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Medsurg Chp32 -Lungs

Non-infectious lower respiratory problems

Gastroesophogeal reflux disease (GERD) thought to be a major trigger for asthma in some people, especially in those who have more asthma manifestations at night
beta-adrenergic receptors in older people less sensitive
asthma rate in old people as new disease 3%
normal anteroposterior-to-transverse diameter 1:1.5 or 5:7
air trapping anteroposterior diameter the AP diameter would equal or exceed the lateral diameter
hypoxemia indicators of hypoxemia include changes in the level of cognition or consciousness and tachycardia; examine oral mucosa and nail beds for cyanosis
Asthma magement Avoid foods with monosodium glutamate (MSG) or metabisulfite.
Corticosteroid used in asthma only used as a control drug
Omalizumab the only drug in this class and is used only for people with asthma who have high blood levels of IgE. It is injected subcutaneously every 2 to 3 weeks. high risk for anaphylaxis
Oxygen therapy for asthma Heliox, a mixture of helium and oxygen (often 50% helium and 50% oxygen), can help improve oxygen delivery to the alveoli. This gas mixture is lower in density than oxygen alone or room air and flows even when airway resistance is high.
Status Asthmaticus airway obstruction not responding to rescue tharapy. Use of accessory muscles for breathing and distention of neck veins are observed. IV fluids, potent systemic bronchodilators, steroids, epinephrine, and oxygen are administered intubation poss
two major changes occurring in emphysema: loss of lung elasticity and hyperinflation of the lung
classifications of alveoli: Emphysema is classified as panlobular, centrilobular, or paraseptal depending on the pattern of destruction and dilation of the gas-exchanging units (acini).
Alpha1-antitrypsin deficiency uncommon risk factor for COPD AAT is a protease inhibitor. a protease is an enzyme that breaks pollutants down in the lungs.
cor pulmonale failure of the heart's right side --caused by increase pressure in the lungs making it difficult of the right ventricle to pump blood into the lungs
Why is it important to check the weight of a COPD patient: weight loss occurs with increased work of breathing and reduced food intake due to dyspnea and mucus production increase weight indicates heart failure b/c of general edema
appearance of patient with COPD thin large neck muscle slow moving sits with forward-bending posture (tripod position) possible neglect of ADLs due to dyspnea
other indications of COPD (chest sounds and vibrations) Chest vibration (fremitus) is often decreased and the chest sounds hyperresonant on percussion because of trapped air.
priorities for COPD patients are: ability to breathe and get enough O2 weight loss r/t dyspnea and fatigue anxiety activity intolerance potential for infections
outcomes for COPD patients are: SPO2 greater than 88% loss of cyanosis maintenance of cognitive orientation coughing and clearance of secretions maintenance of RR and rhythm appropriate clear of secretions by patient maintain patent airway
assessment frequency for COPD patients every 2 hours
breathing techniques Diaphragmatic or abdominal and pursed-lip breathing teach only when patient is free of dyspnea
isocapneic hyperventilation and resistive breathing helps recondition respiratory muscles
suctioning COPD patients: only when needed assess for improved breath sounds after suctioning.
surgical management of COPD lung transplantation and lung reduction
post-op care: pulmonary hygiene incentive spirometer use 10 times/hour pulmonary assessment every hour chest pt
Natural and synthetic prostacyclin agents provide the best specific dilation of pulmonary blood vessels Continuous infusion of epoprostenol (Flolan) or treprostinil (Remodulin) reduces pulmonary pressures and increases lung blood flow. can be done by patient at home. Sildenafil taken or
Prostacyclin nursing intervention stop the infusion can cause death; thus teach the patient to always carry backup drug casssetes and battery packs teach patient to use aseptic technique to prevent infection of IV line
Restrictive diseases do not affect airway, but affect the alveoli. No barrel chest development With restrictive disease, the lung tissues thicken, causing reduced gas exchange and “stiff” lungs that do not expand well (Pruitt, 2008).
Sarcoidosis a granulomatous disorder of unknown cause that can affect any organ, but the lung is involved most often.
Sarcoidosis patho granulomas form in the lungs granulomas contains WBCs WBCs cause inflammation in lung tissue, resulting in fibrotic tissue which reduces lung compliance and elasticity. Cor pulmonale can result
true or false: hypercalcemia is an indicator of sarcoidosis treatment: true
treat of sarcoidosis: Corticosteroid (40 to 60 mg) towards a maintenance dose of 10 to 15mg for 6 months. assessment include: function studies, chest x-rays, a complete blood count, serum creatinine, serum calcium, and urinalysis.
true of false: cytotoxic drugs used to treat idiopathic pulmonary fibrosis True
Created by: ekm