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nsg 210 ch 24 respir

NSG 210 ch 24 respiratory

What is COPD? Disease characterized by airflow limitation that is not fully reversible and abnormal inflammatory response to noxious particles or gases.
what 2 diseases make up COPD? Emphysema and Chronic bronchitis.
When do people with COPD usually become symptomatic? middle adult years.
In COPD where does the inflammatory response occur? Proximal Airways ( trachea and bronchi) Peripheral airways ( bronchioles), lung parenchyma and pulmonary vasculature.
What is bronchitis? Disease in which there is the presence of cough and sputum for at least 3 months in each of 2 consecutive years.
What causes bronchitis? Irritants cause the bronchials to inflame and narrow and the same irritants also cause mucous secreting cells and goblet cells to produce more mucous further narrowing the airway.
When are acute exacerbations of chronic bronchitis most likely to happen? During the winter.
What are the clinical symtoms of bronchitis? Productive cough, decreased exercise tolerance, prolonged expiration adn cyanosis with peripheral edema (blue bloater).
Medical mngmt of bronchitis? Stop smoking, decrease irritants,antibiotics, increase fluids, corticosteriods, bronchodialators.
What are the clinical symtoms of emphysema? Accessory muscle use, barrel chest, pink color (pink puffer).
What part of the lung does emphysema effect and how? It effects the alveoli by over distention prohibiting gas exchange.
Complications of emphysema? Increased CO2 leading to repiratory acidosis and right sided heart failure.
What are the risk factors for COPD? Exposure to tobacco smoke, Passive smoking, occupational exposure ( dust and chemicals), ambient air pollution, genetic abnormalities (antitrypsin deficiency).
What is spirometry used for? Evaluate airflow obstruction determined by the ratio between FEV to FVC ( forced vital capacity).
What are the complications of COPD? Respiratory insufficiency and failure, pneomonia, chronic atelectasis, pneomothorax and pulmonary arterial hypertension.
What would you include in your health history and assessment of a pt. with COPD? Exposure to risk factors, Hx of COPD or respiratory problems, length of time for repiratory difficulty, is there exercise, smoking HX, exposure to smoke.
What is the single most cost effective intervention to reduce the risk of developing COPD? STOP SMOKING!!!!
What is the phamacologic therapy for COPD? Bronchodialaters Which relax smooth muscle dialating the airway and Inhaled corticosteriods which decrease inflamation and swelling, diuretics for bronchitis, O2, flu vaccine Q year and pneumovax Q 5 years.
When giving O2 to a COPD pt. what do you need to watch for? Giving to much can cause them to stop breathing from the build up of CO2 witch shuts down the respiratory drive.
Surgical management of COPD? Bullectomy, Lung volume reduction surgery and lung transplant.
What is a bullectomy? Bullae are enlarged airspace that do not contribute to ventilation and impair gas exchange and are surgically removed.
what is lung volume reduction surgery? Removal of a portion of the diseased lung parenchyma which allows functional tissue to expand.
What breathing exercises should you teach a pt. with COPD? Diaphragmatic breathing which reduces respiratory rate and increases alveolar ventilation.
What nursing Management would you do for a pt. with COPD? Monitor for dyspnea and hypoxemia, increasing fluids, use if incentive spirometer, effective coughing, cough turn and deep breathe, pursed lip breathing, pace activities, ambulate pt., monitor LOC and O2 saturation.
What is brochiectasis? A chronic irreversable dilation of the bronchi and bronchioles.
WHAT CAN CAUSE BRONCHIECTASIS? Airway obstruction, duffuse airway injury, pulmonary infection, cystic fibrosis and idiopathic causes.
clinical manifestations of bronchiectasis? Chronic cough, purulent sputum in copious amounts, clubbing of fingers and hemoptysis.
Medical management of bronchiectasis/ Promote bronchial drainage by gravity, percussion to loosen secretions and antibiotics if C&S confirms.
What is Asthma? Chronic inflammatory disease of the airways that cause hyperresponsivness, mucosal edema and mucus production.
What is the strongest predisposing factor for asthma? Allergies
What types of irritants can set off an asthma attack? Pollen, mold, dust, cold, heat, perfumes, smoke, exercise.
What role do mast cells play in asthma? They release histamine, bradykinin, prostiglandins and leukotrienes which perpetuate inflamation and vasocostriction.
Clinical manifestations of asthma? Cough with or without sputum, dyspnea, wheezing, chest tightness, diaphoresis, tachycardia, and widened pulse pressure.
What is the clinical significance of a normal PaCO2 during an asthma attack? May signal impending respiratory failure.
What is the best prevention for asthma? Undergo test to indentify the substances that precipitate the symptoms.
Complications of asthma? Status asthmaticus, respiratory failure, pneumonia, atelectasis and airway obstruction.
Why would you administer fluids to a person with asthma? Thin secretions and because people with asthma are frequently dehydrated from diaphoresis.
Asthma quick relief medications? Beta 2 agonists such as albuterol, levalbuterol and pirbuterol.
How do beta 2 agonists work? They relax smooth muscle causing bronchial dilation.
Long term asthma control medications? Inhaled corticosteroids such as beclomthasone, fluticasone. ( look for ending in ide or one). Long term Beta 2 agonists such as salmeterol and formoterol ( look for erol).
When a pt. is on a inhaled corticosteroid what should you instruct them to do after taking it? Wash mouth out with water cause they can get thrush.
Can long term asthma control medications be used for an acute asthma attack? NO! you must use a short term beta 2 agonist.
Side effects of corticosteroids? Cough, thrush, glucose abnormalities, osteoporosis, growth suppression, dermal thinning and cushings syndrome.
Side effects of short term beta agonists? Tachycardia, muscle tremor, hypokalemia and headache.
What would be used in a typical asthma medication regiment? Short term beta2 agonist for acute episodes, inhaled corticosteroids for inflammation, long term beta2 agonists and leukotriene modifiers for decreased mucus production.
What interventions would the nurse preform for an asthma pt.? Obtain Hx of allergic reactions to medications, identify medications pt. is already taking, administer medications and monitor pt. responce and administer fluids if pt. is dehydrated.
What is peak flow monitoring and why is it used? A meter that measures the highest airflow during a forced expiration. It is used to measure asthma severity and when added to symptom monitoring indicates the current degree of asthma control.
What is status asthmaticus? A severe and persistant asthma attack that does not respond to conventional therapy.
Clinical manifestations of status asthmaticus? Labored breathing, prolonged exhalation, wheezing. ( as the obstruction worsens the wheezes may disappear).
Medical management of status asthmaticus? Short term beta2 agonist, systemic corticosteroids, O2.
Nursing management of status asthmaticus? Actively access airway, fluid intake, monitor B/P and HR.
What is cystic fibrosis? Multisystem genetic disease characterized by thick viscous secretions in the lungs, pancreas, liver, intestine and reproductive tract.
Clinical manifestations of CF/ Productive cough, wheezing, hyperinflation of the lung fields on chest X ray, chronic respiratory inflammation, sinusitis and nasal polyps.
Medical Management of CF? Antibiotics based on results of C&S, airway clearance, effective coughing and supplements of vitamins A,D,E and K.
Nursing Management of CF? Help pt. manage pulmonary symptoms, chest physiotherapy, breathing exercises, adequate fluid and dietary intake and to keep away from crowded places to lessen the chance of getting a respiratory infection.
Created by: lantztw