Overview of COPD Quiz

Overview of COPD

• COPD affects approximately 15 million individuals in the U.S. and 900,000 in Canada.
• It is the 4th leading cause of morbidity and mortality in the U.S.
• Defined as a collection of lower airway disorders impacting airflow and gas exchange.

Components of COPD

• Emphysema:

  • Involves destruction of lung elastic tissue, causing hyperinflation and air trapping due to damaged alveoli.
  • Results in increased work of breathing and sensations of "air hunger".

• Chronic Bronchitis:

  • Characterized by inflammation of bronchi and bronchioles due to irritants like cigarette smoke.
  • Causes mucus overproduction, thickening of airway walls, and obstructed airflow.

Risk Factors for COPD

• Cigarette smoking is the primary risk factor.
• Other factors include alpha-1 antitrypsin deficiency and a history of asthma.

Complications of COPD

• Hypoxemia and respiratory acidosis can occur.
• Increased risk of respiratory infections, cardiac failure (cor pulmonale), dysrhythmias, and respiratory failure.

Assessment of COPD

• Use of ABGs to monitor hypoxemia and hypercapnia is crucial.
• Oxygen saturation levels should be maintained between 88-92%.
• Physical and psychosocial assessments are essential to recognize symptoms and cues.

Management Strategies

• Smoking cessation as a key component of health promotion.
• Importance of a balanced diet to prevent weight loss and manage symptoms.
• Strategies for anxiety management, including writing plans and practicing relaxation techniques.

Evaluating Outcomes in COPD Care

• Goals include maintaining effective breathing patterns, ensuring a patent airway, achieving ideal body weight, reducing anxiety, and increasing acceptable levels of activity.

Case-Based Learning

• Understanding how symptoms, like weight changes and exertion levels, indicate potential exacerbations or complications.
• Familiarity with clinical scenarios to improve critical thinking regarding assessments and interventions for clients with COPD.

Overview of COPD

• COPD affects approximately 15 million individuals in the U.S. and 900,000 in Canada.
• It is the 4th leading cause of morbidity and mortality in the U.S.
• Defined as a collection of lower airway disorders impacting airflow and gas exchange.

Components of COPD

• Emphysema:

  • Involves destruction of lung elastic tissue, causing hyperinflation and air trapping due to damaged alveoli.
  • Results in increased work of breathing and sensations of "air hunger".

• Chronic Bronchitis:

  • Characterized by inflammation of bronchi and bronchioles due to irritants like cigarette smoke.
  • Causes mucus overproduction, thickening of airway walls, and obstructed airflow.

Risk Factors for COPD

• Cigarette smoking is the primary risk factor.
• Other factors include alpha-1 antitrypsin deficiency and a history of asthma.

Complications of COPD

• Hypoxemia and respiratory acidosis can occur.
• Increased risk of respiratory infections, cardiac failure (cor pulmonale), dysrhythmias, and respiratory failure.

Assessment of COPD

• Use of ABGs to monitor hypoxemia and hypercapnia is crucial.
• Oxygen saturation levels should be maintained between 88-92%.
• Physical and psychosocial assessments are essential to recognize symptoms and cues.

Management Strategies

• Smoking cessation as a key component of health promotion.
• Importance of a balanced diet to prevent weight loss and manage symptoms.
• Strategies for anxiety management, including writing plans and practicing relaxation techniques.

Evaluating Outcomes in COPD Care

• Goals include maintaining effective breathing patterns, ensuring a patent airway, achieving ideal body weight, reducing anxiety, and increasing acceptable levels of activity.

Case-Based Learning

• Understanding how symptoms, like weight changes and exertion levels, indicate potential exacerbations or complications.
• Familiarity with clinical scenarios to improve critical thinking regarding assessments and interventions for clients with COPD.

COPD Overview

• Chronic Obstructive Pulmonary Disease (COPD) affects 15 million individuals in the U.S. and 900,000 in Canada.
• Fourth leading cause of morbidity and mortality in the U.S.

Definition and Pathophysiology

• COPD is a collection of lower airway disorders that interfere with airflow and gas exchange.
• Key components of COPD include emphysema and chronic bronchitis.

Emphysema

• Destructive condition affecting lung elastic tissue, leading to reduced recoil and hyperinflation.
• Damaged alveoli cause air trapping and decreased gas exchange, resulting in CO2 retention and respiratory acidosis.

Chronic Bronchitis

• Inflammation of the bronchi and bronchioles due to irritant exposure, primarily cigarette smoke.
• Thickening of bronchial walls and increased mucus production result in obstructed airflow and chronic infection.

Risk Factors

• Major risk factor: Cigarette smoking.
• Other risks include alpha1-antitrypsin deficiency and a history of asthma.

Complications of COPD

• Hypoxemia can lead to respiratory acidosis, respiratory infections, cardiac failure (cor pulmonale), dysrhythmias, and respiratory failure.

Assessment and Recognition of Cues

• Physical assessment includes respiratory and cardiac changes, as well as psychosocial factors.
• Laboratory assessments involve monitoring ABG’s and pulse oximetry, aiming for O2 saturation of 88-92%.

COPD Management Strategies

• Emphasize weight management and dyspnea management through small, frequent meals and energy conservation techniques.
• Encourage anxiety management techniques and regular physical activity.

Health Promotion

• Smoking cessation is crucial for disease management and secondary prevention.
• Use of the I-PREPARE model for health promotion.

Care Coordination

• Home care management should include oxygen therapy, self-management education, and access to healthcare resources.
• Focus on maintaining gas exchange, effective breathing patterns, and preventing serious respiratory infections.

Goals of Evaluation

• Maintain gas exchange at chronic baseline values; achieve a breathing pattern that lowers work of breathing.
• Control body weight within 10% of ideal weight and reduce anxiety levels.

NCLEX Style Questions

• Example question regarding dyspnea indicates that nighttime breathing difficulties may suggest worsening condition.
• Proper assessment of chest tubes involves ensuring no loose bandages post-surgery.
• Emergency response for asthma involves prioritizing rescue drug administration when peak flow readings are critical.

Concepts

• Priority Concept: Gas Exchange
• Interrelated Concepts: Perfusion, Inflammation, Cellular Regulation

Respiratory System Overview

• Upper Airway Components: Nares (nostrils), pharynx, larynx (houses vocal cords), ciliated mucous membranes, tonsils
• Lower Airway Components: Trachea, bronchi, bronchioles, alveoli (site of gas exchange)

Differences in Pediatric and Adult Respiratory Systems

• Infants have insufficient surfactant and smaller, undeveloped airways
• Infants primarily breathe through their nose and have less-developed intercostal muscles
• Brief apnea episodes are common in newborns
• Higher respiratory rates due to increased metabolic needs
• Eustachian tubes are more horizontal, leading to greater susceptibility to ear infections
• Tonsillar tissue is more pronounced, and larynx flexibility makes it prone to spasms
• Infants predominantly use abdominal breathing

Asthma: Incidence and Prevalence

• Asthma can develop at any age but peaks between 10-17 years
• It is the leading cause of acute and chronic illness in children
• About 8.3% of children in the U.S. have asthma, with prevalence higher in African Americans and urban areas

Asthma Pathophysiology

• Chronic and intermittently occurring disease influenced by genetic and environmental factors
• Results in airway inflammation and sensitivity
• Characterized by bronchoconstriction, mucus production, and airway tissue edema

Asthma Reactions

• Immediate Reaction: Triggered by allergens activating IgE receptors on mast cells; leads to bronchoconstriction
• Late Reaction: Involves eosinophils and neutrophils causing prolonged inflammation, edema, and mucus plugging

Assessment of Asthma History

• Considerations include premature birth, family history, previous wheezing, exercise-induced cough, and allergies
• Hospitalization history and frequency of asthma episodes should be noted

Risk Factors for Asthma

• Strong family history of asthma
• Severe lower respiratory infections in the past
• Presence of allergies or atopy (allergic triad)
• More common in boys and those born prematurely

Asthma Triggers

• Include cold air, smoke, allergens, respiratory infections, stress, exercise, and certain medications

Assessment: Signs and Symptoms

• Monitor vital signs and watch for color changes, lung sounds (wheezing, stridor), and use of accessory muscles
• Signs of distress may include restlessness, anxiety, and difficulty talking or moving

Asthma Diagnostics

• Use of pulse oximetry, end-tidal CO2 monitoring, arterial blood gases (ABGs)
• Peak flow meters used for daily monitoring; abnormal pulmonary function tests are diagnostic
• Testing for allergic rhinitis or sinusitis is common among asthmatics

Asthma Classification

• Categories: Intermittent, Mild Persistent, Moderate Persistent, Severe Persistent

Therapeutic Management of Asthma

• Goals include improving airflow and gas exchange through assessment, collaboration, avoidance of triggers, and medication management
• Education for patients and families is essential, including adherence to asthma action plans

Asthma Medications

• Rescue Drugs: Short-acting bronchodilators (e.g., Albuterol, Levalbuterol) used for acute attacks
• Control Therapy Drugs: Long-term management includes inhaled corticosteroids, long-acting beta agonists, and leukotriene inhibitors

Signs of Emergency Treatment Needs

• Urgent symptoms: worsening wheeze, ineffective bronchodilator response, difficulty breathing, fatigue
• Severe signs: gray or blue lips, weak cry, trouble walking or talking

Status Asthmaticus

• Life-threatening acute episode not responsive to typical treatments
• Can lead to pneumothorax or cardiac arrest; requires aggressive treatment including IV fluids, bronchodilators, steroids, and potential intubation

Environmental Modifications for Asthma Management

• Recommendations include frequent washing of bedding, avoiding certain materials, and using air filters and dehumidifiers to reduce allergens in the home

General Overview of Anemia

• Anemia is characterized by a reduction in the number of red blood cells (RBCs), hemoglobin levels, and hematocrit percentages.
• It serves as a clinical indicator rather than a specific disease, implying various underlying causes.

Causes of Decreased RBCs

• Increased Destruction of RBCs

  • Examples include autoimmune hemolytic anemia and G6PD deficiency anemia.

• Decreased Production of RBCs

  • Often linked to iron deficiency, resulting from insufficient dietary iron.

• Chronic Blood Loss

  • Potential sources include:
    • Acute trauma leading to blood loss.
    • Gastritis, which can contribute to chronic blood loss.
    • Menstrual periods, which can result in significant blood loss.
    • Hemorrhoids, another source of blood loss.

Nursing Interventions

• Nursing interventions remain consistent regardless of the anemia's underlying cause.

Hemoglobin and Hematocrit in CBC

• Hemoglobin (Hgb)

  • An iron-rich protein within RBCs, vital for oxygen transport.
  • Measured in grams per deciliter (g/dL).
  • Level varies with age and sex.

• Hematocrit (Hct)

  • Represents the percentage of packed RBCs in a given volume of blood.
  • Expressed as a percentage (%) and varies with age and sex.

General Overview of Anemia

• Anemia is characterized by a reduction in the number of red blood cells (RBCs), hemoglobin levels, and hematocrit percentages.
• It serves as a clinical indicator rather than a specific disease, implying various underlying causes.

Causes of Decreased RBCs

• Increased Destruction of RBCs

  • Examples include autoimmune hemolytic anemia and G6PD deficiency anemia.

• Decreased Production of RBCs

  • Often linked to iron deficiency, resulting from insufficient dietary iron.

• Chronic Blood Loss

  • Potential sources include:
    • Acute trauma leading to blood loss.
    • Gastritis, which can contribute to chronic blood loss.
    • Menstrual periods, which can result in significant blood loss.
    • Hemorrhoids, another source of blood loss.

Nursing Interventions

• Nursing interventions remain consistent regardless of the anemia's underlying cause.

Hemoglobin and Hematocrit in CBC

• Hemoglobin (Hgb)

  • An iron-rich protein within RBCs, vital for oxygen transport.
  • Measured in grams per deciliter (g/dL).
  • Level varies with age and sex.

• Hematocrit (Hct)

  • Represents the percentage of packed RBCs in a given volume of blood.
  • Expressed as a percentage (%) and varies with age and sex.

General Overview of Anemia

• Anemia is characterized by a reduction in the number of red blood cells (RBCs), hemoglobin levels, and hematocrit percentages.
• It serves as a clinical indicator rather than a specific disease, implying various underlying causes.

Causes of Decreased RBCs

• Increased Destruction of RBCs

  • Examples include autoimmune hemolytic anemia and G6PD deficiency anemia.

• Decreased Production of RBCs

  • Often linked to iron deficiency, resulting from insufficient dietary iron.

• Chronic Blood Loss

  • Potential sources include:
    • Acute trauma leading to blood loss.
    • Gastritis, which can contribute to chronic blood loss.
    • Menstrual periods, which can result in significant blood loss.
    • Hemorrhoids, another source of blood loss.

Nursing Interventions

• Nursing interventions remain consistent regardless of the anemia's underlying cause.

Hemoglobin and Hematocrit in CBC

• Hemoglobin (Hgb)

  • An iron-rich protein within RBCs, vital for oxygen transport.
  • Measured in grams per deciliter (g/dL).
  • Level varies with age and sex.

• Hematocrit (Hct)

  • Represents the percentage of packed RBCs in a given volume of blood.
  • Expressed as a percentage (%) and varies with age and sex.

Respiratory Drugs Overview

• Beta2-adrenergic agonists are used for bronchodilation and have inhaled, systemic, and long-acting forms.
• Common short-acting examples include Albuterol, Levalbuterol, and Terbutaline; long-acting examples are Formoterol and Salmeterol.
• Beta-adrenergic blockers can diminish the bronchodilating effects of agonists.

Anticholinergic Drugs

• Anticholinergics, like Ipratropium bromide, provide bronchodilation and relieve COPD and asthma symptoms.
• Inhalation forms work locally, onset is 15-20 minutes, with effects lasting 3-5 hours.

Corticosteroids

• Corticosteroids are effective for preventing acute asthma attacks.
• Inhaled forms (e.g., Beclomethasone) and systemic forms (e.g., Prednisone, Hydrocortisone) may be used.
• Special considerations for corticosteroid use include monitoring growth in children, osteoporosis in the elderly, and blood glucose levels in diabetics.

Leukotriene Modifiers

• Leukotriene modifiers (e.g., Montelukast, Zafirlukast) inhibit the effects of leukotrienes, reducing airway constriction and inflammation.
• They are often prescribed for mild to moderate asthma.

Mast Cell Stabilizers

• Mast cell stabilizers, such as Cromolyn sodium, prevent the release of inflammatory mediators and are suitable for long-term asthma control.
• They are particularly effective in children and for exercise-induced asthma.

Methylxanthines

• Theophylline, aminophylline, and caffeine fall under methylxanthines, which promote bronchodilation and reduce airway reactivity.
• Therapeutic levels for Theophylline are between 10-20 mcg/mL; toxicity risk increases with high-fat diets.

Expectorants

• Guaifenesin is a commonly used expectorant that thins mucus, easing its clearance from airways.
• It alleviates symptoms associated with bronchitis, colds, and other respiratory conditions.

Antitussives

• Antitussives like Dextromethorphan and Codeine help manage non-productive coughs but carry risks of CNS depression, especially with certain drug combinations.
• Not recommended for chronic conditions such as asthma or COPD.

Mucolytics

• Mucolytics, including Acetylcysteine, thin thick secretions and are used in conditions like bronchitis and cystic fibrosis.
• Acetylcysteine is also an antidote for acetaminophen overdose.

Decongestants

• Decongestants cause vasoconstriction, decreasing inflammation and capillary permeability.
• Topical decongestants typically have fewer side effects, while systemic options may lead to jitteriness and sleep disturbances.
• Pseudoephedrine is sold behind the counter due to its potential misuse in methamphetamine production.

Colony Stimulating Factors

• Epogen, a colony stimulating factor, increases red blood cell production and is utilized to treat anemia.