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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
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What is the most important risk factor for COPD?
Cigarette smoking
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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
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This risk factor for COPD alone plays a small role and can be additive to other risks.
Air pollution
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COPD affects the ___ and ___ to all tissues
oxygenation and tissue perfusion
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What are the 5 major problems that can occur in pts with COPD
- Hypoxemia
- Acidosis
- Respiratory infections
- Cardiac failures
- Cardiac dysrhythmias
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____ and ____ occur because the pt with COPD is less able to exchange gas, oxygenation decreases and co2 levels increase.
Hypoxemia and acidosis
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In a pt with COPD, ____ ______ risk increases because of the increased mucous and poor oxygenation.
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What cor pulmonale?
right sided heart failure
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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
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______ ______ are common in patients with COPD and may resulf from hypoxemia (from decreased ox to the heart muscle)
Cardiac dysrhythmias.
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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
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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
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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
- Wheezes
- cyonotic or blue tinged, dusky appearance.
- clubbing of the fingers
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What could a nurse anticipate regarding cardiac changes with a pt that has COPD?
a faster heart rate as it tries to compensate
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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
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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.
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Why are sputum sample obtained for patients with an acute respirator infection?
Looking for bacteria
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With a pt with COPD, ____ ____ is going to occur because of the increase PaCo2 in the blood.
Chronic respiratory acidosis
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in a Pt with COPD, _______ ________ occurs as kidneys retain HCO3 (bicarb) to compensate for respiratory acidoses
Metabolic alkalosis
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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
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What are some nonsurgical interventions for a pt with COPD
- airway management
- monitoring pt
- cough enhancement
- o2 therapy
- drug therapy
- pulmonary rehabilitation
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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.
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How often should the nurse monitor the pt with COPD?
every 2 hours
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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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