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LPN Respiratory 2012

LPN Respiratory Disorders

What location in the brain is the center of Respiratory functioning? Medulla
What arterial changes occur that stimulate the respiratory function? Stimulated by arterial changes of increasing CO2 and decreasing O2 levels. Chemoreceptors in the carotid and aortic arteries monitor pH, CO2 and O2.
What happens when changes in pH, CO2 and O2 levels are detected? These changes signal the Phrenic nerves who signal the respiratory function. Respiration is acheived by the diaphragm, chest and intercostal muscles
Name four respiratory diseases. Pneumonia, Tuberculosis, Cystic Fibrosis and COPD.
What is pneumonia? Pneumonia is inflammation of the alveoli and bronchioles caused by an infectious (bacteria or virus) agent or noninfectious agent (irritating fumes, chemicals or radiation) that are inhaled.
What is the etiology of pneumonia? Viruses are the most common, Bacteria are referred to as "typical pneumonia" and mycoplasma is the most common type of atypical pneumonia. Has characteristics of both viral and bacterial, develops slowly and takes a long time to recuperate.
Risk factors for pneumonia: SAD ICE Smoking, altered consciousness (ETOH-blood alcohol level, seizure, anesthesia and drug OD). Debilitated or malnourished state, impaired mobility, chronic illness and elderly.
What is the pathophysiology of pneumonia? The infection and resultant inflammation, cause the alveoli to fill with fluid (exudate) which affects gas exchange which then gives us respiratory symptoms.
What are the two types of pneumonia according to their locations in the lungs? Bronchopneumonia is infection that is patchy and diffuse and scattered throughout both lungs. Lobar pneumonia is infection that is confined to one or more lobes of the lungs.
What are the complications of pneumonia? PEADS Pleural effusion, empyema, atelectasis, death from hypoxia and septicemia.
What diseases are included in the general term COPD? Asthma, chronic bronchitis, emphysema (or a combination of any of these)and bronchiectasis
How is COPD defined? A broad nonspecific term that describes a group of pulmonary disorders with symptoms of chronic cough and expectoration, dyspnea and impaired expiratory air flow.
Is COPD reversible? Obstruction is usually progressive and irreversible and may be associated with hyperreactivity. (2.4% of Canadians have been diagnosed with it)
What are the risk factors for COPD? SPOG..instead of SMOG- Smoking, passive smoking, Occupational exposure(benzene), and genetic abnormalities including alphal-antitrypsin (an enzyme inhibitor that normally counteracts the destruction of lung tissue by certain other enzymes.
What is the pathophysiology of COPD..for chronic bronchitis? Excessive accumulation of mucus and secretions block the airway.
Pathophysiology for emphysema? Impaired gas exchange results from destruction of the walls of over-distended alveoli.
Pathophysiology for asthma? Inflamed, constricted airways obstruct airflow.
What does smoking do to the airways? Smoking depresses the cleansing mechanism of the respiratory tract which obstructs airflow. Air becomes trapped behind the obstruction. It also irritates the goblet cells and mucus glands, causing an increased production of mucus.
What are four clinical manifestations of COPD? Dyspnea, cough, increased workload of breathing, cough, weight loss.
What are five complications of COPD? HACP2 Hypoxemia, Atelectasis, Cor Pulmonale, Pneumonia and Pneumothorax.
What are five items you would educate a client about who has COPD? Breathing exercises-Change uppper chest breathing to diaphragmatic with practise, Pursed lip breathing-slows breathing, prevents collapse of small airways, and controls rate and depth of respiration. Actibity pacing, Avoid extreme temps and quit smokin
What is chronic bronchitis and how is it characterized? Bronchial inflammation resulting in increased secretion of mucus, caused by inhaled irritants (cig smoke). Characterized by a productive cough lasting more than 3 mos in two consecutive years.
What is emphysema? Degenerative nonreversible-characterized by enlargement of airways beyond terminal bronchioles, causing enlarged abnormal air spaces. Air pockets (bullae and blebs) collect and rupture.Bullae are between alveoli and blebs are in lung parenchyma.
What is bronchiectasis? A form of COPD characterized by chronic infection and irreversible dilation of the bronchi and bronchioles. Dilated areas collect purulent material.
What causes bronchiectasis? Chronic obstruction caused by congenital abnormalities, tumors, and infection.
How is COPD medically dx? Health history, Physical exam (wheezes, A-P diameter increased).Pulmonary function tests, CXR.
What is the medical treatment for COPD? Bronchodilators such as ventolin. O2 therapy.(may rely on hypoxic drive to breath, so monitor O2 carefully) Chest physiotherapy, exercise rehab program, nutrition (good hydration).
What is Asthma? Also called reactive airway disease. Potentially reversible obstructive airway disorder-occurs across the lifespan. Can range from a mild nuisance to life threatening.
How was asthma traditionally classified? Obstructive disorder because of the narrowing of the airway and presence of the mucus plugs. It is now often defined as an inflammatory disorder.
What are the two phases of asthma? Early phase is the trigger. This activates the inflammatory response. Airways constrict and become edematous. Mucus secretion increases forming plugs in airways, and tenacious sputum is produced. Air is trapped so hypoxemia and hyperventilation result.
What happens to the alveoli in the first phase of asthma? Alveoli are perfused but unable to be oxygenated. The late phase begins 5-6 hours after the acute phase. The airway inflammation is present and airways are hyperreactive (very sensitive)making a recurrent attack more likely during this time.
What is the route of an asthma attack? The pathophysiology? Exposure to the trigger, Mast cells release leukotrines, Leukotrines and histamine cause bronchoconstriction, inflammation and increased mucos. This results in a narrowed airway and dyspnea.
What are the clinical manifestations of asthma? Dyspnea, tachypnea, productive cough, tachycardia, audible expiratory wheezes, accessory muscle use.
What are the signs that respiratory arrest is imminent? Drowsiness, confusion, absense of wheezing, bradycardia, suprasternal retractions.
How is asthma dx? Based on health history, physical exam, Pulmonary function tests (decreased forced expiratory volume (FEV)-in one sec. Decreased peak expiratory flow rate (PEFR). CXR (to r/o other dx's.)
What drugs are the relievers in an asthma attack? Relievers treat acute symptoms. 1.Bronchodilators (albuterol or salbutamol) ventolin. 2. Anticholinergics (Ipratropium bromide or atrovent use as an adjunct only. 3. xanthines (adjunct only)theophylline and aminophylline.
What are the maintenance drugs? Anti inflammatories-1. anti-leukotrines-a.montelukast-singulair (blocks receptors). b Zileutin-zyflo (blocks formation of leukotrines)c. Omalizumab-xolair(modulates immuno response). 2. Mast cell stabilizers-a inhaled cromolyn (Intal) cromolyn sodium.
When do you use Intal and what does it do? Used regularly and just prior to exposure to trigger. Supresses mast cell production of leukotrines.
How is corticosteroids classified? Anti inflammatory. Examples are pulmicort or flovent (inhaled) and prednisone which is a po drug. Systemic effects.
what should patient teaching for asthma include? Chronic condition that needs to be managed. Teach how to: identify and avoid trigggers., need to have infections treated promptly, and need to take asthma meds as prescribed.
What is TB? An infectious disease caused by mycobacterium tuberculosis. Major problem throughout the world, and is leading cause of death from infectious disease.Higher incidence in developing world. Higher in first nations in canada.
How is it transmitted and what does it affect? By droplet infection dispensed in the air when an infected person sneezes or coughs. Affects primarily lungs, and also other organs can be affected. i.e. bone, liver, kidneys, spleen and uterus.
Pathophysiology of TB? Invading bacterium escapes immune response and is carried to lymph nodes or throughout body.Sites of infection fill with infected material, lesion is a tubercle, site often heals,creating scar tissue which can shelter inactive bacteria that can reactivate
Risk factors for TB? Lower socioeconomic status, living in crowded conditions, elderly or under 5, substance abuse, compromised immunity, debilitative conditions (chronic illness).
Clinical manifestations of TB? cough, night sweats, chest pain, wt loss, anorexia, low grade fever, pneumonia that does not respond to usual tx.
How is TB dx? History and physical exam. CXR sputum cultures for acid fast bacilli (AFB) early a.m. specimens x 3 for children-gastric washing.
What is the screening for TB? TB skin test (PPD)protein fraction of bacillus is injected and if response means they were exposed to TB. Red, hard area >5mm at site of injection within 48-72 hours is positive result. Also CXR then.
What is mx treatment for TB? Anti tubercular drugs treat active cases and also serve as prophylactic to decrease spread. Combination of drugs are used.
Do they cure TB? No cure but considered noninfectious then.
What are primary and secondary lines? Primary drugs provide the foundation for tx. Secondary drugs are less effective and more toxic. Used to treat extra-pulmonary TB drug resistant organisms.
Name three drugs used as primary lines? Isoniazid (INH), Rifampin and streptomycin.
What is one secondary drug? Aminosalicylate
What is cystic fibrosis? Hereditary disorder with dysfunction of exocrine glands and copius production of thick sputum. The mucus in lungs leads to infection, emphysema, and atelectasis.
Created by: Sully45