Chapter 31 - Obs. Pulmonary Dis - Exam 2 Flashcards
what is bronchiectasis
chronic condition characterized by abnormal widening and inflammtion fo the airways in the lungs known as bronchi
symptoms of bronchiectasis
chronic cough, large amounts of mucus, shortness of breath, chest pain, fatigue
treatment of bronchiectasis
managing symptoms, preventing complications
chest physiotherapy: postural drainage, percussion, and vibration help loosen and clear secretions from the airways
pnemonia vaccine
surgery to remove affected lung
what is cystic fibrosis
genetic disease affecting many organs, lethally impairing pulmonary function
mucus plugs up glands causing atrophy and organ dysfunction
pathology of cystic fibrosis
mutation of CFTR gene. when this gene is defective or absent it results in thick sticky mucus buildup in various organs, leading to a range of symptoms and compliations
pathology of cystic fibrosis to the lungs
thick mucus accumulates in the airways, obstructing airflow and trapping bacteria. this environmet promotes recurrent lung infections inflamaton and progressive lung damage
cystic fibrosis can lead to
bronchiectasis
cystic fibrosis is characterized by
abnormal mucus production, respiratory symptoms including chronic cough, frequent lung infections,wheezing, shortness of breath pancreatic insufficiency, digestive issues, SALTY SKIN, infertility
patients with CF will have __________enzyme deficiency
pancreatic
sweat chloride analysis can test for
CF
nurses role pt w/ CF
education, support, monitor resp status, nutritional status, VS, oxygen levels, lung function tests, meds
nurse: medical management of CF
mucolytics
pancreatic enzyme replacement
etc
preventive/maintenance therapy of CF
chest physiotherapy
exercise
COPD is a term that describes
a term that can be used to describe a range of pulmonary conditions including chronic bronchitis, emphyema, irreversible asthma
what is asthma
chronic inflammatory disease of the airway that causes intermittent hyper responsiveness, mucosal edema and mucus
patho asthma
when an allergen activates a mast cell it releases histamine and other chemicals and creat inflammation leading to inc blood flow, smooth muscle contraction and bronchoconstriction
asthma is characterized by
chest tightness, wheeze, increased RR, SOB, inc cough, use of accessory muscles, barrel chest, long breathing cycle, cyanosis, hypoxemia
what is an asthma action plan
personalized asthma action plans that outline specific steps to take based on asthma symptoms, peak flow measurements, meds
what is a meter dose inhaler
commonly used to deliver bronchodilators to relieve acute asthma symptoms or rescue meds during asthma attacks
what is a dry powder inhaler
unlike metered-dose inhalers, which deliver meds in the form ofa pressurized aerosol spray, DPIs deliver meds in the form of a dry powder
commonly used to deliver bronchodilators and corticosteroids for long term control of asthma and copd symtoms
what is a nebulizer
delivers meds such as bronchodilators or corticosteroids in the form of a fine mist, used for a range of conditions.
easy to use, can deliver large volume of meds over extended periods
what is status asthmaticus
severe and potentially life threatening form of asthma exacerbation that doesnt respond adequately to standard asthma treatments such as bronchdilatros and corticosteroids
characteristics of status asthmaticus
wheezing coughing chest tightness SOB which can rapidly escalate to resp failure if not treated promply and aggressively
nurse role: status asthmaticus
immediate intervention to address airway obstruction and improve oxy
treatment of status asthmaticus
short acting beta adrenergic agonist nebulizzer, steroids
what is chronic bronchitis
type of copd, inflammation and irritation of the brochia tubes leading to persistent cough and excessive mucus production
risks include smoking
symptoms of chronic bronchitis
persistent productive cough 3 month to 2 years, excessive mucus production, airway inflammation
treatment of chronic bronchitis
relieving symptoms, improving lung function, preventing exacerbations, reducing complications
quit smoking
inhaled corticosteroids, pulmonary rehab, oxygen therapy
what is emphysema
irreversible tissue damage, loss of lung elasticity and hyperinflation of the lung, overstretchingand enlargement of alveoli, collapse of small airways bonchioles
symptoms of emphysema
dyspnea, wheezing, chronic cough, sputum, symptoms worsen overtime
what is panlobular emphysema
uniform enlargement of airspaces aka the alveoli throughout the entire lung lobule
what is centrilobular emphysema
primarily affects the upper lobes of the lungs and is associate with smoking
what is a bullectomy
procedure to remove abnormally large air spaces or air filled sacs that develop within the lung tissue r/t emphysema or COPD
what is lung volume reduction surgery
treat severe emphysema
traditionally performed by making incision in chest to access the lungs, damaged areas of lung tissue are removed. aims to improve lung function by reducing hyperinflation and improve respiratory mechanics
what is chest physiotherapy
set of techniques aimed at improving lung function and clearing mucus or secretions from airways
chest percussion
chest vibration
postural drainge
breathing exercises
complications of oxygen therapy
oxygen toxicity
absorption atelectasis
fire hazard
drying of mucus membranes
oxygen induced hypoventilation
low flow oxygen therapy
flow rate of oxy is lower than the patient’s peak inspiratory flow rate. continuous or intermittent supply of oxy
- nasal cannula
- simple face mask
patients may have COPD, congestive heart failure, pneumona
the flow rate of oxygen delivered via nasal cannula is
1 to 6 liters per minute
the flow rate of oxygen via face mask is
5 to 10 liters per minute
the mask delivers a higher concentration of oxygen compared to nasal cannula
nursing responsiblity r/t oxygen therapy
monitored closely for signs of oxygen toxicity, hypoventilation, etc
high flow oxygen therapy is
therapy that delivers a high flow rate of heated and humidified oxygen to patient with respiratory insufficiency.
unlike low flow which delivers a variable oxygen concentration depending on the patient’s breathing pattern, high flow oxy therapy delivers a constant and controlled concentration of oxygen, regardless of patient’s inspiratory flow rate
typically delivered through a “high-flow nasal cannula”
high-flow oxygen therapy flow raes
20 to 60 liters per minute or higher
heated and humidified oxygen
the oxygen delivered through a high flow nasal cannula is heated and humidified to minimize drying and patient comfort
what is a non-invasive positive pressure ventilation
type of ventilatory support that delivers mechanical ventilation to the lungs without the need for invasive procedures. it is typically delivered thru a mask or nasal interface providing continuous positive airway pressure CPAP or BIPAP to support breathing
low-flow nasal cannula flow rate
1 to 6 L/min
low-flow simple face mask flow rate
5 to 10 L/min
low-flow partial rebreather mask flow rate
8 to 15 L/min
low flow non-rebreather mask flow rate
10 to 15 L/min
high-flow venturi-mask flow rate
4 to 15 L/min
high-flow trach collar O2 and T tube flow rate
10 to 15 L/min
high-glow nasal cannula flow rate
20 to 60 L/min
trach care assessment
tube inspection, skin, stoma, respiratory rate/effort/oxy sat levels, secretions management
trach - preventing aspiration
positioning, food/liquid consistency, monitoring
what is the hallmark characteristic of bronchiectasis
Ectasis” is a term derived from the Greek word “ektasis,” which means expansion or dilation. In medical terminology, it is used to describe the abnormal enlargement or dilation of a tubular structure in the body, such as blood vessels or hollow organ
thus,
permanent abnormal dilation of medium-sized bronchi
why doses it matter if the bronchi are over dilated?
inflammatory changes weaken the bronchial wall, therefor airway damage, the walls can develop colonies of microorganisims leading to infection
when the walls of the bronchi are injured, the mucociliary mechanisim is damaged (that escalator thing) and again this leads to infection
the main points of bronchiectasis
the bronchi are over dilated leading to mucus/bacteria/infection accumulation that is nearly impossible to cough out
there is no cure
cystic fibrosis is a type of
bronchiectasis
main points of cystic fibrosis
-genetic disease
- increased abnormally thick, sticky mucus production
- GI, pancreas issues
- recurrent resp infections, persistent cough
-
what is the gold standard for diagnosing CF
the sweat chloride test
main points of asthma patho
- reversible airflow obstruction, usually temporary attacks
- chronic inflammatory disease
- bronchoconstriction, mucus, edema
- bronchial hyperreactivity
what are the risk factors for asthma
genetics and environment
what is “silent chest”
if the patient with asthma has been wheezing, followed by sudden absence of a wheeze and the patient is struggling to breathe this is a life threatening emergency
drug therapy for asthma can be complex. usually divided in to two types what are they
- short term “rescue” inhaler
- preferred reliever agents
where as asthma is reversible and temporary, COPD is progressive and _______ airflow limitation
persistent
copd patho main points
- chronic inflammation of lungs
- airflow limitation not fully reversible during forced exhalation
- main cause is the loss of elastic recoil and airflow obstruction from mucus hypersecretion, mucosal edema, and bronchospasm
true or false: status asthmaticus is a mild form of asthma
false!
this is a life threatening emergency, most extreme form of asthma
s/s hypoxia, hypercapnia
patient is unresponsive to treatment with bronchodilators and corticosteroids
patient will most likely need immediate mechanical ventilation
main points chronic bronchitits
- inflammation of bronchi caused by chronic exposure to irritants such as cigarette smoke
- constant irritants produce mucus
- bronchial walls become thickened, and lumen narrow
-irreversible tissue damage
main points emphysema
-destruction of alveoli, lungs loose elasticity and alveoli hyperinflate
- overstretching and enlargement of alveoli into bullae
there are 2 types of emphysema what are panlobular and centrilobular what is the difference
panlobular - uniform destruction of functional unit of the resp system where gas exchange occurs; bronchioles, alveolar ducts and alveoli
centrilobular - primarily affects the upper lobes of the lungs
what is a bullectomy
1 or more very large bullae are removed. this help WOB.
what is lung volume reduction
surgery that reduces the size of the lungs by removing some of the diseased tissue so that remaining healthy tissue can thrive
oxygen therapy is a common treatment for
hypoxemia and hypoxia
we classify O2 delivery systems as low flow or high flow. Low flow delivery devices are appropriate for patients who are ____,____,_____
awake, alert, and spontaneously breathing with a stable intact respiratory drive
high flow o2 delivery devices differ because they deliver a _____O2 concentration independent of the patients respiratory rate or pattern
fixed
high flow systems provide O2 that ____ or _____ the patient’s resp demand
meet, exceed
patients requiring high flow therapy are also awake, alert, and spontaneously breathing but have _____o2 requirements that low flow devices cannot meet
higher
examples of low flow devices include
nasal prongs, simple masks, non rebreather maskse
examples of high flow masks include
venturi mask and high flow nasal cannula
we all know what a god damn nasal cannula (low flow) is but tell me about it anyway
most commonly used
used for patients requiring low o2 concentrations
achieves o2 concentrations of 1 L/min to 6 L/min
Okay, main points of partial and non-rebreather masks
used for short term therapy for patients with higher O2 needs
achieves o2 concentrations of 10-15 L/min
o2 flows into reservoir bag and mask during inhalation
bag allows patient to rebreathe 1/3 of oxygen rich air
- vents stay open on mask
high flow venturi mask main points
- mask can deliver precise, high flow rates of o2
low, constant o2 concentrations, used for COPD patients
true or false: smoking is recommended around o2 cannisters
false that shit will blow up
what the hell is O2 toxicity
prolonged exposure to a high level of o2, can result in severe inflammatory response which can lead to pulmonary edema, shunting of blood, hypoxemia, pulmonary edema
the alveoli contain many different gases, including o2, co2, and nitrogen. Nitrogen helps maintain the size, shape and structure of the alveolus.
if the brochial tubes become obstructed (mucus) the exchange of co2 and o2 cant occur.
nitrogen will eventually move out of the alveolus and into the bloodstream
this is called “nitrogen washout”
as a result, the alveoulus collapses, and absorption atelectasis occurs.
what does this result in?
absorption atelectasis
______ helps maintain the size, shape, and structure of the alveolus
nitrogen
okay we are almost there,
clean the o2 device. why would we clean it?
because a bunch of bacteria will grow on it and lead to infection
okay,
chemo receptors control the drive to breathe. They respond to co2 and o2 concentrations in the blood. as we know, normally an increase in co2 in the blood is a major stimulant of the resp center
however, patient with COPD develop a TOLERANCE for higher co2 levels. as a result the resp loses it sensitivitey to high co2 levels.
For these patients a major drive to breathe is hypoxemia (low oxygen in the blood). If we are giving a bunch of oxygen and its getting in the patient blood then we have some problems.
as a result, there is a concern about the dangers of giving o2 to a copd patient and reducing their stimulus or drive to breathe
what is this called
oxygen induced hypoventilation
or co2 narcosis
co2 retention is also known as
hypercapnia
what is hypercapnia
how can it happen
abnormally high level of CO2 in the blood, the body is unable to eliminate co2 efficiently leading to its accumulation in the blood stream
COPD, CNS disorders, meds, severe anemia
nasal cannula flow rate
(low flow)
1 L/min to 6 L/min
simple face mask flow rate
(low flow)
6 -12 L/min
partial rebreather flow rate
(low flow)
10 to 15 L/min
non rebreather flow rate
low flow
10-15 L/min
tell me again about a high flow venturi mask. who would find it beneficial?
mask can deliver precise high flow rate of o2
low, constant o2 concentration for copd patients
can be humidified
its uncomfortable
tell me about a tracheostomy collar, how does it work, who would use this?
collar attaches to neck, delivers humidity and o2, needs to be cleaned q4hr and prn to prevent aspirtation
high flow nasal cannula flow rate
up to 60L/min!
the endotracheal tube is a long flexible plastic tube that secures a patients airway when they need mechanical ventilation. An ET consists of a standard adaptor, cuff, pilot balloon along the length of the tube
the cuff pressure needs to be checked every 8 hours
what should the pressure be?
15-22 mmHG
which condition may develop if severe pneumonia is left untreated?
a. atelectasis
b. hemoptysis
c. bronchiectasis
d. chronic bronchitis
c. bronchiectasis
_______ is a complication of asthma due to hyperinflation of the lungs and increased dead space
atelectasis
what is the primary cause of brochiectasis
untreated or delayed treatment of bacterial lung infections
which diagnostic test will help to determine the condition of a patient that has a productive cough, perfuse sweating, local hypoxia, and arteriolar vasoconstriciton?
a. sweat chloride test
b. spirometry
c. tomography
d. hemoglobin test
a. sweat chloride test
this person may have CF
