NCM 118: COPD and Altered Ventilatory Function

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Questions and Answers

Which physical examination finding is characteristic of a patient with panlobular emphysema?

Fluid accumulation in the abdomen

Barrel chest appearance (correct)

Cyanosis of the lips

Decreased chest expansion

What is a primary cause of the panlobular (panacinar) type of emphysema?

Decreased air volume in the lungs

Narrowing of the bronchi

Clogging of air passages due to mucus (correct)

Increased elasticity of alveolar walls

How does the panlobular type of emphysema primarily affect the alveoli?

Increases the number of alveolar sacs

Causes hyperplasia of alveolar walls

Promotes the loss of stretching ability (correct)

Enhances gas exchange efficiency

What symptom is most commonly associated with advanced panlobular emphysema?

Marked dyspnea on exertion Signup and view all the answers

What anatomical changes are typical in the lungs due to the panlobular type of emphysema?

Enlargement of all air spaces within the lobule Signup and view all the answers

What is the primary characteristic of Chronic Obstructive Pulmonary Disease (COPD)?

It is a progressive disease that causes airflow obstruction. Signup and view all the answers

Which of the following best describes emphysema?

Destruction of the walls of over distended alveoli. Signup and view all the answers

Which statement regarding the treatment of COPD is accurate?

COPD is both preventable and treatable with various interventions. Signup and view all the answers

What is the leading cause of morbidity and mortality currently in the United States?

Chronic Obstructive Pulmonary Disease (COPD). Signup and view all the answers

What happens to the alveoli in chronic emphysema?

They undergo permanent destruction leading to fewer and larger air sacs. Signup and view all the answers

Which of the following is a primary cause of respiratory exacerbation?

Air pollution Signup and view all the answers

What condition might lead to CO2 narcosis when certain agents are used?

Antitussive agents Signup and view all the answers

Which nursing intervention focuses on helping the client control dyspnea?

Pursed lip breathing Signup and view all the answers

What is NOT an indication for hospitalization in respiratory conditions?

Mild shortness of breath Signup and view all the answers

What is the primary benefit of long-term oxygen therapy?

Improves quality of life and survival Signup and view all the answers

Which physical condition is NOT commonly associated with chronic obstructive pulmonary disease (COPD)?

Insomnia Signup and view all the answers

Which of these statements about self-care activities is true?

Increasing participation in self-care is encouraged as breathing improves. Signup and view all the answers

Which of the following conditions can lead to anxiety and changes in behavior in COPD patients?

Breathing difficulties Signup and view all the answers

What is a recommended exercise for improving respiratory function?

Inspiratory muscle training Signup and view all the answers

What dietary consideration is crucial for COPD patients?

Thorough assessment of caloric needs Signup and view all the answers

Which statement reflects a misconception about activity pacing for respiratory patients?

Clients should be discouraged from structured activities. Signup and view all the answers

What emotional effect might chronic breathing difficulties have on a client?

Frustration and depression Signup and view all the answers

Which of the following is NOT a symptom of respiratory exacerbation?

Mild muscle strain Signup and view all the answers

Which management strategy emphasizes the timing of activities for COPD patients?

Self-care activity planning Signup and view all the answers

What is the central feature of centribolular (centroacinar) pulmonary changes?

Preservation of peripheral portions of the acinus Signup and view all the answers

What are the common initial signs of chronic bronchitis?

Persistent cough with clear sputum Signup and view all the answers

Which risk factor accounts for the majority of COPD cases?

Exposure to tobacco smoke Signup and view all the answers

What characterizes the 'Blue Bloater' phenotype of COPD?

Cyanosis and excess mucus production Signup and view all the answers

Which of the following best describes the typical progression of COPD symptoms?

Gradual worsening of chronic cough and sputum production Signup and view all the answers

What is a key component of pharmacologic therapy for managing COPD?

Bronchodilators to relieve bronchospasm Signup and view all the answers

Which symptom is most commonly associated with advanced COPD?

Difficulty catching breath while talking Signup and view all the answers

What does the presence of central cyanosis in a patient indicate?

Low levels of oxygen in the blood Signup and view all the answers

Which diagnostic test is commonly used to evaluate airflow obstruction in COPD?

Spirometry Signup and view all the answers

What is the role of diuretics in the management of COPD?

To relieve peripheral edema Signup and view all the answers

Which clinical manifestation is considered a common sign of COPD?

Persistent cough with sputum for 3 months Signup and view all the answers

Which statement accurately reflects the relationship between smoking and COPD?

Smoking cessation is critical in preventing or slowing COPD progression Signup and view all the answers

What measurement indicates the severity of respiratory failure in COPD patients?

Pulse oximetry and ABG values Signup and view all the answers

Study Notes

Chronic Obstructive Pulmonary Disease (COPD)

COPD encompasses two primary conditions: emphysema and chronic bronchitis.
It is a progressive and preventable disease, primarily characterized by airflow obstruction.
COPD severely affects breathing through limited airflow into the lungs.
It is a leading cause of morbidity and mortality in the U.S., ranking as the 5th leading cause of death.

Emphysema

Emphysema involves damage to the alveolar sacs, leading to loss of shape and fewer air sacs, with reduced gas exchange surface area.
Can progress to permanent destruction of alveoli due to irreversible elastin destruction.
Two forms of emphysema:
- Panlobular (Panacinar) Type: Destruction occurs in all air spaces within a lobule, characterized by hyperinflated chest, marked exertional dyspnea, and weight loss.
- Centrilobular (Centroacinar) Type: Pathologic changes mainly occur in the center of lobules, causing ventilation issues, hypoxemia, and may lead to right-sided heart failure.

Chronic Bronchitis

Involves inflammation of the air passages, leading to mucus clogging and chronic cough.
Most individuals with COPD exhibit both emphysema and chronic bronchitis.

Typical Progression of COPD

Symptoms may be absent during the first 10 years of smoking.
Chronic cough with clear sputum typically develops after a decade of smoking.
Dyspnea usually begins between 40-50 years of age.
Increased susceptibility to respiratory infections occurs around age 50.

Common Signs and Symptoms

Persistent productive cough lasting 3 months over two consecutive years.
Dyspnea, particularly during physical activities.
Frequent respiratory infections and feelings of tightness in the chest.
Symptoms may include wheezing and fatigue.

Risk Factors

Tobacco smoke exposure accounts for 80-90% of COPD cases.
Additional risk factors include secondhand smoke, aging, occupational exposure, air pollution, and genetic factors like Alpha 1-Antitrypsin Deficiency.

Advanced COPD Symptoms

Increased difficulty breathing during talk or physical exertion.
High CO2 levels can cause fever and headache.
Cyanosis noted in lips and fingernails signifies low O2 levels in the blood.
Physical signs may include barrel chest, swollen limbs, and diminished mental alertness.

Smoking Impacts

Smoking destructs lung tissue; it impairs cell function in the respiratory tract and reduces lung capacity.
Carbon monoxide from smoking creates carboxyhemoglobin, which impairs oxygen transport.

Medical Management

Risk Reduction: Smoking cessation is the most effective intervention to prevent or slow COPD progression.
Education on quitting smoking and support are crucial for clients diagnosed with COPD.

Pharmacologic Therapy

Bronchodilators: Help alleviate bronchospasms and enhance airflow; can be administered via inhalers or nebulizers.
- Classes include beta-adrenergic agonists, anticholinergic agents, and methylxanthines.
Corticosteroids: Administered inhaled or systemically, often in conjunction with bronchodilators.

Preventive Care

Annual influenza vaccination and pneumococcal vaccine every 5-7 years recommended for high-risk patients.

Nursing Alert

Extreme care is needed when administering oxygen to COPD patients; high oxygen levels can artificially stimulate respiration in those with hypoxemia.### Management of Exacerbation
Respiratory drive suppression occurs with the use of antibiotic, mucolytic, and antitussive agents, potentially leading to CO2 retention and narcosis.
Primary causes of exacerbation include tracheobronchial infection and air pollution.
Secondary causes encompass pneumonia, pulmonary embolism, pneumothorax, rib fractures, chest trauma, inappropriate use of sedatives or beta-blockers, heart failure, and secondary polycythemia.

Symptoms

Key symptoms are increased dyspnea, sputum production, respiratory failure, mental status changes, and worsening blood gas abnormalities.

Indications for Hospitalization

Severe, unresponsive dyspnea, confusion, respiratory muscle fatigue, paradoxical chest wall movement, peripheral edema, new cyanosis, and persistent hypoxemia necessitate hospitalization.

Oxygen Therapy

Long-term oxygen therapy enhances quality of life and survival, can be administered during exercise, and aids in preventing acute dyspnea.

Breathing Exercises

Pursed lip breathing facilitates controlled expiration, prevents airway collapse, promotes relaxation, and reduces feelings of panic related to dyspnea.

Inspiratory Muscle Training

Following mastery of diaphragmatic breathing, a regimen of inspiratory muscle training improves strength of respiratory muscles, requiring daily resistance breathing exercises.

Activity Pacing and Self-Care

Activity limitations and careful planning for daily tasks help manage energy and accommodate breathing difficulties.
As lung function improves, clients are encouraged to engage more in self-care activities, integrating diaphragmatic breathing.

Physical Conditioning

Exercises designed to improve energy conservation and pulmonary ventilation are essential, showing a direct relationship between overall fitness and respiratory health.
Graded exercises, such as walking and biking, contribute to respiratory fitness.

Nutritional Therapy

Comprehensive assessment of caloric needs and dietary counseling play vital roles in the rehabilitation process for clients with COPD.
Meal planning and supplementation help optimize nutritional intake for improved health outcomes.

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Description

This quiz covers the response to altered ventilatory function, specifically focusing on Chronic Obstructive Pulmonary Disease (COPD) and its relationship with emphysema. It is designed for Level IV Nursing students, providing essential knowledge for understanding these respiratory conditions.