Clients w/ Respiratory Alterations - Exam 2 Flashcards
Condition characterized by excessive mucous production resulting in chronic productive cough for at least 3 months in each of 2 consecutive years
Chronic bronchitis
Why is mucous production increased in bronchitis?
-increased number and size of goblet cells
-enlarged submucosal glands
-dysfunction of cilia
-stimulation from inflammatory mediators
Condition characterized by abnormal distention of airspaces beyond the terminal bronchioles and destruction of the walls of alveoli
Emphysema
The physiologic changes of emphysema lead to what?
Increase in dead space lead to impaired oxygen diffusion - hypoxemia and hypercapnia
Where is inflammation found in COPD?
airways
lung parenchyma
pulmonary blood vessels
COPD is an air _____ disease
Trapping
Airflow is not fully what in COPD?
Reversible
What does it mean for airflow to not be ‘fully reversible’ in COPD?
Air gets trapped in the bottom of the lungs during exhalation
What causes airflow limitations in COPD patients?
loss of elastic recoil
Airflow obstruction in COPD is due to what factors?
Hypersecretion of mucous
Mucosal edema
Bronchospasm
Risk Factors for COPD
Smoking
Occupational chemicals and dust
Air pollution
Recurring respiratory infections
Alpha-antitrypsin deficiency
Low SES
What diagnosis should be considered with any patient who is over 40 years old with a history of 10 or more pack years OR after 20 pack years?
COPD
How does nicotine affect the body?
Stimulates SNS
Decreases amount of functional hemoglobin
Increases platelet aggregation
Compounds CAD complications
How does smoking effect the respiratory tract?
Hyperplasia of goblet cells
Lost/decreased ciliary activity
Destruction and dilation of alveoli
Inflammation
Decreases oxygen carrying capacity
Effects of Aging on Respiratory System
Loss of elastic recoil in lungs
Stiffening of chest wall
Decreased exercise tolerance
Lungs are smaller and rounder
Number of functional alveoli decreases
COPD Clinical Manifestations
Chronic cough
Sputum production
Dyspnea
Accessory muscle use
Inefficient breathing pattern
Weight loss
Exercise intolerance
Wheezing
Decreased breath sounds
Crackles
Tripod position
Pursed lip breathing
Prolonged expirations (blowing off CO2)
What COPD manifestation usually prompts patients to seek care?
Dyspnea
COPD Assessment and Diagnostics
H&P
ABG
CXR or CT
Alpha-antitrypsin screening
PFTs
Patients with COPD have an increased ______ volume
residual
The FEV1 FVC ratio must be what percent to diagnose COPD?
<70%
What will a CXR or CT show in a patient with COPD?
flattened diaphragm
COPD can lead to what complications
Exacerbations
Respiratory insufficiency
Respiratory Failure
Pulmonary hypertension
PNA
The result of pulmonary hypertension in which the right side of the heart is dilated or hypertrophied
Cor pulmonale
Cor pulmonale is a result of what?
PAH
Cor pulmonale eventually leads to what?
R sided HF
What 3 muscles are involved in breathing?
- Diaphragm
- Rib cage muscles
- Abdominal muscles
What is responsible for the act of breathing?
Pressure gradient
Clinical manifestations of cor pulmonale
Dyspnea with possible crackles
JVD
Hepatomegaly w/ RUQ tenderness
Peripheral edema
Weight gain
When pt’s with COPD are experiencing difficulty in breathing, what is the best position?
Tripod
Susie presents to the ER complaining of severe dyspnea and weight gain of 5 lbs in the last 4 days. She has a history of COPD, HTN, and diabetes. Auscultation of her lungs reveals crackles and she displays obvious signs of JVD. Her RUQ is tender upon light palpation, what do you as the nurse think Susie may be experiencing?
Cor pulmonale
In patients that have chronic COPD, what lab value can be elevated due to the lack of O2?
Hemoglobin
What diagnostics would be performed on Susie to confirm our diagnosis of cor pulmonale?
CXR
R sided cardiac cath (gold standard)
Echo
BNP levels
How is cor pulmonale treated?
Tx underlying cause (COPD)
Meds to decrease BP
Diuretics to reduce fluid retention
Oxygen
A patient with COPD is experiencing sudden dyspnea with SOB, cough, and increased sputum with purulence - what is this?
An exacerbation
What system is activated due to pH changes in COPD, in response to decreased left ventricular output? And what is the result?
RAAS causing fluid retention
How do you determine the severity of a COPD exacerbation?
Use of accessory muscles
Central cyanosis
Definition: When your body makes too many RBC’s, thickening your blood, making you more susceptible to blood clots.
Polycythemia
How do you treat a COPD exacerbation?
Short-acting bronchodilator or nebulizer
Steroids
Abxs
Oxygen
Type of ventilation that on inspiration delivers more air pressure, on expiration, the machine reduces the air pressure.
BIPAP
COPD acute respiratory failure is caused by
Exacerbations
Overuse of sedatives, opioids, or benzos
Surgery or painful illness
Type of ventilation that delivers PEEP (positive end-expiratory pressure) but also maintains the set pressure t/o the respiratory cycle.
CPAP
What should a patient with COPD experiencing anxiety r/t SOB do?
Pursed lip breathing
What condition causes reduced FVC & FEV1?
COPD
What do bronchodilators specifically allow to be increased in COPD patients?
FEV1
What is the goal of oxygen therapy in a COPD patient?
Keep sats above 90% or PaCO >60 mmHg
What are the GOLD classifications of COPD?
GOLD 1: Mild FEV1 >= 80% pred
GOLD 2: Moderate 50% <= FEV1 <80% pred
GOLD 3: Severe 30%<= FEV1 <50% pred
GOLD 4: Very Severe FEV1 <30% pred
Long-term oxygen therapy improves what for COPD patients?
Survival
Exercise capacity
Cognitive performance
Sleep in hypoxemic patients
What ventilator support is used when a pt. has acute respiratory failure?
Intubation
If incubation lasts longer than 7-10 days, what should be inserted?
Trach
How can low-flow oxygen been delivered to patients?
Nasal cannula
Non-rebreather
Simple mask
What are some examples of subjective data in pts with lung cancer?
-Fatigue
-Dyspnea
-Pain (chest, shoulder, arm, bone)
-HA
-Smoking hx (pack years)
-Family hx of lung cancer
-Dysphagia
-Weight loss (unintended)
-Anorexia, nausea, vomiting
-Exposure to carcinogens
-Secondhand smoke, asbestos, radon
How can high-flow oxygen been delivered to patients
Venturi mask
Heated high flow nasal cannula
Trach mask
How is humidification supplied in oxygen?
Nebulizer
Vapotherm
bubble-through humidifier
How are pack years calculated?
of years smoking X # of packs per day
Why do we maintain COPD patients oxygen sats between 88%-90% and not 100%?
If oxygen is at 100%, it will decrease the patient’s respiratory drive meaning they cannot breathe on their own
Complications of oxygen therapy
Combustion
CO2 narcosis
O2 toxicity
Absorption atelectasis
Infection
What are examples of objective data for pts with lung cancer?
-Fever
-Lymphadenopathy
-Jaundice
-Edema
-Clubbing
-Adventitious breath sounds
-Pleural effusions
If nitrogen is depleted from the alveoli, what can develop?
Absorption atelectasis
What are some health promotions for pts with lung cancer?
-Avoid smoking
-Promote smoking cessation programs
-Support education & smoking policies
-Smoke-free environments
-Model health behavior by not smoking
Surgical therapy options for COPD pts
Lung volume reduction surgery (LVRS)
Bronchoscopic lung volume reduction surgery
Bullectomy
Lung transplantation
A large air sac that forms from destroyed alveoli
Bullae
Surgery in which diseased lung is removed to enhance performance of remaining lung tissue
LVRS
What are some post operative complications for lung cancer pts?
-Respiratory failure
-Pulmonary edema
-Arrhythmias
-Shock
-Infection
-Pneumothorax
-Hemothorax
Surgery in which one-way valves are placed in the airways to the diseased parts of the lung
BLVR
What is the most important aspect of nursing management with COPD patients?
Teaching / pt education surrounding:
-pulmonary rehab
-activity
-sexual activity
-sleep
-psychosocial
What positioning should a post-op lung cancer pt be placed in?
Supine or operative side
Either side after lobectomy
Comorbid conditions characterized by excessive mucous in the bronchioles
COPD with chronic bronchitis
What will lung sounds be in a COPD with bronchitis?
Wheezes and crackles
Rales
What diagnosis do patients have when they are called “blue bloaters”
COPD with bronchitis
What diagnosis do patients have when they are called “pink puffers”
COPD w/ emphysema
What is the most common type of lung cancer in non-smokers?
Non-small-cell lung cancer specifically Adenocarcinoma
What is the most common type of lung cancer?
Adenocarcinoma
Condition characterized by a decreased in elastin and collagen causing decreased pressure during exhalation leading to lung collapse and trapped air with reduce surface area for gas exchange
COPD w/ emphysema
What is the most deadly type of lung cancer?
Small-cell lung cancer
What are the 3 ways that lung cancer can metastasize?
- Direct extension
- Blood circulation
- Lymph system
Where can lung cancer metastasize to?
-Lymph nodes
-Liver
-Brain
-Bones
-Adrenal glands
What type of breathing can a patient use to prevent lung collapse with COPD/emphysema>
pursed lip breathing
Where is the most common place for lung metastasis?
Brain- b/c of the flow of blood
When is a barrel chest most common?
COPD with emphysema
(all COPD patients can develop barrel chest though)
What are clinical manifestations of lung cancer?
-Dyspnea
-Hemoptysis
-Chest or shoulder pain
-Pneumonitis
-Persistent cough with sputum
Where does lung cancer primarily occur?
Segmental bronchi and upper lobes
How long does a patient have to be smoke-free to be considered back to ‘nonsmoker’ status?
10-15 years
Lung Cancer Risk Factors
Smoking
Exposure to smoke
How is lung cancer initially diagnosed?
CXR- takes years to show up
If there is a suspicion of lung cancer, what diagnostic is performed?
CT scan
Who should receive a lung cancer screening?
Patients 55-80 with a hx of smoking
Anyone who has smoked >1 pack/day for 30 years
Anyone who currently smokes
Anyone who quit less than 15 years ago
How is a lung cancer screening completed?
low dose CT
What types of diagnostics can be performed on pts with lung cancer?
-CXR
-CT scan
-Fiberoptic bronchoscopy
-PET scan
-Lung biopsy for definitive diagnosis
Most lung cancers are what type?
Non-small-cell lung cancer
Two types of lung cancers
Small-cell lung cancer
Non-small-cell lung cancer
How many stages of NSCLC are they and how are they determined? (acronym)
4
T-TUMOR size, location, & degree of invasion
N-extent of lymph NODE invasion
M-presence/absence of METASTASES
What is the treatment of choice for NSCLC?
Surgery - lobectomy or removal of entire side of lung
Removal of one entire lung
Pneumoectomy
How many stages of SCLC are there? & what are they?
Limited
Extensive
Removal of one or more lobes of the lung
Lobectomy
How is immunotherapy used to treat lung cancer?
Targets programmed cell death proteins and prevents T cells from attacking other cells in the body in order to mount a better immune response
