MS chapter 32 part 3
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What are the 3 main type of etiology/ genetic risk factors for COPD
- Cigarette smoking
- alpha 1- antitrypsin (AAT) deficiency
- air pollution
What is the most important risk factor for COPD?
This type of etilogy/ genetic risk factor for COPD is less common and involves a deficient amount of the AAT enzyme that regulates the proteases (pac men) keeping them in control. If this enzyme is deficient, COPD can develop at an early age.
Alpha 1-antitrypsin (AAT) deficiency
This risk factor for COPD alone plays a small role and can be additive to other risks.
COPD affects the ___ and ___ to all tissues
oxygenation and tissue perfusion
What are the 5 major problems that can occur in pts with COPD
- Respiratory infections
- Cardiac failures
- Cardiac dysrhythmias
____ and ____ occur because the pt with COPD is less able to exchange gas, oxygenation decreases and co2 levels increase.
Hypoxemia and acidosis
In a pt with COPD, ____ ______ risk increases because of the increased mucous and poor oxygenation.
What cor pulmonale?
right sided heart failure
Why does cardiac failure, especially cor pulmonale occur with patients with COPD?
Because the right side of the heart has to work alot harder to pump blood into the lungs
______ ______ are common in patients with COPD and may resulf from hypoxemia (from decreased ox to the heart muscle)
What does the History of a physical assessment for a pt COPD involve?
- Smoking histroy in pack years
- AAT deficiency?
- Breathing promblems
- Cough pattern
- sputum and apperance of it
- difficulty eating/sleeping
- unplanned weight loss
What does the general appearance of COPD pt look like?
- Pt can have thin extremities with a barrel chest
- Pt can have weight loss because of the increase metabolic needs
- slow moving and slightly stooped
- clubbed fingers
- person sits forward with a bending posture
What are some finding in a respiratory assessment the nurse would expect to see for a pt with COPD?
- rapid, shallow respirations
- use of accessory muscles
- cyonotic or blue tinged, dusky appearance.
- clubbing of the fingers
What could a nurse anticipate regarding cardiac changes with a pt that has COPD?
a faster heart rate as it tries to compensate
How do you calculate a pt's pack year history?
- multiply the # of years smoked by packs per day
- 28 years x 2 packs a day= 56 pack years
What tool would a nurse use to assess the degree of syspnea a pt is experiencing?
a tool called a Visual Analog Dyspnea Scale (VADS) is used. It is a straight line with verbal anchors and the beggining and end. Ask the pt to mark the line to indicate their perceived breathing difficulty.
Why are sputum sample obtained for patients with an acute respirator infection?
Looking for bacteria
With a pt with COPD, ____ ____ is going to occur because of the increase PaCo2 in the blood.
Chronic respiratory acidosis
in a Pt with COPD, _______ ________ occurs as kidneys retain HCO3 (bicarb) to compensate for respiratory acidoses
In a lab assessment for a pt with COPD, what should the nurse expect to review besides ABGs?
- CBC- wbc elevation?
- H and H- Both will be elevated.
- Serum electrolyte levels- elevated or decreased?
- Serum AAT leves
- Other assessments:
- Chest X ray
- pulmonary function tests
What are some nonsurgical interventions for a pt with COPD
- airway management
- monitoring pt
- cough enhancement
- o2 therapy
- drug therapy
- pulmonary rehabilitation
What does airway management involve for a nurse performing a nonsrugical interventino on a pt with COPD
Assist pt to liquefy secretions and clear the airway.
How often should the nurse monitor the pt with COPD?
every 2 hours
What can cough enhancement do for a pt with COPD
can improve gas exchange by helping increase airflow in the larger airways.
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