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Med Surg 3 (theory class) > NURS 444 week 2 > Flashcards

NURS 444 week 2 Flashcards

1
Q

GERD and asthma

A

asthma meds. may worsen GERD
treating GERD may reduce nocturnal asthma

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2
Q

Asthma triad

A

nasal polyps
asthma
sensitivity to aspirin or NSAIDs

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3
Q

Asthma

A

a hyperactive inflammatory response

early-phase: 30-60 min response to allergen or irritant, inflammation, and release of kines

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4
Q

Asthma late phase

A

inflammation after 4-6 hrs from initial response
continued release of cell mediators
can last more than 24 hrs
corticosteroids are used

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5
Q

Airway Remodeling

A

due to chronic inflammation include
- fibrosis
- smooth muscle hypertrophy
- mucus hypersecretion
- angiogenesis

progressive loss of lung function not fully reversible results in persistent asthma

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6
Q

Early manifestations of asthma attack

A

! expiratory wheezes
! cough
! dyspnea
! chest tightness

!! worsening- wheezing inspiratory and expiratory
!!! severe- wheezing with forced expiratory or no breath sounds

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7
Q

Asthma classifications

A
  • intermittent:
  • mild persistent
  • moderate persistent
  • severe persistent

re-evaluation of treatment efficacy in 2-6 weeks

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8
Q

type of impairment criteria for asthma: components of severity

A

frequency in symptoms
nighttime awakenings
SABA use for symptoms
Interference with normal activity
lung function: FEV1, FVC

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9
Q

Intermittent asthma

A

symptoms less or 2 days/ week
nighttime awakenings less than or 2 times/ month
SABA use less than or 2 days/week
does not interfere with normal activity
Lung function= FEV1 >80%, FEV1 FFVC normal

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10
Q

Mild asthma

A

symptoms occur more than 2 days/week, not daily
nighttime awakening 3-4 times/month
SABA use for symptoms more than 2 days/ week, not daily
minor interference with normal activity
FEV1/ FVC normal

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11
Q

Moderate asthma

A
  • symptoms happen daily
  • nighttime awakenings more than 1 time/ week, not nightly
  • SABA use daily
  • some limitation with normal activity
  • FEV1 60%- 80% predicted. FEV1/ FVC reduced by 5%
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12
Q

severe asthma

A

! symptoms are continuous
! nighttime awakenings happen often 7/week
! SABA used several times/ day
! extremely limited in normal activity
! FEV1 <60% predicted. FEV1/ FVC reduced by 5%

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13
Q

Asthma complications

A

! pneumonia
! tension pneumothorax
! status asthmaticus
! acute respiratory failure

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14
Q

Goals of Asthma treatment

A

achieve and maintain control
return to optimal functioning

medication guidelines
- go up as symptoms worsen
- go down as symptoms improve

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15
Q

Mild to Moderate asthma attacks: symptoms and treatment

A

symptoms: no more than 2x/week
- minimal ADL interference
- may have some chest tightness
- A&O and speaks in sentences
- increased use of asthma meds.
- o2 sats >90%
- PEFR >50% predicted or personal best

treatment:
*** inhaled bronchodilators and oral corticosteroids
- monitor VS
- monitor as outpatient unless meds. not working
- f/u with HCP

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16
Q

Severe asthma attack: symptoms and treatment

A

symptoms:
! A&O but focused on breathing: frightened/ agitated if hypoxemic
! tachycardia, tachypnea (>30 breaths/min)
! accessory muscle use, sits forward
! wheezing
! symptoms interfere with ADLs
! PEFR < 50% predicted or personal best

treatment:
! ED –> admission
! supp. oxygen and oximetry: PaO2 >60% or O2 >93%
! monitor ABG, PEFR, and VS
! bronchodilators and oral corticosteroids
! silent chest- IMMEDIATELY NOTIFY HCP!!!***

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17
Q

Status asthmaticus

A
  • hypoxia –> hypercapnia
  • ARF – life-threatening
    chest tightness, increased SOB, sudden inability to speak

without tx leads to:
- hypotension, bradycardia (muscle exhaustion)
- resp./ cardiac arrest
- bronchodilators and corticosteroids not effective

emergent Tx
- intubation and mechanical ventilation
- hemodynamic monitoring
- analgesia and sedation
- IV magnesium sulfate- relaxes bronchial muscles and expands airways

18
Q

RECUE medications for asthma attacks

A

Short-acting bronchodilators
- inhaled B2-adrenergic agonists (SABAS): albuterol most common
- onset is minutes, duration 4-8 hours
- overuse can result in; tremors, anxiety, tachycardia, palpitations, nausea

Anti-inflammatory drugs
- IV corticosteroids

19
Q

Long-term Asthma medications

A

used to achieve and maintain control

Bronchodilators
- long-acting inhaled or oral B2- adrenergic agonists (LABAs)
** NEVER used for acute attacks
- methylxanthines- ex. theophyline. less effective and high risks for toxicity
- anticholinergics

Anti-inflammatory drugs
- oral or inhaled corticosteroids (ICS)
- leukotrienes modifiers
- Anti-IgE

20
Q

Anticholinergics in asthma

A
  • promote bronchodilation- preventing muscles around bronchi from tightening
  • less effective than SABAs for asthma- used more in COPD
  • not routinely used in asthma management unless severe acute attacks
21
Q

non-prescription combinations

A

bronchodilator (ephedrine) and expectorant (guaifenesin)
- OTC- many SE so should avoid

  • epinephrine and ephedrine inhalers- stimulate CNS CV, potentially dangerous
  • ephedrine can be used to produce meth.
  • reformulated with phenylephrine
22
Q

overall goals for asthma management

A
  • have minimal symptoms during the day and night
  • maintain acceptable activity levels (including exercise)
  • maintain greater than 80% of personal best PEFR
  • few or no adverse effects of therapy
  • adequate knowledge to carry out plan
23
Q

Yellow zone

A

Asthma is getting worse: - symptomatic, limited activity, PEFR 50% - 79% personal best.

24
Q

Red zone

A

Medical alert
symptomatic
meds. not helping
unable to do usual activities
50% or less PEFR personal best

CALL DOCTOR, AMBULANCE

25
Q

Nursing Acute Care: Asthma

A

> monitor cardiac and lungs
pulse oximetry, peak flow, ABGs
give meds.
evaluate response to therapy; may take days

Decrease patient’s anxiety
> position Semi-Fowler’s
> “talking down” to keep calm- used pursed lips
> stay with patient
> allow rest when attack subsides; get H & P

26
Q

COPD risk factors

A

-smoking
- infection
- severe recurring resp. infections in childhood
- HIV
- asthma
- tuberculosis
- air pollution
- occupational dust and chemicals
- aging
- genetics- a1 antitrypsin deficiency

27
Q

Pulmonary vascular changes in COPD

A
  • vasoconstriction of small pulmonary arteries due to hypoxia
  • vascular smooth muscle of pulm. arteries thickens in advanced disease
  • pressure in pulm. circulation increases
  • results in pulm. htn resulting in right ventricular hypertrophy and right-sided heart failure
28
Q

COPD classification

A

FEV forced expiratory volume

FEV/ FVC1 of < 70%

severity of obstruction- postbronchodilator FEV1 results:
-GOLD 1 Mild
-GOLD 2 Moderate
-GOLD 3 Severe
-GOLD 4 Very severe
-global initiative for Chronic Obstructive Lung Disease

29
Q

COPD clinical manifestations

A

^ develops slowly
^ dx considered with chronic cough, sputum production, dyspnea, exposure to irritants
^ symptoms may be ignored
^ dyspnea usually prompts medical attention: occurs with exertion in early stages. present at rest in advanced stages
^ peripheral edema
^ hypoxemia: PaO2 < 60, SaO2 < 88%
^ hypercapnia >45%
^ increased hemoglobin (may reach 20 g/dl, RBC

30
Q

Pulmonary HTN, cor pulmonale

A

Pulmonary hypertension
- Pulmonary vessel vasoconstriction due to alveolar hypoxia
- Increased pulmonary vascular resistance
- Polycythemia from chronic hypoxia results in increased viscosity

Cor pulmonale (right-sided heart failure)
- Late manifestation
- Pulmonary HTN results in increased right ventricle pressure
- Dyspnea most common
- Other: S3 and S4, murmurs, distended neck veins, hepatomegaly, peripheral edema, weight gain

31
Q

Dx and Tx for Cor Pulmonale

A

CXR, US, BNP levels

  • long-term O2 therapy
  • diuretics
  • anticoagulation
32
Q

Specific Tx for COPD

A

SABAS and corticosteroids
- anticholinergic, antibiotics, diuretics

Oxygen

***ARF may occur if patient waits too long

33
Q

COPD dx studie

A
  • History and physical exam
  • Spirometry—confirms diagnosis: FEV1/FVC ratio <70% ***
  • Chest x-ray
  • Serum a1-antitrypsin levels
  • 6-minute walk test: Pulse ox <88% at rest—qualify for supplemental O2
  • ABGs
  • ECG, Echo, MUGA scan
  • Sputum culture and sensitivity
34
Q

COPD drug management

A

Bronchodilators
relax smooth muscle in the airway, improve lung ventilation, decreased dyspnea and increased FEV1, inhaled route is preferred,
include adrenergic agonist, anticholinergics, methylxanthines

moderate stage: FEV < 60%
-inhaled long-acting anticholinergics
-inhaled corticosteroids

35
Q

COPD oxygen therapy

A
  • used to treat hypoxemia
  • keep O2 sats > 90% during sleep, rest or exertion or PaO2 >60

-low flow delivery is most common
-high flow fixed concentration with venturi mask
- humidification

36
Q

Miliary TB

A

TB that travels out of the lungs

37
Q

Acute TB symptoms

A

generalyzed flu symptoms

  • high fever
  • chills
  • pleuritic pain
  • productive cough
38
Q

TB complications

A

! pleural effusion- caused by bacteria in pleural space, inflammatory reaction
! empyema
! TB pneumonia
! miliary TB- other organ involvement: CNS, bone and joint, kidneys, heart

39
Q

Meds. for TB

A

2 MONTH INITIAL PHASE:
1) Isoniazid (INH)
2) Rifampin
3) pyrazinamide
4) ethambutol

INH alone for 6 to 9 months for latent infection (HIV patients should take INK for 9 months)

40
Q

SE of INH

A

monitor liver function
- hepatotoxicity
- arthralgias
- vomiting
- confusion

*teach not to drink alcohol

Med Surg 3 (theory class) (13 decks)

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