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Med Surge 1 - Exam 1 > Asthma & COPD > Flashcards

Asthma & COPD Flashcards

1
Q

What is the first thing you should do if your pt is having trouble oxygenating?

A
  • raise HOB

- turn up / apply O2

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2
Q

What is asthma?

What can happen with repeated attacks?

A
  • chronic condition with intermittent and reversible obstruction of airway d/t inflammation and hypersensitivity
  • repeated attacks can lead to permanent damage to airway = enlarged epithelial cells and changes in bronchiole smooth muscle
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3
Q

Describe inflammation and hypersensitivity in relation to asthma?

A
  • inflammation occurs in the lumen causing obstruction inside the airway
  • hypersensitivity causes constriction of bronchial smooth muscle narrowing the outside of the airway (=bronchospasm)
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4
Q

What are the 4 hallmark sx of asthma?

A
  • wheezing
  • SOB / dyspnea
  • chest tightness
  • coughing
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5
Q

What are some s/s of an acute asthma attack?

A
  • audible wheeze
  • inc RR
  • use of accessory muscle
  • prolonged exhalation : d/t air trapping
  • hypoxemia –> hypoxia
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6
Q

What should the normal PaO2 range be for someone who is diagnosed as having asthma, but has no other lung problems?

A

80 - 100 : may be below this during an attack

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7
Q

How does the PaCO2 change throughout the course of an asthma attack?

A
  • Early : CO2 will be low –> still able to blow it off with inc in RR
  • late : CO2 will be high –> can no longer effectively blow off CO2
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8
Q

What test is used to determine the severity of an acute asthma attack?
What test is used to diagnose it?

A
  • Acute : ABG

- Dx : pulmonary function test

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9
Q

What is the criteria to be dx with asthma from a pulmonary function test?

A
  • FEV 15-20% below normal
  • 12% inc in FEV after administration of bronchodilator
  • methacholine : test for hypersensitivity –> induces bronchospasm
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10
Q

What are 4 interventions that can be used for a pt with asthma?

A
  1. personal asthma action plan
  2. edu
  3. drug therapy : knowing when to use what drug
  4. lifestyle modification
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11
Q

What is included in a personal asthma action plan?

A
  • empowerment
  • goals : inc sx free pds, and reduce severity of attacks
  • self assessment : triggers, timing, sx, and reaction to meds
  • medication adjustment s
  • when to call the provider
  • when to call 911
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12
Q

How is a peak flow meter used to determine tx for an asthma pt?
How do you establish baseline?

A
  • Baseline : 2-3 weeks measure BID when sx are well controlled to establish a PR
  • should continue to measure BID
  • if peak flow is 80-100% of PR : ur good
  • if peak flow is 50-80% of PR : take rescue med and recheck
  • if peak flow is < 50% of PR : take rescue med and call 911
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13
Q

What are 9 common triggers of asthma

A
  • cold air
  • dry air
  • NSAIDS & ASA
  • beta blockers
  • small air particles
  • exercise
  • upper resp illness
  • MSG
  • stress
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14
Q

What types of medications are used to tx asthma?

A
  • control therapy : take everyday –> LABA, cholinergic antagonist, corticosteroid
  • rescue meds : SABA, to tx/prop
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15
Q

When is an asthma attack considered an emergency?

A
  • < 50% of PR with peak flow
  • at 50-80% of PR with peak flow but not responding to meds
  • cyanosis
  • nasal flaring
  • retractions
  • trouble talking/walking d/t inc work to breathe
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16
Q

What is status asthmaticus?

A
  • medical emergency
  • asthma attack not responding to tx
  • can lead to pneumothorax –> resp arrest –> cardiac arrest
  • severe labored breathing with use of accessory muscles
  • distended neck veins
17
Q

What is done for tx of status asthmaticus?

A
  • raise HOB
  • O2
  • start and IV
  • bronchodilators : ned
  • IV steroids
  • Epi
  • fluids
  • may require intubation
18
Q

What is emphysema?

What does it cx?

A
  • emphysema : inc proteases that breakdown elastin in the lungs which causes damage to alveoli and small airways
  • cx : hyperinflation and air trapping –> reduced gas exchange and inc work to breathe
19
Q

What is air trapping?

A

when there is a residual volume in the lungs –> cannot exhale completely

20
Q

If a pt who is 22 yo and reports no current or previous use of cigarets or vaping but is dx with COPD, what do you suspect is the cause?

A
  • alpha 1 antitrypsin deficiency

- the lack the enzyme that controls protease activity –> inc breakdown of elastic

21
Q

What is chronic bronchitis?
What is it cx by?
What is it characterized by?

A
  • chronic bronchitis : inflammation of the bronchi and bronchioles
  • cx by : irritants
  • characteristics : mucosal edema, congestion, bronchospasms, inc mucus production
22
Q

Pts with COPD what impaired gas exchange, you would expect __ (high/low) PaO2 and ___ (high/low) PaCO2

A
  • low PaO2

- high PaCO2

23
Q

Why is it important to assess ability to preform ADLs and note general appearance in a pt who has COPD?

A

changes (dec ability) to preform ADLs may indicate disease progression

24
Q

Cor pulmonale is more closely associated with ___ (CB/Em), and is cx by ___

A
  • chronic bronchitis

- inc pressure in the lung and artery d/t congestion

25
Q

A person who experiences significant unintentional weight loss most likely has ___ (CB/Em). The weight loss is explain by __

A
  • emphysema

- there is a large inc in metabolic demand in order to breathe

26
Q

What psychosocial aspects would it be important to address in a pt with COPD?

A
  • anxiety
  • fear of future
  • expenses
  • social support
  • smoking cessation
27
Q

A pt with well managed COPD most likely has a baseline ABG with what general trends (high/low) : pH PaO2 PaCO2 HCO3
What value would change indicating an acute exacerbation?

A
  • pH : normal 7.35-7.45
  • PaO2 : low
  • PaCO2 : high
  • HCO3 : high
  • an acute exacerbation would be indicated by a change in pH
28
Q

Why is it important to collect sputum cultures on a pt who has COPD and is being tx for a resp infection?

A
  • they are treated very often therefore it is best to get a culture so a narrow antibiotics can be used (if appropriate) to help reduce resistance
29
Q

Why would and H&H be high for a COPD pt?

A

their body is trying to compensate for dec perfusion by making more RBCs

30
Q

What test is used to dx COPD

A

pulmonary function test : at risk and FEV???

31
Q

A COPD pt is beginning exercise conditioning, what points should the nurse include in pt edu?

A
  • start slow and incorporate rest pds –> inc activity over time
  • may req inc O2
  • try to exercise 2-3 x / wk
32
Q

When should you suction a pt who has COPD (generally)?

A

only if needed –> very painful for pt

33
Q

What time of day would a pt with chronic bronchitis be able to cough most effectively?
What should also be considered with effective coughing (esp after surgery)

A
  • in AM : mucus builds up over night
  • after hot shower
  • after hot beverage
  • should also consider pain management
34
Q

Why is pursed lip breathing effective?

A

creates pressure to help push the air out of the lungs

35
Q

What is diaphragmatic breathing and how is it helpful

A
  • apply pressure with hand over abd

- allow pt to engage abd muscles to help breathe

36
Q

What is the drive to breathe in COPD pts?
How does this effect their O2 therapy?
What is our goal for O2 therapy?

A
  • drive : hypoxia = O2
  • alter O2 tx to keep their SpO2 b/t 88-92% or <95% (they still need O2)
  • goal is to get them to their home O2 level
37
Q

What type of diet should a person with COPD be on?

A
  • low card
  • high calorie high protein
  • small frequent meals
  • premed
38
Q

What is involved in the coordination of care for a COPD pt?

A
  • home health
  • O2
  • equipment
  • understanding long term health challenges and management
  • goal setting

Med Surge 1 - Exam 1 (6 decks)

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