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N233 > N233 Final > Flashcards

N233 Final Flashcards

1
Q

Dyspnea causes

A 
COPD
Asthma
Pregnancy
MI
Panic Attack
Chocking/Obstruction
CHF
Age
Pulmonary embolism
Allergies
Pneumothorax
...
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2
Q

Dyspnea

A

Difficult or laboured breathing
Shortness of breath
A person’s expression with dyspnea may not correlate with respiratory rate or oxygen saturation

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3
Q

Signs and symptoms of respiratory disease

A
  • Dyspnea
  • Sputum production
  • Cough
  • Chest pain
  • Wheezing
  • Clubbing of fingers
  • Hemoptysis
  • Cyanosis (late sign)
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4
Q

Risk factors for dyspnea

A 
SMOKING
exposure to 2nd hand smoke
Family medical hx of lung disease - genetic
Allergens
Poor nutrition
Inadequate exercise
Substance abuse
Stress
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5
Q

Dyspnea: Subjective data questions

A
  • Complaints of chest tightness, can’s get air, air hunger
  • Fatigue
  • On exertion
  • Cough
  • When? Position? Worse when walking?
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6
Q

Dyspnea: Objective Data

A 
Nasal Flaring
Increased RR
Chest symmetry
Rate and depth of respirations
Use of accessory muscles
Wheeze, creackles, decreased or absent LS
Vitals signs
Tracheal tug (https://www.youtube.com/watch?v=xM92cP5pE_Q)
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7
Q

Dyspnea: diagnostic tests

A 
Oxygen sats
Hbg, RBCs, WBCs
ABGs
CXR
CT chest
Throat and sputum cultures
Bronchoscopy?
PFT - pulmonary function tests = aka Spirometry
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8
Q

Pulmonary Function Tests

A 
Tidal volume
Forced vital capacity (FVC)
Forced Expiratory Volume (FEV1)
Used to assess respiratory function and stage COPD (obstructive or restrictive)
To determine if Tx is working
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9
Q

Restrictive Lung Disease

A

Lungs can’t move well d/t fibrosis, scoliosis, pregnancy, obesity, pulmonary edema

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10
Q

Obstructive Lung Disease

A

Narrowing of the airways (COPD, Asthma)

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11
Q

Palliative Nursing Interventions for Dyspnea

A

Decrease anxiety
Treat underlying pathology
Reduce respiratory demand
Alter perception of breathlessness

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12
Q

Pneumonia

A

Inflammation of the lung parenchyma

Caused by many microorganisms

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13
Q

Pneumonia causes

A 
Bacteria
Viruses
Parasites
Aspiration
Opportunistic - immunocompromised
..
Typical pneumonia - bacteria
Atypical pneumonia "walking pneumonia", less severe symptoms

Community acquired pneumonia (<48h)
Hospital acquired pneumonia/ Nosocomial (>48h)

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14
Q

Reasons why Pts develop HAP (Hospital acquired pneumonia)

A

Impaired defenses (skin, immune sys)
Highly virulent
Organisms reach lower respiratory tract

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15
Q

Aspiration Pneumonia

A

Pulmonary consequences of resulting from the entry of endogenous or exogenous substances into the lower airway.

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16
Q

Pneumonia- Objective data

A 
Hx
Px (fever,chills, rigors, pleuritic chest pain - worsen by coughing or deep breathing, severily ill appearance)
Tachypnea (25-45)
SOB
Use of accessory muscles
Tachycardia, bounding pulse
Upper resp tract infection s+s (eg. runny nose)
Rash?
Pharyingitis
Mucoid or purulent sputum
17
Q

Pneumonia diagnostics

A 
Chest XRay
CT chest
CBC
Blood cultures
Sputum sample for C&amp;S
ABGs
Oxygen saturation
VS
18
Q

Pneumonia: Medical Treatments

A 
Abx (if bacterial)
Bed Rest
Hydration (Oral or IV)
O2 &amp; humidification ( to avoid hypoxemia and help break down sputum)
Supportive medication
19
Q

Pneumonia: Gerontological considerations

A

Difficult to treat
Higher mortality rate
symptoms: weakness, abdominal symptoms, anorexia, confusion, tachycardia, tachypnea
Breath sounds are difficult indicators of pneumonia in elderly

20
Q

Pneumonia: Nursing Diagnoses

A
  • Ineffective airways clearance r/t copious tracheobronchial secretions
  • Activity intolerance r/t impaired resp fx
  • Risk for deficient fluid volume r/t fever and tachypnea
  • Imbalanced nutrition (less than body requirements)
  • Deficient knowledge about the treatment regimen and preventive health measures
21
Q

Pneumonia: Nursing Assessments

A

In hospitalized pts:
- fever, chills, night sweats, pleuritic plain, tachypnea, accessory muscle use, coughing purulent sputum

Once diagnosed watch for:

  • VS: temp, pulse, O2 sats
  • amount, odour, and colour of secretions
  • tachypnea and SOB?
  • XRay changes
  • fatigue
  • knowledge deficit?
22
Q

Pneumonia: Nursing Interventions

A
  • Improve airway patency
  • Rest to conserve energy - Bed rest
  • Maintenance of proper fluid volume - Hydration (2-3L per day)
  • Adequate nutrition
  • Positioning
  • Incentive Spirometry
  • Deep breathing and coughing
  • NG suctioning
  • Humidification via face mask
23
Q

Asthma Triggers

A
  • Respiratory infections (use of more bronchodilators for relief)
  • Aiway irritants (smoke, perfume, weather changes- heat or cold)
  • Exercise
  • Stress
  • GI reflux (GERD)
24
Q

Asthma: S+S

A 
WHEEZING
COUGH
DYSPNEA
Chest tightness
May be abrupt
Increased effort with expiration
tachycardia
Severe hypoxia
25
Q

Asthma: diagnostics

A 
ABGs (after an acute episode)
Pulmonary function test
Labs - WBCs
Chest Xray
...
26
Q

Asthma Complications

A

Status asthmaticus
Respiratory Failure
Pneumonia

27
Q

Bronchiolitis

A

Inflammation of the fine bronchioles & small bronchi
Lower tract infection
Usually due to RSC (Respiratory synctial virus)

28
Q

COPD

A
  • Diseases that cause airflow obstruction (emphysema, chronic bronchitis) or combination
  • Progressive associated with abnormal inflammatory response
  • Preventable
  • Airflow limitation is irreversible
    Etiology: smoking or exposure to air irritants/pollutants, genetics
29
Q

COPD: Risks and Causes

A
  • smoke, air pollution, occupational dust and chemicals
  • alpha-1 antitrypsin deficiency (genetic)
  • premature infants
30
Q

COPD Stages

A

Stage 1: FVE1 = 80%
Stage 2:FVE1 50%-80%
Stage 3:FVE 30%-50% > severe restraint of respiration, thightness of breath, COPD exacerbations
Stage 4:FEV1 <30% > very severe and risky, Low quality of life with vital COPD exacerbations

31
Q

COPD: mnfts

A 
Increasing DYSPNEA
COUGH and SPUTUM
Rigid chest, ribs fixed at joints
"barrel chest"
"Clubbed" fingers
Weight loss
Limited ADLs
Use of accessory muscles 
Paradoxal respiration > https://youtu.be/8TnrNrrEjuE
Chronic Hypoxemia, hypercapnia, polycythemia
RHF > Cor Pulmonale
32
Q

COPD specific assessments (tests, labs)

A 
RBG > polycythemia vera?
ABGs > oxygenation levels, hypercapnia?
Exercise testing
Exacerbations? > spirometry
PFTs
Pulse oxymetry
CXR
CT
33
Q

COPD Nursing Management

A

PATIENT EDUCATION: how to deep breathe and cough, pursed lip breathing
Oxygen therapy
Safety > DO NOT SMOKE w/ O2
Nutrition and hydration (high protein, high caloric meals)
Quality of life?
ADLs?

34
Q

COPD: Pt education

A

Teach about:

  • disease
  • medications (how to take and when)
  • When and how to seek help with exacerbations
  • Infection control ( vaccinations)
  • Avoid irritants
  • Lifestyle changes (eg. smoking cessation, address anxiety)

N233 (2 decks)

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