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N3561 Exam 2
Question | Answer |
---|---|
Asthma Risk Factor | Risk factors for developing Asthma â¢Genetics â¢Immune response â hygiene hypothesisâ â¢Allergens â¢Exercise- exercise induced asthma â¢Air pollutants- smoke ,climate, â¢Occupational factors- 15% diagnosed are r/t job related exposure â¢Respi |
Asthma side effects? | Can be severe & life threatening odyspnea at rest ocan speak in words not sentences oSitting forward oWheezing oRR > 30 oPulse > 120 oAccessory muscle use oAgitated oPeak expiratory flow < 40% of personal best or < 150 L/minute oNeck vein dissention IN SE |
Asthma Symptoms | Can be severe & life threatening odyspnea at rest ocan speak in words not sentences oSitting forward oWheezing oRR > 30 oPulse > 120 oAccessory muscle use oAgitated oPeak expiratory flow < 40% of personal best or < 150 L/minute oNeck vein dissention IN SE |
Nursing Management for Asthma | Teach patient to identify & avoid known personal triggers ⢠if triggers can not be avoided â teach the patient how to premedicate prior to exposure of known trigger â¢Acute management â ASSESSMENT! Aggressive breathing treatments, and medications , |
Medications for Asthma | inflammatory drugs Corticosteroids â inhaled or oral Leukotriene modifiers Anti- IgE Bronchodilators Long acting B2 âadrenergic agonists Long acting oral B2- adrenergic agonist Methylxanthines ( rarely used) Bronchodilators Short acting inhaled B2 a |
COPD cause? | Occupational chemicals and dust, air pollution, infection, genetics, AAT deficiency. Cigarette smoking #1!! |
COPD Clinical Manifestations | â¢Develops slowly â¢Chronic intermittent cough may develop first â¢Dyspnea is progressive , occurs with exertion â¢Inability to take a deep breath â¢Gradually symptoms interfere with ADL â¢When COPD is advanced : â¢Frequent experiences weigh |
COPD Exacerbation | Acute event â¢Assess â increase in dyspnea, sputum volume, sputum purulence, malaise, insomnia, fatigue, depression, confusion, decrease exercise tolerance, confusion, increased wheezing, may have fever . â¢Increase in exacerbation â poor outcomes â |
COPD Respiratory Failure | COPD patients who have had exacerbations are @ risk to develop respiratory failure. â¢Use of B- adrenergic blockers (atenolol)-may improve survival rate & â risk of exacerbations. â¢If patient retains CO2 â carefully monitor when on oxygen or durin |
COPD Diagnostic testing | â¢Spirometry â must confirm airflow obstruction (PFT) â¢Chest x-ray- usual findings- flat diaphragm hyper inflated lungs â¢Serum á¾ antitrypsin levels â¢ABG â¢6 minute walk test â¢COPD assessment test |
Collaborative Care COPD | cessation â¢Drug therapy â reduce symptoms â¢Bronchodilators â¢LABA â¢Inhaled corticosteroids â¢Long acting bronchodilators â¢Oxygen therapy â¢Goal to maintain O2 > 90% â¢Always start with a low liter flow â¢Breathing Retraining â¢Purse lipped |
COPD Nursing Management | Heath promotion â¢Smoking cessation â¢Early diagnosis and treatment âdecrease in progression of disease â¢Family with history of COPD need to be aware of possible genetic link â¢Acute intervention â¢Bronchodilators, corticosteroids â¢Position to m |
Tuberculosis | Infectious disease â¢Caused by mycobacterium tuberculosis â¢Usually involves lungs â¢Leading cause of mortality in patients with HIV â¢Worldwide problem â¢Occurs more in the underserved, poor, and minorities â¢Population @ risk in the US : â¢Prison |
Risk Factor fo Tuberculosis | Latent TB vs TB disease â¢Latent â¢No symptoms â¢Does not feel sick â¢Cannot spread TB â¢Skin test or blood test = positive â¢Normal chest x-ray â¢Needs treatment to prevent active TB â¢TB Disease â¢Symptoms present: bad cough >3week duration, pa |
Diagnostic testing for Tuberculosis | Skin test â mantoux is done â¢Interferon ây release assays â¢Chest x-ray Bacteriologic studies â¢sputum collection â¢3 specimens must be taken on different days â usually first morning sputum . |
Tuberculosis Treatment | Usually as an outpatient â¢If patient has positive sputum â they are considered infective for the first two weeks after starting treatment- â¢Advise these patients to avoid travel, public transportations, limit visitors ⢠TB treatment involves medic |
Tuberculosis Drug Therapy | Initial phase â¢4 drug regimen â INH, rifampin (Rifadin), pyrazinamide(PZA), ethambutol(Myambutol) â given daily for 8 weeks. Continuation phase â¢INH and rifampin or INH and Rifapentine daily for 4 or 7 months. |
TB Nursing Management | â¢Health Promotion â¢Ultimate goal wipe TB off the globe â¢Screening programs for high risk populations â¢Acute intervention â¢Placed on air borne precautions (HEPA mask ) â¢Chest x-ray, sputum collection, receive correct drug therapy â¢Teach patie |
TB Discharge teaching | Teach patient â¢to minimize exposure to close contacts â¢Homes should be well ventilated â¢If still infectious â they should sleep alone â¢Spend as much time outside â¢Limit time in areas where people congregate. â¢Teach importance of adherence to |
Pulmonary Emboli | Obstruction of pulmonary artery or branch by blood clot, air, fat, amniotic fluid, or septic thrombus â¢Inflammatory process obstructs area, results in diminished or absent blood flow â¢Bronchioles constrict, further increasing pulmonary vascular resist |
Risk Factors for Pulmonary Emboli | Immobility, venous stasis â¢Hypercoagulability â¢Venous endothelial disease â¢Heart disease, trauma, postoperative/postpartum, diabetes, COPD â¢Obesity, oral contraceptive use â¢Previous history of thrombophlebitis |
Preventions and treatment for pulmonary emboli | Prevention â¢Exercises to avoid venous stasis â¢Early ambulation â¢Sequential compression devices (SCDs) â¢Anti embolism stockings â¢Treatment â¢Anticoagulation, thrombolytic therapy |
Atelectasis | Airless condition of alveoli caused by hypoventilation, obstruction to airways, or compression â Postoperative patients at high risk â Symptoms: insidious, include cough, sputum production, low-grade fever â Respiratory distress, anxiety, hypoxia occur |
Atelectasis Nursing Management | Prevention â Turn, cough, deep breathe âEarly mobilization âIncentive spirometer âJudicious administration of opioids and sedatives |
Atelectasis Collaborative Care | â Remove secretions: coughing exercises, suctioning, aerosol therapy, chest physiotherapy â¢Oxygen therapy âEndotracheal tube intubation Mechanical ventilation Bronchoscopy to remove obstruction to relieve compression |
Pulmonary Infections | â Severe acute respiratory syndrome (SARS)âviral, no cases reported since 2004, CDC â Lung abscess â Tuberculosis â Tracheobronchitis â Pneumonia |
Pulmonary infection lung abscess | â Most are a complication of bacterial pneumonia â Drainage achieved through postural drainage and chest physiotherapy â IV antibiotic therapy for 3 to 5 days, followed by oral antibiotics for 4 to 12 weeks â Diet high in protein to facilitate healin |
Pneumonia | Facts Community acquired pneumonia (CAP) sixth leading cause of death for people over 65. Risk factors: abdominal or thoracic surgery > 65 years old air pollution altered LOC chronic disease immunosuppressed resident of long term ca |
Types of Pneumonia | â Community acquired (CAP) âAcute infection of the lung, patients who have not been hospitalized or resided in a long-term care facility with 14 Days of onset. â Medical care- associated pneumonia âHospital acquired- occurs 48 hours or longer after |
Pneumonia Collaborative Care | â Vaccination â for patients > 65 years. Old. â Prompt treatment â Supportive measures â like bronchodilators, corticosteroids â Rest but not too much â WHY? Improved diaphragm movement, chest expansion, mobilization of secretions & prevention |
Nursing care for pneumonia | Assessment : âPast history âMedication history âPotential Objective findingâ â fever, lethargy , â Tachypnea, â work of breathing, crackles , production of sputum â Tachycardia â Changes in mental statusGoal â reduce risk of pneumonia â |
Evaluation for Pneumonia | Patient has received antibiotics â finished course of treatment â Respiratory pattern has returned to normal â Lungs are clear â Fatigue has decreased â Lab studies have improved â No further need for oxygen |
Aspiration | â Risk factors â Can cause pneumonia â Nursing interventions: âKeep HOB elevated >30 degrees âAvoid stimulation of gag reflex with suctioning or other procedures âCheck for placement before tube feedings âThickened fluids for swallowing problem |
Pleural issues | Pleurisy: inflammation of both layers of pleurae âInflamed surfaces rub together with each respiration, causes sharp pain intensified with inspiration â Pleural effusion: fluid collection in pleural space usually secondary to pneumonia âLarge effusio |
Pleural infection | Empyema: accumulation of thick, purulent fluid in pleural spaces âAcutely ill patient; fibrin development loculated (walled-off) impairing lung expansion âChest tube for drainage âResolution is a prolonged process, 4 to 6 weeks of antibiotic therapy |