Chronic Obstructive Pulmonary Disease

Chronic Obstructive Chronic Obstructive Pulmonary DiseasePulmonary Disease

Diminished Diminished inspiratory/expiratory inspiratory/expiratory

capacity of the lungs. A capacity of the lungs. A group of disorders relating to group of disorders relating to

inadequate ventilation inadequate ventilation concerns.concerns.

By Becky DeNeve, R.N.

Which pathophysiology do Which pathophysiology do you choose???you choose???

1. Bronchiectasis1. Bronchiectasis 2. Bronchial Asthma2. Bronchial Asthma 3. Chronic Bronchitis3. Chronic Bronchitis 4. Emphysema4. Emphysema

Write the choices down then Write the choices down then answer the next 4 slides. answer the next 4 slides.

Spasm of the bronchioles Spasm of the bronchioles with increase narrowing with increase narrowing and mucus production.and mucus production.

Triggered by respiratory Triggered by respiratory infection or environmental infection or environmental

allergens such as pollens, allergens such as pollens, dust, animal dander's dust, animal dander's

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Widening of the smaller Widening of the smaller airways.airways.

Results in permanent dilation and Results in permanent dilation and scarring.scarring.

Occurs as a complication of Occurs as a complication of inflammation/infectious processes inflammation/infectious processes that eventually destroys bronchial that eventually destroys bronchial elastic and muscular elements. elastic and muscular elements. 22

Inflammation causing Inflammation causing narrowing of the narrowing of the

bronchioles.bronchioles.

Altered cilia function and recurrent Altered cilia function and recurrent productive coughing.productive coughing.

Caused by by physical or chemical Caused by by physical or chemical irritants such as smoking.irritants such as smoking.

Presence of bacterial and/or viral Presence of bacterial and/or viral infections. infections. 33

Over-inflated, destroyed Over-inflated, destroyed alveoli (air sacs).alveoli (air sacs).

Pulmonary connective tissue, lung Pulmonary connective tissue, lung elastin, is destroyed by enzymes elastin, is destroyed by enzymes causing decreased pulmonary surface causing decreased pulmonary surface area affecting gas exchange.area affecting gas exchange.

Hypoxia and hypercapnia symptoms. Hypoxia and hypercapnia symptoms. Expiration becomes difficult.Expiration becomes difficult.

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How did you do???How did you do???

Slide One - Slide One - Bronchial AsthmaBronchial Asthma

Slide Two - Slide Two - BronchiectasisBronchiectasis

Slide Three - Slide Three - Chronic BronchitisChronic Bronchitis

Slide Four - Slide Four - EmphysemaEmphysema

Regulation of RespirationsRegulation of Respirations

Which section of the brain is Which section of the brain is responsible for the basic rhythm and responsible for the basic rhythm and depth of respirations?depth of respirations?

A. Cerebellum A. Cerebellum B. Cranial nerve VIIB. Cranial nerve VII C. Medulla oblongata/ponsC. Medulla oblongata/pons D. Frontal cerebral lobe D. Frontal cerebral lobe

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Chemical StimuliChemical Stimuli

Which is considered the chemical Which is considered the chemical stimulant for the regulation of stimulant for the regulation of breathing?breathing?

A. OxygenA. Oxygen B. HemoglobinB. Hemoglobin C. SurfactantC. Surfactant D. Carbon Dioxide D. Carbon Dioxide

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Pulmonary Pressure Pulmonary Pressure Changes...Changes...

For inspiration to occur, the lungs must For inspiration to occur, the lungs must be __________ atmospheric pressure.be __________ atmospheric pressure.

A. less thanA. less than B. equal to B. equal to C. greater than C. greater than

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Non-invasive Pulse Non-invasive Pulse OximetryOximetry

Which is considered Which is considered a normal value in a normal value in measuring arterial measuring arterial oxygen saturation?oxygen saturation?

A. > than 75%.A. > than 75%. B. > than 80%.B. > than 80%. C. > than 90%.C. > than 90%. D. > than 98%. D. > than 98%.

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Sibilant and Sonorous Sibilant and Sonorous WheezingWheezing

You would expect wheezing when You would expect wheezing when _____________ is present._____________ is present.

A. PneumoniaA. Pneumonia B. TuberculosisB. Tuberculosis C. PleurisyC. Pleurisy D. Emphysema D. Emphysema

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Fine and Coarse RalesFine and Coarse Rales

You would expect “crackles” or rales You would expect “crackles” or rales when ____________ is present.when ____________ is present.

A. Bronchial AsthmaA. Bronchial Asthma B. Acute BronchitisB. Acute Bronchitis C. Pericarditis (heart)C. Pericarditis (heart) D. Bronchiectasis D. Bronchiectasis

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Pleural Friction RubPleural Friction Rub

Which disease process would Which disease process would probably auscultate the above lung probably auscultate the above lung sounds? sounds?

A. C.O.P.D.A. C.O.P.D. B. Pleurisy with pneumoniaB. Pleurisy with pneumonia C. Pulmonary collapseC. Pulmonary collapse D. Bronchial Asthma D. Bronchial Asthma

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Arterial Blood GasesArterial Blood Gases

Metabolic evaluation Metabolic evaluation is assessed by is assessed by measuring the measuring the bicarbonate (HCO3), bicarbonate (HCO3), oxygen saturation oxygen saturation (Pao2 and O2), and (Pao2 and O2), and pH of the blood.pH of the blood.

A. TrueA. True B. False B. False

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Increased Carbonic AcidIncreased Carbonic Acid

Which of these situations is the Which of these situations is the EXCEPTION to respiratory acidosis EXCEPTION to respiratory acidosis (retained CO2)?(retained CO2)?

A. Chronic smoking historyA. Chronic smoking history B. AtelectasisB. Atelectasis C. Use of sedatives and narcoticsC. Use of sedatives and narcotics D. Crushing chest trauma D. Crushing chest trauma

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Carbon Dioxide LevelsCarbon Dioxide Levels Which of these CO2 Which of these CO2

arterial blood gas arterial blood gas levels would best levels would best represent an represent an emphysema patient’s emphysema patient’s compensated level?compensated level?

A. 30 C. 61A. 30 C. 61 B. 42 D. 89B. 42 D. 89

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Assessment SkillsAssessment Skills Each of these findings are associated with Each of these findings are associated with

a respiratory disease process. What’s your a respiratory disease process. What’s your interpretationinterpretation of EACH? of EACH?

A. Right lobar consolidation, coughingA. Right lobar consolidation, coughing B. Weight loss, night sweats, feverB. Weight loss, night sweats, fever C. Barrel chest, pursed-lip breathingC. Barrel chest, pursed-lip breathing D. Pleural rub, stabbing pain (insp.) D. Pleural rub, stabbing pain (insp.) E. Flaring nares, clubbing of fingers, E. Flaring nares, clubbing of fingers,

substernal retractions 15 substernal retractions 15

A Diagnostic ToolA Diagnostic Tool

Which of these tests would confirm the Which of these tests would confirm the exacerbationexacerbation of emphysema returning? of emphysema returning?

A. ThoracentesisA. Thoracentesis B. ABG’sB. ABG’s C. Chest x-ray C. Chest x-ray D. CBC with differential, D. CBC with differential,

Sedimentation Rate Sedimentation Rate

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Priority EvaluationPriority Evaluation A patient brought into ER severely A patient brought into ER severely

dyspneic, stabbing pain in the chest, dyspneic, stabbing pain in the chest, and diaphoretic said, “I was just trying and diaphoretic said, “I was just trying to pick a tree limb up.” These to pick a tree limb up.” These symptoms appear to be:symptoms appear to be:

A. a splinter attack.A. a splinter attack. B. gallbladder indigestion.B. gallbladder indigestion. C. Status Asthmaticus.C. Status Asthmaticus. D. Pneumothorax.D. Pneumothorax. 17 17

““I’m to old for I’m to old for

all of this!”all of this!”

Pediatric Math DosagesPediatric Math Dosages

A physician ordered 60 mg’s. of A physician ordered 60 mg’s. of Robitussin Cough Syrup for a 42 lb. Robitussin Cough Syrup for a 42 lb. child. The label reads: 40 mg./10 ml. child. The label reads: 40 mg./10 ml. How many How many tsps.tsps. are you giving per are you giving per dose?dose?

And, what is the And, what is the weightweight of this child in of this child in kilograms? kilograms?

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Pediatric “Croup” Pediatric “Croup” (Laryngotracheobronchitis(Laryngotracheobronchitis

))

HoarsenessHoarseness of a child’s voice would of a child’s voice would most likely be a symptom related to: most likely be a symptom related to:

A. Swelling of the larynxA. Swelling of the larynx B. Constrictive bronchiolesB. Constrictive bronchioles C. Room vaporizer useC. Room vaporizer use D. Coughing irritation D. Coughing irritation

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I kind of like the peace I kind of like the peace and quiet for a changeand quiet for a change

BronchodilatorsBronchodilators

Which of these medications is a p.o. Which of these medications is a p.o. bronchodilator?bronchodilator?

A. Aminophylline injectibleA. Aminophylline injectible B. Theo-DurB. Theo-Dur C. Ventolin aerosolC. Ventolin aerosol D. Solu-medrol D. Solu-medrol

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Susan is taking Brethine, a Susan is taking Brethine, a bronchodilator, bronchodilator,

Her theophylline level sent back from Her theophylline level sent back from the lab was 24. Is this considered the lab was 24. Is this considered WNL’s?WNL’s?

A. YESA. YES B. NOB. NO C. Depends on the symptomsC. Depends on the symptoms

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IV Concentrations IV Concentrations (Optional Slide)(Optional Slide)

How many How many gramsgrams of Aminophylline of Aminophylline are in a 2:1 concentration of 500 are in a 2:1 concentration of 500 ml’s of D5W running at a titration of ml’s of D5W running at a titration of 18 ml’s/hr?18 ml’s/hr?

A. 0.3 g.A. 0.3 g. B. 0.5 g.B. 0.5 g. C. 1.0 g.C. 1.0 g. D. 2.0 g. D. 2.0 g. 22 22

ExpectorantsExpectorants

Which of the following medications is Which of the following medications is commonly given as a respiratory commonly given as a respiratory expectorant?expectorant?

A. Robitussin DMA. Robitussin DM B. Humibid LAB. Humibid LA C. Slo-BidC. Slo-Bid D. Terbutaline D. Terbutaline 23 23

Acute Bronchitis Acute Bronchitis develops into develops into Pneumonia...Pneumonia...

Which symptoms would you expect to Which symptoms would you expect to see with a progressing bacterial see with a progressing bacterial pneumonia?pneumonia?

A. Fever 99.7F., infrequent coughingA. Fever 99.7F., infrequent coughing B. Brownish-orange sputum, febrile, B. Brownish-orange sputum, febrile,

chillingchilling C. Flushed skin, gray, copious C. Flushed skin, gray, copious

expectorant expectorant D. Diaphoretic, swollen glands 24D. Diaphoretic, swollen glands 24

One of the latest and new One of the latest and new anti-infectives choicesanti-infectives choices

Which of the following medications is Which of the following medications is the the latest releaselatest release in fighting in fighting respiratory infections?respiratory infections?

A. BiaxinA. Biaxin B. ZithromaxB. Zithromax C. AugmentinC. Augmentin D. LevaquinD. Levaquin

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Anti-infectives for Anti-infectives for Bronchitis!Bronchitis!

Why is it important to Why is it important to completecomplete a whole a whole course of antibiotics prescribed?course of antibiotics prescribed?

A. So, you don’t develop a candida A. So, you don’t develop a candida superinfection. superinfection.

B. You want to improve in 72 hours.B. You want to improve in 72 hours. C. Resistant strains could develop.C. Resistant strains could develop. D. Eat yogurt, avoid alcohol, drink D. Eat yogurt, avoid alcohol, drink

plenty of water. plenty of water. 2626

Mary Beth’s breathing Mary Beth’s breathing patterns developed into...patterns developed into...

Exacerbation of emphysema, resp. rate of Exacerbation of emphysema, resp. rate of 30 - 34 with forced expirations. Her nurse 30 - 34 with forced expirations. Her nurse should perform and/or review a teaching should perform and/or review a teaching demonstration regarding:demonstration regarding:

A. Use of her inhalersA. Use of her inhalers B. Increasing her O2 via NCB. Increasing her O2 via NC C. Purse-lip breathingC. Purse-lip breathing D. Breathing into a paper bag for D. Breathing into a paper bag for

increased anxiety 27 increased anxiety 27

Mary Beth is coughing a Mary Beth is coughing a great deal…great deal…

There seems to be a lot of dust particles There seems to be a lot of dust particles collecting because the windows were open. collecting because the windows were open. How does dust How does dust affectaffect her disease process? her disease process?

A. Dust is a respiratory irritant.A. Dust is a respiratory irritant. B. She is having a bronchospasm.B. She is having a bronchospasm. C. It makes her angry. C. It makes her angry. D. Heavy morning pollens ease D. Heavy morning pollens ease

her distress. her distress. 28 28

The first ACTION for... The first ACTION for...

Mary Beth’s nurse to assist with when Mary Beth’s nurse to assist with when she is having “dyspnea” is to:she is having “dyspnea” is to:

A. Call respiratory therapy STAT!A. Call respiratory therapy STAT! B. Offer Mary a backrub.B. Offer Mary a backrub. C. Make sure she is sitting upright. C. Make sure she is sitting upright. D. Control her anxiety by offering a D. Control her anxiety by offering a

PRN Xanax. PRN Xanax. 29 29

Samantha’s asthma Samantha’s asthma attacksattacks

In reviewing In reviewing patient education, patient education, Samantha admits Samantha admits that her cat is that her cat is probably probably contributing to her contributing to her asthma problems. asthma problems. Why is that?Why is that? Choices are on the Choices are on the next page.next page. I’m such a FUR BALL!

Fluffy the “feline” is Fluffy the “feline” is clueless...clueless...

A. Cat hair flies everywhere causing a A. Cat hair flies everywhere causing a sneezing attack.sneezing attack.

B. Cats carry human diseases B. Cats carry human diseases Samantha could catch. Samantha could catch.

C. Only Purina fed cats cause her C. Only Purina fed cats cause her wheezing difficulties.wheezing difficulties.

D. Known allergens such as animal D. Known allergens such as animal danders can trigger an attack. danders can trigger an attack.

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That’s all for now!!!That’s all for now!!!