Chronic Obstructive Pulmonary Disease (COPD) questions and answers with complete top solutions

Chronic Obstructive Pulmonary Disease (COPD) questions and answers with complete top solutions Chronic Obstructive Pulmonary Disease Airflow obstruction, not fully reversible Generally progress, abnormal inflammatory response of lungs to noxious particles gases Chronic Bronchitis and emphysema Major Risk Factor of COPD Cigarette Smoking Clinically significant airway obstruction develops in 15% of smokers 80% to 90% of COPD deaths in the U.S. are related to tobacco smoking What does cigarette smoking do to the body Cellular hyperplasia Decreased ciliary activity( increase production of mucous, decrease airway diameter..lose of cilia Decreased amount of hemoglobin Compounds problems in CAD Tell how infection is a risk factor Major contributing factor to the aggravation and progression of COPD Recurring infections impair normal defense mechanisms Tell how gerontology is a risk factor Some degree of emphysema is common Gradual loss of elastic recoil Lungs become rounded and smaller Give the pathophysiology of Emphysema Hyperinflation of alveoli, Destruction of alveolar walls, Destruction of alveolar capillary walls, Narrowed airways, Loss of lung elasticity, Barrel chest, Pursed lips- pink puffers Give pathophysiology of chronic broncitis Hyperplasia of mucus-secreting glands in the trachea and bronchi, Increase in goblet cells Disappearance of cilia Clinical Manifestations of Emphysema Dyspnea Minimal coughing with small amount of sputum Flatten & AP diameter increase, Chest breather Underweight , minimal cyanosis, SOB, tachynipia, Barrel chest, use of accessory muscles Clinical manifestaion of Chronic Bronchitis Bronchospasm ,Dyspnea Cough exacerbated by irritants, Normal weight Hypoxemia and hypercapnia Ruddy appearance , Blue bloating, pursed lips, cyanosis, Signs: 3 consecutive months over 2 years clubbing, Co2 increased, hemoglobin increased COPD complications Cor pulmonale- enlarged R ventricle, occur late in disease Pulmonary hypertension Acidosis Polycythemia- acidosis, blood occupied by R cells Right side of the heart must increase to push blood into the lungs Right-sided heart failure develops Subsequent intravascular volume expansion Systemic venous congestion- R heart Cath to see pressure COPD complications contiune Peripheral edema- cor pulmonale, SOB, lightheadness Weight gain Acute exacerbations of chronic bronchitis Acute respiratory failure Indiscriminate use of sedatives and narcotics may suppress respiratory drive and lead to respiratory failure Peptic ulcer disease and GERD Presence of acid in esophagus can cause vagally mediated reflex Pneumonia COPD diagnostic Studies Chest x-rays, History and physical exam, Pulmonary function studies Spirometry Exercise test to determine O2 saturation in the blood and pulse ox- ABG ECG can show signs of right ventricular failure BQ scan- scan of lungs if detect clots COPD diagnostic study ABGs Decreased¯ PaO2 80-100 Increased PaCO2 22-27 Reduced¯ pH 7.35-7.45 Bicarbonate level found in late stages COPD increase Explain some COPD exacerbations A change in the natural course of the disease characterized by a change in the patient's baseline dyspnea, cough, sputum ( nonproductive, productive, SOB.) COPD collaborative Care b-adrenergic agonists MDI or nebulizer Albuterol or ipratropium (atrovent) Combivent Spirival Servent Advair Explain what O2 therapy does for COPD patients Raises PO2 in inspired air Treats hypoxemia Classified as high- or low-flow systems Simple Face Mask for Oxygen Administration ... Plastic Face Mask with Reservoir Bag for Oxygen Administration Humidification is commonly used because O2 has a drying effect on the mucosa Nebulizers provide humidified O2 monitor for aspiration Chronic O2 therapy at home Improved prognosis Improved neuropsychologic function Increased exercise intolerance Decreased hematocrit Reduced pulmonary hypertension Surgical Therapy for COPD Lung volume reduction surgery Median sternotomy Video-assisted thoracoscopy Respiratory Therapy Breathing retraining, Pursed-lip breathing Prolongs exhalation and prevents bronchiolar collapse and air trapping Diaphragmatic breathing Focuses on using diaphragm instead of accessory muscles to achieve maximum inhalation and slow respiratory rate Chest Physiotherapy Postural drainage- uses gravity to assist in bronchial drainage, position determined by areas of lung involved Percussion- in the appropriate position, hands in cup like position, crating an air pocket Vibration- tensing the hand and arm muscles repeatedly, pressing mildly with the flat of the hand on the affected area while the patient slowly exhales a deep breath. Helps bring secretions into larger, more central airways Aerosol nebulization therapy Powered by a compressor air or O2 generator Medication is nebulized depending on factors such as droplet size Complications of oxygen therapy Combustion, CO2 narcosis, O2 toxicity, Absorption atelectasis , Infection Nutritional Therapy Full stomachs press on diaphragm causing dyspnea and discomfort, Difficulty eating and breathing at the same time leads to inadequate amounts being eaten, rest 30 min before eating, bronchodilators before meals. 5-6 meals avoid foods with more chewing, high calorie, high protein, avoid gas forming foods, avoid exercise 1 hr before and after Health History Exposure to chemical pollution Respiratory irritants Recurrent respiratory infections Nursing Management Nursing Assessment Subjective data Objective data Goals Return of baseline respiratory function Ability to perform ADLs Relief from dyspnea No complications related to COPD Knowledge and ability to implement long- term regimen Overall improved quality of life Health Promotion STOP SMOKING!!! Avoiding or controlling exposure to occupational and environmental pollutants and irritants Acute Intervention Required for complications like pneumonia, cor pulmonale, and acute respiratory failure Once crisis is resolved, assess degree and severity of underlying respiratory problem Ambulatory and Home Care Pulmonary rehabilitation Control and alleviate symptoms of pathophysiologic complications of respiratory impairment Teach patient how to achieve optimal capability in carrying out ADLs Physical therapy Nutrition Education Activity considerations Exercise training of upper extremities to help improve function and relieve dyspnea Alternative methods of ADLs explored Encourage patient to sit while performing activities Coordinated walking More care the patient should be taught Emphasize slow, pursed-lip breathing After exercise, instruct pt. /family the importance of waiting 5 minutes before using b-adrenergic agonist MDI Keep diary of activity to see progress sexual activity and COPD Plan during part of day when breathing is best Refrain from activity after eating or other strenuous activity Do not assume dominant position Do not prolong foreplay Sleep considerations Nasal saline sprays Decongestants Nasal steroid inhalers Long-acting theophylline Decreases bronchospasm and airway obstruction Psychosocial considerations Guilt Depression Anxiety Social isolation Denial Dependence