COPD Overview (Chronic Obstructive Pulmonary Disease Overview)
Inhaled Toxins Smoking AAT Deficiency Emphysema Chronic Bronchitis Asthma Spirometry Slow Progression COPD gradation and treatment
Mild - short acting bronchodilator PRN Moderate - long acting bronchodilator + short acting PRN Severe - INHALED corticosteroid + long acting + short acting very severe - O2 therapy, lung TP CHRONIC COPD Treatment
Vaccines Influenza Pneumococcal Quit smoking Beta-2 agonists Anti-cholinergics (e.g. ipratropium) anti-cholinergics (tiotropium) Beta-2 agonists (salmeterol) Inhaled corticosteroids Oxygen PaO2 < 55 SpO2 < 88 SYSTEMIC steroids Antibiotics Chronic Bronchitis Assessment
Chronic Productive Cough > 3 Months for 2 Years Increased Mucus Production Dyspnea Cyanosis Wheezes Right Side Heart Failure Jugular Venous Distention (JVD) Peripheral Edema Emphysema
Hyperinflation and Loss of Elasticity Pursed Lip Breathing Barrel Chest Dyspnea on Exertion Clubbing Depression and Anxiety Thin Appearance CO2 Retention Low Concentration of O2 High Fowler's Position High Calorie, High Protein Diet Chronic Bronchitis Interventions
Tripod Position Humidified Oxygen Pursed Lip Breathing Increase Fluid Intake ABGs Early Detection of Exacerbation Lowest O2 Therapy Assisted Ventilation Increased Infection Risk Respiratory Acidosis Interventions
Improve Respiration Bronchodilators Respiratory Stimulants Drug Antagonists Oxygen Assisted Ventilation Prevent Complications Respiratory Acidosis
Hypoventilation Increased PaCO2 > 45 Barbiturates Depress Central Respiratory Center of Brain Opioids Depress Central Respiratory Center of the Brain Airway Obstruction Respiratory Muscle Weakness/Paralysis Beta-2 Agonists
Short-term Treatment Terbutaline Asthma Tocolysis Albuterol Asthma Long-term Treatment Salmeterol Asthma Chronic Obstructive Pulmonary Disease (COPD) Acute Respiratory Distress Syndrome (ARDS) Assessment
Damaged Alveolar-Capillary Membrane Restlessness Dyspnea Refractory Hypoxemia Decreased PaO2 Diffuse Pulmonary Infiltrates Atelectasis Pulmonary Hypertension Restrictive vs. Obstructive Lung Diseases
Restrictive Lung Disease Decreased Lung Volume FEV1/FVC Ratio Normal to Increased Obstructive Lung Disease Increased Lung Volume Decreased FEV1/FVC Ratio Acute Bronchitis
Cough and Sputum Production Viral upper respiratory infection Hemoptysis Fever is NOT typical Antibiotics not beneficial Self limiting- just treat symptoms procalcitonin to distinguish between bacterial and viral Lung Sounds - Wheezes
Throughout Lung High Pitched Musical Air Moving through Narrowed Airways Lung Sounds - Crackles
Lower Lobes Fine/Coarse Fine: Twisting Hair through Fingers Coarse: Velcro Collapsed Small Airways and Alveoli "Popping Open" Lung Sounds - Rhonchi
Trachea and Bronchi Low Pitched Rumbling Gurgling Narrowed Airway Secretions or Bronchospasm Inhaled Corticosteroids
Inhaled Corticosteroid Budesonide Ages 12 + Beclomethasone Fluticasone MOA: Anti-Inflammatory through Gluc. Response Elements Fx: Candidiasis Fx: Bone Resorption Fx: Osteonecrosis Fx: Psychosis Candida albicans (Oral Thrush) Fx: Cushing Syndrome Characteristics Inhaled corticosteroids for asthma
Fluticasone Budesonide Ciclesonide Beclomethasone Prodrug activates by airway esterase Less SEs than other corticosteriods Chronic asthma 1st Line Therapy (I) Inhibits synthesis of virtually all cytokines (MOA) Inactivates NF-Kappa-B the TF responsible for making TNF-Alpha (MOA) Oral thrush (SE) Limited role in COPD (I) Beneficial combination with beta-2-agonists Corticosteroids
Inhibit NF-κB. Suppress both B- and T-cell function by transcription of many cytokines. Induce apoptosis of T lymphocytes. Transplant rejection prophylaxis, many autoimmune and inflammatory disorders Hyperglycemia, osteoporosis, central obesity, muscle breakdown, psychosis, acne, hypertension, cataracts, avascular necrosis (femoral head).Cushing syndrome Anticholinergics
B.O.AT.S Acronym Benztropine Parkinson's Disease Oxybutynin Decrease bladder spasms Atropine Mydriasis and Cycloplegia Scopolamine Motion Sickness Anticholinergics Continued
Glycopyrrolate Reduces Airway Secretions Ulcer Treatment Ipratropium Asthma and C.O.P.D Dicyclomine Hyoscyamine Irritable Bowel Syndrome View More
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