Asthma/COPD/Infectious Resp illness

Question 1

Managing Asthma

Answer 1

Assessment: vital signs, respiratory assessment, peak flow readings

Interventions: Meds, high fowlers, O2, keep pt calm, pursed lip breathing, teaching

Meds: Bronchodilators, Leykotriene inhibitors, corticosteroids

Question 2

Asthma Symptom Progression

Answer 2

Well-managed
No limits or daytime symptoms

Mild-Moderate symptoms
Frequent cough
Night-waking to cough
Increased wheezing
Gradual increase in activity tolerance

Severe symptoms
Rescue meds not effective
Significant difficulty in breathing
Increased wheezing, uncontrollable cough
cyanosis

Life-threatening symptoms
Retractions in intercostal muscles
Severe distress
Rapid breathing, no wheezing (no air exchange)
Meds not effective

Question 3

Asthma self management

Answer 3

Knowing triggers
peak flow meters
meds
avoiding illness
medic alert bracelet
action plan

Question 4

COPD Pathophysiology (Chronic bronchitis and emphysema)

Answer 4

Mucus hypersecretion
Cilia dysfunction
Airflow limitation
Hyperinflation of lungs
Alveolar destruction
Loss of elastic recoil
Gas exchange abnormalities
Cor pulmonale (R side HF)
Systemic effects

Question 5

COPD vs Asthma clinical features

Answer 5

COPD onset later in life than asthma

COPD caused by smoking, asthma not.

Clinical symptoms persistent with COPD but not asthma. Asthma is variable.

Sputum production often with COPD. Sputum production infrequent with Asthma.

Spirometry may improve, but never normalize with COPD.
Spirometry findings often normalize with asthma.

COPD has progressive worsening with exacerbations. Asthma is stable with exacerbations.

Question 6

COPD signs/symptoms/grading

Answer 6

Intermittent cough that gradually worsens, sputum production, increased dyspnea (esp on exhalation), lung infections, weight loss common.

Grade 1: Breathless with strenuous exercise

Grade 2: SOB when hurrying on level or walking on hill

Grade 3: Walks slower than people of same age. Has to catch breath

Grade 4: Stops for breath after 100 yards

Grade 5: Too breathless to leave house. Breathless when dressing

Question 7

Testing for COPD

Answer 7

Spirometry/Pulmonary function test

Arterial blood gas

Chest X-ray

Question 8

Respiratory medications

Answer 8

SABA - Short Acting Bronchodilators
•Beta-adrenergic agonists (salbutamol)
•Anticholinergics (Atrovent/ipatropium)

LABA - Long-acting bronchodilators
•Beta-adrenergic agonists (Advair)
•Anticholinergics (Spiriva)

ICS - Inhaled corticosteroids

OCS - Oral corticosteroids

Question 9

Meds for respiratory management

Answer 9

Rescue/ Symptom Relief:
SABA: Short Acting Beta-Adrenergic Agonists (Salbutamol)

Maintenance

Anticholinergics/SAMA: Short-acting bronchodilator effect (Atrovent/ipratropium)

LABA: Long-Acting Beta-Adrenergic Agonists: Foradil, Serevent

Inhales corticosteroids: Flovent, Pulmucort

Question 10

Salbutamol side effects

Answer 10

Tremors, nervousness, tachycardia

Question 11

Anticholinergic / SAMA (Atrovent) side effects

Answer 11

Dry mouth, cough

Question 12

LABA - Long acting adrenergic agonist side effects

Answer 12

Tremor, nervousness, tachycardia (same as short acting)

Question 13

Inhales Corticosteroid Side Effects

Answer 13

Increased appetite, mood, skin or menstrual changes, immunosuppressant

Question 14

COPD and Asthma nursing interventions

Answer 14

Oxygen therapy

Humidification

Dyspnea management: breathing exercises, coughing

Med education

Nutrition

Pulmonary rehab

Smoking cessation (most important for COPD and asthma management)