Care of Patients With Noninfectious lower respiratory problems

Question 1

Asthma Risk Factors:

Answer 1

• Inherited Disorder
• Environmental Factors: Viral infection, Allergens, pollutants
• Excitatory States: Stress, Laughing, Crying
• Aspirin & NSAIDS
• GERD
• Exercise, changes in temperature, strong odors

Question 2

Asthma Pathophysiology: Early Phase

Answer 2

Shortness of breath, chest tightness, wheezing

Question 3

Asthma Pathophysiology: Immune Activation

Answer 3

IgE, Mast cells, chemical mediators

Question 4

Asthma Pathophysiology: Vasodilation

Answer 4

Edema in airway, attempt to dilute the allergen

Question 5

Asthma Pathophysiology: Bronchospasm

Answer 5

narrowing of bronchial tubes by constriction of the smooth muscle around and within the bronchial walls

Question 6

Asthma Pathophysiology also includes Late Phase

Answer 6

Bronchial Hyperresponsiveness, cyanosis (late sign)

Question 7

Asthma Clinical Manifestations

Answer 7

Cough  
Wheezing
Chest tightness
Dyspnea
Nasal flaring
Use of accessory muscles
Cyanosis

Question 8

Nursing Interventions

Answer 8

Auscultate breath sounds
Monitor respiratory pattern
Monitor oxygen saturation
Elevate head of bed
Deep breathe 
Activity
Encourage fluid intake

Question 9

Asthma Treatment

Answer 9

Inhaled Beta2 agonists
Corticosteroids
Anticholinergics
Mast cell stabilizers
Leukotriene modifiers
Oxygen

Question 10

Chronic Obstructive Bronchitis Risk Factors

Answer 10

Chronic productive cough
Smoking
Exposure to air pollution
Older adults
Repeated infections

Question 11

Chronic Bronchitis Pathophysiology:

Answer 11

Irritant triggers:

• Inflammation of airway
• Infiltration of inflammatory cells
• Continuous irritation and inflammation
• Bronchial edema
• Hypersecretion of mucus
• Bacterial colonization
• Airway obstruction: not alveoli
• Air trapping

Question 12

Chronic Bronchitis Clinical Manifestations:

Answer 12

Acute versus Chronic
Productive cough “smoker’s cough”
Decrease exercise tolerance
Wheezing
Shortness of breath
Prolonged expiration

Question 13

Emphysema Risk Factors

Answer 13

Cigarette smoking
Alpha1-antitrypsin deficiency
Air pollution
Occupational chemicals or dust

Question 14

Emphysema Pathophysiology:

Answer 14

Irritant or Alpha 1 antitrypsin deficiency triggers:

• Inflammation of airway
• Infiltration of inflammatory cells: Inhibition of normal endogenous antiproteases
• Increased protease activity
• Destruction of alveolar septa: Loss of elastic recoil
• Blebs
• Bullae
• Air trapping

Question 15

Emphysema Clinical Manifestations:

Answer 15

• Dyspnea on exertion
• Dyspnea at rest
• Anteroposterior diameter of chest enlarges
• Chest hyperresonant sound with percussion
• Cyanosis lips
• Neck vein distention
• Pitting peripheral edema

Question 16

Chronic Obstruction Pulmonary Disease(COPD) Risk factors:

Answer 16

• Primary risk factor = SMOKING
• Air pollution
• Second-hand smoke
• History of childhood respiratory tract infections
• Hereditary

Question 17

COPD stimulates

Answer 17

excessive mucus production

Question 18

COPD causes

Answer 18

• Cough
• Destroy ciliary function
• Inflammation
• Damage to bronchiolar and alveolar walls
• Increased airway resistance secondary to bronchial mucosal edema
• Decreased elastic recoil

Question 19

COPD manifestations:

Answer 19

Easily fatigued
Frequent Respiratory Infections
Use of Accessory to Breathe
Orthopneic
Cor Pulmonale (late in disease) 
Thin in appearance
Wheezing
Pursed lip breathing
Chronic cough
Dyspnea
Prolonged expiratory time
Bronchitis - increased sputum
Digital clubbing

Question 20

Laboratory assessments for all these diseases:

Answer 20

-Arterial Blood Gas (ABG):
Identify abnormal gas exchange, oxygenation, ventilation & acid-base status
-Sputum & WBC:
Acute respiratory infection
-Hemoglobin & hematocrit:
polycythemia
-Electrolytes:
acidosis

Question 21

Diagnostics:

Answer 21

-Chest x-ray:
Rule out lung disease
Check progress of infection or chronic disease
Emphysema – hyperinflation & flattened diaphragm
-Pulmonary Function Test:
Determines lung flow volumes

Question 22

Medications For Treatment of COPD:

Answer 22

-Bronchodilator:
Beta2-agonists (albuterol/ Proventil)
Adrenergic (salmeterol/ Serevent)
Leukotriene antagonist (montelukast/ Singulair)
-Anticholinergic:
Ipratropium bromide (Atrovent)
-Methylxanthines:
Theophylline, Aminophylline
-Corticosteroid:
(fluticasone/ Flovent)
-Glucocorticosteroids:
Prednisone (prednisone/ Deltasone)

Question 23

Other Therapies for COPD

Answer 23

Long term oxygen therapy
Pulmonary hygiene
Deep venous thrombosis
Influenza vaccine
Pneumococcal vaccine
Exercise
Smoking Cessation
Nutrition