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COPD Flashcards

1
Q

forced Expiratory Volume (FEV1)

A

amount of air exhaled in the 1st second of forced exhalation

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2
Q

Forced Vital capacity (FVC)

A

total volume of air exhaled during a forced expiratory effort

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3
Q

in the absence of an acute episode, what could be expected to be found in the PE in regards to lung sounds and AP diameter?

A

AP diameter is increased b/c of hyperinflation and there may be an abdominal breathing pattern

lung assessment:
-prolongation of expiratory phase
-expiratory wheezing
-coarse crackle
-unequal breath sounds

child who is not sick:
-forced exhalation may reveal expiratory wheezing
-ask to blow hard or push on abdomen

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4
Q

Family history of which 5 conditions could be indicators for asthma

A
  1. ashtma
  2. allergies
  3. Sinusitis, rhinitis
  4. atopic dermatitis
  5. nasal polyps
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5
Q

what peak expiratory flow rate is the red zone, indicating major airflow obstruction?

A

<50% of personal best or predicted

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6
Q

name precipitating or aggravating factors ofr asthma

A
  1. viral infections
  2. environmental allergens
  3. irritants (e.g. smoke exposure, chemical, vapors, dust)
  4. excercise
  5. hoe environment (carpets, pets, mold)
  6. emotions
  7. stress
  8. drugs (aspirin, beta blockers)
  9. foods
  10. changes in weather
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7
Q

pulmonary function test are ___ in patients younger than 5 years old.

A

not reliable

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8
Q

what three criterias must be met to diagnose asthma?

A
  1. episodic symptoms of airflow obstruction are present
  2. airflow obstruction or symptoms are at least partially reversible
  3. alternative diagnosis are excluded
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9
Q

symptoms of asthma?

A

-wheezing
-cough
-cough at night
-cough during or after excercise
-SOB
-chest tightness
-sputum production

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10
Q

what FEV1/FVC ratio indicates obstruction?

A

<80%

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11
Q

when would eosinophil counts and IgE levels be useful in the diagnosis of asthma?

A

when allergic factor are suspected

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12
Q

what peak expiratory flow rate is the green zone, indicating good control?

A

80-100% of personal best or predicted

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13
Q

T/F chronic symptoms and signs of reversible bronchospasms are required for asthma diagnosis

A

False.
>3 episodes of reversible bronchospasm or chronic symptoms

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14
Q

what is the essential objective measure of establishing the diagnosis of asthma?

A

spirometry

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15
Q

what are the signs of atopy or allergic rhinitis

A

-atopic dermititis/eczema
-conjunctival congestion and inflammation
-ocular shiners
-transverse crease on the nose due to constant rubbing
-pale violasceous nasal mucosa

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16
Q

T/F In a PE a patient with asthma who is not having an exacerbation, abnormal findings are expected?

A

False
In mild asthma, there may be normal findings. In severe asthma, signs of chronic respiratory distress and chronic hyperinflations may be present.

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17
Q

patterns for asthma symptoms?

A

-perennial, seasonal, or both
-continous or intermitten
-daytime or night time
-onset and duration

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18
Q

what peak expiratory flow rate is the yellow zone, indicating caution?

A

50-80% of personal best or predicted

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19
Q

T/F asthma is an isolated condition not affected by other disease process

A

false.
asthma can be affected by
-thyroid disease
-pregnancy
-menses
-gastroesophageal disease (GERD)
-sinusitis
-rhinitis

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20
Q

asthma is characterized by ___ and ___ , which leads to clinical symptoms.

A

airway hyperresponsiveness and airway obstruction

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21
Q

name 3 airflow limitation

A
  1. acute bronchoconstriction
  2. airway edema
  3. mucus plug formation
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22
Q

what is the difference between asthma and COPD

A

asthma obstruction is often reversible

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23
Q

why is it important to treat asthma?

A

persistent inflammation leads to airway remodeling and irreversible changes

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24
Q

is asthma a genetic disease?

A

it is a combination of genetic and environmental factors

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25
how does airway inflammation lead to bronchospasm, mucosal edema, and mucus plugs
inflammation limits airflow, which leads to functional and structural changes in the airway.
26
how does airway obstruction result in hyperinflation?
airway obstruction leads to increased resistance to airflow and decreased expiratory flow rates, which leads to decreased ability to expel air, which results in hyperinflation.
27
how does asthmatic help maintain airway patency?
overdistention helps improve expiratory flow, but it alters pulmonary mechanics and increases the work of breathing
28
hyperinflation compensates for the airflow obstruction. compensation is limited when tidal volume approaches volume of ___. The result is alveolar ____.
dead space, hypoventilation
29
uneven changes in airflow resistance _ uneven distribution of air + alterations in circulation from increased intra-alveolar pressure due to hyperinflation= ____.
ventilation-perfusion mismatch
30
what is an adaptive response to ventilation-perfusion mismatch?
vasoconstriction due to alveolar hypoxia
31
what is the strongest predisposition risk factors for asthma?
genetic predisposition for the development of IgE-mediated response to common aeroallergens (atopy)
32
8 risk factors for asthma mortality
1.one or more life threatening exacerbations 2.severe asthma requiring oral corticosteroids 3. poor control of daily symptoms requiring frequent short-acting beta2 agonist medication 4. abnormal forced expiratory volume in 1 second (FEV1) 5. frequent visits to ED 6. Low socioeconomic status 7. family dysfunction 8. patient psychosocial problems
33
what two ethnicity has the highest rate of asthma?
Puerto Ricans African Americans (reflects limited access to outpatient health services)
34
is this a mild, moderate, or severe episodes of status astmaticus with imminent respiratory arrest? accessory muscles used
moderate severe
35
is this a mild, moderate, or severe episodes of status astmaticus with imminent respiratory arrest? suprasternal retractions presents
moderate severe
36
is this a mild, moderate, or severe episodes of status astmaticus with imminent respiratory arrest? moderate wheezing which is often end expiratory
mild
37
is this a mild, moderate, or severe episodes of status astmaticus with imminent respiratory arrest? HR 100-120
moderate
38
is this a mild, moderate, or severe episodes of status astmaticus with imminent respiratory arrest? increased respiratory rate
all episodes
39
is this a mild, moderate, or severe episodes of status astmaticus with imminent respiratory arrest? paradoxical thoracoabdominal movement
status asthmaticus imminent respiratory arrest signifies significant respiratory muscle fatigue and is considered a critical signs of impending respiratory failure
40
Is this a finding for a mild, moderate, or severe episode or status asthmaticus with imminent respiratory arrest? Pulsus paradoxus not present and never was present. (check patient's BP, there is not noticeable drop in systolic pressure during inhalation)
mild
41
Is this a finding for a mild, moderate, or severe episode or status asthmaticus with imminent respiratory arrest? Pulsus paradoxus may be present (10-20 mm Hg).
moderate
42
Is this a finding for a mild, moderate, or severe episode or status asthmaticus with imminent respiratory arrest? O2 is 91-95%.
moderate
43
Is this a finding for a mild, moderate, or severe episode or status asthmaticus with imminent respiratory arrest? Wheezing may be absent d/t severe airway obstruction.
Status asthmaticus with imminent respiratory arrest
44
Is this a finding for a mild, moderate, or severe episode or status asthmaticus with imminent respiratory arrest? Accessory muscles not used.
mild
45
Is this a finding for a mild, moderate, or severe episode or status asthmaticus with imminent respiratory arrest? Pulsus paradoxus often present (20-40 mm Hg).
severe
46
Is this a finding for a mild, moderate, or severe episode or status asthmaticus with imminent respiratory arrest? RR often greater than 30.
severe
47
Is this a finding for a mild, moderate, or severe episode or status asthmaticus with imminent respiratory arrest? O2 >95%.
mild
48
Is this a finding for a mild, moderate, or severe episode or status asthmaticus with imminent respiratory arrest? Loud biphasic (expiratory and inspiratory) wheezing.
severe
49
Is this a finding for a mild, moderate, or severe episode or status asthmaticus with imminent respiratory arrest? HR less than 100.
mild
50
Is this a finding for a mild, moderate, or severe episode or status asthmaticus with imminent respiratory arrest? Loud expiratory wheezing.
moderate
51
Is this a finding for a mild, moderate, or severe episode or status asthmaticus with imminent respiratory arrest? Pulsus paradoxus may disappear, which suggests respiratory muscle fatigue.
status astmaticus with imminent respiratory arrest
52
Is this a finding for a mild, moderate, or severe episode or status asthmaticus with imminent respiratory arrest? O2 <91%.
severe
53
Is this a finding for a mild, moderate, or severe episode or status asthmaticus with imminent respiratory arrest? Severe hypoxemia may manifest as bradycardia.
Status asthmaticus with imminent respiratory arrest
54
Intermittent, mild persistent, moderate persistent, or severe persistent? Requires SABA >2 days/week but not >1/day.
Mild Persistent
55
What treatment step is appropriate for intermittent in all ages?
step 1: SABA prn
56
which of the following is not a goal for asthma therapy? -Control asthma and reduce impairment through prevention of chronic and troublesome symptoms. -Reduce need for short-acting beta2-agonist (SABA) for quick relief of symptoms. -Maintain normal pulmonary function. -Maintain normal activity levels. -Satisfy patients’ and families’ expectations for asthma care.
Maintain near-normal pulmonary function.
57
What are the 4 components of care for asthma management?
1. Assessment and monitoring. 2. Education. 3. Control of environmental factors and comorbid conditions. 4. Pharmacologic treatment.
58
Impairment Assessment
- Frequency and intensity of symptoms - The functional limitations associated with symptoms.
59
Risk Assessment
1. Likelihood of asthma exacerbations 2. adverse effects from medications 3. likelihood of the progression of lung function decline.
60
How often is spirometry measured?
Every 1-2 years or more frequently for uncontrolled asthma.
61
How often do you follow up with asthma?
Every 2-6 weeks when gaining control and then every 1-6 months.
62
How do vitamin D levels help with asthma control?
1. Enhance corticosteroid responses 2. Control atopy 3. Improve asthma control
63
Which meds are relief agents?
1. SABAs 2. Systemic corticosteroids 3. Ipratropium (anticholinergic)
64
Asthma _____ dictates initial therapy and level of asthma _____ dictates adjustment of therapy.
severity, control
65
What level of SABA use indicates the potential need to step up treatment?
More than 2 days/week.
66
3 classes of rescue meds
SABA anticholinergic systemic corticosteroids
67
peak affect of SABA
15-30 minutes (wears off in 4-6 hours)
68
SABA meds
albuterol sulfate proventil ventolin nonracemic: levalbuterol xopenex
69
anticholinergic
ipratropium atrovent
70
systemic steriod
prednisone prednisolone methylprednisolone dexamethasone
71
6 classes of long-term control meds.
Inhaled Corticosteroids Cromolyn Sodium and Nedocromil Immunomodulators Leukotriene Modifiers LABA Methylxanthines
72
LABA
salmeterol serevent formeterol
73
inhaled corticosteroid
fluticasone flovent diskus budesonide pulmicort flexhaler respules
74
lukotriene Modifier
Montelukas Singulair
75
methylxanthine
theophylline
76
what class is omalizumab
monoclonal antibodies
77
combo
symbicort (combined ICS/LABA - budesonide/formeterol)
78
Prolonged use of albuterol is associated with what?
Tachyphylaxis d/t beta2-receptor downregulation and receptor hyposensitivity. worse asthma control (overuse of albuterol can lead to a cycle of dependence where using albuterol makes attacks more frequent and symptoms worst) more frequent asthma attacks (coughing, chest tightness, wheezing, and night time awakening) dependence how to avoid use only as rescue not controlled asthma use no more than twice per week if controlled
79
albuterol side effects
shakiness in arms, hands, legs, or feet trembling or shaking of hands and feet
80
Nonracemic form of albuterol offers a significant reduction in which adverse effects?
Muscle tremors Tachycardia Hyperglycemia Hypokalemia
81
T/F Levalbuterol is effective in smaller doses than albuterol.
True. And dose may be doubled in acute severe episodes.
82
SABAs are used for what 2 situations?
Treat bronchospasm in acute episodes. Prevent bronchospasm in exercise-induced asthma.
83
Acts as bronchodilator by inhibiting muscarinic receptors and reduces vagal tone of airways.
Anticholinergics
84
Adjuvant therapy with SABA for treatment of acute exacerbations.
Anticholinergics
85
Works to inhibit secretions from serous and seromucous glands lining nasal mucosa.
Anticholinergic (applied locally)
86
Used for a short course (3-10 days) to gain control of poorly controlled episodes.
Systemic Corticosteroids
87
What does a systemic corticosteroid do for SABAs?
It reverses the subsensitivity and downregulation of beta2 receptors from frequent and repetitive use of SABAs.
88
When are systemic corticosteroids used long-term?
Used for long-term prevention of symptoms in severe persistent asthma as well as for suppression, control, and reversal of inflammation.
89
Which systemic corticosteroid is not associated with vomiting?
Dexamethasone
90
Adverse effects of ICSs.
Oral candidiasis Dysphonia Reflex cough Bronchospasm
91
How are adverse effects of ICS minimized?
With spacer and MDI.
92
How do leukotrienes cause problems?
+ bronchospasm, increased vascular permeability, mucosal edema, and inflammatory cells.
93

Nursing 112 (7 decks)

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