fund nursing 51 - asthma Flashcards
asthma is
chronic but reversible. different that COPD. it’s really upper bronchi. intermittent airway obstruction. muscles around bronchioles tighten.
mortality for emphaysmia and chronic bronchitis
Mortality is >50% within 10 years of diagnosis. we try to slow progression.
chronic airway limiting diseases cause
and increase in CO2 so it causes hypercapnia
asthma more common in women or men?
women, but kids it’s boys
is alveoli affected with asthma?
nope, just bronchioles. triggered by an irritant. dust mites, smoke, etc. viral infections, nasal polyps. meds, emotional stress.
asthma increases
work of breathing to maintain MV (minute volume - this is what gets rid of CO2)
asthma and mucus?
Leads to an increased number and size of mucous glands and secretion of thick mucous
during asthma attack, where does air get trapped? (A for asthma and alveoli)
the alveoli so we can’t bring down CO2 hypoxic and hypercapnic. also causes tachycardia from stress maybe.
cholinergic receptors are what type of cells?
mast cells
vitamins associated with asthma (Ce, you have asthma)
Diets low in vitamins C, E and omega-3 fatty acids, obesity
asthma diagnosis
Diagnosis
History & Symptoms
PFTs – especially peak flow (spironmetry, pulse ox, use every morning, measuring expiratory volume)
Methacholine challenge test (MCT
Tests airway sensitivity to detect asthma
Increasing amounts methacholine inhaled causes airways to spasm and narrow if asthma present
Measures spirometry before & after and is + if FEV drops by 20% or more
Bronchodilator given at end of test to reverse effects
asthma using peak volume flow - measures what?
expiratory volume
Peak flow meter - how to use (peaking 3 times a day)
do 3 times take a break in between. do same time every day. sometimes twice a day.
asthma meds - in order (SMAL AB - asthma meds are big A little A)
1) steroids
2) mast cell stablizers
3) antihistamines and leukotrienes
4) anticholeringenics and bronchodilators
asthma listen to what part of lungs (asthma is everywhere)
brioch, bronchi-vesic, vesic.
hydrate or not?
hydrate but don’t overhydrate. usually use a mask not cannula.
CPAP expands what? (alvin with a cpap)
alveoli
short acting meds - within 5 min (terol is shorty)
ending in terol, terbutaline and epinephrine
long acting meds - within 20-30 min (salmon and meta are long)
salmetrol, metaproterononal tablets, and other tablets
status ashtmatics in what respiratory state? (status is almost gone)
respiratory distress
status asthmatics triggers (latin from fires and cold)
upper respiratory infection, wildfire, or exercising in cold
meds to status asthmatics (maticus needs epi pen and maggie)
epinephrine, corticosteroids, magnesium sulfate (relax smooth muscle), terbutaline, leukotriene inhibitors (anti inflammatory)
emphysema air gets trapped where?
alveoli, they get flattened out, bronchioles narrow.
emphysema cough or not? (emphsymia is out the door too)
can’t cough, sleep with multiple pillows, prolonged expiratory
chronic bronchitis definition (chronic addicts are 3 months or longer)
Becomes chronic > 3 months a year for 2 years. mucus trapping. can occur with emphasymia or alone.
chronic bronchitis - blue bloater
wheezing, coughing, blue. digital clubbing. edematous.
bronchietasis (elongating bronchitis, elongating airways)
can occur with cystic fibrosis. exposed to TB maybe or another pathogen. Resp infections are usually staph.
bronchietasis is constriction or dilation?
dilated, filled with thick secretions. many infections. usually on antibotics. usually become resistant.
bronchietasis symtoms (think bronchitis)
purulent sputum, hemoptysis, clubbing, SOB, wheezing and rhochi, don’t clear with coughing usually. fevers from infections. loss of appetite. lose cilia.
bronchietasis treatment
fluids and nutrition, prevent RTI. bronchodilators, exportants, mucolytics. Pulmonary toilet/hygiene (percussion, postural drainage). oral care.
what 3 things increase CO2 in COPD pts? (pink has high co2 from hal, vasoconstriction, and low mv)
Haldane effects
Hypoxic vasoconstriction
Decrease minute ventilation
Haldane effects (hal is high in oxygen, so CO2 gets pushed aside to plasma and can’t blow it off)
desaturation of hemoglobin increases CO2 bonding, so it gets higher. High O2 displaces CO2, which makes it higher in plasma. pts can’t blow off the CO2 then. pH decreases and causes respiratory acidosis.
in COPD pts, is there vasoconstriction with o2 administration? (O2 is usually a vasoconstrictor)
no, they don’t respond to oxygen administration and the V/Q doesn’t match. it just increases dead space and CO2.
COPD O2 administration
Although patients with COPD & acute respiratory failure (ventilation failure)may increase PaCO2 with provision of oxygen:
Maintain O2 saturation at 90-93% with PaO2 of 60-70 mmHg
If PaCO2 rises, assist patient to blow off CO2
NIV or intubation with ventilator
asthma med that is a mast cell stablizer (chrome mast)
Cromolyn sodium
6 Ps of dyspnea
pulmonary bronchial constriction, foreign body obstruction, pneumonia, heart failure usually right side (left is pulmonary edema), pneumothorax, pump failure, (no breath sounds if lungs collapse)
bullae
Bullae are enlarged airspaces that do not contribute to ventilation
jugular vein distention - bronchiospasm or not?
nope
main goal for COPD pt
provide sufficent O2
lower respiratory drugs - Bronchodilators - BAM! you’re dilated
beta 2 agonist, anticholinergics, methylxathines
lower respiratory drugs - Anti-inflammatory - SLM anti-inflammatories
steroids, leukotriene inhibitors, mast cell stablizers
beta 2 agonists end in (B for beta, B for buterol)
buterol
buterol is B for
brutal asthma attacks - 1st drug for severe asthma attacks. use before steroids.
acute asthma attack is 3 drugs - AIM (in order)
albuterol, ipratroprium, methypredsidone (steroids act slow)
if albuterol not working after how many puffs?
3, then notify provider
albuterol ONLY cleaned
1 -2 times a week. STEROIDS (steroids go in sink) are washed after every use
anticolinergics (dry you out) - end in what? (anti troops)
tropium - used for moderate asthma and COPD
tropeeeem
you can’t pee with them
methylxanthines end in (philleen the meth)
phylline - makes heart race
phylline has you feelin
caffienated and toxic - take in am
SLM - S for steroids = ends in
sone
AIM for
acute
order of lungs (Us, I, Ole)
trachea, bronchus, bronchi, bronchioles
vesicular
soft and low - goes from loud to low
what level of PaO2 warrants O2 administration for COPD? (Pa is 20 less than normal)
Give O2 when PaO2 < 55 mmHg & sat < 88%
