Exemplar associated with Oxygenation

Question 1

chronic condition that is reversible airflow obstruction in the airways that occurs intermittently.

Answer 1

Pathophysiology of Asthma

Question 2

triggers asthma for some people when asthma when allergens bind to specific antibodies. These antibodies that start the local inflammatory responses. Chemicals an attract more WBCs to the area which will continue responses of blood vessel dilation and capillary leak leading to mucous membrane swelling and increased mucus production. these responses narrow the lumens more and interferes with airflow and gas exchange.

Answer 2

inflammation

Question 3

narrowing of the bronchial tubes by constriction of the smooth muscle around and within the bronchial wall. This occurs when small amounts of pollutants or respiratory viruses stimulate nerve fibers causing constriction of bronchial smooth muscle. if the inflammatory response occurs it can cause constriction. This greatly affects air flow and gas exchange.

Answer 3

Bronchospasm

Question 4

_____ is a chronic disease often identified in childhood. The airways of the child react to stimuli such as allergens, exercise, or cold air by constricting, becoming edematous and producing excessive mucus. Airflow is impaired and the child may wheeze as air moves through narrowed passages.

Answer 4

Asthma

Question 5

coughing, wheezing, shortness of breath, difficulty speaking more than 2-3 words, retractions (the use of accessory muscles), chest tightness, tachypnea, tachycardia, fatigue, anxiety, rapid labored respirations, nasal flaring and intercostal retractions may be common

Answer 5

clinicial manifestations of asthma

Question 6

_____ have smaller airway diameters therefore attacks can progress quickly, Children’s respiratory system is not developed causing a quicker onset of symptoms

Answer 6

pediatrics

Question 7

exposure to smoke, indoor air contaminants (pet dander, cockroach feces), outdoor air pollutants, recurrent respiratory viral infections, and allergic disease (food allergies, atopic eczema)

Answer 7

risk factors of asthma

Question 8

day time manifestations may occur twice a week or less: no activity limitations or nighttime manifestations; reliever drug used twice per week or less; PEF or FEV are within normal limits; treatment is maintained by lowest step that controls manifestations. Generally temporary and reversible.

Answer 8

Well controlled asthma

Question 9

day time manifestations occur more than twice a week; may have activity limitations and night time manifestations; PEF and FEV are less than 80% of predicted or established personal best; treatment requires continuous progression on a regular basis. May lead to chronic inflammation that causes damage and hyperplasia of the cells and smooth muscle. Can lead to COPD

Answer 9

partially controlled / uncontrollable

Question 10

what are some nursing interventions of asthma?

Answer 10

ineffective airway clearance
impaired gas exchange
risk for deficient fluid volume
anxiety and fear and ineffective therapeutic regimen management .

Question 11

persistent hypoxemia and acid base imbalance

Answer 11

Respiratory failure

Question 12

striking of the back with a cupped hand, loosens the secretions

Answer 12

percussion

Question 13

flat hand on back, and shaking to loosen drainage.

Answer 13

vibration

Question 14

putting in different positions to loosen and move secretions

Answer 14

postural drainage

Question 15

severe life threatening acute episode of airway obstruction that intensifies once it begins it does not respond to usual therapy. Patient will arrive with labored breathing and wheezing, use of accessory muscles for breathing and distention of neck veins are observed. If not reversed patient my develop pneumothorax and cardiac or respiratory arrest. Patient may start off wheezing, coughing, with diminished breath sounds that eventually leads to an ineffective cough, wheezing has decreased, no active breath sounds means there is no air movement and intubation may be necessary.

Answer 15

Status Asthmaticus

Question 16

This exemplar includes both emphysema and chronic bronchitis. Although they are separate disorders with different pathological processes, many patients with emphysema also have chronic bronchitis. Once the lung tissue is damaged it is not reversible. Modifying risk factors will help to not worsen your condition, but does not repair damaged tissue. May affect older adults more acutely, particularly after years of exposure to cigarette smoke or industrial pollutants. Obstructive airway changes are accelerated with the genetic defiency of the enzyme alpha 1 antitrypsin.

Answer 16

pathophysiology of COPD

Question 17

loss of lung elasticity and hyperinflation of the lung. These changes result in dyspnea and the need for an increased respiratory rate. In healthy lungs enzymes (proteases) are present and destroy inhaled particles and organisms. If these enzymes begin occurring in larger amounts they will damage the alveoli and the small airways. Over time this causes the alveolar sacs to lose their elasticity and the small airways to collapse or narrow. The alveoli are either destroyed or become large and flabby which causes a decrease in are for gas exchange. Air begins to be trapped in the lungs. The excess of air causes the diaphragm to flatten. As a result, the diaphragm works less efficiently, and the patient will need to use accessory muscles (in the neck, chest wall, and abdomen) to exhale and inhale. This increased effort causes a patient to be in air hunger and to have an uncoordinated breathing patter (inhalation will begin before exhalation is complete)

Answer 17

Emphysema

Question 18

what is the nursing diagnosis associated with emphysema?

Answer 18

Ineffective Gas Exchange

Question 19

Inflammation of the bronchi and bronchioles caused by exposure to irritants (chemicals, factory work, hair salons, smoke, etc) especially cigarette smoke. The irritant triggers inflammation, vasodilation, mucosal edema, congestion, and bronchospasm. Only effects the airways not the alveoli. Chronic inflammation increases the number and size of mucus glands, which will create excess amounts of secretions. The bronchial walls thicken and impair airflow, and this thickening in combination with the excessive mucus, blocks smaller airways and narrow larger ones. Excessive mucus is a breeding ground for organisms causing chronic infections.

Answer 19

Chronic Bronchitis

Question 20

What risk factors are associated with emphysema?

Answer 20

Protein deficiency (alpha 1 antitrypsin) may cause a small percentage of chronic emphysema patients. This protein protects the elasticity of the lungs, without it lung elasticity decreases.

Question 21

Greatest risk factor for emphysema and chronic bronchitis. Inhaled smoke triggers the release of excessive proteases in the lungs. these break down elastin (major component of alveoli. ______ will impair the action of cilia which causes the inhibition of clearing bronchi or mucus, cellular debris and fluids.

Answer 21

Cigarette Smoking

Question 22

inability to remove carbon dioxide out of the lungs and move oxygen into the lungs, patients will likely have a decreased oxygen level as a result. This can be an end result of emphysema because of the increased respiratory rate.

Answer 22

chronic respiratory acidosis

Question 23

impairs gas airflow and gas exchange b/c mucus plugs and infection narrows the airways. AS a result O2 levels decrease causing hypoxemia and Co2 levels increase causing respiratory acidosis.

Answer 23

Chronic Bronchitis

Question 24

this occurs because the gas exchange impairment. This leads to a decrease in oxygenation and an increase in CO2. These issues cause cellular dysfunction. ph: <7.35 , CO2 > 45 and decreased oxygen levels

Answer 24

Acidosis and Hypoxemia

Question 25

increased mucus production and poor oxygenation are a breeding ground for bacterial infections and will worsen COPD by causing an inflammatory response. airflow decreases causing dyspnea.

Answer 25

Respiratory Infection

Question 26

cough lasting longer than 3 months, mucus production, fatigue, shortness of breath, slight fever and chills, chest discomfort

Answer 26

signs and symptoms of chronic bronchitis

Question 27

shortness of breath will eventually progress to shortness of breath even at rest, cyanosis in later stages, confusion, barrel chest, pursed lip breathing, tripod positions.

Answer 27

signs and symptoms of emphysema

Question 28

what are the late signs of COPD?

Answer 28

clubbing and cyanosis

Question 29

retained CO2 causes the kidneys to conserve bicarbonate which leads to an increase in bicarbonate. Decreased pH, increased PaCO2 and HCO-3, respiratory acidosis is considered chronic when HCO-3 is greater than 26 (renal compensation)

Answer 29

Acid-Base Imbalance (compensation)

Question 30

airway obstruction, brain injury, strike, trauma, drugs, anesthesics, opioids, sleep apnea, scoliosis, flail chest, obesity, muscular weakness, muscle relaxants, electrolyte disturbance, chronic obstructive airways, sever asthma, pneumothorax, and more

Answer 30

cause of acid base imbalance (compensation)

Question 31

occurs in october to march, transmitted through direct contact with respiratory secretions or indirectly through contaminated surfaces. Infected children sheds the virus for 3 to 8 days, with an incubation period of 2 to 8 days. Viruses are able to invade the mucosal cells that line the small bronchi and bronchioles, these invaded cells die when the virus bursts inside the cell when trying to invade adjacent cells. This causes adjacent cells to infuse with the membranes of infected cells creating large masses of cells or syncytia and irritates the airway. This causes the airway lining to swell and an increase in mucus production. Despite the attempt to fix the issue, this results in partial airway obstruction and bronchospasm. Air can get in, but cannot get out. This creates wheezing and crackles in the airways.

Answer 31

Pathophysiology of Respiratory Syncytial Virus (RSV)

Question 32

begins in upper airway, quickly progresses, lethargy leads to dehydration..spreads easily through children

Answer 32

notes to remember about RSV

Question 33

immunosuppression, very low birth weight, lung disease, severe neuromuscular disease, or complicated congenital heart defects.

Answer 33

risk factors for RSV

Question 34

cannot treat disease but must treat symptoms. Peak is around day five.
day 1-2 child may be slightly tired and may have a ough.
fever - treat with antipyretics
cough
increased mucus production
fatigue
activity intolerance - change from baseline
“they don’t feel right - “malaise”
retractions
decreased fluid intake. IV may be hard to palce

Answer 34

Clinical manifestation of RSV