NURSE-UN 240 A&E1 Exam 2 Study Guide Latest Updated 2022
COPD
• Explain the risk factors, pathophysiology, clinical
manifestations, and complications associated with
COPD
COPD
Chronic obstructive pulmonary disease (COPD) refers to
chronic lung disorders that result in blocked air flow in the
lungs. The two main COPD disorders are Emphysema and
Chronic Bronchitis, the most common causes of respiratory
failure. Damage from COPD is usually permanent and not
reversible.
- Chronic Bronchitis: Chronic inflammation of
the bronchi and the bronchioles causing
constriction, congestion, mucosal edema (mucus
production).
- Emphysema: Loss of lung elasticity and abnormal
permanent enlargement of the air space distal to the
terminal bronchioles
Essentially, both will lead to COPD (i.e. an obstruction
issue), but the way there is different.
- For chronic bronchitis, it’s an airway problem
- For emphysema it’s an alveolar problem
Cigarette Smoking
Consequences (Due to increase in proteases): these will
lead to the chronic obstruction issues.
● Decreased ciliary activity
● Possible loss of ciliated cells
● Cellular hyperplasia
● Production of mucus
● Reduction in airway diameter
● Increased difficulty in clearing secretions
Nicotine acts as a stimulant to the cardiovascular and
sympathetic nervous system resulting in:
● Increased heart rate
● Peripheral vasoconstriction
● Increase blood pressure and cardiac workload
Assessm
ent
History:
● Risk Factors: age, gender, occupational history, family history etc.
● Check activity tolerance and dyspnea, determine orthopnea
● Unplanned weight loss
• Might not eat because getting enough oxygen
1
, becomes their main concern
Physical Assessment
● Usually assumes a ‘tripod’ position
• They will always be SOB
● Use of accessory muscles
● Wheezes
● Crackles may be present
● “Barrel Chest”
● Clubbing
● Cyanosis – late sign
● Use the Visual Analog Dyspnea Scale (VADS)
• You ask the patient to place a mark on the line
to indicate his or her perceived breathing
difficulty
• No SOB [ ---------- ]SOB as bad as can be
2
,Diagnostic Tests
● Laboratory:
🞆 Arterial Blood Gas (ABG)
Hypercarbia or Hypercapnia (both mean
increased CO2 in the blood)
Chronic Respiratory Acidosis can
occur when you have high levels of
CO2 in the blood.
In general, pH is related to increased CO2
retention, oxygen levels and ?
🞆 Complete Blood Count
Polycythemia could be present
● In response to low levels of O2
🞆 Alpha-1 AntiTrypsin Serum Level
Perform this test on a young, non-
smoker, who does not fit the COPD
profile. This is because some forms of
emphysema have a genetic link, in which
individuals inherit a deficiency in Alpha-
1 AntiTrypsin.
● Alpha-1 Antitrypsin
Deficiency is the most
common genetic factor for
emphasima 2.
🞆 Sputum Analysis
For hospitalized patients with acute respiratory
infection
🞆 Decreased oxygen saturation
Know patient’s baseline
Oxygen saturation of patients with
COPD is lower than normal, which
means that they will have a lower
baseline which is ok for them (even
though normal range is from 95%-
100%)
🞆 Chest X-Ray:
Not useful in early or moderate disease
Used to rule out other pulmonary conditions
You’ll see a flattened diaphragm and
hyper-inflation of the lungs
● Patient Presentation:
🞆 Productive cough (especially for people with
chronic bronchitis) lasting for at least 3
months in a year for at least consecutive 2
years is diagnostic of Chronic Bronchitis
3
, 4
COPD
• Explain the risk factors, pathophysiology, clinical
manifestations, and complications associated with
COPD
COPD
Chronic obstructive pulmonary disease (COPD) refers to
chronic lung disorders that result in blocked air flow in the
lungs. The two main COPD disorders are Emphysema and
Chronic Bronchitis, the most common causes of respiratory
failure. Damage from COPD is usually permanent and not
reversible.
- Chronic Bronchitis: Chronic inflammation of
the bronchi and the bronchioles causing
constriction, congestion, mucosal edema (mucus
production).
- Emphysema: Loss of lung elasticity and abnormal
permanent enlargement of the air space distal to the
terminal bronchioles
Essentially, both will lead to COPD (i.e. an obstruction
issue), but the way there is different.
- For chronic bronchitis, it’s an airway problem
- For emphysema it’s an alveolar problem
Cigarette Smoking
Consequences (Due to increase in proteases): these will
lead to the chronic obstruction issues.
● Decreased ciliary activity
● Possible loss of ciliated cells
● Cellular hyperplasia
● Production of mucus
● Reduction in airway diameter
● Increased difficulty in clearing secretions
Nicotine acts as a stimulant to the cardiovascular and
sympathetic nervous system resulting in:
● Increased heart rate
● Peripheral vasoconstriction
● Increase blood pressure and cardiac workload
Assessm
ent
History:
● Risk Factors: age, gender, occupational history, family history etc.
● Check activity tolerance and dyspnea, determine orthopnea
● Unplanned weight loss
• Might not eat because getting enough oxygen
1
, becomes their main concern
Physical Assessment
● Usually assumes a ‘tripod’ position
• They will always be SOB
● Use of accessory muscles
● Wheezes
● Crackles may be present
● “Barrel Chest”
● Clubbing
● Cyanosis – late sign
● Use the Visual Analog Dyspnea Scale (VADS)
• You ask the patient to place a mark on the line
to indicate his or her perceived breathing
difficulty
• No SOB [ ---------- ]SOB as bad as can be
2
,Diagnostic Tests
● Laboratory:
🞆 Arterial Blood Gas (ABG)
Hypercarbia or Hypercapnia (both mean
increased CO2 in the blood)
Chronic Respiratory Acidosis can
occur when you have high levels of
CO2 in the blood.
In general, pH is related to increased CO2
retention, oxygen levels and ?
🞆 Complete Blood Count
Polycythemia could be present
● In response to low levels of O2
🞆 Alpha-1 AntiTrypsin Serum Level
Perform this test on a young, non-
smoker, who does not fit the COPD
profile. This is because some forms of
emphysema have a genetic link, in which
individuals inherit a deficiency in Alpha-
1 AntiTrypsin.
● Alpha-1 Antitrypsin
Deficiency is the most
common genetic factor for
emphasima 2.
🞆 Sputum Analysis
For hospitalized patients with acute respiratory
infection
🞆 Decreased oxygen saturation
Know patient’s baseline
Oxygen saturation of patients with
COPD is lower than normal, which
means that they will have a lower
baseline which is ok for them (even
though normal range is from 95%-
100%)
🞆 Chest X-Ray:
Not useful in early or moderate disease
Used to rule out other pulmonary conditions
You’ll see a flattened diaphragm and
hyper-inflation of the lungs
● Patient Presentation:
🞆 Productive cough (especially for people with
chronic bronchitis) lasting for at least 3
months in a year for at least consecutive 2
years is diagnostic of Chronic Bronchitis
3
, 4
