NSG 210 ch 24 respiratory
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| What is COPD? | Disease characterized by airflow limitation that is not fully reversible and abnormal inflammatory response to noxious particles or gases.
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| what 2 diseases make up COPD? | Emphysema and Chronic bronchitis.
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| When do people with COPD usually become symptomatic? | middle adult years.
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| In COPD where does the inflammatory response occur? | Proximal Airways ( trachea and bronchi)
Peripheral airways ( bronchioles), lung parenchyma and pulmonary vasculature.
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| 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.
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| 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.
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| When are acute exacerbations of chronic bronchitis most likely to happen? | During the winter.
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| What are the clinical symtoms of bronchitis? | Productive cough, decreased exercise tolerance, prolonged expiration adn cyanosis with peripheral edema (blue bloater).
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| Medical mngmt of bronchitis? | Stop smoking, decrease irritants,antibiotics, increase fluids, corticosteriods, bronchodialators.
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| What are the clinical symtoms of emphysema? | Accessory muscle use, barrel chest, pink color (pink puffer).
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| What part of the lung does emphysema effect and how? | It effects the alveoli by over distention prohibiting gas exchange.
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| Complications of emphysema? | Increased CO2 leading to repiratory acidosis and right sided heart failure.
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| 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).
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| What is spirometry used for? | Evaluate airflow obstruction determined by the ratio between FEV to FVC ( forced vital capacity).
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| What are the complications of COPD? | Respiratory insufficiency and failure, pneomonia, chronic atelectasis, pneomothorax and pulmonary arterial hypertension.
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| 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.
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| What is the single most cost effective intervention to reduce the risk of developing COPD? | STOP SMOKING!!!!
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| 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.
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| 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.
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| Surgical management of COPD? | Bullectomy, Lung volume reduction surgery and lung transplant.
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| What is a bullectomy? | Bullae are enlarged airspace that do not contribute to ventilation and impair gas exchange and are surgically removed.
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| what is lung volume reduction surgery? | Removal of a portion of the diseased lung parenchyma which allows functional tissue to expand.
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| What breathing exercises should you teach a pt. with COPD? | Diaphragmatic breathing which reduces respiratory rate and increases alveolar ventilation.
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| 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.
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| What is brochiectasis? | A chronic irreversable dilation of the bronchi and bronchioles.
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| WHAT CAN CAUSE BRONCHIECTASIS? | Airway obstruction, duffuse airway injury, pulmonary infection, cystic fibrosis and idiopathic causes.
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| clinical manifestations of bronchiectasis? | Chronic cough, purulent sputum in copious amounts, clubbing of fingers and hemoptysis.
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| Medical management of bronchiectasis/ | Promote bronchial drainage by gravity, percussion to loosen secretions and antibiotics if C&S confirms.
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| What is Asthma? | Chronic inflammatory disease of the airways that cause hyperresponsivness, mucosal edema and mucus production.
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| What is the strongest predisposing factor for asthma? | Allergies
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| What types of irritants can set off an asthma attack? | Pollen, mold, dust, cold, heat, perfumes, smoke, exercise.
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| What role do mast cells play in asthma? | They release histamine, bradykinin, prostiglandins and leukotrienes which perpetuate inflamation and vasocostriction.
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| Clinical manifestations of asthma? | Cough with or without sputum, dyspnea, wheezing, chest tightness, diaphoresis, tachycardia, and widened pulse pressure.
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| What is the clinical significance of a normal PaCO2 during an asthma attack? | May signal impending respiratory failure.
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| What is the best prevention for asthma? | Undergo test to indentify the substances that precipitate the symptoms.
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| Complications of asthma? | Status asthmaticus, respiratory failure, pneumonia, atelectasis and airway obstruction.
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| Why would you administer fluids to a person with asthma? | Thin secretions and because people with asthma are frequently dehydrated from diaphoresis.
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| Asthma quick relief medications? | Beta 2 agonists such as albuterol, levalbuterol and pirbuterol.
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| How do beta 2 agonists work? | They relax smooth muscle causing bronchial dilation.
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| 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).
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| 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.
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| Can long term asthma control medications be used for an acute asthma attack? | NO! you must use a short term beta 2 agonist.
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| Side effects of corticosteroids? | Cough, thrush, glucose abnormalities, osteoporosis, growth suppression, dermal thinning and cushings syndrome.
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| Side effects of short term beta agonists? | Tachycardia, muscle tremor, hypokalemia and headache.
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| 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.
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| 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.
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| 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.
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| What is status asthmaticus? | A severe and persistant asthma attack that does not respond to conventional therapy.
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| Clinical manifestations of status asthmaticus? | Labored breathing, prolonged exhalation, wheezing. ( as the obstruction worsens the wheezes may disappear).
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| Medical management of status asthmaticus? | Short term beta2 agonist, systemic corticosteroids, O2.
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| Nursing management of status asthmaticus? | Actively access airway, fluid intake, monitor B/P and HR.
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| What is cystic fibrosis? | Multisystem genetic disease characterized by thick viscous secretions in the lungs, pancreas, liver, intestine and reproductive tract.
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| Clinical manifestations of CF/ | Productive cough, wheezing, hyperinflation of the lung fields on chest X ray, chronic respiratory inflammation, sinusitis and nasal polyps.
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| Medical Management of CF? | Antibiotics based on results of C&S, airway clearance, effective coughing and supplements of vitamins A,D,E and K.
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| 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.
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