Chapter 11 patients with COPD and Asthma

COPD exacerbation have been linked to

Respiratory Insufficiency Respiratory Failure Respiratory Acidosis Pneumonia Atelectasis Pneumothorax Pulmonary Hypertension

COPD is the ____ leading cause of death in the United States

fourth

COPD accounts for an annual cost estimated to be nearly ____ billion a yr to take care of these pts

$50

how many americans a yr are diagnosed with COPD?

12 to 14 million Americans have the diagnosis of COPD

During morning rounds on a medical floor, the nurse assesses a patient admitted the previous evening with an exacerbation of COPD. The patient is complaining of increased dyspnea. He is sitting on the side of the bed with his arms braced against his knees. His respiratory rate was 20 on admission and is now 28. His breath sounds are diminished, with coarse crackles heard throughout. His oxygen saturation is 93% on 2L/min of supplemental oxygen. The nurse would perform which of the following actions? Select all that apply. A. Administer albuterol using a spacer that has been ordered "as needed." B. Switch the patient's oxygen to a Venturi mask at 32%. C. Instruct the patient to begin pursed-lip breathing. D. Instruct the patient in controlled cough.

A. Administer albuterol using a spacer that has been ordered "as needed." C. Instruct the patient to begin pursed-lip breathing. D. Instruct the patient in controlled cough.

A 45-year-old woman with a diagnosis of asthma comes to the emergency room with worsening symptoms of cough and wheeze. She has been using her albuterol in haler every 3 hours for the past 2 days. She denies allergies to medications, foods, and the environment. She has no other major medical problems, and has never been a smoker. She is recovering from a viral respiratory infection. Her respiratory rate is 28; she is sitting upright on the stretcher. Her breath sounds are markedly diminished. Her room air oxygen saturation is 89%. Which of the following actions should the nurse take? A. Administer oxygen to keep her oxygen saturation > or = 92%. B. Recommend discharge with follow-up to her primary care doctor. C. Administer inhaled corticosteroids. D. Review asthma triggers and early warning signs.

A. Administer oxygen to keep her oxygen saturation > or = 92%.

A 62-year-old woman is seen at the doctor's office for an initial evaluation of her symptoms of shortness of breath, cough, and sputum production. Her spirometry reveals an FEV 1 of 65% predicted. Her FVC is 90%. Her FEY tfFVC is 60%. She has been given a diagnosis of COPD. She reports a smoking history of 35 years. She now smokes 10 cigarettes a day. She has tried to quit several times and has been able to stay quit for 1 week several years ago. She is concerned about weight gain if she quits smoking. The doctor gave her a prescription for bupropion and nicotine nasal spray. The nurse is asked to review an approach to smoking sessation. Which of the following approaches should be included? Select all that apply A. Bupropion and nicotine replacement can assist in the quitting process. B. Successful smoking cessation includes multiple approaches. C. Dealing with the habit of smoking is important to success. D. Quitting smoking once COPD is diagnosed has no effect on prognosis.

A. Bupropion and nicotine replacement can assist in the quitting process. B. Successful smoking cessation includes multiple approaches. C. Dealing with the habit of smoking is important to success.

A nurse teaches a COPD patient not to smoke because smoking: A. Increases the amount of mucus production B. Decreases the amount of mucus production C. Shrinks the alveoli in the lungs D. Collapses the alveoli in the lungs

A. Increases the amount of mucus production

The following day, the patient's symptoms are improving. He is less short of breath and able to walk to the bathroom with minimal assistance. In preparing for discharge, a home oxygen assessment is ordered. The patient's room air oxygen saturation is 88% at rest and 86% with exertion. Oxygen administered by nasal cannula at 2 L/min raises the oxygen saturation to 94% at rest and 92% when walking. Home oxygen is ordered as2L/min 24 hours a day. What would the nurse include in patient teaching about home oxygen? A. Oxygen improves cardiac and cognitive function and improves prognosis. B. Oxygen only needs to be worn when the patient is short of breath. C. Oxygen improves cardiac and cognitive function but does not improve prognosis. D. Home oxygen is dangerous and will explode.

A. Oxygen improves cardiac and cognitive function and improves prognosis.

Asthma Characteristics:

Acute inflammation leads to airflow limitation, hype-responsiveness, airway edema and increase in mucus secretion Mast cells, neutrophils, eosinophils, and lymphocytes are involved Big airways respond narrowing of bronchus

Medications:

Bronchodilators ( Anticholinergics & Sympathomimetics) via MDI's: ease dyspnea nebulizers are used in the hospital, Corticosteroids: iv or MDI, cant stay on steroids because you become immunosuppressed. Inhaled ones can stay on longer

__________ are enlarged airspaces that do not contribute to ventilation but occupy space in the thorax.

Bullae

A camp nurse is providing immediate care for a child who is having an asthma attack. What is the preferred treatment to alleviate this patient's airflow obstruction? A. Corticosteroids B. Anticholinergics C. Beta-adrenergics D. Peak flow monitoring device

C. C. Beta-adrenergics (albuterol)

chronic bronchitis vs. emphysema (primary sx, sputum, cor pulmonale, lung cap, elastic recoil)

CB: cough, copius sputum, common cor pulmonale, lung cap and recoil normal E: dyspnea, scant amount of sputum, cor pulmonale is rare, increased (barrel) lung cap, and elastic recoil decreased.

Epidemiology of Asthma

Characterized by recurring and variable symptoms, airflow obstruction and bronchial hyper - responsiveness, wheezing Inflammation is the key underlying factor, Reversible, Exercise induced, allergen, premature and lungs didn't develop fully

The nurse is teaching a COPD patient about his newly prescribed corticosteroid. The nurse should explain that the drug is used for: A. Relieving bronchospasm in an emergency (beta adrenergic albulterol) asthma attack B. Curing underlying systemic infections C. Preventing recurrent pulmonary infections D. Achieving longer-term control of COPD symptoms

D. Achieving longer-term control of COPD symptoms

A hospital conducts an outpatient clinic for patients with asthma. The nurse working in the clinic is responsible for teaching patients about their medications. Which of the following statements is true about inhaled medications? A. All inhalers must be given with a spacer device. B. Inhaled corticosteroids are used on an as needed basis for quick relief. C. LABAs can be used as monotherapy to control asthma. D. LABAs and inhaled corticosteroids are used as controllers in the management of asthma.

D. LABAs and inhaled corticosteroids are used as controllers in the management of asthma.

Asthma Manifestations:

Diagnosis is based on history, physical exam and spirometry Administer bronchodilator and test FEV and if improved then have asthma Most common manifestations are dyspnea, cough and wheezing After age 40 women have it more than men Can be exercise induced

COPD Diagnosis is based on Lung Function Testing:

Diagnostic criteria are FEV1 of < 80% and an FEV1/FVC ratio < 70% Forced expiratory volume CT scan

COPD Clinical Manifestations Most Common:

Dyspnea Chronic Cough Sputum Production

COPD Types:

Emphysema Chronic Bronchitis (Possible to have both)

Asthma managing exacerbations

Exacerbations may be mild moderate, severe or life threatening (worse than the usual= exacerbation) Complications include worsening disease, status asthmaticus, and respiratory failure (trach) Interventions focus on resolving the exacerbation (ie. Maintaining the patients airway, and breathing) and preventing complications Environmental control: try to reduce allergic rxn Ongoing education

Asthma Risk Factors:

Genetic predisposition Inhaled allergens Exposure to environmental factors Viral respiratory infections Diet

COPD assessment

Health History Question the patient about dyspnea(duration?), sputum production and cough Physical Exam: Inspection, Palpation, Percussion(hyperressonance), Auscultation(might hear crackles, decreased breath sounds, and wheezing) Nursing Diagnosis Primarily involve ADL's and Respiratory Function

An __________ is a pressurized device that contains an aerosolized suspension of medication.

MDI

emphysema types

Pan lobular (PLE): genetic disorder a1at (alpha 1 antitrypsin) Centrilobular (CLE): terminal airway expands and possibly collapse when they breathe out and air gets trapped in there, barrel chest

Goals and Interventions address:

Promoting smoking cessation Managing Chronic Dyspnea: teach how to breathe: pursed lip and diaphragmatic breathing Managing Impaired Gas Exchange: admin O2 Managing cough and sputum production: chest PT, mobilize, mucolytic, keep hydrated Improving exercise tolerance, self care and coping: strengthen their extremities to have good muscle tone to support themselves Promoting Nutrition: lose weight or gain: want healthy bmi Preventing Complications: pneumonia and infection. Wash hands and keep kids away when they are sick

COPD Risk Factors

Smoking Second Hand Smoke Occupational Dust and Chemicals Air Pollution Infection Alpha 1-antitrypsin deficiency (Emphysema)

COPD Management

Smoking Cessation: welbutrin (antidepressant), nicotine patch, Chantix, therepy

chronic bronchitis

Structural changes occur in the bronchioles, productive cough with sputum production for 3 mo for 2 consecutive years, chronic inflammation of increased mucus production atrophy of the wall and the airway gets smaller and smaller Look sicker than person with emphysema, coughing all the time swelling bloated blue around the mouth, not usually barrel chest, doesn't change the dimensions of thoracic cage Decreased gas exchange and decreased tissue perfusion Repeat exacerbations the more they have structural changes, so if the exacerbations are decreased you can decrease the changes

Asthma Goals of Management are:

Symptom Control: open the airway (bronchodilator, SABA, albuterol MDI, can use spacer) Maintenance of Pulmonary Function and activity Prevention of recurrence Optimal Pharmacotherapy Patient Education

COPD comorbities

anxiety depression, diabetes, atherosclerosis

__________ describes an abnormal enlargement of the air spaces beyond the terminal bronchioles, with destruction of the walls of the alveoli.

emphysema

COPD is primarily attributable to non-modifiable risk factors. true or false?

false

True/False Cognitive impairment is less in hypoxemic patients.

false greater

True/False Asthma is irreversible.

false largely irreversible either spontaneously or with treatment

True/False The pulmonary arteries respond to hypoxemia by dilating, causing increased pulmonary pressure to occur.

false, constricting

Bronchodilators are usually delivered by the __________ route.

inhaled

Chronic obstructive pulmonary disease (COPD)

is a disease state characterized by chronic airflow limitation that is not fully reversible, increased mucous production chronic inflammation, structural changes

Status asthmaticis:

severe asthma attack resistant to all the meds that are given life threatening respiratory failure

True/False Many hypoxemic patients do not feel dyspnea.

true

True/False Smoking cessation slows the accelerated decline in lung function and the progression of COPD.

true

true/false? COPD can be a consequence of aging even if they never smoked

true

The hormone BNP is produced by the __________ of the heart.

ventricles