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Med Surg 1 > concepts of care for pt. with noninfectious lower respiratory problems > Flashcards

concepts of care for pt. with noninfectious lower respiratory problems Flashcards

1
Q

asthma

A
  • chronic disease that occurs intermittently

- inflammation and airway tissue sensitivity

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2
Q

asthma symoms

A
  • daytime symptoms of wheezing, dyspnea, coughing presents more than 2 a week
  • waking from night sleep with symptoms of wheezing, dyspnea, coughing
  • relieved drug needed more than twice weekly
  • number of times per week activity was limited or stopped by symptoms
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3
Q

asthma history

A
  • history of dsypna, shortness of breath, chest tightness, coughing, wheezing, increased mucous production
  • same pt. have symptoms 4-8 weeks after a cold or other upper respiratory infection
  • pt. with atopic (allergic) asthma may have other allergic problems
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4
Q

common symptoms with acute asthma

A

audible wheezing

increased respiraotry effort

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5
Q

asthma attack cues

A

inflammation occurs, coughing may increase

  • accessory muscle use
  • breathing cycle is longer, prolonged exhalation and requires more effort
  • unable to speak
  • hypoxia
  • poor o2 levels
  • examine oral mucosa, nail beds, change in loc, & tachycardia
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6
Q

pulmonary function tests

A
  • forced vital capacity: total amount of air exhaled
  • forced expiratory volume in first second- how much air a person exhale during forced breath
  • peak expiratory rate flow- air flowing out of lungs
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7
Q

asthma interventions

A
  • control and prevent episodes
  • improve air flow and gas exchange
  • relieve symptoms
  • self management education
  • ASSESSMENT OF ASTHMA SEVERITY DAILY WITH A PEAK FLOW METER IS RECOMMENDED FOR PT. WHOSE ASTHMA IS NOT WELL CONTROLLED
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8
Q

asthma drug therapy

A
  • control therapy drugs
  • reliever drugs
  • bronchodilators
  • anti-inflammatory agents
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9
Q

control therapy drugs (used daily)

A

used to reduce airway sensitivity (responsiveness) to prevent asthma attacks from occurring and maintain gas exchange
- inhaled cortical steroid- reduce inflammation

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10
Q

reliever drugs

A

used to stop an attack

- short acting bronchodilator

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11
Q

bronchodilators

A

induce rapid bronchodilation through relaxing the smooth muscle

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12
Q

what do anti-inflammatory agents do?

A

help to improve bronchiolar airflow and increase gas exchange

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13
Q

high flow delivery cause

A

bronchospasms are severe and limit flow of oxygen through bronchiole tubes

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14
Q

status asthmaticus

A
  • severe life threatening acute episode of airway obstruction
  • intensifies once it begins, often does not respond to common therapy
  • can develop pneumothorax and cardiac or respiratory arrest
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15
Q

treatment for status asthmaticus

A 
Iv fluids
potent systemic bronchodilator
steroids
epinephrine
oxygen
prepare for emergency intubation
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16
Q

emphysema

A

destructive problem of lung elastic tissue that reduces its ability to recoil after stretching, leading to hyperinflation of the lung
- changes result in dyspna with reduced gas exchange and the need for an increased respiratory rate

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17
Q

chronic bronchitis

A

inflammation of the bronchi and bronchioles caused by exposure to irritants, especially cigarette smoke

  • trigger inflammation, vasodilation, mucosal edema, congestion, and bronchospasm
  • affects airways not alveoli
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18
Q

why is chronic bronchitis a blue bloater

A
  • presence of cyanosis of skin and mucous membranes
  • hypoxemia occurs early in disease
  • c02 retention
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19
Q

when does dyspnea occur for bronchitis

A

occurs later in disease

20
Q

when does hypoxemia and hypercapnia occur for chronic bronchitis

A

early in disease

21
Q

why is emphysema a pink puffer

A
  • there color and the way they breathe through pursed lips on expiration
  • hypoxemia occurs late in disease
  • damage not in bronchioles therefore no c02 retention
  • no cyanosis just pink
22
Q

when does dyspnea occur in emphysema

A

-occurs early

23
Q

when does hypoxemia and hypercapnia occur

A

later in disease

24
Q

complications of COPD

A
  • hypoxemia
  • acidosis: decreased 02, increased c02
  • respiratory infection
  • CARDIAC FAILURE: cor pulmonale- ride sides heart failure
  • dysrhthmias: due to acidosis and perfusion
  • respiratory failure: hypoxemia
25
Q

copd history & risk factors

A

risk factors:

  • age
  • gender
  • occupational history
  • SMOKING
  • breathing problems
  • activity level
  • weight
26
Q

the general appearance of copd

A
  • weight is proportionate to height, posture, mobility, muscle mass, and overall hygiene
  • pt. with severe copd are THIN
  • orthopneic or tripod position
27
Q

respiratory changes in copd assessment

A
  • assess chest size
  • fatigue
  • breathing rate and pattern
  • chest for retractions and asymmetric chest expansion
  • depth of inspiration
  • abnormal breath sounds
  • degree of dyspnea
  • barrel chest
  • cyanosis
28
Q

cardiac changes

A
  • assess heart rate and rhythm
  • swelling of feet or ankles
  • nail beds
  • oral mucous membranes
29
Q

copd assessment cues: lab

A
  • abg value
  • sputum specimens
  • WBC count
  • h&h serum
  • electrolyte levels
30
Q

copd assessment cues: imaging assessmenr

A

chest x ray

31
Q

copd assessment cues: other test

A
  • pulmonary function test: primary testing
  • COPD assessment test
  • lung volumes
  • diffusion test
  • oxygen saturation
  • peal expiratory flow meter
32
Q

COPD analysis

A
  • decreased gas exchange
  • weight loss
  • decreased endurance
  • potential for pneumonia
33
Q

COPD planning and implementation

A
  • improve gas exchange and reduction of carbon dioxide retention
  • ensure consistent use of drug therapy, airway maintenance, monitoring, breathing techniques, positioning, effective coughing, oxyen therapy, exercise conditioning, suctioning, and hydration
  • surgical intervention
  • preventing weight loss
  • minimizing anxiety
  • improving endurance
  • preventing respiratory infection
34
Q

surgical intervention for copd

A

lung transplantation

- lung volume reduction surgery

35
Q

preventing weight loss for copd

A

dyspnea management

food selection

36
Q

improving endurance for copd

A
  • energy conservation
37
Q

what is common complication of COPD

A
  • PNA is a common complication of COPD

- teach pt. to reduce the risk of infection

38
Q

COPD evaluating outcomes

A
  • attain and maintain gas exchange at a level within his or her chronic baseline values
  • achieve an effective breathing pattern that decrease the work of breathing
  • maintain a patent airway
  • achieve and maintain a body weight within 10% of his or her ideal weight
  • have decreased anxiety
  • increase activity to a level of acceptance to him or her
  • avoid serious respiratory infections
39
Q

Cystic Fibrosis

A
  • autosomal recessive genetic disease
  • diagnosed in early childhood
  • blocked chloride transport in cell mebranes
  • thick, sticky mucous
  • affects lungs and non-pulmonary ograns and pancreatic function
  • blocks chloride transport and cell membrane
  • impaired gas exchange
40
Q

cystic fibrosis assessment clues: nonpulmonary symtoms

A
  • abdominal distension
  • GERD, rectal prolapse, foul smelling stool, steatorrhea
  • malnourishment
  • DIABETES
  • OSTEOPOROSIS, OSTEOPENIA
41
Q

cystic fibrosis assessment clues: pulmonary symtoms

A
  • respiratory infections
  • chest congestion and sputum production
  • limited exercise tolerance
42
Q

cystic fibrosis interventions nonsurgical: nutrition management

A
  • focus on WEIGHT maintenance (protein & fat intake), vitamin supplementation, diabestes management, and pancreatic enzyme replacement
43
Q

cystic fibrosis interventions nonsurgical: preventitive/maintenance therapy

A
  • use of positive expiratory pressure
  • active cycle of breathing techniques
  • indivdualized exercise program
  • adn chest physiotherapy with postural drainage
44
Q

cystic fibrosis interventions nonsurgical: drugs

A

bronchodilators
anti-inflammatories
mucolytics
antibiotics

45
Q

cystic fibrosis interventions nonsurgical: exacerbation therapy

A
  • increased chest congestion
  • reduced activity
  • onset of crackles
  • 10% decrease in FEV1
  • bipap for advanced disease 14-21 day course of antibiotics
46
Q

cystic fibrosis interventions nonsurgical: gene therapy

A
  • pt. with specific gene mutations

- drug Ivacaftor aka CFTR modulator or potentiator is valuable to pt. with CF

47
Q

cystic fibrosis interventions nonsurgical: surgical

A

lung transplantation

  • does not cure
  • extends life by 1-15 years
  • transplant rejection is high
  • continue for infections

Med Surg 1 (25 decks)

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