COPD, asthma and pneumonia Flashcards
Why is asthma usually not listed under COPD?
Unlike emphysema and chronic bronchitis which are not reversible and increase in severity, asthma is considered an intermittent disease with reversible airflow obstruction and wheezing.
Which diseases is the term COPD primarily used for?
Chronic bronchitis and emphysema
What is the order of things that happen as emphysema disease progresses?
- Loss of elastic recoil
- Airway collapse
- Alveolar hyperinflation
- Bullae formation
And emphysema, what happens as a result of the loss of elasticity?
It prevents for recoil so Air is trapped in the lungs.
And emphysema, what causes some of the airways to collapse?
Forceful exhalation causes increased in intrathoracic pressure which collapses the terminal bronchioles, then the Alveoli expand or hyperinflate
Why does cigarette smoking cause the person to be more susceptible to infections in the lungs?
Cilia die so mucus isnt moved out of the respiratory tree…. So dirt and everything inhaled gets stuck in the lungs.
What are some symptoms of emphysema?
Barrel Chest Clubbing of fingers Hypercapnea Decreased diaphragm excursion Respiratory acidosis Increased tactile fremitis
What is the reason for the barrel chest and emphysema? And what happens to the diaphragm
Due to Lungs being over inflated and chronic use of accessory muscles
Diaphragm - It becomes flatten or has decreased excursion
What is the swelling in the disco fingers caused by?
Chronic hypoxemia
A patient with emphysema develops acidosis as a result of retention of?
CO2
What triggers the respiratory drive and a healthy person?
High PaCO2
What triggers the respiratory drive in a person with COPD?
High PaO2
Why does the person with emphysema and chronic bronchitis have more severe hypercapnia and hypoxemia?
Mucus and swelling reduces the airway going through both the little and smaller airways. Also less gas exchange as decreased # of alveoli
What are some other reactions to the stressors of COPD not mentioned in the film?
- Egophony
- hyperresonance on chest percussoon
- Cardiac symptoms
- respiratory tract infections
What does Egophony mean?
E to A changes with auscultation
Often, COPD patients in the later stages developed right-sided heart failure which leads to?
- increased heart rate
- swelling on the feet
What are some reactions to stressors noted in diagnostic studies in COPD?
- besides the ABGs usually showing respiratory acidosis, the 02 sat is usually less than 90%
- polycythemia can occur which results from body’s attempts at compensation
- electrolyte disturbances
- abnormal pulmonary function test
- abnormal peak flow meter
What are some changes that will happen in somebody’s daily life who has chronic respiratory disorder?
- activity intolerance
- sleep and eating is affected
- Weight loss as disease worsens
“sonorous wheezes as air moves through mucus filled airways” describes breath sounds from which disease?
Chronic bronchitis
This disease is a chronic inflammatory disorder of the airways which results in bronchospasms or bronchoconstriction in response to triggers from a variety of sources
Asthma
Why is asthma called a reactive airway disease?
Due to damage from irritants which cause increased mucus production, the mucosal lining the bronchial tree becomes over reactive to triggers which leads to recurrent bronchoconstriction
Which substances are responsible for some of the inflammation in asthma?
- histamine
- acetylcholine
- serotonin
- leukotrienes
- corticosteroids
What contributes to airflow obstruction in acute exasperation of asthma?
Airway constriction
Airway inflammation
Alveolar hyperinflation
In the early stages of an asthma attack the client may be experience respiratory ______? If airway bronchoconstriction is unrelieved, the client may move into respiratory _______ due to the retention of____?
Respiratory alkalosis
Respiratory acidosis
PaCO2
A patient remains in the ED and is progressively getting worse with their asthma exasperation. What ABGs might reflect this?
The answer should indicate a rising CO2 level and a following O2. A person gets tired, making it more and more difficult to blow off the CO2
Initially as the O2 drops what will happen to the respiratory rate and depth?
Increased rate and depth.
As the person gets more and more fatigued with the labor of breathing, the respiratory rate will drop and thus so will the oxygen level
Goals of treatment for asthma patients
Prevention is key
- client will have fewer asthma exasperations
- The client will maintain normal activity levels (especially important in children)
- The client will maintain normal lung function
- The client will have minimal or no side effects while receiving medications
List some nursing diagnoses related to asthma
Ineffective breathing pattern Ineffective airway clearance Impaired gas exchange Activity intolerance Risk for suffocation Interrupted family processes – especially in children --see pages 1400 through 1402 of Ricci
For asthma, the nursing interventions should be aimed at?
Prevention and symptom assessment and control
It’s important for the caregiver or the adult patient to know when they are getting into trouble with your asthma. Wait before having to go into the ED. A peak flow meter is a device that patients can use at home to determine if there respiratory disease is worsening.
Special considerations in the asthmatic child
Be alert for other symptoms of respiratory distress, no position child chooses to remain in and that will usually be there more comfortable position for breathing, teach family to recognize and avoid triggers, support groups, exercise.
What are some additional nursing diagnoses for asthma regarding children?
Altered family processes and risk for suffocation (due to narrowed airway)
What are some causes of pneumonia?
Viral, bacterial, fungal, aspirated food, and inhaled fumes
aspiration pneumonia is most common in.?
The elderly in and anyone who has upper body neuromuscular impairment
Infants and children rarely get aspiration pneumonia unless they have neuromuscular impairments. Infants innately turn their heads to the side when they regurgitate or vomit
What are some stressors that can lead to pneumonia?
Underlying chronic disease Compromised immune system Altered level of consciousness is Neuromuscular conditions Institutionalization (Nursing home) Existing infection elsewhere in body
What are some nursing diagnoses for pneumonia?
impaired gas exchange
ineffective airway clearance
Risk for greater affection (sepsis)
Risk for fluid volume deficit
And children, viral pneumonia will usually cause?
Mild fever, nonproductive cough, and rhinitis. It is usually self-limiting
In children, bacterial pneumonia, the child usually has?
High fever, productive cough and I’ll appearance, retractions, grunting respirations, chills, chest pain, respiratory distress is significant and accompanied by restlessness
For management of pneumonia and children, in addition to adult remedies, also use:
Cool mist Clear secretions with bulb syringe or deep suctioning on younger child or infant IV fluids Monitor for dehydration Anticipatory guidance Emotional support to caregivers
