COPD Past Paper PDF

CHRONIC OBSTRUCTIVE PULMONARY DISEASE (COPD) Robin K. Long, MSN, RN, CPNP  15 million in U.S. COPD: INCIDENCE AND 900,000 in Canada PREVALENC E 4th leading cause of morbi...

CHRONIC OBSTRUCTIVE PULMONARY DISEASE (COPD) Robin K. Long, MSN, RN, CPNP  15 million in U.S. COPD: INCIDENCE AND 900,000 in Canada PREVALENC E 4th leading cause of morbidity and mortality in the U.S. GAS EXCHANGE  Pathophysiology Overview  Def: A collection of lower airway CONCEPT disorders that interfere with airflow and gas exchange. EXEMPLAR:  COPD includes: CHRONIC  Emphysema  A destructive problem of lung OBSTRUCTIVE elastic tissue that reduces its ability to recoil after stretching, leading to hyperinflation of the PULMONARY  lung. Chronic bronchitis DISEASE  An inflammation of the bronchi and bronchioles caused by (COPD) exposure to irritants, especially cigarette smoke.  Emphysema is a destructive problem of lung elastic tissue (alveoli) that reduces its ability to recoil after stretching, leading to hyperinflation of the lung. Alveoli are damaged.  Results in air trapping  See increased work of breathing  “air hunger” sensation  Gas exchange decreased: (CO2 retention, respiratory acidosis) EMPHYSEMA  Inflammation of the bronchi and bronchioles (bronchiolitis) caused by exposure to irritants (cigarette smoke)  Irritant triggers inflammation, vasodilation, mucosal edema, congestion, and bronchospasm.  Bronchitis affects only the airways, not the alveoli.  Chronic inflammation increases the number and size of mucus- secreting glands, which produce large amounts of thick mucus. The bronchial walls thicken and impair airflow. This thickening, along with excessive mucus, blocks some of the smaller airways and narrows larger ones. The increased mucus provides a breeding ground for organisms and leads to chronic infection. CHRONIC BRONCHITIS Cigarette smoking is the COPD: greatest risk factor RISK FACTORS AND Alpha1-antitrypsin GENETIC deficiency RISK Asthma BASICS OF GAS EXCHANGE Hypoxemia Acidosis COMPLICATIONS OF COPD Respiratory infection Cardiac failure (cor pulmonale) Dysrhythmias Respiratory failure  Risk Smoking History Breathing Activity COPD Weight factors history problems level ASSESSMEN T: Physical Assessment/Signs and RECOGNIZE General Symptoms appearance Respiratory Cardiac changes CUES Psychosocial Assessment BARREL CHEST COPD: ASSESSMENT: RECOGNIZE CUES (2 OF 2) Laboratory assessment  ABG’s (baseline, repeat, follow pattern).  See hypoxemia and hypercapnia  Pox (to gauge treatment response), 45).  High CO2 levels reduce respiratory drive. Can lead to respiratory arrest.  Safe sats strategy: Aim for O2 sats 88-92%  Deliver O2 by Venturi mask (control amount delivered)…(24 %-28%). Careful with NC delivery…uncontrolled pure O2 delivery COPD PATIENTS AND O2 ADMIN..CAREFUL!  Weight loss  Dyspnea management  Small meals 2-3 x/day, eat big meal when most hungry  Good food selection/high calorie foods  Pursed lip breathing and inhaler before eating.  Anxiety prevention  Write down a plan  Pursed lip breathing/diaphragm breathing  Support people/counseling for anxiety  Hypnosis, relaxation techniques PREVENTING WEIGHT LOSS AND MINIMIZING ANXIETY  Decreasing Infection  Pneumonia complication  Improving Endurance  Fatigue  Help with ADL’s  Energy conservation DECREASING INFECTION AND IMPROVING ENDURANCE  SMOKING CESSATION!  I-PREPARE model COPD: HEALTH PROMOTION AND MAINTENANCE COPD: CARE COORDINATION AND TRANSITION MANAGEMENT  Home care management  Use of oxygen  Self-management education  Drug therapy  Breathing techniques  Health care resources  Attain and maintain gas exchange at a level within his or her chronic baseline values  Achieve an effective breathing pattern that decreases the work of breathing  Maintain a patent airway  Achieve and maintain a body weight within 10% of his or her ideal weight  Have decreased anxiety  Increase activity to a level acceptable to him or her  Avoid serious respiratory infections COPD: EVALUATION: EVALUATE OUTCOMES NCLEX STYLE QUESTIONS COPD content QUESTION 1 A client with COPD who smokes 1 PPD presents for a routine appointment. Which client statement causes the nurse to suspect an increase in dyspnea? A. “I prop myself up at night to sleep.” B. “I decided to put on some makeup today.” C. “I have a productive cough in the morning.” D. “I have gained weight since I was here last.” ANS: A  Clients with COPD, who smoke, may have a productive morning cough. Weight loss (not gain) often occurs when dyspnea is increased due to the increased metabolic demand. A disheveled appearance may indicate an increase in dyspnea, if the client doesn’t feel well enough to perform ADLs. Sleeping propped up indicates that breathing may be worse while lying down. ANSWER TO QUESTION 1 QUESTION 2 The nurse is assessing a client with a chest tube following a pneumonectomy. Which assessment finding requires nursing intervention? A. Bandage around the posterior tube is loose. B. 2 cm of water is in the second chest tube chamber. C. The water in the water seal chamber rises and falls with inhalation/exhalation. D. Bubbling present in the water seal chamber when the client coughs. ANS: A  After lung surgery, two tubes, anterior and posterior, are used. Dressings around the wound should not be loose. Other findings are normal. ANSWER TO QUESTION 2 QUESTION 3 A client with a history of asthma reports shortness of breath. The nurse observes that the peak flowmeter indicates a peak expiratory flow (PEF) reading that is in the red zone. What is the priority nursing action? A. Obtain vital signs. B. Administer rescue drugs. C. Notify the health care provider. D. Repeat the PEF reading to verify results. ANS: B  A PEF reading in the red zone indicates a range that is 50% below the client’s personal best PEF reading and indicates serious respiratory obstruction. The client needs to receive rescue drugs immediately, and then the health care provider should be notified. Repeating the PEF reading and taking vital signs are also important, but doing so delays the administration of the rescue drugs. These can be done after rescue drugs are given. ANSWER TO QUESTION 3