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68c Ph2 Exam 5

Chronic Obstructive Pulmonary Disease

Emphysema causes smoking; air pollution; age; may lead to cor pulmonale
Emphysema clinical manifestation exertional dyspnea; septum; accessory muscle use; spontaneous pursed-lip breathing; development of barrel-chest; wheezing; chronic weight loss
Emphysema Assessment Hx; tachycardia; tachypnea; peripheral cyanosis; clubbing of fingers; lung examination
finger clubbing enlargement of fingertips and loss of normal angle of nail bbed
emphysema diagnostic tests pulmonary function test (PFT) arterial blood gas chest x-ray Labs alpha-antitrypsin assay Complete Blood count
Nursing interventions for PT with ineffective airway clearance r/t narrowed bronchioles 1) assist with chest physiotherapy and postural drainage 2) encourage fluids 2-3L/day 3) assist with respiratory treatments 4) auscultate lungs frequently and notify physician of changes 5) administer medications as ordered
Nursing interventions for PT with activity intolerance related to imbalance between O2 demand secondary to inefficient work of breathing 1) organize care so PT can have periods of uninterrupted rest 2) advise PT to rest 30 minutes before meals 3) assist PT with ADLs and exercises to increase stamina 4) asses PTs respiratory response to activity
PT teaching for Emphysema Nutrition Smoking cessation Infection control Relazation techniques
________ is usually irreversible and is the fourth leading cause of death in the US COPD
chronic bronchitis is... recurrent chronic productive cough for a minimum of 3 months for at least 2 months.
causes of chronic bronchitis chemical irritants or bacteria or viral infection; SMOKING IS THE MOST COMMON CAUSE
in chronic bronchitis... the cilia are impaired; hypersecretion of mucous
chronic bronchitis risks infection; chronic infection leads to scarring which causes obstruction. this leads to increased airway resistance and bronchospasm, hypoxia, and hypercapnia
chronic bronchitis clinical manifestations productive cough most pronounced in the morning; dyspnea; cyanosis and right ventricle failure; polycythemia; cyanosis; dependant edema
chronic bronchitis assessment assess cough, severity of dyspnea, patient's anxiety/restlessness level; auscultation for presence of wheezing; vital signs
Chronic bronchitits diagnostic tests CBC ABG Pulse Oximetry PFT Electrolyte abnormalities
Chronic bronchitis medical management aimed at minimizing disease progresion and facilitating optimal air exchange
chronic bronchitis medication Bronchodilators Mucolytics antibiotics
NI for PT with fatigue related to increased respiratory effort 1) assess degree of fatigue 2) provide treatments in a calm, unhurried manner 3) encourage adequate periods of rest 4) Identify support systems and support if needed
NI for PT with ineffetive breathing pattern related to retained pulmonary secretions 1) assess degree of dyspnea 2) teach/assess understanding of effective breathing techniques 3) suction as needed
Causes of extrinsic asthma caused by external factors and occurs in response to allergens, such as pollens, dust, spores, feathers, or animal dander, food etc
causes of intrinsic asthma from internal causes. not fully understood but often triggered by upper respiratory infection and emotional upsets
COPD is an umbrella term that includes Asthma C. Bronchitis Bronchiectasis Emphysema
Emphysema symptoms begin in ____ progressing to disability in ____ and _____ 40s 50s and 60s
emphysema is characterized by... changes in alveolar walls and capillaries
In emphysema ___, ______, and ______ become inflamed bronchi, bronchioles, and alveoli
pulmonary blebs are air-filled alveolar dilation less than 1 cm in diameter on the edge of the lung at the apex of upper lobe or superior segment of lower lobe; usually occurs in young people and can rupture, producing primary pneumothorax.
cor pulmonale definition right side of heart fails in later stages of COPD.
causes of asthma reoccurrence of attacks is influenced by mental or physical fatigue
asthma is... the narrowing of the airways resulting from an altered immune response acute attacks are casued by the release of histamine
COPD diet high calorie and high protein
Clinical manifestations mild asthma acute asthma status asthmaticus
asthma assessment gather information identify S/S suggesting severity of respiratory distress
asthma diagnostic tests ABG PFTs Chest xray Sputum Culture CBC Theophyllline level
emphysema medical management classification bronchodilators antibiotics corticosteroids diuretics oxygen therapy anti-anxiety agents
NI for PT with ineffective breathing pattern related to narrow airway PART 1 1) assess ventilation and respiratory effort 2) monitor closely for S/S of increased dyspnea 3) maintain position to facilitate optimal ventilation 4) administer prescribed meds and monitor effects
NI for PT with ineffective breathing pattern related to narrow airway PART 2 5) assist with respiratory treatments 6) provide care in calm manner 7) attempt to minimize exposure to triggers 8) maintain adequate hydration
NI for PT with ineffective Health maintenance related to possible allergen exposure in the home PART 1 1) assist PT and family identify allergens and asthma triggers 2) facilitate allergy testing if necessary 3) teach/assess understanding of the importance of allergy avoidance
NI for PT with ineffective health maintenance related to possible allergen exposure in the home PART 2 4) Teach/asses use of medications i.e. hold breath for seceral seconds then exhale slowly p inhaling the med. 5) teach/assess understanding of use of peak flow meter and goals for individual PT 6) teach/assess understanding of reasons to call physician
Death rate for asthma has increased by ___% over the past 10 years 50%
_______ is fatal if not reversed Status asthmaticus
Bronchiectasis is... a gradual irreversile process of chronic dilation of the bronchi following repeated lung infections. it is secondary to failure of normal lung tissue defenses (cystic fibrosis, lung tumor, foreign body..) and is a complication of inflammation
Bronchiectasis assessment note complaints of dyspnea, weight loss, and fever; dyspnea, cyanosis, and clubbing of fingers; paroxysmal coughing episodes; foul-smelling sputum; fatigue, weakness, and anorexia; crackles and wheezing; prolonged expiratory phase; hemoptysis
Medical management of bronchiectasis low-flow O2 chest physiotherapy adequate hydration
bronchiectasis medications mucolytic agents bronchodilators antibiotics
NI for PT with ineffective airway clearance related to retained pulmonary secretions 1) assess PTs ability to mobilize secretions 2) encourage postural drainage, cough, and suction as needed 3) encourage frequent position changes 4) maintain adequate hydration 5) admin meds as prescribed and monitor effects
asthma medications/therapy used to prevent or minimize symptoms. the medications are taken long-term
asthma acute or rescue therapy works immediately to relieve symptoms
NI for PT with impaired physical mobility related to exercise tolerance 1) assess PTs activity tolerance and promote adequate rest periods 2) promote gradual increase of activity 3) problem solve with PT and family on energy conserving technques
antiasthmatics use management of acute and chronic episodes of reversible bronchoconstriction
antiasthmatics--adrenergic ex_: epinephrine (Adrenalin, Asthma-Haler mist, Primatene)
antiasthmatics--anticholinergics ex_: ipratropium (Atrovent HFA)
antiastmatics--bronchodilators ex_: albuterol (Proventil, Proventil HFA) salmeterol (Serevent) terbutaline (Brethaire)
antiasthmatics--coricosteroids ex_: beclomethasone (Beclovent) flunisolide (Aerobid) triamcinolone (Azmacort)
antiasthmatics--leukotriene receptor antagonist ex_: zileuton (Zyflo) zafirlukast (Acculate)
antiasthmatics--mast cell stabilizers ex_: cromolyn (Intal) nedocromil (Tilade)
antiasthmatics contraindications inhaled coricosteroids long-acting adrenergic agents mast cell stabilizers should not be used during acute asthma attacks
antiasthmatics precautions should be used cautiously in PTs with CV disease chronic use of systemic corticosteroids should be avoided diabetic PTs may experience loss of glycemic control
antiasthmatics side effects MOST COMMON: tremors, anxiety, nausea, vomiting, throat irritation SERIOUS ADVERSE REACTION: bronchospasm, dyspnea
intiasthmatics interactions May have additive CNS and CV effects with other adrenergic agents cimetidine increases theophylline levels corticosteroids may decrease effectiveness of antidiabetic agents, cause hypokalemia, or increase risk of digoxin toxicity
antiasthmatics nursing implications ASSESSMENT lung sounds, respiratory function, CV status of PT taking bronchodilators or anaticholinergics can be inhaled or PO gum, small sips of water for dry mouth
antiasthmatic PT teaching take as directed; avoid smoking; proper technique for using inhalers; instruct client on use of peak flow meters; prevention adn reduction in symptoms of asthma
Leukotriene Antagonists long-term control for asthma (prevention of exercise-induced broncoconstriction in pts 15yrs+) antagonize leukotrienes to mediate airway edema, smooth muscle contraction, and cellular activity SE: headache, dizziness, nausea, dyspepsia, diarrhea
leukotriene antagonists NI assess lung sounds and respiratory; assess allergy symptoms monitor liver function periodically during therapy; may cause increase AST and ALT concentrations
Leukotriene antagonists implementation Administer 1 hr before or 2 hr after meals For asthma, administer once daily in the evening For allergic rhinitis, may be administered at any time of day Administer granules directly into mouth
lekotriene antagonists PT teaching Instruct pt to take medication on an empty stomach as directed; pt not to discontinue or reduce other asthma meds; Advise pt that leukotrienes ain't used to treat acute asthma attacks; Advise pt to notify doc if symptoms of Churg-Strauss syndrome occur
action of zafirlukast a leukotriene receptor antagonist Leukotrienes are a class of anti-inflammatory agents that block leukotriene formation. Leukotrienes are part of the inflammatory pathway that causes bronchoconstriction.
Bronchodilator use Treatment of reversible airway obstruction due to asthma or COPD
bronchodilator action Adrenergic Relaxation of airway smooth muscle Allows use in management of acute attacks Xanthines Anticholingerics Leukotrienes
bronchodilators--adrenergices albuterol (Proventil). epinephrine (Adrenalin). salmeterol (Serevent). Terbutaline (Bricanyl).
bronchodilators--anticholinergics ipratropium (Atrovent HFA).
bronchodilators--leukotriene antagonists montelukast (Singular). zafirlukast (Accolate
bronchodilators--Xanthines aminophylline (Phyllocontin, Truphylline). theophylline (Theo-Dur, Uniphyl).
Bronchodilators contraindications and precautions Contraindications: Hypersensitivity to agents. Avoid use in uncontrolled cardiac arrhythmias. Precautions: Diabetes. CV disease. Hyperthyroidism.
Bronchodilators side effects Nervousness, restlessness, tremor. Palpitations, angina, arrhythmias. Nausea, vomiting. Hyperglycemia.
bronchodilators interactions Therapeutic effectiveness may be antagonized by concurrent use of beta blockers Additive sympathomimetics effects with other adrenergic drugs, including vasopressors and decongestants CV effects may be potentiated by antidepressants and MAO inhibitors
bronchodilators assessment Assess BP, P, R, lung sounds, and character of secretions before and throughout therapy Patients with a history of CV disease should be monitored for EKG changes and chest pain
bronchodilators PT teaching Avoid OTC cough, cold or breathing preparations Avoid foods that contain xanthine Avoid smoking Use bronchodilator first and allow 5 minutes to elapse before administering the other medication
adrenergics use Used as a bronchodilator to control and prevent reversible airway obstruction Used as a quick-relief agent for acute bronchospasm Used as a long-term control agent
adrenergics action Binds to beta 2-adrenergic receptors in airway smooth muscle Relaxation of airway smooth muscle with subsequent bronchodilation. Relatively selective for beta2 (pulmonary) receptors. Therapeutic Effects: bronchodilation.
adrenergics category Therapeutic: bronchodilators. Pharmacologic: adrenergics. Examples: albuterol (Proventil). epinephrine (Adrenalin). salmeterol (Serevent). terbutaline (Bricanyl).
adrenergics contraindications and precautions Contraindications: Hypersensitivity to adrenergic amines Hypersensitivity to fluorocarbons Precautions: Cardiac disease Hypertension Hyperthyroidism Diabetes Glaucoma Seizure disorders Lactation
adrenergics side effects nervousness, restlessness, tremor, headache, insomnia, hyperactivity in children chest pain, palpitations, angina, arrhythmias, hypertension nausea, vomiting hyperglycemia tremor
adrenergics interactions Use with MAO inhibitors may lead to hypertensive crisis; Beta blockers may negate therapeutic effect; May lower serum digoxin levels; Risk of hypokalemia increases with concurrent use of K-losing diuretics
adrenergics assessment Assess lung sounds, pulse, and blood pressure Note amount, color, and character of sputum Monitor pulmonary function tests Observe for paradoxical bronchospasm May cause transient decrease in serum potassium
adrenergics pt teaching Administer oral medication with meals Shake inhaler well Contact doc if shortness of breath is not relieved Prime unit with 4 sprays before using Consult health care professional before taking any OTC medications Use albuterol first
xanthines use Long-term control of reversible airway obstruction Increases diaphragmatic contractility Unlabeled Use: respiratory and myocardial stimulant in premature infant apnea
Xanthines category Therapeutic: bronchodilators. Pharmacologic: xanthines Examples: aminophylline (Phyllocontin, Truphylline). theophylline (Theo-Dur, Uniphyl)
Xanthines contraindications and precautions Contraindications: Hypersensitivity to aminophylline or theophylline. Precautions: CHF, liver disease, or hypothyroidism Cardiac arrhythmias Peptic ulcer disease Seizure disorder
Xanthines side effects and interactions SE: SEIZURES, Anxiety, headache, insomnia, irritability. Arrhythmias, tachycardia, angina, palpitations Nausea, vomiting, anorexia, tremor, rash Interactions: May ↓the therapeutic effect of lithium and phenytoin Nicotine Decreased metabolism
Xanthines assessment Assess BP, pulse, respiratory status Ensure that oxygen therapy is correctly instituted Monitor intake and output and for chest pain and ECG changes Monitor pulmonary function tests Monitor ABGs, acid-base, and fluid and electrolyte balance
Xanthines NI Admin round the clock to maintain therapeutic plasma levels; Do not refrigerate elixirs Admin oral preps with food or a full glass of water Wait at least 4-6 hr after stopping IV therapy to begin immediate-release oral dose.
Xanthines PT teaching drink adequate liquids avoid OTC cough, cold, or breathing preparations not to smoke not to change brands Advise patient to minimize intake of xanthine-containing foods or beverages Importance of having serum levels routinely tested
xanthines evaluation Increased ease in breathing Clearing of lung fields on auscultation Respiratory and myocardial stimulation in apnea of infancy (aminophylline)
Created by: sydcpepper