Chronic Obstructive Pulmonary Disease (COPD) Exam 2023

Chronic Obstructive Pulmonary Disease (COPD) Exam 2023 Chronic Obstructive Pulmonary Disease - ANS-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 - ANS-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 - ANS-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 - ANS-Major contributing factor to the aggravation and progression of COPD Recurring infections impair normal defense mechanisms Tell how gerontology is a risk factor - ANS-Some degree of emphysema is common Gradual loss of elastic recoil Lungs become rounded and smaller Give the pathophysiology of Emphysema - ANS-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 - ANS-Hyperplasia of mucus-secreting glands in the trachea and bronchi, Increase in goblet cells Disappearance of cilia Clinical Manifestations of Emphysema - ANS-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 - ANS-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 - ANS-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 - ANS-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 - ANS-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 - ANS-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 - ANS-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 - ANS-b-adrenergic agonists MDI or nebulizer Albuterol or ipratropium (atrovent) Combivent Spirival Servent Advair Continues...