COPD
COPD risk factors
Smoking-greatest risk factor, White, Older men, Environmental pollutants/air pollutants, Asthma, Genetics- alpha-1 antitrypsin deficiency (both parents have to have this gene to develop COPD related to AATD)
What is emphysema?
loss of elasticity and hyperinflation of the lungs which results in dyspnea and tachycardia. Inhalation can start before exhalation, which can lead to uneven breathing.
Affects alveoli
What is asthma?
reversible airflow obstruction that is the result of inflammation or hyperresponsiveness that leads to bronchospasm
Albuterol
causes bronchodilation and has a rapid onset of action
S/E= Headache, rhinitis, excitability, tremors
What is the hypoxic drive theory?
the main drive to breathe. In COPD patients, the stimulation to breathe leads to decreased O2 levels.
What is chronic bronchitis?
occurs when bronchial tubes are inflamed, often by irritants (especially cigarette smoke). Inflammation narrows airways causing hypoxemia and then the arterial CO2 levels increase (this could lead to respiratory acidosis).
Affects bronchioles
S/S of asthma
cough, dyspnea, chest tightness, tachycardia, use of accessory muscles, possible cyanosis
Ipratropium
maintenance treatment of bronchospasm associated with COPD
S/E= Dry mouth, constipation, dyspepsia- indigestion, abdominal pain, insomnia
S/S of COPD exacerbation
increasing SOB, wheezing, increased frequency or severity of cough, sleep problems, anxiety, decreased appetite
S/S of emphysema
PINK PUFFERS
thin stature, cardiac enlargement, barrel chest, reddish color, pursed lips
Complications of asthma
respiratory failure, pneumonia, atelectasis, airway obstruction
Theophylline
relaxes smooth muscle of bronchi and bronchioles increasing cAMP promoting bronchodilation
Blood draw will have to occur (therapeutic range 5-15 mcg/mL)
S/E= Dizziness, headache, irritability, nervousness, GI distress
“Caffeine pill”
COPD management/treatment
pursed lip breathing, 1500-200mL of hydration per day, humidification of oxygen, positioning (at least 45 degrees), change positions q2hr, exercise, diet (high cal, high protein, avoid dairy, small frequent meals), infection control, incentive spirometer, med compliance, decreasing anxiety
S/S of chronic bronchitis
BLUE BLOATER
daily productive cough, obesity, ankle edema, JVD, cyanosis
What is status asthmaticus? (some S/S too)
unresponsive to treatment with bronchodilators
S/S= prolonged expiratory phase, JVD, increased wheezing
Glucocorticoids
anti inflammatory
S/E= Dry mouth, throat irritation, headache, confusion, depression, fluid retention
Complications of COPD
respiratory failure, cardiac dysrhythmias, respiratory infections, osteoporosis, lung cancer, chronic atelectasis, secondary spontaneous pneumothorax, sleep problems, cor pulmonale
What is the normal O2 stat for COPD patients?
88-92%
Nursing interventions for asthma
patient positioning (at least 45 decrees), monitor dyspnea, assess LOC, meds, IV fluids if needed, education patient (inhaler use, pursed lip breathing, smoking cessation, cleaning of equipment)
Leukotriene Receptor Antagonists
reduce inflammatory process and decrease bronchodilation
S/E= Dizziness, headaches, confusion, GI distress, depression
Use every day if prescribed