Obstructive Pulmonary

Question 1

What are all COPD patients more suseptable to and why

Answer 1

lung infections because mucus builds up in the lungs and they take corticosteroid

Question 2

Is the clinical course of asthma predictable

Answer 2

no

Question 3

What are the triggers of asthma

Answer 3

Allergen inhalation
Air pollutants
Viral upper respiratory infection (most common cause)
Sinusitis
Exercise and cold, 	dry air
Stress
Drugs
Occupational exposure
Food additives
Hormones/ menses
GERD

Question 4

What is the early phase of asthma

Answer 4

bronchospasms so wheesing, chest tightness, dyspnea cough

Question 5

What is late-phase for asthma

Answer 5

peaks 5-6hrs after exposure

airways are the most sensitive and resistant and inflammed

Question 6

When does early phase peak for asthma

Answer 6

30-60 min

Question 7

What does good asthma control mean

Answer 7

minimal symptoms

able to ecercise and sleep through the night

Question 8

What are the classifications of asthma

Answer 8

mild intermittent
mild persistent
moderate persistent
severe persistent

Question 9

What is mild intermittent asthma

Answer 9

symptoms no more than twice weekly
nocturnal symptoms less than twice monthly
FEV1/FVC at least 80% of personal best and PEFR has a less than 20% variability

Question 10

Wha tis mild persistent asthma

Answer 10

symps more than twice weekly butless than daily
nocturnal symps more than 2 monthly
FEV1/FVC at least 80% of pers best and PEFR variability between 20-30%

Question 11

Wha tis moderate persistent asthma

Answer 11

Daily symps
more than 1 weekly nocturanl symps
FEV1/FVC between 60-80% of pers best and PEFR greater than 30% variabilty

Question 12

What is severe persisten t

Answer 12

continual symps
frequent nocturnal symps
FEV1/FVC less than 60% of pers best and PEFR variability greater than 30%

Question 13

Is wheesing a reliable sign to guage the severity of asthma and whyy

Answer 13

no bec as asthma gets worse wheesing actually stops and you get silent chest

Question 14

When analysing the resp sys for an asthma patient during an ecacerbation what would percussion reveal and why

Answer 14

hyperresonance bec the lungs are full of trapped air

Question 15

When aucultating the lungs for an asthma patient what could diminished or absent breath sounds indicate

Answer 15

atelectasis

pneumonia

Question 16

In the emergency room settings, if the patients peak/flow is less than 75% what should you give

Answer 16

bronchodilator

Question 17

What are some diagnostic test used to diagnose asthma and its severity

Answer 17

PFT’s
sputum specimen (for infection)
serum IgE and eosinophil levels
Chest ecs-ray

Question 18

For ABG’s what might a mild asthma attack show and why

Answer 18

resp alkalosis with near normal O2 bec their ability to ecshale is still good so they end up hyperventilating causing too much loss of CO2

Question 19

For ABG’s what might a severe asthma attack show and wy

Answer 19

hypercapnia and resp and meta acidosis bec now they cant ventilate as well bec the airways are even more narrow so CO2 levels rise

Question 20

What is status asthmaticus

Answer 20

severe asthma complications that are unresponsive to treatment

Question 21

What are some causes of status asthmat

Answer 21

viral illnesses
increased allergen ecsposure
abrupt discontinuation of drugs especially corticosteroids
aerosol medication abuse

Question 22

What do status astmat patients usu report

Answer 22

poorly controlled asthma that has been progressing over days or weeks

Question 23

What are some complications that a status asthmaticus ecacerbation can lead to

Answer 23

pneumothorax, pneumomediastinum, acute cor pulmonale, and respiratory muscle fatigue leading to respiratory arrest

Question 24

What is cor pulmonale

Answer 24

when the pressure in the lungs gets high enough to cause HTN in the blood vessels innervating the lungs causing the right side of the heart to work harder against that resistance eventually leading to heart failure

Question 25

What may be added to the care of a status asthmat during an ecacerbation when they arent responding to a beta adrenergic agonist

Answer 25

IV aminophylline

Question 26

What are some interventions for status asthmat

Answer 26

IV corticosteroids every 4-6 hours
sometimes IV MgSO4 for brondchodilation 
A-line inserted for freq ABG monitoring 
IV fluids for insensible fluid loss
bicarbonate (NaHCO3) for meta acidosis
mechanical ventilationi

Question 27

What is some teaching/health ppromo for asthma

Answer 27

avoid triggers- like using dust covers, using scarves or masks for cold air, and avoiding aspirin or NSAIDS
promptly report signs of URI or Sinusitis bec early treatment may prevent ecacerbations
intake 2-3L daily
adequate nutrition and sleep
take beta-adre agonist 10-20 minutes before activity

Question 28

What are some main teaching points for medications with asthma pats

Answer 28

teach the importance of continuing the med even without symps
develop self-management strategies
tremors are a common SE of short actign beta’s so dont stop taking
All dry powder inhaled drugs (DPI) must be inhaled quickly
inhaled steroids are never fast acting
hold breath for 10 secs after using inhaler

Question 29

What is some teaching for using a peak flow meter

Answer 29

teach what the colors mean
take short acting beta if in yellow
dont do anything ecstra if in green
if in red take short acting beta and call doc immediately
how to use the meter
make sure you get a good seal on it
mearsure flow daily bec you probs wont see a difference of resp at first

Question 30

What are some interventions for asthma pats including actions, collaborative care, and demeanor

Answer 30

Have a Calm, quiet, reassuring attitude
Positioned comfortably (sitting)
Staying with the patient
Slow breathing through pursed lips
Administering oxygen
Bronchodilators & anti-inflammatory drugs
Beware – ß-blockers (like propanolol) can cause bronchospasms in patients with asthma – be aware at initial diagnosis. . . . . BOLO
Chest physical therapy- cupping technique
Medications (as ordered