Pathophysiology
Destruction of alveolar sacs leading to obstruction
What is: structural changes in Emphysema
Purpose of medications/ treatment of COPD
What is improve airflow, reduce symptoms, and prevent exacerbations
4 Physical findings- Lungs
What are: Accessory respiratory muscle use/ Prolonged expiration/ Wheezing/ Pursed-lip breathing
Use this with pt with weak cough & or high sputum production
Ineffective Airway Clearance, Related to hi mucus production, bronchospasm, and decreased energy.
One common risk factor for COPD development.
What is smoking
3 chronic & progressive symptoms of COPD
What are:Dyspnea, Cough, Sputum Production (with wheezing & chest tightness)
Most common medication categories used
What are: inhaled bronchodilators (LABA/LAMA) (SABA/ SAMA) and inhaled corticosteroids
2 physical findings: Extremities
What is digital clubbing & LE edema
Us this for pt with abnormal ABG, low oxygen saturation, etc.
Impaired Gas Exchange r/t alveolar destruction, air trapping
Pts with COPD prefer warm or cool Room temperatures
What is cool. AC, fan, cool rag, etc.
cool, moving air directed at the face rapidly alleviates the sensation of breathlessness (dyspnea) and "air hunger".... stimulates facial trigeminal nerve receptors, sending signals to the brain that reduce the feeling of suffocation and anxiety, providing immediate, portable relief
____ Deficiency: lack of antiproteases leaving the lung parenchyma at risk for protease-mediated damage/ in COPD pts who present with liver damage/ primarily involves the lower lobes.
What is Alpha-1 antitrypsin deficiency
The 2 main methods of medication delivery
What are inhaled via MDIs (metered-dose inhalers) or DPIs (dry powder inhalers).
A physical finding: Skin
What is Central Cyanosis (in low arterial oxygenation)
Use this for a pt with tachypnea, dyspnea, resp distress
Ineffective breathing pattern related to anxiety, fatigue, barrel chest
Pts with COPD breath better laying flat or sitting up
What is breathe better sitting up
—especially leaning forward (the tripod position)—relieves pressure on the diaphragm, allows for greater lung expansion, and reduces the work of breathing. This position helps the diaphragm move down, optimizes the use of accessory muscles, and helps alleviate dyspnea (shortness of breath)
Seen on imaging studies, due to air trapping from airway collapse during exhalation.
What is Hyperinflation of the lungs
Common side effects of long acting beta agonists & inhaled corticosteroids
What are palpitations (with LABA) & increase risk of pneumonia or oral infections (with ICS).
2 physical findings: General
What are: Significant Resp Distress (during exacerbation) & Muscle Wasting
Use this for a pt struggling with ambulation due to shortness of breath.
Activity Intolerance Related to imbalance between oxygen supply and demand, leading to fatigue and dyspnea.
What is the Tripod effect?
Sitting on the edge of a chair or bed
leaning forward (torso)
elbows/ arms resting on your knees/ table
The inability to fully _____ causes elevations in carbon dioxide (CO2) levels
What is Exhale
Long acting maintenance meds & Short acting rescue meds
LABA, LAMA, LABA + LAMA (ex: Salmaterol, Tiotropium/ Spiriva, Stiolto Respimat)
SABA, SAMA (ex: albuterol, ipratropium)
A physical finding: Chest
Barrel chest: increased anterior- posterior chest wall diameter
Use this for pt on oxygen nasal canula, smoking, and lost the long acting inhaler 3 weeks ago, now dyspneic and increasing oxygen to help
Knowledge Deficit related to smoking cessation, disease management, and fire hazards.
Do COPD pts need more oxygen to resolve dyspnea?
No- COPD pts retain CO2: hypercapnea because of impaired gas exchange. Excess oxygen decreases respiratory drive, leads to oxygen toxicity. Keep O2 sats 88-92% with and without oxygen