Chapter 14. Respiratory Diseases

Question 0

This disease is characterized by abnormal permanent enlargement and destruction of the alveolar air spaces.

Answer 0

Emphysema

Question 1

COPD encompasses two main diseases. What are they?

Answer 1

Chronic bronchitis and emphysema.

Question 2

This condition is characterized by a productive cough for three months in each of two successive years.

Answer 2

Chronic bronchitis

Question 3

The most significant cause of COPD is?

Answer 3

Cigarette smoking

Question 4

What group has had the most number of deaths attributed to COPD.

Answer 4

For the last eight consecutive years it is been women.

Question 5

Symptoms of COPD are often absent early in the disease, delaying diagnosis until the disease has reached a moderate stage. Signs and symptoms may include:

Answer 5

dyspnea on exertion (early) and at rest in advanced. Chronic cough, sputum production, wheezing, decreased breath sounds, increased anterior posterior diameter of the chest, muscle wasting.

Question 6

Diagnosis of COPD is made by?

Answer 6

Pulmonary function tests or PFTs or spirometry Testing.

Question 7

This guideline divides COPD into four stages. Mild, moderate, severe, and very severe, based on S EV one values that range from 80% from mild to 30% for very severe.

Answer 7

The gold guidelines

Question 8

Education is a key component in the management of COPD. What elements of management are central for best outcomes?

Answer 8

Smoking cessation
Exercise
Weight control
Limiting occupational exposure to air pollution and other toxins
Immunizations, adequate nutrition, and pharmacological therapy

Question 9

These medications are the most important rescue medications for acute shortness of breath in both COPD and asthma:

Answer 9

Short acting beta agonists Such as albuterol, levolbuterol,& pirbuterol (maxair).

Question 10

Older adults with ischemic heart disease can develop What from beta agonist, so they should be used with extreme caution.

Answer 10

They can develop angina from the tachycardia caused by these medications.

Question 11

Use of what on the standard inhaler can improve the delivery of the medication to the Lungs?

Answer 11

Use of a spacer.

Question 12

How do inhaled anticholinergics work?

Answer 12

They inhibit vagal stimulation and prevent contraction of smooth muscle In the airway, as well as decrease mucus production.

Question 13

Name a couple of inhaled anticholinergics.

Answer 13

Atrovent (iptratorpium bromide)

Spiriva (tiotropium bromide)

Question 14

Inhaled corticosteroids are indicated in patients who achieve what?

Answer 14

Improvement in FEV1 after a 6 to 12 week trial or who have frequent exacerbations of COPD. Inhaled corticosteroids should be considered if older patients in the severe or very severe categories have suffered more than three COPD exacerbations Within the last three years.

Question 15

Name a couple of inhaled corticosteroids.

Answer 15

Budesonide (pulmicort)

Fluticasone (Flovent)

Question 16

Theophylline may be added to other therapies during times of exacerbations for people with severe respiratory disease. what is the drawback of this medication?

Answer 16

Major drawbacks are the potential for toxicity from multiple drug interactions and reduced clearance in older adults.

Question 17

Supplemental oxygen is useful in patients with resting oxygen saturation of what? by pulse oximetry or PaO2 of what by ABG?

Answer 17

Oxygen saturation less than 88% By pulse oximetry or PaO2 less than 55 mm Hg by ABG. It is also useful in patients with symptoms of right-sided heart failure, even with slightly higher saturation levels.

Question 18

Are patients with COPD good candidates for lung transplantation surgery?

Answer 18

In general, patients age 65 or older are not candidates for lung transplantation. Neither lung volume reduction surgery nor lung transplantation is appropriate for most patients.

Question 19

This is a chronic inflammatory disorder of the airways characterized by variable and recurring symptoms, including airflow limitation, bronchial hyper responsiveness, and Underlying inflammation.

Answer 19

Asthma

Question 20

Signs and symptoms of an asthma attack include:

Answer 20

Dyspnea, wheezing, increased respiratory rate, palpitations or tachycardia, use of accessory muscles, diaphoresis, pulses paradoxes.

Question 21

Common asthma triggers include?

Answer 21

Allergens such as dust and pollen, environmental changes such as heat and cold, smoke, strong odors or perfumes, and respiratory infections.

Question 22

In severe persistent asthma and oral corticosteroids are used, Gerontological nurses should be aware that systemic corticosterone I can have what effect on older adults?

Answer 22

These include hypertension, elevated blood glucose, cataracts, osteoporosis, and especially in patients with underlying cognitive impairment, confusion and agitation.

Question 23

Name two medications that block the action of leukotrienes. Leukotrienes are the inflammatory mediators that cause asthma symptoms.

Answer 23

Singular and Accolate (montelukast & zafirlukast)

Question 24

This is an inflammatory illness of the lung, resulting in alveolar fluid accumulation. Can be caused by bacteria, viruses, fungi, or parasites.

Answer 24

Pneumonia, The leading cause of infectious deaths in The United States.

Question 25

What percentage of deaths by pneumonia occur in persons 65 years of age and older?

Answer 25

Over 50%

Question 26

Most pneumonia is caused by?

Answer 26

Micro aspiration of bacteria and viruses that colonize the oropharnyx

Question 27

The clinical presentation of pneumonia in older adults is typically different From that of the general population. Name some of the signs and symptoms.

Answer 27

Confusion, falls, anorexia, decreased functional ability, dehydration, tachyapnea, and exacerbation of other illnesses such as diabetes or coronary artery disease.

Question 28

This simple scoring system helps the clinician decided if an older patient should be admitted to the hospital.

Answer 28

The CURB - 65. Points are assigned for each of the five factors, including presence of confusion, blood urea nitrogen levels, respiratory rate, systolic blood pressure, and age. A total score of three, four, or five suggest the patient should be admitted to the hospital.

Question 29

Pneumonia is divided into two categories. Name them.

Answer 29

1. Community acquired pneumonia.

2. Hospital acquired pneumonia. Occurs around 48 hours following admission to hospital or long-term care facility

Question 30

What are the parameters for the pneumonia vaccine?

Answer 30

One vaccine at age 65 generally provides coverage for a lifetime, but a booster vaccine is needed for some high-risk people. Medicare will also cover a booster vaccine for high-risk people if five years has passed since their last vaccine.

Question 31

Name some nursing interventions that are appropriate for patients with pneumonia.

Answer 31

Position and semi Fowler’s
Encourage coughing and deep breathing
Maintain hydration, but monitor fluid status
Monitor vital signs and oxygenation
Position with the good lung down to promote perfusion to the good long and drainage of secretions from the affected lung

Question 32

Hospitalized patients with pneumonia should be treated until they reach the following clinical indicators.

Answer 32

Temperature less then 100 Fahrenheit or 37.8 Celsius
HR 90
O2 > 90%, Ability to maintain oral intake.

Question 33

Some common over-the-counter treatments for allergic rhinitis include?

Answer 33

Antihistamines, oral decongestants, intranasal anticholinergics, intranasal glucocorticoids, intranasal cromolyn sodium, and leukotriene modifiers.

Question 34

Risk factors for lung cancer include?

Answer 34

Cigarette smoking, marijuana use, chronic exposure to talc, exposure to arsenic, ether, or chromates, exposure to coal oven fumes, Nickel,or petroleum products. Exposure to radon, Asbestos, vitamin A deficiency, vitamin E use in person who smokes tobacco cigarettes.

Question 35

The risk of lung cancer persists for how many years after the individual stop smoking?

Answer 35

For 15 years. After that the risk is similar to that of a non-smoker.

Question 36

Some common signs and symptoms of lung cancer include?

Answer 36

Anorexia, weight loss, or fatigue. Hoarseness, shoulder pain, dysphagia, head or neck swelling, hemoptysis, or recurring pneumonia and bronchitis with persistent cough.

Question 37

What may be performed to confirm the diagnosis of lung cancer?

Answer 37

Bronchoscopy is used to confirm the diagnosis. If metastatic disease is suspected, total body bone scan and MRI of the brain are done.

Question 38

This type of lung cancer is linked to cigarette smoking and tends to occur in the central airways and bronchi, making it difficult to detect until very late in the disease.

Answer 38

Squamous cell cancers.

Question 39

This type of lung cancer usually appears in the peripheral lung fields and are often found incidentally on a chest x-ray. These tumors appear as small round, well Demacerated lesions on the x-ray, often referred to as coin lesions.

Answer 39

Adenocarcinomas

Question 40

Lung cancers can be divided into two parts, name them.

Answer 40

Small cell, also called “oat cell,” and non-small cell. The non-small cell cancers are further subdivided into squamous cell, adenocarcinoma which is the most common, and large cell or anaplastic.

Question 41

Factors that have correlated with adverse prognosis with lung cancer include:

Answer 41

Presence of Pulmonary symptoms, large tumor size greater than 3 cm, metastasis to multiple lymph nodes, vascular invasion.

Question 42

Tuberculosis is transmitted by?

Answer 42

Droplet particles aerolyzed from the cough or sneeze of an infected person.

Question 43

How many bacilli does it take to infect a person?

Answer 43

It takes several hundred bacilli to infect an immunocompetent person, yet only a few bacilli to infected persons in an immune compromised state.

Question 44

Active TB occurs when?

Answer 44

When the person is exposed and develops the illness. The Bacillus causes inflammation and necrosis of the lung parenchyma.

Question 45

Gerontological nurses should suspect tuberculosis in any older patient who Presents with?

Answer 45

Night sweats, atypical pneumonia, chronic low grade fever, nonproductive cough, hemoptysis, and Anorexia or weight loss. Tuberculosis incidence is highest among individuals age 65 and older, especially those who have pre-existing lung problems.

Question 46

Because TB skin testing often is unreliable in older adults, what process should be used.

Answer 46

A two-step process must be carried out to achieve accurate results.

Question 47

How is TB treated?

Answer 47

A person who is asymptomatic is treated with six months of isoniazid (INH) In select cases as a prophylaxis against active disease.

Question 48

A patient who is symptomatic with TB is referred to an infectious disease specialist. The usual regimen of drugs includes?

Answer 48

INH, Rifampin , pyrazinamide, ethambutol.

Pyridoxine (vit B6) is Also given to prevent resulting peripheral neuropathy from The INH.

Question 49

For drug resistant tuberculosis the course of treatment can last?

Answer 49

18 to 24 months with the four drugs to which the Bacillus is sensitive. Multi drug resistant TB is approximately 50 to 60% curable compared with 95 to 97% cure rate for people with drugs Susceptible TB.

Question 50

40% of the new cases of tuberculosis in united states occurred and what group?

Answer 50

Foreign-born individuals

Question 51

Older adults being treated for tuberculosis should have what monitored monthly?

Answer 51

LFTs, As older adults are more susceptible to INH hepatitis then younger persons

Question 52

The nurses main role in the care of patients with tuberculosis is?

Answer 52

Education about the disease process and how it is transmitted, and in informing patients and family members or caregivers about the importance of taking all of medications and of good nutrition.

Question 53

Nursing consideration for isoniazid

Answer 53

No alcohol

Question 54

Nursing education for rifampin

Answer 54

May turn urine, saliva, in tears orange. Makes the patient photosensitive.

Question 55

Nursing consideration for pyrazinamide

Answer 55

Thrombocytopenia and nausea are common

Question 56

Streptomycin is not a first-line drug for the treatment of tuberculosis but maybe added if patient is intolerant to others. What are some symptoms to be alerted to?

Answer 56

Tinnitus and loss of hearing