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Block 2 Week 3 & 4 Respiratory System > COPD: Asthma > Flashcards

COPD: Asthma Flashcards

0
Q

What are the signs and symptoms of Samter’s triad?

A

Asthma, Aspirin and NSAID sensitivity, causing the growth of Nasal polyps.

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1
Q

What does Retraction mean?

A

Retraction occurs when the intercostal muscles surrounding the lungs retract/constrict showing the outline of the patient’s ribs.

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2
Q

Psychological issues can cause an asthma exacerbation. True or False?

A

True. Strong psychological emotions such as (crying, laughing, anger, fear)

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3
Q

What is a secondary effect of Beta Blockers on a patient with asthma?

A

Beta Blockers ( aka Beta 2 Antagonist) also decrease the patient’s response to inhaled or oral Beta 2 Receptor Agonists.

Study Tip: These meds have opposite effects so they cancel each other out.

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4
Q

People with emphysema have very collapsible airways. If you teach them to breathe in normally but breathe out through a narrow orifice of their lips, they keep the pressure up in their airways and it tends to prevent the large airways from collapsing. In COPD patients with advanced emphysema, this type of breathing can also open up airways enough to release more air. That may allow some air that’s trapped in the lungs to exhale out, so it decreases the amount of gas trapped in your chest.

What type of breathing technique does this define?

A

Pursed Lip Breathing

Study Tip: To do pursed lip breathing:

Relax your neck and shoulder muscles.
Breathe in for two seconds through your nose, keeping your mouth closed.
Breathe out for four seconds through pursed lips. If this is too long for you, simply breathe out twice as long as you breathe in.

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5
Q

What is the #1 most polluted U.S. city?

A

Los Angeles is the most polluted.

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7
Q

What Is important for Nurses to obtain from the patient for Long Term Management of Asthma before educating the patient?

A

Obtain health & medication history
Things that trigger lifestyle, environment, and work.
Study Tip: Teaching self-care Education is Key

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8
Q

Why does the medication Beta Blockers cause an Asthma exacerbation?

A

Beta-blockers causes bronchoconstriction which may increase risk for airway reactivity which causes bronchospasm,

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9
Q

Asthma Pathophysiology: Irritants causes a cascade effect which stimulates the inflammatory response. The Immune system is then activated. IgE is produced. ______degranulate. The granules are made up of cellular mediators. Cellular Mediators cause Inflammation which leads to Vasodilation and increased capillary permeability which leads to cellular infiltration which causes ___________, ___________, Mucus Secretion (which further clogs airways), _____________(causes patient not to be able to clear the airways). Thickening of airway walls (also called remodeling the lungs). Leads to bronchiole hyper responsiveness and airway obstruction.

A

Mast cells
Bronchospasm
Impaired mucocilliary function
Vascular congestion

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9
Q

People with asthma do not have changes in pulmonary tissue unless the asthma is not treated. This only occurs in untreated asthma patients. This also makes lungs less effective. What is this abnormal reaction to asthma called?

A

Airway Remodeling

Study Tip: Thickening of the walls of the bronchioles which decreases the size of the lumen.

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11
Q

Can someone die from asthma?

A

Patients can die from an asthma attack if the ineffective airway clearance is not resolved.

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12
Q

Why does the medication Aspirin cause an Asthma exacerbation?

A

Some people with asthma cannot take aspirin because of what’s known as Samter’s triad which is a combination of asthma, aspirin sensitivity, and nasal polyps. Nasal polyps are small growths that form inside the nasal cavity.

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13
Q

Name the 7 medications that you would administer to a patient with Asthma?

A
  1. Beta 2 Agonists Bronchodilators
  2. Anti-Cholinergic Bronchodilators
  3. Mast Cell Inhibitors
  4. Mast cell stabilizers
  5. Corticosteroids
  6. Theophylline Bronchodilators
  7. Singulair Leukotriene Receptor Blockers

Study Tip: Mast Cell Inhibitors and Mast cell Stabilizers: Both Prevent Inflammation

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14
Q

What are the 4 most common signs and symptoms of asthma?

A

S/Sx: Wheezing, Breathlessness, Tightness in their chest, Cough especially at Night (caused by PNS bronchoconstriction).

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15
Q

What are 3 priority Independent Interventions that a nurse is required to implement for Acute Management of Asthma?

A
  1. Re-Positioning? High-fowlers allows for more effective lung expansion ALLOWS FOR MORE EFFECTIVE LUNG EXPANSION
  2. Breathing techniques. Educate the patient to use Pursed Lip Breathing and Diaphragmatic Breathing
  3. Do NOT leave the patient.

Study Tip: Always Stay calm. DO NOT PANIC! If you panic your patient will panic if you feel yourself panicking get assistance from another nurse.

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16
Q

Asthma attacks can be abrupt or gradual and they can also last from a few minutes to a few hours. Asthma normally has an onset of before the age of ______. Usually is also usually seen in ______ gender patients. Between asthma attacks the patients lungs may seem fine and have normal or near normal functioning.

A

12

Males

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17
Q

Name the 5 Collaborative Interventions required to treat a patient with asthma?

A
  1. IV fluids (Hydration to Decrease Secretions)
  2. Medication (Beta 2 Agonists & Ect.)
  3. Intubation if airway closes (If Necessary)
  4. Oxygen Therapy (O2 via NC to Hyperoxygenate)
  5. Respiratory Therapy (Can Administer SVN Treatment)
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18
Q

What 4 pharmacological medications can cause an Asthma exacerbation?

A

NSAIDS, Beta Blockers, GERD, ACE inhibitors (causes a cough),

19
Q

An increase in secretions can cause a patient to cough due to increased mucus. If your patient can’t cough or experiences diminished or absent breath sounds (if they stop wheezing) during an asthma exacerbation that is a sign that your patient is going into __________ because they are not even moving enough air to wheeze. If this happens to your patient you need to do something fast.

A

Respiratory Failure

20
Q

Why do the medication NSAIDS cause an Asthma exacerbation?

A

Some people with asthma cannot take NSAIDs because of what’s known as Samter’s triad which is a combination of asthma, aspirin sensitivity, and nasal polyps. Nasal polyps are small growths that form inside the nasal cavity.

21
Q

What is Asthma?

A

Chronic intermittent inflammatory disorder of the airways. Inflammation causes a vicious cycle. Chronic inflammation causes the airways to be very sensitive causing them to hyper-respond to triggers. Asthma patients will have an exaggerated response to stimulus.
Study Tip: A normal person can walk through a cloud of dust and sneeze and the irritant will go away. When this happens to someone in asthma they will have bronchoconstriction and wheezing.

22
Q

______ is prolonged in asthma patients.

A

Expiration

24
Q

Normally Inspiration and Expiration has a 1:2 ratio. Asthma has a 1:4 ratio. Air trapping causes hyper-inflation of the lungs which will cause the patient’s lungs to retain Co2 because they cannot blow it off. This can cause what fluid and electrolyte imbalance?

A

Respiratory Acidosis

25
Q

The diaphragm is the main muscle of breathing. It’s supposed to do most of the work. When you have COPD, the diaphragm doesn’t work as well and muscles in the neck, shoulders and back are used. These muscles don’t do much to move your air. Training your diaphragm to take over more “work of breathing” can help.

What type of breathing technique does this define?

A

Diaphragmatic Breathing

Study Tip: How to do a diaphragmatic breath:

  1. Sit or stand in a comfortable position with your back straight and your feet flat on the floor.
  2. Slowly inhale through your nose, counting slowly to 4.
  3. Slowly exhale through the mouth, counting slowly to 6.
  4. That’s it! Repeat several times.

Not Common Practice because once patients stop doing the exercise, they revert back to their usual way of breathing. Trying to teach someone to diaphragmatic-breathe or breathe with their belly probably doesn’t work because your mind will take you back to a way that’s less taxing for your abdominal muscles.

26
Q

Expiration (exhalation) is normally a passive process. Asthma causes exhalation (Breathing out) to become labored and can cause the patient to become exhausted over time because of the increase in the amount of _____ it takes to continue breathing.

A

Work

Study Tip: During Asthma exacerbations airflow is limited both ways into the lungs and out of the lungs because of bronchoconstriction and bronchospasms.

27
Q

Why do ACE Inhibitor medications cause an Asthma exacerbation?

A

ACE Inhibitors usually have a cough as a side effect. This cough is not necessarily asthma. But, it can be confused with asthma or, in the case of unstable airways, may trigger asthma symptoms.

28
Q

Asthma is reversible. It is NOT a chronic obstructive pulmonary disease. Asthma occurs with variations of airflow overtime. Asthma patients have normal lung functioning in between the asthmatic exacerbations. When you compare Asthma to ____________ and _________you will notice that the latter have continuous decreased lung functioning. Limitations are more consistent they are always present.

A

Chronic Bronchitis and Emphysema

29
Q

Name what each Asthma nursing diagnosis is related to?

  1. Impaired Gas Exchange R/T?
  2. Ineffective Airway Clearance R/T?
  3. Anxiety R/T?
A
  1. Airway Obstruction (R/T Bronchospasms)
  2. Increased mucus secretions (Mucus causes inability to blow off CO2 and blocks airways)
  3. Inability to breathe (Can cause stress)
30
Q

What are the four priority collaborative and independent interventions a nurse must do when a patient is having an acute asthma attack and cannot breathe in an emergent situation?

A
  1. Assess respiratory system (RRR, lung sounds, O2 Sat, and Effort) : Independent
  2. Administer ordered medications : Collaborative
  3. Administer SVN : Collaborative
  4. Administer IV fluids (Quick relief of Acute exacerbation) : Collaborative
31
Q

What amount of IV fluids is usually given to asthma patients? Why are IV fluids given?

A

IV Fluids 3,000-4,000 mL/day of solution to increase hydration to thin the mucus secretions so the patient can cough them out.

32
Q

What Does Asthma exacerbation look like on a Bronchial Level. Name three common characteristics?

A

Mast cells release histamine among other mediators to make capillary membrane more permeable.

The permeable membrane causes fluid to leak out of the cells causing edema and mucus congestion.

Smooth muscle constricts around the bronchial tube closing the airway which when paired with a swollen mucosa and mucus collecting in the center of the bronchiole breathing can become difficult.

33
Q

Patients with asthma should be given large meals in case they have another asthmatic attack and are unable to eat. True or False?

A

False. Asthma patients must be fed small frequent meals using so much energy to breathe may prevent the patient from eating large meals because the patient will become exhausted easily.

34
Q

What kind of interview questions should you ask your asthma patients?

A

Yes/No questions Do NOT ask drawn out questions because of difficulty breathing

35
Q

What is important to remember when managing Asthma in older adults?

A

Older adults were unable to tell their asthma symptoms from their other medical issues. They did not even know that they had asthma. Must assess history thoroughly.

36
Q

What is the most important part to explain when educating the patient on How to Use the Peak Flow Meter?

A

Asthma exacerbation will show on the peak flow meter before the actual asthma attack occurs. Correct education will prevent the patient from reaching the critical level of inflammation.

  • Green Zone 80-100% of their best (The Patient is Fine)
  • Yellow Zone 50-80% (Start Worrying)
  • Red Zone Below 50% (Notify the Physician)
37
Q

When you have a patient on both a bronchodilator inhaler and steroid inhaler. Which do you give first?

A

A bronchodilator is used to open up and relax constricted airways making it easier to breathe. And, steroids are used to reduce inflammation and swelling in the airways. Use the bronchodilator first, wait a few minutes, and then to use the steroid inhaler, after the airways have been opened up and are more relaxed. This way, the steroid can penetrate the lungs more effectively.

38
Q

An infection will always be accompanied by what process of immunity?

A

The Inflammatory Process > Inflammation.

This is why respiratory infections cause asthma attacks because the infections causes the airways to become inflamed leading to bronchoconstriction.

39
Q

How does an SVN treatment work?

A

A device used to reduce liquid medication to an extremely fine aerosol cloud, which is inhaled and used especially for delivering medication to the deep part of the respiratory tract.

40
Q

What can a nurse teach an asthma patient to prevent exacerbations?

A
  1. Avoid triggers (Stimulus/Irritants)
  2. Implement Proper medication administration
  3. Promote usage of Peak flow meter to measure how much air the patient is able to move.
41
Q

Why do signs and symptoms of GERD cause an Asthma exacerbation?

A

GERD can irritate asthma and damage the esophagus. It is believed that asthma attacks can also cause the sphincter to relax, making it easier for acid reflux to occur.GERD may worsen asthma symptoms, and asthma and some asthma medications may worsen GERD symptoms. Treating GERD often helps to relieve asthma symptoms.

42
Q

_______ can decrease the inflammatory response.

A

Vaccinations

42
Q

What 4 physical adaptations can cause an Asthma Attack Exacerbation?

A

Respiratory Infections (get vaccinations to decrease inflammation), Exercise, Flu, and Cold cause a cascade effect which stimulates the inflammatory response.

43
Q

During an asthma attack or within minutes of exposure to an allergen such as dust or pollen, ___________ are released by a type of blood cell in the lungs, causing the following responses:

  1. Contraction of the bronchial airway muscles
  2. Inflammation of the airway linings
  3. Swelling and narrowing of the airways
  4. Production of mucus and fluid
  5. wheezing and shortness of breath
  6. nasal congestion
A

Leukotrienes

44
Q

Why do asthma patients cough especially at night?

A

This is caused by PNS bronchoconstriction. Why?

PNS takes over at night

Block 2 Week 3 & 4 Respiratory System (13 decks)

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