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NRSG 110: Med Surg 2 > [Exam 2] Chapter 24: Management of Patients with Chronic Pulmonary Disease (Page 634-665) > Flashcards

[Exam 2] Chapter 24: Management of Patients with Chronic Pulmonary Disease (Page 634-665) Flashcards

1
Q

What is COPD?

A

Respiratory disease of airflow obstruction involving the airways, pulmonary parenchyma or both

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2
Q

Parenchyma includes what?

A

Any form of lung tissue, including brochioles, blood vesels, alveoli

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3
Q

COPD is characterized by

A

airflow limitation that is not fully reversible (chronic bronchitis and emphysema)

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4
Q

What is Asthma considered to be?

A

Abnormal airway condition characterized by reversible inflammation

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5
Q

COPD, what is airflow limitation?

A

Progressive, associated with abnormal inflammatory respose to noxious particles or gases

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6
Q

COPD: Chronic inflammation causes

A

damage to tissues

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7
Q

COPD: Scar tissue in airways results in

A

narrowing

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8
Q

COPD: Scar tissue in the parenchyma decreases

A

elastic recoil (compliance)

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9
Q

COPD: Scar tissue in pulmonary vasculature causes

A

thickened vessel lining and hypertrophy of smooth muscle

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10
Q

COPD: Alveolar wall destruction leads to

A

loss of alveolar attachments and a decrease in elastic recoil

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11
Q

Chronic Bronchitis: What is this?

A

Disease of airway defined as presence of cough and sputum production for at least 3 months in each of 2 consecutive years.

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12
Q

Chronic Bronchitis: What happens to the ciliary?

A

Function is reduced, bronchial wall thicken, bronchial airway narrow and mucous may plug airways

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13
Q

Chronic Bronchitis: What happens to alveoli?

A

Become damaged, fibrosed, and alveolar macrophage function diminishes leading to more infections

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14
Q

Chronic Bronchitis: Patient is more susceptible to

A

respiratory infections due

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15
Q

Emphysema: What is this?

A

This describes abnormal distention of air spaces beyond the terminal bronchioles with destruction of the walls of the alveoli

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16
Q

Emphysema: DEcreased alveolar surface area in direct contact with capillaries decreases causing

A

an impaired oxygen diffusion which leads to hypoxemia

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17
Q

Emphysema: Hypoxemia results with

A

decreased carbon dioxide elimination

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18
Q

Emphysema: What is Cor Pulmonate?

A

One of the complications of emphysema, and is right-sided heart fialure brought on by long term high blood pressure in pulmonary arteries

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19
Q

Emphysema: What happens in Panlobular Emphysema?

A

Destruction of respiratory bronchiole, alveolar duct.Creates an enlarged airspace , causing expiration to become active and requiring muscle effort

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20
Q

Emphysema: What happens in Centrilobular Emphysema?

A

Changes take place mainly in center of seconday lobule causing a derangement of ventilation-perfusion ratios.

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21
Q

COPD, Risk Factors: Most important worldwide risk factor is

A

cigarette smoking

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22
Q

COPD,Clinical Manifestations: GEnerally a progressive disease characterized by what three primary symptoms?

A

Chronic Cough

Sputum Production

Dyspnea

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23
Q

COPD,Clinical Manifestations: Why is weight loss common?

A

Dyspnea interferes with eating and work of breathing is energy depleting.

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24
Q

COPD ,Clinical Manifestations: Why do some people deleveop “Barrel Chest”?

A

Results from more fixed position of the ribs in inspiratory positoin and from loss of lung elasticity.

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25
Q

COPD, Assessment and Diagnostic Findings: Pulmonary function studies help determine

A

diagnosis of COPD

Disease SEverity

Monitor Disease Progression

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26
Q

COPD, Assessment and Diagnostic Findings: Spirometry used to evaluate

A

airflow obstruction, which is determined by ratio o fFEV1 to FVC

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27
Q

COPD, Assessment and Diagnostic Findings: Why would arterial blood gas measures be obtained?

A

To assess baseline oxygenation adn gas exchange and are especially important in advanced COPD

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28
Q

COPD, Complications: What are the major life threatening complications of COPD?

A

Respiratory insufficiency and failure

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29
Q

COPD , Complications: What are some complications?

A

Pneumonia, Chronic Atelectasis, Pneumothorax, and Pulmonary Arterial Hypertension (Cor Pulmonale)

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30
Q

COPD , Medical Management: Therapeutic strategies include

A

promoting smoking cesssation, prescribing medications like bronchodilators and managing exacerbations.

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31
Q

COPD , Medical Management - Risk Reduction: Major RF with COPD is

A

environmental exposure, and it is modifiable. Most chronic is smoking.

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32
Q

COPD , Medical Management - Pharmacologic Therapy: What is use for Grade I (Mild) COPD?

A

Short acting bronchodilator

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33
Q

COPD , Medical Management - Pharmacologic Therapy: What is used for a Grade II /III COPD?

A

Short acting bronchodilator and regular treatment with one or more long lasting bronchodilators

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34
Q

COPD , Medical Management - Pharmacologic Therapy and Bronchodilators: Relieve bronchospasm by improving

A

expiratory flow through widening of the airways and promoting lungs with each breath. Alter smooth muscle tone and reduce airway obstruction.

Increases expiratory flow rate and eases dyspnea

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35
Q

COPD , Medical Management - Pharmacologic Therapy and Bronchodilators: Can be delievered by

A

pMDI, nebulization, or via oral route

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36
Q

COPD , Medical Management - Pharmacologic Therapy and Bronchodilators: What devices are available to allow medication to be inhaled

A

pMDI

Powder Inhalers

Spacers

Nebulizers

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37
Q

COPD , Medical Management - Pharmacologic Therapy and Bronchodilators: What is a pMDI?

A

Pressurized device that contains an aerosolized powder of medication.

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38
Q

COPD , Medical Management - Pharmacologic Therapy and Corticosteroids: Allow inhaled and systemic corticosteroids may improve symptoms of COPD, they do not slow down the decline of

A

lung function

39
Q

COPD , Medical Management - Pharmacologic Therapy and Corticosteroids: Long term treatment with oral corticosteroids is not recommened in COPD and can cause

A

steroid myopathy, leading to muscle weakness and decreased ability to function

40
Q

COPD , Medical Management - Pharmacologic Therapy and Other Medications: Vaccines are effective because they prevent

A

exacerbations by preventing respiratory infections

41
Q

COPD , Medical Management - Pharmacologic Therapy Corticosteroids: Why do they help?

A

Decrease inflammation

42
Q

COPD , Medical Management - Pharmacologic Therapy: What must you do with mucolytics?

A

Increase fluid intake in order to thin secretions

43
Q

COPD , Medical Management - Management of Exacerbations: Exacerbation of COPD definied as

A

event in the natural course of the disease characterized by acute changes in the pateints respiraotry system beyond the normal day-to-day variations

44
Q

COPD , Medical Management - Management of Exacerbations: Primary causes of acute exacerbation include

A

infections and air pollutions

45
Q

COPD , Medical Management - Management of Exacerbations: Treatment of exacerbation requires what?

A

Identifying primary cause and administering primary treamtnet

46
Q

COPD , Medical Management - Management of Exacerbations: OPtimization of bronchodilator medications is a first line therapy and involves

A

identifying the best medication or combinations of medications tkane on a regular schedule for a specific patient

47
Q

COPD , Medical Management - Management of Exacerbations: When patient arrives to ED< first line of treatment is

A

supplemental oxygen therapy and rapid assessment to determine if exacerbation is life threatening

48
Q

COPD , Medical Management - General Principles of Oxygen Therapy: Goal of oxygen supplmental therapy is to

A

increase the baseline resting partial pressure of arterial oxygen to at least 90%

49
Q

COPD , Medical Management - General Principles of Oxygen Therapy: Administering too much oxygen can result in the retention of

A

carbon dioxide.

50
Q

COPD , Medical Management - Surgical Management - Bullectomy: What is this?

A

Surgical option selected for patients with bullous emphysema.

51
Q

COPD , Medical Management - Surgical Management - Bullectomy: What are bullae?

A

Enlarged airspaces that do not contribute to ventilation but occupy space in thorax. Compress areas of the lung and may impair gas exchange.

52
Q

COPD , Medical Management - Surgical Management - Lung Volume Reduction Surgery: What is this surgery?

A

Removal of portion of the diseased lung parenchyma . This reduces hyperinflation

53
Q

COPD , Medical Management - Surgical Management - Lung Volume Reduction Surgery: This surgery improves

A

Life expectancy , decrease dyspnea, improve lung function, and exercise tolerance.

54
Q

COPD , Medical Management - Surgical Management - Lung Volume Reduction Surgery: What were Bronchoscopic lung lolvune reduction therapies designed to do?

A

Collapse areas of emphysematous lung and this improve aeration of the functional lung tissue. One-way valve placed to allow air and mucus to exit treated area

55
Q

COPD , Medical Management - Surgical Management - Lung Volume Reduction Surgery: What is biologic lung volume reduction?

A

Instillation of a sealant or gel, valves, or coils into the airway of the hyperinflated lung tissue

56
Q

COPD , Medical Management - Pulmonary Rehab Breathing Exercises: Piursed lip breathing helps do what?

A

Slow expiraation, prevents collapse of small airway, and helps patient control the rate and depth of respirations

57
Q

COPD , Medical Management - Nursing Management : What is Huff coughing?

A

One or two forced exhalations (Huffs) from low to medium lung volume with the glottis open

58
Q

Bronchiectasis: What is this

A

Chronic, irreversible dilation of the bronchi and bronchioles that results from destruction of muscles and elastic connective tissue. Considered separate from COPD

59
Q

Bronchiectasis: Inflammatory processed associted with pulmonary infections damages teh

A

inflammatory wall, causing loss of its support structure and thick sputum

60
Q

Bronchiectasis: What happens in saccular bronchiectasis?

A

Each dilated peribronchial tube amounts to a lung abscess

61
Q

Bronchiectasis: Retention of secretions ultimately cause teth alveoli distal to obsturction to

A

collapse (atelectasis)

62
Q

Bronchiectasis: What are some signs and symtpoms?

A

Chronic cough and production of purulent sputum .

Along with clubbing of fingers

63
Q

Bronchiectasis - Assessment adn Diagnostic Findings: Not really diagnosed because symptoms can be mistaken for

A

signs of chronic bronchitis

64
Q

Bronchiectasis - Assessment adn Diagnostic Findings: DEfinitive sign of this is

A

a prolonged history of productive, chronic cogh with sputum

65
Q

Bronchiectasis - Medical Management: Treatment objectives are to promote

A

bronchial drainage, to clear excessive secretions form the affected portion of the lungs.

66
Q

Bronchiectasis - Medical Management: Postural drainage is included in all treatment plans because

A

draining the bronchoiectatic area by gravity reduced amount of secretions

67
Q

Asthma: What is this?

A

chracterized by chronic airway inflammation

68
Q

Asthma: Chronic inflammatory disease of the airway causes

A

airway hyperresponsiveness, mucosal edema, and mucus production

69
Q

Asthma: Inflammation leads to what signs of asthma symptoms?

A

Cough, Chest Tightness, Wheezing, Dyspnea

70
Q

Asthma: Over time, patient may have structural changes in response to chronic inflammation that causes a

A

narrowing of teh airways

71
Q

Asthma: Simple definition of an acute exacerbation of asthma

A

bronchial smooth muscle contraction or bronchoconstriction occurs quikcly to narrow the airway

72
Q

Asthma: Acute bronchoconstriction can be due to

A

IgE mediated response or alpha-adrenergic receptor stimulation

73
Q

Asthma: Three common signs and symptoms are

A

cough, dyspnea, and wheezing

74
Q

Asthma: If the exacerbation progresses, what signs and symptoms may occur?

A

Diaphoresis, tachydria, and hypoxemia

75
Q

Asthma: What may happen if asthma does not get treated?

A

Respiratory Failure, Pneumonia, and Atelectasis

76
Q

Asthma - Medical Management: What are the two general classe of asthma medications?

A

Quick-relief medications for immediate treatment of asthma symptoms

Exacerbations and long-acting medication to achieve and maintain control of persistent asthma

77
Q

Asthma - Medical Management, Quick-Relief MEdications: They are used to relax

A

smooth muscle

78
Q

Asthma - Medical Management, Quick-Relief MEdications: What do Anticholinergics do?

A

Inhibit muscarinic choliergic receptors and reduce intrinsic vagal tone of airway

79
Q

Asthma - Medical Management, Long-Acting Control MedicationS: What do these do?

A

Alleviate symptoms

Improve airway function

Decrease peak flow variability

80
Q

Asthma - Medical Management, Long-Acting Control MedicationS: Why should you drink water after?

A

To prevent thrush

81
Q

Asthma: What is status asthmaticus?

A

Does not respond to treatment. Nurses thing pt getting better because cough/wheezing lears but this can be sign of impending respiratory failure

82
Q

Asthma: Treatment for status asthmaticus?

A

Oxygen, IV fluids for dehydration, beta-adrenergic agonist, corticosteroids

83
Q

Asthma: Due to patient having low respirations they will have hypocapnia (low CO2) or respiratory alkalosis (low pPaCO2 due to breathing rapidly) IF normal or high PaCO2 seen, this indicates

A

impending respiratory failure

84
Q

Asthma: What labs should be looked at?

A

Eosinophils elevated

IgE elevated if allergen present

ABG = RespiratoryAlkalosis

85
Q

Asthma - Medical Management, Peak Flow Measuring: They measure the

A

highest airflow during a forced expiration

86
Q

Asthma - Medical Management, Peak Flow Measuring: Daily peak flow monitoring recommended for those who have

A

moderate to severe asthma

Poor perception of changes in airflow

Worsening symptoms

87
Q

Asthma - Medical Management, Peak Flow Measuring: This is done for how long?

A

2-3 weeks, then the patients personal best value is measured

88
Q

Asthma - Assessment includes

A

Breath Sounds

Use of Accessory Muscles

O2 Saturation

Pulse and RR

Triggers

89
Q

Asthma - Nursing Mmanagement: What is the stepwise method?

A

Using short acting and long acting medications but increasing in medications and use

90
Q

Asthma - Nursing Mmanagement: What are soem quick-relief medications

A

Beta2 Adrenergic Agonists

Anticholinergics

91
Q

Asthma - Nursing Mmanagement: What are some Long-Acting Medications

A

Corticosteroids

Longacting Beta2 Adrenergic Agonists

Leukotriene Modifiers

92
Q

Asthma - Interventions: What to know about a dry pwoder inhaler?

A

Exhale via pursed lips

Store in a dry place

93
Q

Asthma - Interventions: What to know about a multi-dose inhaler

A

Inhale and exhale freely

Breathe deeply while compressing canister.

Hold 10 seconds and exhale.

rinse after administration

NRSG 110: Med Surg 2 (29 decks)

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