25 - Respiratory Flashcards
- The most significant etiology for chronic obstructive pulmonary disease (COPD) is:
a. ) tobacco use.
b. ) chronic bronchitis.
c. ) exposure to carcinogens in the workplace.
d. ) emphysema.
a.) tobacco use.
Tobacco use or exposure is the most significant etiology for COPD and accounts for 80% to 90% of all cases of COPD. Exposure to certain chemicals in the work environment may be a causative factor of COPD but is not as significant as tobacco. COPD includes emphysema and chronic bronchitis.
The daughter of an older patient with chronic bronchitis says to the nurse, “I don’t understand why my father has not been prescribed antibiotics for his bronchitis. The last time I had bronchitis I got antibiotics.” The nurse considers the following when formulating a response:
a. ) Antibiotics tend to be less effective in older adults than in younger adults.
b. ) Antibiotics are not prescribed in chronic bronchitis since the cause is usually not bacterial.
c. ) The routine use of antibiotics is controversial because the causal role of bacterial infection is often not clear.
d. ) Normal age-related decreases in immune response delay the presentation of classic symptoms.
c.) The routine use of antibiotics is controversial because the causal role of bacterial infection is often not clear.
In chronic bronchitis, the routine use of antibiotics is controversial because the causal role of bacterial infection is often difficult to document. Antibiotics are generally indicated in frail elders when the possibility of pneumonia or an acute exacerbation of bronchitis is suspected.
There is no evidence that antibiotics are less effective in older adults or that chronic bronchitis is usually caused by a nonbacterial cause. While it is correct that a normal age-related decreased immune response may delay the presentation of classic symptoms, this does not explain why antibiotics are often not prescribed.
The nurse is preparing discharge teaching for a client diagnosed with chronic obstructive pulmonary disease (COPD). Which nursing statement would be included in this intervention? (Select all that apply.)
a. ) “Are you familiar with pursed-lip breathing?”
b. ) “It will be necessary to demonstrate postural drainage techniques with a caregiver.”
c. ) “We will need to discuss alterations in your diet.”
d. ) “Can you explain the purpose of the medications you have been prescribed?”
e. ) “There are some things I’d like to discuss about adaptive sexual practices.”
a, b, d, e
a.) “Are you familiar with pursed-lip breathing?”
b.) “It will be necessary to demonstrate postural drainage techniques with a caregiver.”
d.) “Can you explain the purpose of the medications you have been prescribed?”
e.) “There are some things I’d like to discuss about adaptive sexual practices.”
Topics that will be included in this client’s discharge teaching include pursed lip breathing, postural drainage techniques, medication education, and safe sexual activity. Diet is not generally a factor in this disease process.
A nurse is organizing a support group for older individuals with COPD in the community. The nurse knows that which of the following individuals is most likely to have COPD?
a. ) A 75-year-old Hispanic male who is a retired truck driver and never smoked
b. ) A 72-year-old non-Hispanic white female who never worked outside of the home and is a former smoker
c. ) A 67-year-old African American male who is a retired physician
d. ) A 70-year-old Asian woman who is a retired college professor
b.) A 72-year-old non-Hispanic white female who never worked outside of the home and is a former smoker
The profile of individuals most likely to have COPD include: persons 65-75 years of age, non- Hispanic whites, women, those who are unemployed, retired or do not work, have less than a high school education, have lower incomes, are current or former smokers, and have a history of asthma. Option B meets all of the criteria listed above.
Asthma is often underdiagnosed in older adults because:
a. ) older adults frequently do not have any of the classic signs and symptoms.
b. ) symptoms of asthma are often attributed to normal age-related changes.
c. ) asthma is very uncommon in older adults.
d. ) asthma symptoms are usually very mild in older adults.
b.) symptoms of asthma are often attributed to normal age-related changes.
Asthma is both underdiagnosed and undertreated in older adults. Instead, the symptoms are attributed to normal changes with aging, cardiovascular disease, or are simply labeled “COPD.” Older adults do present with the usual signs and symptoms; however, they are often overlooked.
Asthma is not uncommon in older adults. Adults over 65 make up a small percentage of those with asthma, and they have the highest associated death rate than any other group. Asthma symptoms in older adults range from mild to very severe.
A nurse assesses an older patient’s blood gases. The patient is 70 years old. The nurse knows that this patient’s maximum PO2 is:
a.) 69.
b. ) 79.
c. ) 89.
d. ) 99.
b.) 79.
The maximal PO2 possible at sea level can be estimated by multiplying the person’s age by 0.3 and subtracting the product from 100.
A nurse practitioner is caring for a 90-year-old adult with asthma who has comorbid dementia and severe osteoarthritis in the hands. The nurse practitioner considers inhaled medications to manage the asthma. Which of the following factors should the nurse take into consideration when developing the medication plan for this patient? (Select all that apply.)
a. ) The patient’s ability to swallow safely
b. ) The patient’s manual dexterity
c. ) The patient’s age
d. ) The patient’s cognitive status
e. ) The patient’s mobility status
b.) The patient’s manual dexterity
d.) The patient’s cognitive status
Inhaled medications may be taken a number of ways. When choosing which method to order, the prescriber needs to consider the manual dexterity of the patient as well as the cognitive ability to follow directions. The patient’s age, ability to swallow, and mobility do not directly impact the ordering of inhaled medications.
A nurse is planning education for a group of older adults at a senior center on promoting respiratory health. Which of the following should the nurse include in the education? (Select all that apply.)
a. ) Annual influenza immunization
b. ) Pneumococcal pneumonia immunization
c. ) Smoking cessation
d. ) Weight reduction
e. ) Benefits of low-sodium low-fat diets
a, b, c
a.) Annual influenza immunization
b.) Pneumococcal pneumonia immunization
c.) Smoking cessation
Guidelines for good respiratory health include pneumonia immunization, annual influenza immunization, avoiding exposure to smoke and pollutants, smoking cessation, avoiding individuals with respiratory illness, promptly treating respiratory infections, and hand hygiene. Although weight reduction and a low-sodium, low-fat diet are important, neither is directly related to respiratory health.
A nurse is assessing an older adult’s respiratory status. Which of the following are normal age-related changes in the respiratory system? (Select all that apply.)
a. ) Diminished cough reflex
b. ) Stiffening of the chest wall
c. ) Increased resistance to airflow
d. ) Decreased respiratory rate
e. ) Loss of elastic recoil
a, b, c, e
a.) Diminished cough reflex
b.) Stiffening of the chest wall
c.) Increased resistance to airflow
e.) Loss of elastic recoil
Age-related changes include loss of elastic recoil, stiffening of the chest wall, and increased resistance to airflow leading to more effort required for movement of the diaphragm. A diminished cough reflex is a normal age-related change. A decreased respiratory rate is not a normal age-related change.
A nurse is involved in primary prevention activities related to the promotion of respiratory health. The nurse is involved in which of the following activities? (Select all that apply.)
a. ) Organizing an influenza vaccination clinic
b. ) Promoting a smoking cessation program in the community
c. ) Referring individuals with respiratory disease to the pulmonology clinic at the hospital
d. ) Visiting a congressman representative to advocate for legislation on clean air
e. ) Teaching individuals with COPD measures to maximize lung function
a, b, d
a.) Organizing an influenza vaccination clinic
b.) Promoting a smoking cessation program in the community
d.) Visiting a congressman representative to advocate for legislation on clean air
Primary prevention includes activities such as promoting or conducting smoking cessation programs and community intervention, including organizational efforts to promote and administer preventive vaccinations such as that for influenza and pneumonia. Primary prevention includes political activism with industry leaders and environmental agencies to push for clean air and water. Referrals to specialists or teaching individuals who already have respiratory illness are not part of primary prevention.
