Medsurg: COPD

Which is the purpose of lung reduction surgery for the patient with chronic obstructive pulmonary disease (COPD)? Returns lung function to normal level for age Allows more room for normal alveoli to expand Permits discontinuation of medications for COPD Replaces diseased lung with healthy tissue from a donor

Allows more room for normal alveoli to expand Lung volume reduction surgery is done for patients with severe COPD to remove diseased lung tissue and allow room for the remaining healthy alveoli to expand and function in gas exchange. Improvement in pulmonary function is expected, but the patient will not return to normal function for age. Medications for COPD will continue to be needed after surgery. Lung volume reduction surgery does not involve transplant of tissue from a healthy donor, although lung transplant is another surgical option for patients with severe COPD.

When caring for a patient diagnosed with cor pulmonale, which finding will the nurse expect? Jaundice Bradycardia Ankle edema Concave abdomen

Ankle edema Cor pulmonale is right-sided heart failure caused by pulmonary hypertension secondary to chronic obstructive pulmonary disease (COPD) disease; symptoms include peripheral edema, jugular vein distension, and hepatomegaly. Polycythemia associated with COPD may cause a bluish tint of the skin; jaundice is associated with liver disease. Because of decreased cardiac output caused by right-sided heart failure, patients with cor pulmonale may have tachycardia. Fluid retention and hepatomegaly caused by right-sided heart failure causes a convex or protuberant abdomen.

When educating a patient with chronic obstructive pulmonary disease (COPD) who continues to smoke cigarettes, which complication of smoking would the nurse discuss with the patient? Cachexia Osteoporosis term-2 Metabolic syndrome Cardiovascular disease

Cardiovascular disease Since tobacco use is a risk factor for cardiovascular disease as well as for COPD, the nurse will educate the patient about the increased risk for coronary artery disease and myocardial infarction. Cachexia is caused by decreased appetite and increased metabolic needs with COPD. Osteoporosis may occur in COPD because of chronic inflammation and use of corticosteroid medications. Metabolic syndrome may occur as a complication of COPD because of chronic inflammation.

Which factor contributes to loss of lung elastic recoil in a patient with chronic obstructive pulmonary disease (COPD) due to cigarette smoking? Increases in norepinephrine level Erythropoiesis leading to polycythemia Suppression of inflammatory mediators Imbalance of protease and antiprotease activity

Imbalance of protease and antiprotease activity Cigarette smoking causes an imbalance in the ratio of protease and antiprotease activity that will result in the destruction of alveoli and the loss of elastic recoil in the lungs. Norepinephrine levels may change with smoking but do not contribute to alveolar destruction or loss of elastic recoil. Erythropoiesis may occur in COPD as a compensatory response to hypoxemia but is not a cause of loss of elastic recoil. Noxious chemicals in cigarette smoke cause chronic inflammation leading to increased levels of inflammatory mediators.

Which factor causes the clinical manifestations of chronic obstructive pulmonary disease (COPD)? Decrease in respiratory drive Inability to effectively expire air Enhanced elastic recoil of airways Diminished inflammatory response

Inability to effectively expire air In COPD, changes in the airways lead to loss of elastic recoil, airflow obstruction during expiration, and ineffective expiration. Respiratory drive is not decreased in COPD. Elastic recoil of the airways is decreased, leading to hyperinflation of the alveoli and loss of lung elasticity. Increased inflammatory response to noxious gases, such as tobacco smoke, leads to chronic inflammatory airway changes that are characteristic of COPD.

Which action will the nurse take to prevent complications when a patient is using an oxygen-conserving cannula? Pad the tubing over the patient's ears. Adjust the tubing to fit tightly over the face. Clean the cannula with a disinfectant solution daily. Decrease the O2 flow rate when patient is exercising.

Pad the tubing over the patient's ears. To avoid tissue damage or necrosis of the tissue over the patient's ears caused by pressure from the tubing, the nurse will pad the tubing where it passes over the upper ear. The tubing does not fit over the face and does not need to be tight, but rather it positioned directly below the nares. The cannula cannot be disinfected, and the manufacturer recommends changing the tubing weekly. The O2 flow rate may need to be increased when the patient's O2 demands are increased with exercise.

Which information about the purpose of pursed-lip breathing will the nurse include when teaching a patient with chronic obstructive pulmonary disease about breathing exercises? Conserving energy Relieving chest pain Preventing air trapping Increasing respiratory rate

Preventing air trapping Pursed-lip breathing decreases air trapping and carbon dioxide retention by increasing positive pressure within the airways, which helps empty the lungs more fully during expiration. Pursed-lip breathing uses slightly more energy than normal exhalation because the patient needs to exhale against positive pressure; patients are taught to use "just enough" positive pressure to avoid increasing the work of breathing. Chest pain is not relieved by pursed-lip breathing. Since the expiratory phase of breathing is lengthened with pursed-lip breathing, respiratory rate is decreased.

Which description best characterizes chronic obstructive pulmonary disease (COPD)? Progressive persistent expiratory airflow limitation Airway obstruction due to increased mucus production Difficulty clearing secretions due to dilated bronchioles Variations in airflow over time with normal lung function in between

Progressive persistent expiratory airflow limitation COPD is characterized by persistent expiratory airflow limitations, which are progressive and not fully reversible. Although increased mucus production may occur with COPD, not all patients with COPD have this finding. Difficulty in clearing secretions may occur with COPD, but dilated bronchioles are more characteristic of bronchiectasis. Asthma is characterized by variations in airflow over time, while patients with COPD have chronic expiratory airflow limitation.

Which is the most common organism found in heated nebulizers used for humidification during oxygen administration? Staphylococcus aureus Burkholderia cepacia Hemophilus influenzae Pseudomonas aeruginosa

Pseudomonas aeruginosa The constant use of humidity supports bacterial growth, with the most common organism being P. aeruginosa. Staphylococcus aureus may colonize nebulizers but is not the most common organism. Burkholderia cepacia is a possible serious chronic infection in patients with cystic fibrosis. Hemophilus influenza is a common infection in patients with cystic fibrosis or bronchiectasis.

Which physiologic effect of ongoing tobacco smoking leads to chronic obstructive pulmonary disease (COPD)? Respiratory tract cell hyperplasia Impairment of the cough reflex Increased antiprotease levels Reversible airway inflammation

Respiratory tract cell hyperplasia Hyperplasia of cells lining the respiratory tract leads to increased mucus production and narrowing of airways and eventually to symptoms of COPD. Frequent coughing is a symptom of COPD, but the cough reflex is not affected by smoking. Tobacco use leads to lower levels of antiproteases, which results in unimpeded destruction of elastin and collagen fibers by proteases. Tobacco smoking causes irreversible airway thickening; reversible airway inflammation is associated with asthma.

Which diagnostic test will the clinic nurse anticipate to confirm a diagnosis of chronic obstructive pulmonary disease (COPD) in a patient with dyspnea? Spirometry Chest x-ray Arterial blood gas (ABG) CT scan of the chest

Spirometry Spirometry is needed to confirm the presence of airflow obstruction and the severity of COPD. The patient is given a short-acting bronchodilator, and post-bronchodilator values are compared with a normal reference value. Chest x-rays are not diagnostic but can show a flat diaphragm caused by hyperinflated lungs. ABGs are used to determine gas exchange but are not diagnostic of COPD because many diseases can impact ABG results. CT scans are not used routinely to diagnose COPD.

Which actions will the nurse include when performing chest physiotherapy on a patient with chronic obstructive pulmonary disease? Select all that apply. Vibration Percussion Huff coughing Postural drainage Pursed-lip breathing

Vibration Percussion Postural drainage Vibration, percussion, and postural drainage are chest physiotherapy techniques that help to remove excessive secretions in the lungs. Huff coughing is an airway clearance technique that is used to help the patient cough up respiratory secretions. Pursed-lip breathing is a technique used to help prolong expiration and reduce air trapping in obstructive airway diseases.

Hyperplasia

the enlargement of an organ or tissue caused by an increase in the reproduction rate of its cells, often as an initial stage in the development of cancer.

Cachexia

weakness and wasting of the body due to severe illness