Chronic Obstructive Pulmonary Disease


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Chronic Obstructive Pulmonary Disease

  1. 1. Chronic Obstructive Pulmonary Disease Diminished inspiratory/expiratory capacity of the lungs. A group of disorders relating to inadequate ventilation concerns. By Becky DeNeve, R.N.
  2. 2. Which pathophysiology do you choose??? <ul><li>1. Bronchiectasis </li></ul><ul><li>2. Bronchial Asthma </li></ul><ul><li>3. Chronic Bronchitis </li></ul><ul><li>4. Emphysema Write the choices down then answer the next 4 slides. </li></ul>
  3. 3. Spasm of the bronchioles with increase narrowing and mucus production. Triggered by respiratory infection or environmental allergens such as pollens, dust, animal dander's 1
  4. 4. Widening of the smaller airways. <ul><li>Results in permanent dilation and scarring. </li></ul><ul><li>Occurs as a complication of inflammation/infectious processes that eventually destroys bronchial elastic and muscular elements. 2 </li></ul>
  5. 5. Inflammation causing narrowing of the bronchioles. <ul><li>Altered cilia function and recurrent productive coughing. </li></ul><ul><li>Caused by by physical or chemical irritants such as smoking. </li></ul><ul><li>Presence of bacterial and/or viral infections. 3 </li></ul>
  6. 6. Over-inflated, destroyed alveoli (air sacs). <ul><li>Pulmonary connective tissue, lung elastin, is destroyed by enzymes causing decreased pulmonary surface area affecting gas exchange. </li></ul><ul><li>Hypoxia and hypercapnia symptoms. Expiration becomes difficult. 4 </li></ul>
  7. 7. How did you do??? <ul><li>Slide One - Bronchial Asthma </li></ul><ul><li>Slide Two - Bronchiectasis </li></ul><ul><li>Slide Three - Chronic Bronchitis </li></ul><ul><li>Slide Four - Emphysema </li></ul>
  8. 8. Regulation of Respirations <ul><li>Which section of the brain is responsible for the basic rhythm and depth of respirations? </li></ul><ul><li>A. Cerebellum </li></ul><ul><li>B. Cranial nerve VII </li></ul><ul><li>C. Medulla oblongata/pons </li></ul><ul><li>D. Frontal cerebral lobe 5 </li></ul>
  9. 9. Chemical Stimuli <ul><li>Which is considered the chemical stimulant for the regulation of breathing? </li></ul><ul><li>A. Oxygen </li></ul><ul><li>B. Hemoglobin </li></ul><ul><li>C. Surfactant </li></ul><ul><li>D. Carbon Dioxide 6 </li></ul>
  10. 10. Pulmonary Pressure Changes... <ul><li>For inspiration to occur, the lungs must be __________ atmospheric pressure. </li></ul><ul><li>A. less than </li></ul><ul><li>B. equal to </li></ul><ul><li>C. greater than 7 </li></ul>
  11. 11. Non-invasive Pulse Oximetry <ul><li>Which is considered a normal value in measuring arterial oxygen saturation? </li></ul><ul><li>A. > than 75%. </li></ul><ul><li>B. > than 80%. </li></ul><ul><li>C. > than 90%. </li></ul><ul><li>D. > than 98%. 8 </li></ul>
  12. 12. Sibilant and Sonorous Wheezing <ul><li>You would expect wheezing when _____________ is present. </li></ul><ul><li>A. Pneumonia </li></ul><ul><li>B. Tuberculosis </li></ul><ul><li>C. Pleurisy </li></ul><ul><li>D. Emphysema 9 </li></ul>
  13. 13. Fine and Coarse Rales <ul><li>You would expect “crackles” or rales when ____________ is present. </li></ul><ul><li>A. Bronchial Asthma </li></ul><ul><li>B. Acute Bronchitis </li></ul><ul><li>C. Pericarditis (heart) </li></ul><ul><li>D. Bronchiectasis 10 </li></ul>
  14. 14. Pleural Friction Rub <ul><li>Which disease process would probably auscultate the above lung sounds? </li></ul><ul><li>A. C.O.P.D. </li></ul><ul><li>B. Pleurisy with pneumonia </li></ul><ul><li>C. Pulmonary collapse </li></ul><ul><li>D. Bronchial Asthma 11 </li></ul>
  15. 15. Arterial Blood Gases <ul><li>Metabolic evaluation is assessed by measuring the bicarbonate (HCO3), oxygen saturation (Pao2 and O2), and pH of the blood. </li></ul><ul><li>A. True </li></ul><ul><li>B. False 12 </li></ul>
  16. 16. Increased Carbonic Acid <ul><li>Which of these situations is the EXCEPTION to respiratory acidosis (retained CO2)? </li></ul><ul><li>A. Chronic smoking history </li></ul><ul><li>B. Atelectasis </li></ul><ul><li>C. Use of sedatives and narcotics </li></ul><ul><li>D. Crushing chest trauma 13 </li></ul>
  17. 17. Carbon Dioxide Levels <ul><li>Which of these CO2 arterial blood gas levels would best represent an emphysema patient’s compensated level? </li></ul><ul><li>A. 30 C. 61 </li></ul><ul><li>B. 42 D. 89 14 </li></ul>
  18. 18. Assessment Skills <ul><li>Each of these findings are associated with a respiratory disease process. What’s your interpretation of EACH? </li></ul><ul><li>A. Right lobar consolidation, coughing </li></ul><ul><li>B. Weight loss, night sweats, fever </li></ul><ul><li>C. Barrel chest, pursed-lip breathing </li></ul><ul><li>D. Pleural rub, stabbing pain (insp.) </li></ul><ul><li>E. Flaring nares, clubbing of fingers, substernal retractions 15 </li></ul>
  19. 19. A Diagnostic Tool <ul><li>Which of these tests would confirm the exacerbation of emphysema returning? </li></ul><ul><li>A. Thoracentesis </li></ul><ul><li>B. ABG’s </li></ul><ul><li>C. Chest x-ray </li></ul><ul><li>D. CBC with differential, Sedimentation Rate 16 </li></ul>
  20. 20. Priority Evaluation <ul><li>A patient brought into ER severely dyspneic, stabbing pain in the chest, and diaphoretic said, “I was just trying to pick a tree limb up.” These symptoms appear to be: </li></ul><ul><li>A. a splinter attack. </li></ul><ul><li>B. gallbladder indigestion. </li></ul><ul><li>C. Status Asthmaticus. </li></ul><ul><li>D. Pneumothorax. 17 </li></ul>
  21. 21. “ I’m to old for all of this!”
  22. 22. Pediatric Math Dosages <ul><li>A physician ordered 60 mg’s. of Robitussin Cough Syrup for a 42 lb. child. The label reads: 40 mg./10 ml. How many tsps. are you giving per dose? </li></ul><ul><li>And, what is the weight of this child in kilograms? 18 </li></ul>
  23. 23. Pediatric “Croup” (Laryngotracheobronchitis) <ul><li>Hoarseness of a child’s voice would most likely be a symptom related to: </li></ul><ul><li>A. Swelling of the larynx </li></ul><ul><li>B. Constrictive bronchioles </li></ul><ul><li>C. Room vaporizer use </li></ul><ul><li>D. Coughing irritation 19 </li></ul>
  24. 24. I kind of like the peace and quiet for a change
  25. 25. Bronchodilators <ul><li>Which of these medications is a p.o. bronchodilator? </li></ul><ul><li>A. Aminophylline injectible </li></ul><ul><li>B. Theo-Dur </li></ul><ul><li>C. Ventolin aerosol </li></ul><ul><li>D. Solu-medrol 20 </li></ul>
  26. 26. Susan is taking Brethine, a bronchodilator, <ul><li>Her theophylline level sent back from the lab was 24. Is this considered WNL’s? </li></ul><ul><li>A. YES </li></ul><ul><li>B. NO </li></ul><ul><li>C. Depends on the symptoms 21 </li></ul>
  27. 27. IV Concentrations (Optional Slide) <ul><li>How many grams of Aminophylline are in a 2:1 concentration of 500 ml’s of D5W running at a titration of 18 ml’s/hr? </li></ul><ul><li>A. 0.3 g. </li></ul><ul><li>B. 0.5 g. </li></ul><ul><li>C. 1.0 g. </li></ul><ul><li>D. 2.0 g. 22 </li></ul>
  28. 28. Expectorants <ul><li>Which of the following medications is commonly given as a respiratory expectorant? </li></ul><ul><li>A. Robitussin DM </li></ul><ul><li>B. Humibid LA </li></ul><ul><li>C. Slo-Bid </li></ul><ul><li>D. Terbutaline 23 </li></ul>
  29. 29. Acute Bronchitis develops into Pneumonia... <ul><li>Which symptoms would you expect to see with a progressing bacterial pneumonia? </li></ul><ul><li>A. Fever 99.7F., infrequent coughing </li></ul><ul><li>B. Brownish-orange sputum, febrile, chilling </li></ul><ul><li>C. Flushed skin, gray, copious expectorant </li></ul><ul><li>D. Diaphoretic, swollen glands 24 </li></ul>
  30. 30. One of the latest and new anti-infectives choices <ul><li>Which of the following medications is the latest release in fighting respiratory infections? </li></ul><ul><li>A. Biaxin </li></ul><ul><li>B. Zithromax </li></ul><ul><li>C. Augmentin </li></ul><ul><li>D. Levaquin 25 </li></ul>
  31. 31. Anti-infectives for Bronchitis! <ul><li>Why is it important to complete a whole course of antibiotics prescribed? </li></ul><ul><li>A. So, you don’t develop a candida superinfection. </li></ul><ul><li>B. You want to improve in 72 hours. </li></ul><ul><li>C. Resistant strains could develop. </li></ul><ul><li>D. Eat yogurt, avoid alcohol, drink plenty of water. 26 </li></ul>
  32. 32. Mary Beth’s breathing patterns developed into... <ul><li>Exacerbation of emphysema, resp. rate of 30 - 34 with forced expirations. Her nurse should perform and/or review a teaching demonstration regarding: </li></ul><ul><li>A. Use of her inhalers </li></ul><ul><li>B. Increasing her O2 via NC </li></ul><ul><li>C. Purse-lip breathing </li></ul><ul><li>D. Breathing into a paper bag for increased anxiety 27 </li></ul>
  33. 33. Mary Beth is coughing a great deal… <ul><li>There seems to be a lot of dust particles collecting because the windows were open. How does dust affect her disease process? </li></ul><ul><li>A. Dust is a respiratory irritant. </li></ul><ul><li>B. She is having a bronchospasm. </li></ul><ul><li>C. It makes her angry. </li></ul><ul><li>D. Heavy morning pollens ease her distress. 28 </li></ul>
  34. 34. The first ACTION for... <ul><li>Mary Beth’s nurse to assist with when she is having “dyspnea” is to: </li></ul><ul><li>A. Call respiratory therapy STAT! </li></ul><ul><li>B. Offer Mary a backrub. </li></ul><ul><li>C. Make sure she is sitting upright. </li></ul><ul><li>D. Control her anxiety by offering a PRN Xanax. 29 </li></ul>
  35. 35. Samantha’s asthma attacks <ul><li>In reviewing patient education, Samantha admits that her cat is probably contributing to her asthma problems. Why is that? Choices are on the next page. </li></ul>I’m such a FUR BALL!
  36. 36. Fluffy the “feline” is clueless... <ul><li>A. Cat hair flies everywhere causing a sneezing attack. </li></ul><ul><li>B. Cats carry human diseases Samantha could catch. </li></ul><ul><li>C. Only Purina fed cats cause her wheezing difficulties. </li></ul><ul><li>D. Known allergens such as animal danders can trigger an attack. 30 </li></ul>
  37. 37. That’s all for now!!!