Lower Respiratory Tract Disorders Flashcards
What is the name of the infection that is a common cause of death?
Pneumonia
What populations are at risk for developing pneumonia?
Very young individuals
Elderly individuals (>65 years)
Those with chronic disease
Those who smoke
Those with compromised immune systems, such as AIDS
Those who are intubated and are mechanically ventilated
Define Hospital Acquired Pneumonia (HAP)
Pneumonia that develops at least 48 hours after a hospital admission
Define Ventilator Associated Pneumonia (VAP)
Pneumonia that can occur after an individual is intubated and placed on mechanical ventilation
What is happening within the body when a patient develops pneumonia?
There is an acute inflammation and/or infection within the lungs
The alveoli become damaged and fill with fluid and exudate
Pneumonia can commonly develop after what hospital procedure?
After surgery
Individuals are taking short and shallow breaths due to pain
The lungs and alveoli aren’t expanding appropriately, bacteria festers and grows within the alveoli
What patient does aspiration pneumonia usually develop in?
Those with decreased LOC and or an impaired gag reflex
How does an individual prevent pneumonia from developing?
Hand washing
Pneumococcal vaccine
Influenza vaccine
Encouraging coughing and deep breathing
Promoting position changes and turning while in bed
Encouraging movement/walking if patient is able to
How can the nurse prevent hospital acquired pneumonia from developing?
Encouraging coughing and deep breathing Promoting position changes and turning while in bed Encouraging movement/walking if patient is able to Incentive Spirometer Hand hygiene Oral hygiene Pneumococcal vaccine Influenza vaccine
List the signs and symptoms of pneumonia
Fever
Shaking
Chills
Chest pain
Dyspnea
Fatigue
Malaise
Productive Cough
Yellow, Rusty or blood tinged (hemoptysis) sputum
Adventitious Lung Sounds (crackles, coarse, wheezes)
New onset confusion and/or lethargy within the older adult patient
List some complications of pneumonia
Plueral Effusion
Atelectasis
Spread of Infection
What diagnostic tests can diagnose pneumonia?
Chest X Ray
Sputum Culture
Blood Cultures
Complete Blood Count
What medications will assist with signs and symptoms that have developed from pneumonia? How do they help?
Bronchodilators (Beta Two Agonist Medications); dilate the bronchioles and improve airflow and gas exchange
Expectorants; aide in ridding sputum from the lungs by breaking mucus up
What medications will treat bacterial pneumonia?
PO or IV antibiotics
What medications will treat viral pneumonia?
None usually given, patient instructed to rest and drink a lot of fluid
List therapeutic interventions for pneumonia
Encourage fluids (helps thin exudate) Encourage rest Encourage deep breathing and coughing (clear exudate from body) Encourage incentive spirometry Supplemental O2 if necessary Chest Physiotherapy Administer bronchodilator if necessary
What is the definition of atelectasis?
Collapse of the alveoli, a restrictive disorder
Why does atelectasis occur?
Due to hypoventilation
When does atelectasis most commonly occur? Why?
In postsurgical patients
They are not taking deep breaths and coughing effectively secondary to pain
The alveoli don’t expand to their full capacity so they eventually collapse
List the signs and symptoms of atelectasis
Adventitious lung sounds; fine crackles, diminished breath sounds, possibly absent
Dyspnea
Pain with breaathing
What measures are taken to prevent atelectasis?
Coughing and deep breathing
Use of incentive spirometer
Turning patient
Ambulating patient
What is the issue that occurs when a patient has an obstructive lung disorder?
Air is trapped
Air can get into lungs but it cannot exit properly
Name the obstructive lung disorders
Chronic Obstructive Pulmonary Disease
Asthma
What two diseases are examples of COPD?
Emphysema
Chronic Bronchitis
Can COPD be treated and go away?
No, COPD is progressive and irreversible
With appropriate lifestyle changes symptoms can improve, but the disease never goes away completely
What happens with the lungs during chronic bronchitis?
Airways are inflammed and narrowed
Mucus develops and remains in the alveoli and lungs
What happens with the lungs during emphysema?
Alveolar walls are destroyed which causes the alveoli to “pop” are merge together
Elasticity within the lung tissue is lost
Air becomes trapped in the alveoli
What is the number one cause of COPD?
Smoking
List the signs and symptoms of Chronic Bronchitis
Adventitious lung sounds; wheezing, crackles, rhonchi Chronic productive cough Thick, tenacious sputum Dyspnea, SOB Dyspnea on Exertion Activity intolerance Prolonged expiration Increased susceptibility to infection Mucous plugs develop Use of accessory muscles to aide in breathing
List the signs and symptoms of Emphysema
Chronic cough Diminished breath sounds Dyspnea, SOB Dyspnea on Exertion Activity intolerance Barrel Chest Prolonged expiration Use of accessory muscles to aide in breathing
What happens in the late stages of COPD?
Patient has difficulty eating due to severe dyspnea
Patient becomes malnourished and experiences weight loss
What diagnostic tests are performed when a patient has an acute exacerbation of COPD or an acute exacerbation of asthma?
Chest Xray and/or CT Scan
Complete Blood Count
Sputum Culture
Arterial Blood Gases (hospital setting only)
What is the baseline range SpO2 for a patient with COPD?
88% - 92%
How much baseline supplemental oxygen should a patient with COPD be on?
1 to 2 LPM
If a patient with COPD is having an acute exacerbation, can they be placed on more than the recommended 1 to 2 LPM of supplemental oxygen?
Yes. However, provider should decrease the oxygen as quickly as possible with the patient keeping SpO2 levels greater than or equal to 88%
Is a patient with COPD required to be on oxygen?
No. If the patient can maintain appropriate oxygen saturations (88-92%) without O2, there is no need to be placed on the oxygen
If the student nurse knows a patient has a history of COPD and their assessment yields an O2 reading of 90%, should they be concerned?
Yes, always concerned if O2 is less than 94%. Performed appropriate assessments, interventions, reassessments and reporting to instructor!
What is the goal of COPD treatment?
To reduce symptoms, slow progression and reduce the amount of exacerbations
Increase quality of life
List therapeutic interventions for COPD
Stop smoking
Provide 1 to 2 LPM oxygen if necessary (if SpO2 <88%)
Increase activity as tolerated
Administer medications as necessary
Encourage vaccinations; pneumococcal and influenza
Encourage a diet high in protein and high in fat
Teaching breathing exercises
What medication drug class should be avoided when a patient has COPD?
Antitussive Agents
These medications reduce coughing
Want to promote coughing in the COPD patient to expectorate secretions
Why does a patient with COPD have an ineffective airway clearance? How can the nurse aide with this issue?
Airway is congested with mucus
The cough is weak and congested
Crackles are present
Nurse should encourage and increase fluids
What can the nurse do when a patient has an ineffective breathing pattern?
Encourage pursed lip and/or diaphragmatic breathing
What is occurring within the lungs when a patient has asthma?
Airways are chronically inflammed
Bronchioles are spasming
Airways are narrow
Air gets trapped
List the causes (etiology) of asthma
Heredity/Genetics
Airborne allergies
Pollution
Smoking
List triggers of asthma
They’re different for every person. Common triggers include:
Smoking, second hand smoke
Allergens such as pollen, pets, environmental triggers
Respiratory infection
Sinusitis
Stress
Medications (non specific beta one blockers)
List signs and symptoms of asthma
Dyspnea Tachypnea Wheezing Chest tightness Cough Sputum Use of accessory muscles
The nurse knows what is happening if the patient with asthma has absent lung sounds?
What medication should be given?
What lung sounds would be heard next?
Bronchioles are completely constricted, minimal air flow, emergency!
Medication: beta two adrenergic agonist to promote bronchodilation
After the medication is given, should hear wheezing. Bronchioles are beginning to open back up, but they’re still very narrow
During acute exacerbations of asthma or COPD, what therapeutic interventions will the nurse implement?
High Fowlers position
Pursed lip breathing
Supplemental O2 if necessary
Nebulized mist treatments (beta two agonists)
Possible corticosteroid treatment to reduce inflammation
What is the purpose of the peak flow meter? Why is it useful?
To measure the peak expiratory flow
Measurement is useful in detecting changes in airways, this could signal worsening respiratory symptoms
What is the purpose of tracking peak flow measurements on the chart?
So the patient and provider can see if current therapy is working, if it is effective, or if it needs to be adjusted
What does the green zone on the peak flow chart mean?
Green = Good
No changes made in treatment
What does the yellow zone on the peak flow chart mean?
Yellow = Caution
Asthma is beginning to worsen
Use rescue inhaler to help improve s/s
Patient needs to see provide if yellow zone is frequently occurring
What does the red zone on the peak flow chart mean?
Red = Get Help!
Less than 50% of personal best
Use rescue inhaler, go get help
What is the difference between daily/maintenance medications and rescue medciations?
Daily/maintenance medications are taken every day to improve symptoms long-term, they are not used for immediate relief or acute issues
Rescue medications are taken when symptoms worsen and immediate relief is needed
What is a pulmonary embolism?
Blood clot within the pulmonary artery
What is the most common cause of pulmonary embolism development?
A deep vein thrombosis (DVT) that dislodged and traveled to the pulmonary artery
How is a pulmonary embolism prevented?
Prevent development of a DVT; move/ambulate regularly, prophylactic DVT treatment if the patient is hospitalized/immobile
How is a DVT treated?
With anticogulant medication
List the signs and symptoms of a pulmonary embolism
Respiratory distress; suddent onset dyspnea, tachypnea, anxiety, decreased oxygen saturation
Tachycardia
Cough
Crackles
How can a pulmonary embolism be diagnosed?
If a D-Dimer is elevated above 500 ng/mL, a CT Angiogram of the Chest will be ordered
If a patient cannot receive a CTA, a ventilation perfusion scan will be performed
List therapeutic interventions for a pulmonary embolism
High Fowlers
Oxygen (Non-Rebreather at 15LPM if severe respiratory distress present)
Anticoagulant medication (heparin or lovenox)
List signs and symptoms of acute respiratory distress
Tachypnea Dyspnea Labored breathing Accessory muscle use Adventitious / Absent lung sounds Decreasing oxygen sats Tachycardia HTN Restlessness Confusion Lethargy
What can the nurse do if a patient presents with respiratory distress?
Place in high Fowlers or tripod position Apply oxygen; non rebreather, 15 LPM Encourage pursed lip breathing Administer medications ordered (short acting bronchodilators, corticosteroids) Assist in intubation
