Exam 2, Ch 31 (Week 4): Obstructive Pulmonary Diseases Flashcards
What are the 4 main OPD’s covered in this class?
-Bronchiectasis
-Asthma
-Cystic Fibrosis
-COPD
In general, what is an Obstructive Pulmonary Disorder.
An obstructive pulmonary disorder is any disorder that causes an Increased resistance to airflow because of an airway obstruction or airway narrowing.
In an Obstructive Pulmonary Disorder, patients find it hard to breath because of some kind of airflow resistance. Speaking generally, what are the two main reasons for their difficulty breathing?
An airway obstruction or an airway narrowing.
What kind of bodily response could lead to the narrowing of the airways in an OPD?
Acute or Chronic inflammation
A patient is suffering from Airflow restrictions due to chronic inflammation. What are two possible reasons for the chronic inflammation??
-Cystic Fibrosis
-The presence of Scar tissue
What can the Alveoli in the lungs lose that can cause airflow resistance in OPD patents?
Alveoli can lose their elasticity and recoil
In an obstructive pulmonary disease, the pulmonary arteries and veins can thicken, causing what effect on the smooth muscle in the lungs?
Hypertrophy. This makes it harder for O2 and CO2 to diffuse because of the enlarged smooth muscle membranes.
What are the 3 main things you would assess for in a patient with an OPD?
-Cyanosis
-Abnormal ABG’s
-Adventitious lung sounds
What are some factors involving a patient’s history that you might assess for when screening for an OPD?
-Do they smoke?
-What are their allergies?
-Have they ever been exposed to pollutants?
-Does anyone in their family have n OPD?
A chronic, irreversible dilation of the bronchi and the bronchioles is which type of OPD?
Bronchiectasis
Bronchiectasis is the irreversible dilation of what?
The bronchi and the bronchioles
True or False:
Bronchiectasis is the irreversible constriction of the bronchi and the bronchioles.
False
Bronchiectasis is the irreversible dilation of the bronchi and the bronchioles.
Bronchiectasis is a condition that FOLLOWS another disease/Infection. What are some diseases that can lead to bronchiectasis?
-Cystic Fibrosis
-The flu
-Tuberculosis
Cystic Fibrosis causes dehydrated mucus to build up in the bronchi and bronchioles, causing increased airway resistance. How would this effect lead to Bronchiectasis?
This could cause in inflammatory reaction to counteract the narrowing of the airways, as well as the addition of neutrophiles in the lung walls to aid in the inflammatory response from bacterial mucus buildup.
Cystic Fibrosis is typically chronic, and so there would be a chronic cycle of airway constriction, then inflammation to dilate, repeated over and over. Eventually, the airways of the bronchi would lose their elasticity from so much constriction/dilation, along with mucus and bacterial built up in pockets of the bronchial wall, damaging it.
Thus, the bronchi remain permanently open.
CT scans are the gold standard to help to visualize the dilation effect of bronchiectasis, but it is often misdiagnosed as chronic bronchitis.
What is another way to diagnose bronchiectasis that would be combined with CT scan results?
A Sputum culture.
Look for an excessive amount of purulent, and blood streaks in the sputum.
Blood streaks mean Bronchiectasis.
What lab values would you assess in a patient suspected of bronchiectasis?
-WBC
-AAT levels above 150mg/dl (From the book, not the PowerPoint, so take it or leave it.)
What is the main pathophysiological marker for bronchiectasis?
Chronic dilation of the bronchi/bronchioles
Which would be advisable in treatment for Bronchiectasis?
a.) Pneumonia vaccine
b.) Sputum drainage
c.) Surgery to remove the effected lung.
d.) Antibiotics
e.) All of the above
f.) None of the above
e.) All of the above.
What would be a priority act for the nurse to engage in for a patient with bronchiectasis?
Postural drainage
What is Cor pulmonale?
Right sided heart failure, due to long-term high blood pressure.
True or False:
Cystic Fibrosis is a genetically linked OPD
True
Cystic Fibrosis causes the altered transport of what ions?
Sodium and Chloride ions in Epithelial cells
Due to the failure of specific transported ions, what effect does Cystic Fibrosis cause on mucus?
It causes thick mucus secretions with low water content.
Due to the thickened mucus caused by Cystic Fibrosis, glands become plugged up. What effect does this have on bodily organs?
Dysfunction and atrophy.
True or False:
When auscultating a patient, the sound is quieter over the area of congestion.
False
Sound is louder over the area of congestion.
A potentially fatal OPD disease that involves the failure of Sodium and Chloride ion transport across epithelial tissue is called what?
Cystic Fibrosis
What other OPD can Cystic Fibrosis lead to?
Bronchiectasis
In Cystic Fibrosis, mucus doesn’t JUST plug up the lungs. What are 4 other places that Cystic Fibrosis affects?
-Pancreas
-Liver
-Salivary glands
-Testes
“Cilia motility is decreased due to overwhelming mucus production, which allows mucus to adhere to airways. At the same time, bronchioles become obstructed by mucus, leading to scaring of the airways, air trapping, and hyperinflation of the lungs”
This paragraph characterizes what OPD?
Cystic Fibrosis
What are 4 comorbidities of Cystic Fibrosis?
-Vitamin deficiencies
-Diabetes mellitus: Pancreatic enzyme deficiency
-Osteoporosis
-GERD
CFRD is the abbreviation of what?
Cystic Fibrosis Related Diabetes
What is the gold standard diagnostic method for Cystic Fibrosis?
a.) ABG test
b.) CT scan
c.) CXR
d.) Sweat Chloride Analysis
e.) Culture swab
d.) Sweat Chloride Analysis to test for Sodium and Chloride levels
What diagnostic test would be used to test for CFRD?
a.) Sweat Chloride Analysis
b.) Bronchi Enzyme Evaluation
c.) GI Enzyme Evaluation
d.) Alveolar Enzyme Evaluation
e.) Peripheral CT scan
c.) GI Enzyme Evaluation
CFRD is Cystic Fibrosis related diabetes.
It requires a GI enzyme evaluation, because it is a result of a Pancreatic Enzyme deficiency.
Which of these actions is included in the nurse’s role for CF? (select all that apply)
-Give patients enzymes
-Conduct chest physiotherapy
-Auscultate for adventitious lung sounds
-Give patient medications
All but Auscultation, because you already know the affliction.
When would be the best time to supply a patient with enzymes for treatment of their Cystic Fibrosis?
a.) When they wake up
b.) Before bedtime
c.) After meals
d.) With meals
e.) All of the above
f.) None of the above
d.) With meals
What type of diet should a patient with Cystic Fibrosis be on?
Diabetes Mellitus diet (DM diet)
Is exercise a good preventative/maintenance therapy for Cystic Fibrosis?
Yes
Would you want a new Cystic Fibrosis patient to lose, gain, or maintain their weight?
Gain weight.
What would be some medical management techniques to handle Cystic Fibrosis?
-Mucolytics
-Nebulized AB: Nebulized (inhaled) Antibodies
-Pancreatic enzyme replacement
-Inhaled hypertonic saline
-Heliox therapy: Helium and Oxygen mixture that is used to treat upper airway obstructions
“An umbrella term used to describe a range of pulmonary conditions.”
What does this sentence refer to?
COPD
Chronic Obstructive Pulmonary Disorder
What is associated with a chronic inflammatory response in the airway and lungs?
COPD
What are 3 examples of COPD?
-Emphysema
-Chronic Bronchitis
-Irreversible/Refractory Asthma
What is the term used for “Reactive Airway Disease?”
Asthma
“A chronic inflammatory disease of the airways caused by intermittent hyperresponsiveness.”
This sentence defines what COPD?
Asthma
A Pneumothorax and potential cardiac arrest are two possible fatal results of what type of COPD?
Asthma
What are two possible fatal results of asthma?
Pneumothorax and Cardiac arrest
Asthma has intrinsic risk factors and extrinsic risk factors. Determine which are which:
-NSAID sensitivities
-Dust/Pollen
-Hx of recurrent respiratory infections
-Cigarette smoke
-GERD
-Exuma
-Chemical agents
Intrinsic is internal risk factors:
-NSAID sensitivities
-Hx of recurrent respiratory infections -
-GERD
-Exuma
Extrinsic is external risk factors:
-Cigarette smoke
-Dust/Pollen
-Chemical agents
Wheezes with inspiration, shortness of breath and cough, and barrel chest are all symptoms of what COPD?
Chronic Asthma
What should you be looking for in the oral mucosa and nailbeds of an asthma patient?
Cyanosis
What blood-affiliated issue would you expect to see in an asthmatic patient?
Hypoxemia
What are 3 diagnostic tests used for Asthma?
-ABG’s
-Pulmonary Function tests
-CXR’s
In an acute Asthma attack, would you expect to see an increase or a decrease in arterial CO2 levels?
Decrease
The Stepwise approach to asthma is a very popular primary care treatment approach. What is the stepwise approach?
Gradually increasing or decreasing medication doses until a good balance for you is found.
A good asthma plan should focus on everyday health. What does this mean for the medication administration a patient?
It means 2 puffs with a spacer in the morning, like “Flovent”
and then 1 tablet, plus 2 spacers at night
So, 2 puffs of Flovent with a spacer in the morning, and then 1 tablet (+) 2 puffs of Flovent with a spacer at night.
What would be an inhalant for severe asthma symptoms, or an emergency asthma attack?
Albuterol
Name some medication types that would be used for Asthma.
-Bronchodilators
-Corticosteroids
-Anti-inflammatories
-Mucolytics
-Vasodilators
-Antibiotics
For asthma treatment, what is an MDI?
What is a challenge in children and the elderly when it comes to the use of an MDI for asthma?
Meter Dose Inhaler, your standard everyday inhaler.
The challenge is that timing of your inhale with the medication being released has to be accurate. Children and the elderly have a difficult time getting the timing of their inhale just right.
What action should you teach a patient to do after they have effectively used their inhaler?
Rinse their mouth and gargle.
Which of these options is the correct serious of events in using an inhaler:
a.) Inhale, spray, exhale
b.) Exhale, spray/inhale, exhale.
c.) Exhale, inhale, spray, exhale
d.) Spray/Inhale, exhale
d.) Spray/inhale, exhale
b is also technically correct if you want to practice timing, but eh. As long as you know that you inhale AS you spray.
Why should you rinse and gargle after you use an inhaler?
Because you can end up with a secondary thrush from the inhalant sitting in their tissues.
A secondary thrush is gross, white tongue patches.
An electronic breathing treatment that is released as a mist, and is good for patients who cannot use an inhaler is called what?
A Nebulizer
Which age group tends to do better with a nebulizer for asthma treatment?
The elderly
What are some downsides to the use of a nebulizer for asthma treatment?
-Its bulky
-Time consuming
-Expensive
-Needs to be properly cleaned
Which method of asthma treatment is held on the mouth for 10 seconds, and is a good alternative to an MDI for less coordinated patients?
a.) Spacer
b.) Nebulizer
d.) Dry Powder Inhaler
a.) A Spacer. Commonly given to children for their doses.
A rapid, severe, and persistent asthma exacerbation is known as a what?
A Status Asthmaticus
What is Status Asthmaticus?
A rapid, severe, persistent asthma exacerbation
What COPD event coincides with acidosis and alkalosis?
Status Asthmaticus
Treatment for Status Asthmaticus are the use of steroids to try to open the airways, and then the use of what?
A nebulizer to relax and facilitate air exchange.
-“I can’t breathe…I really can’t breathe.”
-Bradycardia
-Silent chest auscultation
-Thickened bronchi mucus
-Cyanosis
-O2 saturation (>)92%
-paradoxical thoraco-abdominal breathing
These events all take place during what COPD event?
Status Asthmaticus.
The patient breathing tubes are sealing shut and filling with mucus due to an acute immune system response. The mucus stops air from getting to his lungs.
What is the biggest risk factor for COPD?
Smoking
If you have an A1A deficiency, what COPD related disease are you more at risk for later in life?
Emphysema
Chronic Bronchitis and Emphysema both have features of COPD, but neither by itself is COPD. Which of the following is Emphysema, and which is Chronic Bronchitis?
-The destruction of the alveoli without fibrosis
-The presence of cough and sputum production for at least 3 months out of the year for 2 years.
Emphysema is the destruction of Alveoli without fibrosis.
Chronic Bronchitis is cough and sputum lasting for 3 months out of a year, for 2 consecutive years.
The destruction of alveoli without fibrosis is known as what?
Emphysema
How long do you have to have a cough and sputum before its classified as Chronic bronchitis?
3 months out of a year, for 2 years.
Match the symptoms with either Emphysema or Chronic Bronchitis:
-Mucus Hypersecretion
-Inflammation
-Loss of elastic recoil
-Peribronchiolar fibrosis
-Airway obstruction
All are Chronic Bronchitis except for:
-Loss of elastic recoil. This effects the alveoli; thus, it is Emphysema.
What are some things you might assess for physically in a patient you suspect of having Emphysema, or Chronic Bronchitis?
-Can they speak in full sentences?
-Shortness of breath?
-Are they using accessory muscles to breath?
-Is there coughing
-Is there a peripheral edema?
-What is the HR/RR?
-IS the RR even?
-Does breathing require effort?
What are some tests you would use to assess for emphysema or chronic bronchitis?
-ABG test
-Spirometry
-Pulmonary Fitness Test
-CXR
What’s the pneumonic from the PowerPoint to remember signs for Chronic Bronchitis? It looks like a dinosaur with an O2 canister, and he is holding a cigarette looking depressed.
“The Blue Bloater”
-Usually on the heavy side
-O2 canister
-Dusky
-Usually effects smokers
These aspects describe patients that are afflicted by what COPD?
Chronic Bronchitis. The Blue Bloater
Is tissue damage due to Chronic Bronchitis irreversible?
Yes, and it can gradually increase in severity and can lead to respiratory failure, if untreated.
What is the most common respiratory complication in patients with Chronic Bronchitis?
Pneumonia
Chronic Bronchitis, aka the Blue Bloater, can eventually lead to Cor Pulmonale. What is Cor Pulmonale?
Cor Pulmonale is right-sided heart failure
Treatment for Chronic Bronchitis is mainly going to be teaching the patient what?
Breathing techniques to keep an open airway and get rid of mucus.
Long-term treatment for Chronic Bronchitis patients may include steroids and mucolytics. What is the mucolytic that is most commonly given?
Mucinex
Aside from reducing sputum, the goal of treatment for Chronic Bronchitis is to Improve oxygenation, while reducing what?
CO2 retention
If a chronic bronchitis patient is in home care, what 2 things should a nurse ensure for the patient?
-Ensure that the patient knows how to use their oxygen
-Ensure that the patient undergoes respiratory rehab.
What diagnosis is the main form of COPD?
Emphysema
The chronic, long-term COPD that slowly causes more and more shortness of breath over the years is known as what?
Why does it cause a gradual worsening of breath?
Emphysema
It slowly destroys the alveoli in the lungs
Co2 elimination in patients with emphysema is impaired because of their alveoli destruction. What respiratory condition does this lack of CO2 exchange lead to?
Respiratory Acidosis.
Emphysema can also lead to Cor Pulmonale. What is Cor Pulmonal?
Right-sided heart failure
Because of the decreased respiratory gas exchange in the alveoli, due to the damage done by emphysema, what effect does this have on the air that the lungs breath in?
The air just sits in the alveoli, and the alveoli get big and swollen.
Emphysema leads to the bloating and destruction of alveoli. There are two separate types of this effect: Panlobular emphysema (PLE), and Centrilobular emphysema (CLE). Which option is PLE, and which option is CLE?
-All of the airspaces are enlarged
-The lobular/alveoli lobes are enlarged.
Panlobular emphysema is when ALL of the airspaces are enlarged and look like a piece of broccoli. Alveoli, Bronchiole, and the alveolar duct are all enlarged.
Centrilobular emphysema is when just the lobular/alveoli LOBES are enlarged.
Muscle wasting and weight loss is associated with:
a.) Emphysema
b.) Chronic Bronchitis
c.) Asthma
d.) Bronchiectasis
a.) Emphysema is associated with muscle wasting and weight loss.
Remember, Blue Bloater for Chronic Bronchitis means that people are heavier set.
A patient presenting with an overdeveloped “barrel-chest” and seemingly underdeveloped legs most likely suffers from what COPD?
a.) Asthma
b.) Emphysema
c.) Chronic Bronchitis
d.) Chronic Asthma
b.) Emphysema. They are overdeveloped in their accessory muscles to breathe, so they are barrel chested up top, and underdeveloped on the bottom.
True or False:
In emphysema patients, you can do lung reduction surgery to remove hyperinflated lung tissue, increasing gas exchange.
True
Lung reduction surgery is a viable option to tackle emphysema and increase gas exchange.
What class of drug would you use to relax and open up the airways of an emphysema patient?
What short-acting drug would you use?
What long-acting drug would you use?
Bronchodilators.
Short acting: Albuterol
Long acting: Bromides
What is a COPD exacerbation?
An acute change or worsening of COPD symptoms.
What is the outcome of COPD exacerbation?
Respiratory Acidosis
…
…
Also…
Death.
Worsening or new onset Cyanosis, a peripheral edema, and signs of Cor Pulmonale are all signs of the “Downward Spiral.” What does the downward spiral refer to?
A COPD Exacerbation
What are some signs of a COPD Exacerbation?
Onset or worsening Cyanosis, a Pulmonary Edema, Cor Pulmonale.
What are 4 methods to treat a COPD Exacerbation?
-Bronchodilators
-Corticosteroids
-Supplemental O2
-Abduction of the limbs to allow for greater lung expansion
In a patient with Emphysema, you want to keep their oxygen sat on the lower side (Between 90-95%). What is the logic behind this?
It’s called the Hypoxic Drive Theory
O2 is kept lower so the patient has a drive to breath. If a patient with Emphysema has their O2 sat raised past 95%, they can lose their drive to breath, and this can lead to cardiac arrest.
How does the therapeutic use of Humidification for an Emphysema patient positively affect them?
It prevents the drying out of mucosa.
Do surgeries like a Bullectomy or lung transplant for Emphysema (and other COPD’s) cure the disease or prolong life?
No, they only improve breathing and the quality of life.
Keeping O2 sat too high in an at-home-care COPD patient could result in what 2 results?
-Combustion
-O2 Toxicity
What is the goal of a Bullectomy?
They remove enlarged air spaces.
What does a “Lung Volume Reduction” surgery do?
Removes damaged portions of the lungs.
True or False:
Acute bacterial pharyngitis is most commonly caused by group A beta-hemolytic streptococci.
True
What is the primary clinical symptom of
emphysema?
A.) Chest pain
B.) Productive cough
C.) Sputum
D.) Wheezing
D.) Wheezing
Productive cough and Sputum are the primary clinical symptoms of Chronic Bronchitis
