive cough C.Sputum Wheezing

D.Wheezing The primary symptom of emphysema is wheezing. Sputum and productive cough are the primary symptoms of chronic bronchitis

If a patient has chronic bronchitis, are they more susceptible to a respiratory infection?

Yes

Is COPD preventable/reversible/and treatable?

You can treat COPD and prevent it however its not FULLY reversible

Describe the early stages of COPD

minor symptoms causing a sedentary lifestyle -prolonged forced expiration with an expiratory wheeze -chronic intermittent cough -Dyspnea interfering with daily activities