2800 Exam Two Flashcards
What are some consequences of untreated pain?
Increased ACH, cortisol, ADH, and epinephrine
Decreased insulin resistance
Increased heart rate, cardiac output, coagulation
Hypoxemia and decreased tidal volume
Decreased urine output and GI motility
Decreased immunity
What are the five dimensions of pain?
Physiologic Affective Cognitive Behavioral Sociocultural
What is included in the physiologic dimension of pain?
Emotional responses to pain, like anxiety, depression, or frustration
Cognitive dimension of pain
Beliefs, attitudes, meanings, and thoughts attached to pain
Behavioral dimension of pain
Observable actions taken to express or control pain
Sociocultural dimension of pain
One’s culture impacts how one expresses and thinks about pain
What is nociceptive pain?
Pain at nocioceptor nerves caused by damage to somatic or visceral tissue
What are the two types of somatic pain?
Deep and superficial
What is somatic pain?
Pain originating from the skin, mucous membranes, subcutaneous tissues, muscles, bones, or tendons
What is visceral pain?
Pain from visceral organs
What are some common causes of visceral pain?
Swelling or ischemia of internal organs
What is neuropathic pain?
Pain from damage to peripheral nerves or CNS structures
How would a patient likely describe neuropathic pain?
Burning, shooting, or shock-like
Acute pain
Sudden onset
Usually lasts less than 3 months
Usually resolvable with care geared towards recovery
Precipitating event can usually be identidad
Chronic pain
Gradual or sudden onset Cause may not be known Pain increases and decreases Goal is pain control to maximize function Behavioral manifestations likely
What is sciatica?
Pain following the course of the sciatic nerve
What is the most consistent pain indicator in infants?
Facial expressions
What are some other ways pediatric clients will express their pain?
Crying Pain facial expressions Localized body response/withdrawal Thrashing Restlessness Muscle rigidity
When should pain be reassessed? What are some dependent factors?
Frequently, especially after meds are given to gauge effectiveness. Assessment also depends on severity, the patient’s condition, the interventions taken, the risk of side effects, and institutional policy
Who might the nurse collaborate with to manage a patient’s pain?
Anesthesiologist Nurse practitioner/doctor Pharmacist Psychologist PT/OT Pain specialist
Planning for pain management should always include…
Patient goals
What is a multimodal approach to analgesic therapy?
Use of two or more classes of analgesics to take advantage of various mechanisms of action or to minimize the amount of narcotic medications needed
What are some barriers to effective pain management that could affect a patient?
Fear of addiction/tolerance
Desire to be stoic
Side effects
Inadequate assessment by the nurse
What is an important question to ask when assessing chronic pain?
How is the pain impacting patient functionality in day to day life?
What are some ethical issues that arise from pain management?
Fear of hastening death by increasing doses of analgesics for terminally ill patients
Assisted suicide requests
Giving placebos
Mismanagement of geriatric pain
Rule of double effect
If an unwanted consequence occurs as a result of an action taken to achieve moral good, the action is justified
What is the rule of double effect commonly applied to?
Giving increasing doses of pain medications to dying patients with the goal of relieving pain
What are some barriers to adequate gerontologic pain management?
Older adults believing pain is inevitable/normal
Use of different descriptive language for pain
Less ability to report pain
Not being believed in their reports of pain
What are some things that could hinder clients from reporting pain?
Hearing/vision deficits Dementia Delirium Poststroke aphasia Communication barriers
What is a primary headache? What are the types?
A headache not caused by disease
Tension, migraine, and cluster headaches
What is a secondary headache? What could be some causative factors?
A headache caused by another condition or disorder, such as a brain tumor, injury, or sinus infection
Tension headache
A stress headache, the most common and least severe form of headache
What are clinical manifestations of a tension headache?
Bilateral pain with a pressing or tightening quality
Mild to moderate pain
Lasts for minutes to days
Possible photophobia or photophobia
Photophobia
Light sensitivity
Phonophobia
Sensitivity to sound
What are premonitory symptoms?
Warning symptoms of an impending headache
Migraine headache
Recurrent headache characterized by unilateral throbbing
Clinical manifestations of a migraine headache?
Aura/premonitory symptoms
Steady, pulsing pain that is usually unilateral
Lasts for 4-72 hours
What is an aura?
A premonitory symptom of a migraine, with visual disturbances or experiencing sensory or motor phenomenon
What are cluster headaches?
Most severe form of primary headaches. Repeated headaches that occur in clusters, generally at the same time of day
Cluster headache: clinical manifestations
Intense pain lasting for minutes to 3 hours Sharp, stabbing pain located around the eye that can radiate Swelling Tearing Facial flushing Nasal congestion Agitation Possible aura Can occur up to 8 times per day
What are some Interprofessional cares for headaches?
Drug therapy Meditation Biofeedback Cognitive/behavioral therapy Relaxation training
What are goals for headache management?
Reduced/eliminated pain
Understanding of triggers and treatments
Using positive coping strategies
Increased quality of life with decreased disability
What are some patient and caregiver teachings for patients with headaches?
Keep headache log Avoid triggers Learn purpose and side effects of drugs Exercise Stress management Med adherence Diet education
What is systemic lupus erythematosus?
Multisystem autoimmune inflammatory disease mainly affecting skin, joints, serous membranes, plus renal, hematologists, and neurological systems
Is there a characteristic disease progression for lupus?
No, it progresses and manifests differently for each patient
Dermatological findings with lupus
Butterfly rash over cheeks and bridge of nose Vascular skin lesions Photosensitive skin reactions Raynaud’s phenomenon Oral/nasopharyngeal ulcers
Musculoskeletal findings with lupus
Arthritis (95% of patients)
Joint pain
Swelling
Bone loss
Cardiopulmonary findings with lupus
Lung disease Pleurisy Dysrhythmias Pericarditis Coagulation disorder (antiphospholipid syndrome)
Renal findings with lupus
Kidney damage (75% of patients)
Nervous system findings with lupus
Seizures
Cognitive dysfunction (disorientation and memory deficits)
Psychosis
Higher stroke risk
Hematologic findings with lupus
Anemia
Leukopenia
Thrombocytopenia
Coagulation disorders
What are some drug therapies used to treat lupus?
NSAIDs Antimalarials Immunosuppressants **limited corticosteroids ** Biologic response modifiers
What are some common comorbidities with lupus?
Depression
Anxiety
Sjögren’s syndrome
Kidney failure
What are major teaching points for patients with lupus?
Disease process Drug treatment information Pain management Energy conservation Stress avoidance Relaxation therapy Counseling services Community resources Avoid sun exposure Self-esteem maintenance
Fibromyalgia
Chronic central pain syndrome marked by widespread, non-articular musculoskeletal pain and fatigue with pain at specific tender points
Assessment findings with fibromyalgia
Widespread burning pain that worsens and improves
Pain with a location that is hard to pinpoint
Head or face pain
Migraines
Memory lapses
Concentration problems
Pain and tender points
Complications of fibromyalgia
IBS Swallowing problems Sleep problems Urinary frequency/difficulty Painful menstruation with possible flare ups Sleep problems
Why is fibromyalgia so difficult to diagnose?
Lack of knowledge about disease and manifestations
Need to rule out many other disorders
No diagnostic test for it
Manifestations unique to each person
Treatment for fibromyalgia
Drug therapy (often anti seizure meds, SSRI’s, pain management drugs)
Stretching
Hot and cold therapy
Vitamin/mineral supplements
What nursing interventions might help with fibromyalgia?
Education
Distraction
Listening
Hot/cold application
What are holistic therapies for pain relief?
Relaxation Biofeedback Heat/cold Massage Yoga Tai chi Distraction/meditation
Diet suggestions for fibromyalgia
Limit sugar, alcohol, and caffeine
Eat balanced, healthy diet
Chronic insomnia definition
Difficulty falling asleep or remaining asleep for at least 3 night a week for 3 months or longer, with daytime complaints of interrupted function
Who is most likely to suffer from insomnia?
Women
Those divorced, widowed, or separated
Low SES or education level
What are some factors that contribute to poor sleep hygiene?
Irregular sleep/wake schedules Drinking close to bedtime Smoking Medications Stress Psychiatric or medical conditions Jet lag Nightmares/PTSD Exercise close to bedtime Napping Genetics
What are clinical manifestations of chronic insomnia?
Difficulty falling asleep Frequent awakening Problems staying asleep Non-restorative sleep Forgetfulness Confusion Grumpiness
What are some nursing diagnoses for sleep disorders?
Insomnia
Sleep deprivation
Disturbed sleep pattern
Readiness for enhanced sleep
What are some nursing interventions to help with insomnia?
Educate about sleep hygiene
Teach relaxation techniques
Education about sleep medications
What are important teachings related to chronic insomnia?
Don’t go to bed unless tired Regular sleep schedule Sleep rituals Quit drinking alcohol 4-6 hours before bed Cool, dark, quiet environment
Systematic exertion intolerance disease (SEID)
Formerly chronic fatigue syndrome
Multisystem disease in which any form of exertion can adversely affect multiple organs/systems
Who is most likely to suffer from SEID?
Women
What are assessment findings in SEID?
6+ months of profound fatigue Postexertional malaise Un refreshing sleep Brain fog Orthostatic intolerance
Disease progression of SEID?
Does not progress, many often recover or gradually improve
What are complications of SEID?
Anger Pain Frustration Inability to do ADLs Loss of livelihood Depression Brain fog
What are some common comorbidities with SEID?
Fibromyalgia
RA
Depression
Why is SEID so difficult to diagnose?
No diagnostic test, so must be diagnosed by elimination. Also shares many symptoms with fibromyalgia
How is SEID treated?
No definitive treatment, but NSAIDS, antihistamines, antidepressants, and SSRIs can be used to manage symptoms
Balanced diet and a carefully graduated exercise program are recommended
What nursing interventions might help with SEID?
Education
Listening/saying you believe them
Connect them to resources
Discourage total bed rest
Define anemia
Deficiency in number of RBCs, quantity/quality of hemoglobin, or volume of packed red blood cells (hematocrit)
What are some causes of chronic anemia?
Iron deficiency Blood loss from trauma Inherited anemia Medications Folic acid or B12 deficiency Radiation Decreased RBC production Increased RBC destruction
What are some causes of decreased red blood cell production?
Decreased hemoglobin synthesis
Defective DNA synthesis
Decreased erythropoietin or iron
Decreased number of RBC production precursors
What are some chronic causes of blood loss?
Gastritis
Menstrual flow
Hemorrhoids
What are some conditions that contribute to increased RBC destruction?
Sickle cell disease Enzyme deficiency Membrane abnormalities Trauma Incompatible blood transfusions
What are common assessment findings/manifestations/complications of anemia?
Palpitations Dyspnea Mild fatigue Pallor/jaundice Increased HR Systolic murmurs/bruits Angina/MI HF
Normal hemoglobin levels
Women: 12-16 g/dL
Men: 14-18 g/dL
Normal hematocrit level?
Women: 37-48%
Men: 45-52%
What is a good rule of thumb for determining hct?
Generally three times the hemoglobin amount
What are manifestations of mild anemia?
Palpitations
Exertional dyspnea
Mild fatigue
Manifestations of moderate anemia?
Palpitations Bounding pulse Dyspnea Fatigue Roaring in ears
Manifestations of severe anemia
Pallor Jaundice Blurred vision Tachycardia Angina HF Headache Vertigo Irritability Anorexia Weight loss Lethargy
Why is jaundice present in anemia?
Hemolysis of RBCs leading to increased concentration of serum bilirubin
What are potential nursing diagnoses related to anemia?
Fatigue
Imbalanced nutrition
Anxiety
What are goals for patients with anemia?
Assume normal ADLs
Maintain adequate nutrition
Develop no complications r/t anemia
What nursing interventions are appropriate for patients with anemia?
Diet changes
Oxygen therapy
RBC replacement/blood transfusion if severe
Medication treatment
What would a nurse teach about activity and exercise r/t anemia?
Alternate rest and activity periods
Prioritize activities
Avoid activity right after meals
What are gerontologic considerations for anemia?
RBC mass changes with age
Anemia is not normal (usually has underlying cause)
What are some underlying causes for anemia in older adults?
Iron deficiency Bleeding Chronic disease/inflammation Renal insufficiency Blood cancer Decreased testosterone
What are some additional clinical manifestations of anemia in older adults?
Pallor Confusion Ataxia (impaired coordination) Fatigue Worsening cardiovascular or respiratory problems
How is hypertension defined?
Greater than 140/90 or a normal BP but on antihypertensive medications
Describe hypertension using normal language
Heart pumping with higher force, causing stress on vessels and the heart
Primary hypertension
No known cause
Secondary hypertension
Elevated blood pressure caused by an underlying condition (can be corrected)
Who is most likely to get hypertension?
African Americans Mexican Americans Middle aged men Women over 60ish Women on oral contraceptives Diabetics Those with family history of HTN/heart disease
Modifiable risk factors for hypertension
Alcohol intake Tobacco use Diabetes/blood sugar control Elevated serum lipids and cholesterol Excess sodium Sedentary lifestyle Stress
Non-modifiable risk factors for hypertension
Age
Gender
Family history
Ethnicity
What are assessment findings in hypertension?
Usually none
If severe, can cause headache,fatigue, dizziness, palpitations, angina, dyspnea
Why is hypertension called the silent killer?
It is often asymptomatic until it is severe and begins to cause organ damage
What are potential complications with HTN?
CAD LVH Cerebrovascular disease PVD Nephrosclerosis Retinal damage
What are lifestyle modification recommendations for HTN?
Weight reduction DASH diet Sodium restriction Moderate alcohol intake Physical activity Tobacco avoidance/cessation Stress reduction
What is the DASH eating plan?
Dietary approaches to stop hypertension
Less red meat, salt, sweets, and added sugars
Increased fruits, veggies, whole grains, fish, low fat milk, legumes
What are physical activity recommendations for hypertension?
30 min/day at least 5 days a week. At least 150 minutes a week
What are some nursing diagnoses for patients with hypertension?
Ineffective health management
Anxiety
Risk for decreased cardiac tissue perfusion
What are goal for clients with hypertension?
Achieve and maintain goal blood pressure
Follow treatment plan
Experience minimal side effects
Manage/cope with condition
What are some reasons clients do not adhere to teaching recommendations for hypertension?
Inadequate teaching Side effects of meds Cost Insurance issues BP returning to normal Lack of trust in healthcare workers
Describe coronary artery disease (CAD) in simple language
Hardening/narrowing of the coronary arteries
Who is most likely to get CAD?
Whites African Americans (earlier onset) Native Americans (earlier deaths) Men under 75 at higher risk, then risk becomes equal Women more likely to die from it
Non-modifiable CAD risk factors
Age
Gender
Ethnicity
Genetics
Modifiable CAD risk factors
Serum lipids Blood pressure Diabetes control Tobacco use Inactivity Obesity
What are some other modifiable risk factors that contribute to CAD?
Fasting blood glucose greater than 100 mg/dL
Depression
Stress
Elevated homocysteine
Metabolic syndrome
Central obesity + hypertension + abnormal serum lipids + elevated fasting glucose
Metabolic syndrome promotes the development of what alteration in tissue perfusion?
Coronary artery disease
CAD clinical manifestations
Often none, maybe chest pain
What are assessment findings with CAD?
High serum lipids
What is a normal total cholesterol level?
Less than 200 mg/dL
What is a potential complication of CAD?
MI
What does nursing and interprofessional care consist of for CAD?
Health promotion (screening!)
Identifying and managing high risk individuals
Physical activity/weight loss
Nutrition therapy
What would be important information to collect in health screening for CAD?
Family history BP Cardiovascular symptoms Lifestyle habits Psychosocial history (stress) Employment Health beliefs Education level/background Cholesterol level
What are FITT recommendations?
Exercise recommendations for CAD.
Stands for Frequency, Intensity, Type, and Time
Involves 30 minutes of moderate activity most days of the week plus two days of weight training per week
What are nutrition recommendations for patients with CAD?
Decrease saturated fat and cholesterol
Increase complex carbs and fiber
Keep fat between 25 and 35% of total intake, mostly from mono/polyunsaturated fats
Less alcohol and simple sugar intake
What are some patient teaching priorities for CAD?
Regular BP checks Reduce fat intake Stop smoking Exercise Be aware of stress/minimize stress Obesity reduction Diabetes control
Define Chronic Heart Failure in simple language
Heart being unable to provide sufficient blood to meet the oxygen needs of tissues and organs
Who is most likely to get CHF?
African Americans
Asians
Those with hypertension, CAD, COPD, or diabetes
What are assessment findings/manifestations for clients with left sided heart failure?
Increased heart rate Decreased 02 sats Increased arterial CO2 Crackles in lungs Extra heart sounds Weakness Fatigue Anxiety Dyspnea Dry, hacking cough
What are manifestations of right sided heart failure?
Murmurs Jugular venous distention Edema Weight gain Ascites Hepatomegaly Fatigue Anorexia Nausea GI bloating Tachycardia Nocturia Confusion Restlessness Stasis ulcers
What does the FACES acronym pertain to and stand for?
Pertains to signs and symptoms of heart failure
Stands for: Fatigue, Activity limitation, Chest congestion/cough, Edema, Shortness of breath
What are potential complications associated with heart failure?
Pleural effusion Dysrhythmias Left ventricular thrombus Hepatomegaly Renal failure
What is nutritional therapy for patients with heart failure?
Low sodium diet
DASH diet
Monitoring of fluid/daily weights
What are potential nursing diagnoses for patients with CHF?
Impaired gas exchange
Decreased cardiac output
Excess fluid volume
Activity intolerance
What are goals for clients with heart failure?
Decreased symptoms and peripheral edema
Increased exercise tolerance
Treatment adherence
No complications from disease
What do we teach CHF patients about activity programs?
Increase activity gradually
Consider cardiac rehabilitation
Avoid temperature extremes
What do we need to teach CHF patients about ongoing monitoring?
Know s/s of worsening heart failure (FACES)
Monitor vital signs and daily weights
Report: weight gain, SOB, dry/hacking cough, fatigue, edema, nausea, dizziness
What do we teach CHF patients about health promotion?
Flu and pneumonia vaccines
Reduction of risk factors
What do we teach CHF patients about rest?
Alternate rest and activity
Rest after exertion
Potentially take shorter work hours
Avoid emotional upset
What do we teach CHF patients about nutrition?
Limit salt
Follow good nutrition plan ( preferably DASH)
Adhere to diuretics
What are guidelines for teaching related to drug adherence for CHF?
Follow regimen closely
Develop system for adherence
Check pulse before medications
Know s/s of orthostatic hypotension and internal bleeding
What is tuberculosis?
A bacterial infection normally involving the respiratory system
How much of the world’s population has TB?
About 1/3
Who is at highest risk to get TB?
HIV/immunosuppressed patients
Poor
Underserved/minority/homeless patients
Inner city people
Those living in or working in institutions
Those living/traveling to other countries
What problems have resulted in drug resistant TB?
Incorrect prescribing
Lack of public health awareness/management of TB cases
Non adherence to treatment
Primary TB
Bacteria are inhaled and start the inflammation reaction. May or may not progress to actual disease (usually doesnt in healthy people)
Latent TB
TB bacteria are present but disease is not active. Patient will test positive but is not contagious
Active TB
Patient is contagious and manifesting symptoms
Primary active TB
Patient gets sick immediately upon initial infection
Post-primary active TB
Patient has latent period before infection becomes active
Assessment findings/manifestations of TB
Dry cough that later becomes productive Fatigue Anorexia Night sweats Weight loss Fever Dyspnea Crackles Chills Blood in sputum (hemoptysis)
How long do TB symptoms take to develop?
2-3 weeks
How/where can extra-pulmonary TB manifest?
Renal TB
Bone TB
Meningitis TB
What are complications of TB?
Scarring
Pulmonary damage
Death
What is miliary TB?
Mycobacterium being systemically distributed in the bloodstream (leads to extra pulmonary TB)
What are potential long term complications of TB?
Death Hepatomegaly Splenomegaly Spinal destruction Peritonitis
What is the standard method to know if someone has been exposed to TB?
TB skin test
Induration
Palpable, raised, hardened area at site of TB injection (positive result)
Other diagnostic studies for TB
Chest x-ray
Interferon y blood tests
What is the only way to actually diagnose TB?
3 sputum cultures (smeared and cultured) collected on 3 different occasions
How long can bacteriological diagnosis of TB take?
Up to 8 weeks
Why is compliance such an issue in TB management?
Long duration of treatment
Side effects to meds
What are nursing interventions for health promotion related to TB?
Screening and follow up
Addressing social and lifestyle factors of TB development
Education
Is TB reportable?
Yes, it must be reported (public health concern)
Directly observed therapy for TB
Making sure patients actually take their meds
What precautions should be taken for TB patients in acute care settings?
Airborne isolation
Drug therapy
Hepa masks
What should patients be taught in acute care settings in regard to TB?
Cover nose and mouth with paper tissues when coughing
Wash hands
Wear mask when leaving the room
Screen visitors and family members
What does ambulatory care consist of for TB patients?
Monthly culture and smear
Drug adherence
Reporting to public health department
What should ambulatory TB patients be taught?
Live in well-ventilated home
Sleep alone while contagious
Spend lots of time outside
Minimize time in crowds or using public transportation
What is a reactivating factor for TB?
Smoking
Asthma definition
Difficulty breathing due to overreactive airways (happens in periods of flare ups)
Who is most likely to get asthma?
Boys before puberty
Women after puberty
African Americans
Puerto Rican’s
What are some asthma triggers?
Mold Pollens Allergens Fumes Chemicals/agriculture/farming Exercise Smoking Stress Anxiety Smog
What is exercise induced asthma?
Asthma brought on by exercise (usually happens after exertion
What are general clinical manifestations of asthma?
Cough
Respiratory symptoms
Gastric reflux
Heartburn
How could the cough in asthma be described?
Hacking
Irritating
Non productive
Rattling
What are respiratory related signs in asthma?
SOB Prolonged exhalation Wheeze Dark red lips Cyanosis Restlessness/anxiety Chest tightness Positioning for optimal breathing
Lung sounds with asthma
Crackles
High pitched wheezes
What changes occur after repeated episodes of asthma?
Barrel chest
Elevated shoulders/changed musculature
Accessory muscle use
Lung damage
What are potential complications with asthma?
Death
Permanent lung damage
What nursing interventions can help prevent asthma complications?
Inhaled medications
Drug therapy
Monitoring
IV fluids
What do medication regimens look like for asthma patients?
Usually SABAs + long term controller medications (often corticosteroids)
What are goals for asthmatic clients?
Minimal symptoms Acceptable activity levels Avoidance of triggers Knowledge about action plan Maintain above 80% of best peak flow
Client teaching about avoiding asthma attacks
Know and avoid triggers
Avoid cold
Promptly treat URIs
What is included in an asthma action plan?
Using peak flow monitoring to determine what to do with medications
Why use a peak flow meter?
It can tell the patient about airway narrowing before symptoms begin
Can help identify triggers
Can let patient know when to take meds
What does the patient need to record with peak flow monitoring?
Peak flow numbers and respiratory symptoms
Peak flow green zone
80% or greater of personal best, take meds as normal
Peak flow yellow zone
50-80% of personal best, take SABA and call doctor
Red zone peak flow
Less than 50% of best, take SABA ASAP and call doc immediately
What holistic therapies can help with asthma?
Breathing techniques
Relaxation
Deep breathing
Yoga
What do we teach asthma patients about exercise?
Use prophylactic treatment
Do things requiring short bursts of energy
Exercise inside if its cold
Define COPD
Chronic progressive inflammatory disease of the airways (chronic bronchitis + emphysema)
Chronic bronchitis
Bronchial inflammation defined as cough and sputum for at least 3 months of the last two consecutive years
Emphysema
Destruction of the alveoli
Most common etiology of COPD
Smoking
Non-modifiable COPD risk factors
Genetics Gender Aging Infection Asthma
What is alpha antitrypsin deficiency?
Autosomal recessive disorder that is a genetic risk for COPD
Modifiable COPD risk factors
Smoking
Occupational exposure
Pollution
Asthma versus COPD: age of onset
Asthma: younger than 40
COPD: usually between 40 and 60
Asthma vs COPD: dyspnea
Asthma: only during exacerbations or when poorly controlled
COPD: during exertion
Asthma vs COPD: sputum production
asthma: infrequent
COPD: often
What are assessment findings/manifestations of COPD?
Chronic cough with sputum production Dyspnea/air hunger Barrel chest Tripod positioning Polycythemia
What are chronic complications associated with COPD?
Cor pulmonale
Acute exacerbations
Acute respiratory failure
Cor pulmonale
Right sided heart failure due to pulmonary hypertension (often seen with COPD patients)
Cor pulmonale assessment findings?
Jugular venous distension Peripheral edema Poor GI drainage Weight gain Dyspnea
What are collective care therapies for COPD patients?
Spirometry Drug therapy Breathing techniques Immunizations (especially pneumonia) Oxygen therapy Hydration Infection prevention
How can a patient prevent COPD exacerbations?
Treatment adherence
Recognize symptoms of exacerbations
CO2 narcosis
Toxic accumulation of CO2 due to chemorecptor tolerance of CO2
With COPD, what should nurses teach in relation to breathing retraining?
Pursed lip breathing
Diaphragmatic breathing
Pursed lip breathing: how to teach
Inhale slowly through nose
Exhale slowly through pursed lips
Exhale for 3 times longer than inhalation
Repeat 8-10 times, for 3 to 4 times per day
Why is effective coughing necessary with COPD?
To get excess secretions out of the lungs
What do we teach COPD clients about huff coughing?
Inhale through mouth using diaphragm
Hold for 2-3 seconds
Exhale forcefully like you’re fogging a mirror
Do this until secretions feel looser, then cough normally to get secretions out
Why do COPD patients often struggle to eat?
Difficulty eating and breathing at the same time
Diaphragm restricted by full stomach
What are possible nutrition recommendations for COPD patients?
High calorie foods first 6 smaller meals per day (high cal + high nutrient) Limit fluids before meals Eat cold foods Rest for 30 minutes before eating Prepare foods in advance
What are activity and exercise goals and recommendations for COPD patients?
Upper extremity training is good
Regular exercise and developing endurance is important
Take breaks
Work up to walking for 15-20 minutes per day, 3 days a week)
Define cystic fibrosis
Recessive genetic disease that causes excess mucous production in lungs, GI tract, and reproductive tract due to exocrine gland dysfunction
Respiratory manifestations of CF
Wheezing respirations Dry, non-productive cough Finger clubbing Hemoptysis Dyspnea Frequent infections Difficulty breathing Cor pulmonale
GI manifestations of CF
Bulky/loose/foul smelling stools Voracious appetite early in disease and no appetite as it progresses Weight loss Failure to thrive Abdominal distension Fat soluble vitamin deficiency Constipation Decreased albumin Hyponatremia
Steatorrhea
Oily, fatty, foul smelling stools often seen in CF patients
Azatorrhea
Excess discharge of nitrogenous substances in feces and urine due to decreased pancreatic enzymes (often found in CF)
Reproductive changes in CF
Delayed puberty/infertility
Normal sperm production but no vas deferens development
Thickened cervical mucous leading to difficulty conceiving
Irregular menstruation
Complications associated with CF
Bone disease Sinus disease Liver disease Renal disease Lung infections Respiratory failure Diabetes Pneumothorax HTN
Goal for client with CF
Adequate airway clearance
Reduced respiratory infection risk factors
Adequate nutrition (may need lots of calories)
Ability to do ADLs
Recognize and treat complications
Active participation in treatment regimen
What are treatments to manage respiratory complications of CF?
Aerosol/nebulizer treatment
Bronchodilators
Breathing exercises
Percussion/pummeling to loosen secretions
What do most CF patients die from?
Complications of respiratory infection
What is an acapella?
Airway clearance device for CF patients
What are treatments to mange GI complications of CF?
Pancreatic enzyme replacement
Adequate nutrition intake
Upright position after eating
Fat soluble vitamin and salt supplementation
What are nursing considerations/recommendations related to CF patients marrying and having children?
Genetic counseling is recommended
Shorter life span
Reduced ability to care for children
