Question Answer
Define COPD in terms of component diseases and effect on airflow: Component diseases: 1.Chronic bronchitis 2.Asthma 3. Emphysema 4.Bronchectasis 5. CF
What is the Effect on airflow in terms of COPD: obstruction/limitation that is not completely reversible
What are the Causes of COPD: •Chronic inflammatory responses, noxious particles, gases
Discuss the progressive nature of COPD and relate it to the need for establishing a baseline and follow up: COPD will get worse over progressive period of time. We should establish a baseline so we know when to start treatment and follow-up to make sure track the progressive of disease.
Explain the etiology of COPD and lung damage risk factors: -Smoking -Genes -Age&gender -Lung growth and development -Exposure to particles -Social status
Describe the general pathophysiology of COPD: 1. Airflow limitation & air trapping 2. Traps air in exhalation leading to hyperinflation3. Break down of the alveolar walls, excess mucus inflamed lining and bronchial
List the general symptoms of COPD: dyspnea, cough, sputum, fever, wheezing, chest tightness, fatigue
Differentiate the major symptomatic difference between chronic bronchitis and emphysema: Chronic bronchitis: excessive sputum production for at least 3 months for a year and 2x in a row Emphysema: destruction of the gas exchange surfaces
Describe the 2 major ways to diagnose COPD: Clinical assessment/history, Spirometer•volumes•capacities•flow
What are Other tools besides the two most common ways to diagnose COPD: Lab values,EKG,ABG,CXR
List the COPD severity staging guidelines: Gold standards-Stages:1 (mild)-FEV1<80% of predicted 2(moderate)-FEV1=50-80% predicted 3 (severe)-FEV1=30-50%pred 4 (very severe)-<30% pred
Explain the main “intervention” for managing COPD: Remove irritant =smoking cessation, Pharmacology agents Pulmonary rehabilitation Surgical options
Explain the effect of bronchodilators on the decline in lung function: Drugs don’t change the progressive decline in lung function. They will only help dilate the bronchotrachael tree to help aide air movement and mucus movement
Explain the main goals of pharmacological COPD management: Improve symptoms & improve quality of life
Describe which medications are used in the management of COPD and in what order they should be used: Racemic epinephrine/micronefrin-vaponefrine, Albuterol/Proventil, ventilin, Levalbuterol/xopenex,Salmeterol/serevent, Formoterol/foradil, Arformoterol/brovana, Ipratropium/atrovent,Tiotropium/sprivia, Budesonide/pulimcort, Mometasone/asmanex
Describe which medications are used in the management of COPD and in what order they Mometasone/asmanex Fluticasone/Flovent Beclomethasone/QVAR, Acetylcysteine/mucomyst, Dornase alpha/rhDNAse Cormide/intal Nedocromil/tilade
Explain the preferred long term steroid administration route and why it is preferred: Inhaled because they don’t have the side effects of systemic steroids
Discuss when it is appropriate to use systemic steroids: Symptom/airflow limitation despite maximal therapy with other drugs.•IV,•shot,•orally, When nothing else works
List the criteria for home oxygen use: 1. PaO2<55% or SaO2 <88% on room air -taken 2 times over 3 weeks period in stable pt 2. PaO2 55-60% if evidence of pulmonary HTN, CHF, or polycythemia
Definition of CB: Chronic ↑↑ production of mucus from bronchi, Not from a specific disease,Cough and ↑ sputum 3 consecutive months Each year for 2 years
Three causes Of CB: •Smoking!!!, •Recurring pulmonary infections as a child may increases susceptibility, •Air pollution
Pathophysiology of CB: Inhale irritant, Bronchial walls inflame, Bronchial mucous glands enlarge,
Advance stages of CB: Larger airways plug, V/Q mismatch, Pulmonary arteries constrict, Polycythemia
CBC for Advance stage of CB CBC-RBC 4.6-6.2 million/UL for M, 4.2-5.4 for F, Hgb 13-18 gm/dl for M, 12-16 gm/dl for F., Cor Pulmonale (hypertrophy R. Ven), Respiratory Failure
Clinical Manifestations of CB:Include: signs, symptoms, observation, percussion, palpation & auscultation- Frequent cough w/mucous expectorate,Slight ↑ RR, Slight ↑ HR, CO, BP, Dyspnea only with lung infection, Breathsounds: no significant changes, Xray – no significant changes, ABG’s slight Resp. Alkalosis with mild hypoxemia (↑PH, ↓PaCO2, ↓HCO3 ↓PaO2)
Advanced signs of CB: Chronic cough with increased mucus,Increased RR, HR, CO, BP, Dyspnea esp. with exertion, Increased WOB – prolonged expiration, Diagnostic palpation/percussion, Decreased tactile & vocal fremitus Hyperresonant percussion note Breathsounds,Decreased, Cr
Diagnostic test and result of CB CXR, Hyperinflation (air trapping), Translucent (very dark), Increased A-P diameter(barrel chest),Flattened Diaphragm-< or blunted costophrenic angle, Spider like projection in the bronchogram, Enlarged heart
Pulmonary function testing of CB: Decreased Expiratory maneuver – Flows, FVC-Lung Volume & Capacity-Increased – Vt, RV,-RV/TLC, FRC-Decreased – VC, IRV, ERV, Normal FEV1/FVC 78 – 83% if less than 50% significant disease
Treatment – medical & respiratory of CB: Stop smoking–eliminate irritant, Avoid other lung infections, Avoid Dry, cold air, Bronchial hygiene, Humidified O2 – PRN,Dilate airway to help cough – Bronchodilator- sympathomimetic, Beta 2-Parasympatholytic, Xanthines (theophylline) –
Treatment -medical and respiratory of CB ,Dilate airway to help cough – Bronchodilator- sympathomimetic, Beta 2-Parasympatholytic, Xanthines (theophylline) – aid bronchial dilation,Thin the thick mucous –Mucolytic–P & PD–USN–Heated Aerosol•Antibiotics – bacterial
What are the Breath sounds in early CB No significant changes
What would an ABG look like if a pt was diagnosed with early stages of CB ABG’s slight Resp. Alkalosis with mild hypoxemia (↑PH, ↓PaCO2, ↓HCO3 ↓PaO2)
What would the breath sounds be in advanced CB Crackles- wet secretions wheezes- bronchoconstriction (mucus plug) Rhonchi- inflammed airways
What would an ABG look like if a pt was diagnosed with the advance stage of CB pH normal,↓ PaO2 (cyanosis & clubbing),↑ PaCO2, ↑ HCO3 Compensated Respiratory Acidosis
Why do the pulmonary vessel constrict during chronic bronchitis because of the hypoxemia leads to PVR 


Question 1

A method of medicine delivery that requires patients to keep track of how many doses they have used is the:

  1. Metered-dose inhaler

 

Question 2

Which of the following statements is true?

  1. COPD is not reversible and asthma is.

 

Question 3

The most important risk factor for COPD is:

  1. Smoking

 

Question 4

Hypercapnia is caused by:

  1. Above normal PaCO2

 

Question 5

A hospice referral should be made:

  1. When the disease enters Stage III-IV

 

Question 6

The most common test in diagnosing and monitoring COPD is:

  1. Spirometry

 

Question 7

The care approach best suited to COPD is:

  1. Palliative care
  2. Home health

 

Question 8

In general, COPD patients are more likely to have complications when surgery is near:

  1. The diaphragm
  2. The throat

 

Question 9

Exacerbation of COPD can be triggered by:

  1. Infection, pollution, and cold weather

 

Question 10

An Advance Directive becomes effective when:

  1. When the patients condition is determined to be non-reversible with no hope of recovery AND the patient is no longer able to speak for herself
  2. It is signed by two doctors

 

Question 11

Which of the following contributes most to COPD?

  1. Pack years

 

Question 12

A Medical Power of Attorney:

  1. Makes healthcare decisions when the patient cannot

 

Question 13

FEV1 is the forced expiratory volume in one minute.

  1. False
  2. True

 

Question 14

COPD:

  1. Involves abnormal inflammation

 

Question 15

A living will can do the following in any state:

  1. Spell out how the patient wishes to be treated at end-of-life
  2. Give directions on how to distribute the patients assets

 

Question 16

A smoker is at least (_____) more likely to die of COPD than a nonsmoker:

  1. 10 times

 

Question 17

Medications that relax the smooth muscles of the airways and make breathing easier are:

  1. Bronchodilators

 

Question 18

COPD can cause a heart problem called:

  1. Cor pulmonale

 

Question 19

A non invasive type of ventilation is:

  1. NPPV

 

Question 20

Which of the following may signal the existence of asthma?

  1. Bronchodilator reversibility
  2. Chronic bronchitis and emphysema

 

Question 21

The following device must be surgically implanted:

  1. Transtracheal catheter

 

Question 22

The following is NOT a benefit of long-term oxygen therapy (LTOT):

  1. Better absorption of medications
  2. Better mental functioning

 

Question 23

Which statement is NOT true?

  1. Lower respiratory infections usually increase once a patient quits smoking.
  2. Because COPD causes wasting, weight gain resulting from smoking cessation is not much of a problem

 

Question 24

COPD is a burden:

  1. For the entire world

 

Question 25

This technique is more difficult to master and little proof has been found that it has positive effects:

  1. Diaphragmatic breathing