Obstructive Pulmonary Flashcards
What is asthma and what does it cause?
Asthma- Chronic Inflammation and nonspecific hyperirritability or hyperresponsiveness of the tracheobronchial tree
- Airway Obstruction
- Recurrent EPISODES of WHEEZING
- Breathlessness
- CHEST TIGHTNESS
- Cough, Particularly at Night and in the Early Morning
What do you give to an asthma patient who is having an episode?
Beta H2 Agnoist
Ex. Albuterol) and Corticosteroid (Ex. FlutaCASONE
Which Gender has more cases of Asthma?
Which race has the most cases of asthma, middle, and least amount of cases?
Women > Men
Blacks > Whites > Hispanics
What are prominent features of asthma pathophysiology?
- Reduction in Airway Diameter
- Increase in Airway Resistance (related to mucosal inflammation)
- Constriction of bronchial smooth muscles
- Excess production of mucus
Is wheezing a great sign of asthma and why?
What does it not identify?
Wheezing is a great sign of asthma because although they are having an asthma attack, it shows that they are breathing
Doesn’t gauge severity of asthma attack
What are the classifications of asthma and describe them?
Mild, Intermittent
- Less than or Equal to 2 episodes a week daytime
- No more than 2 episodes a month nighttime
FEV1/PEFR is at least 80% of predicted
Mild, Persistent
- More than 2 episodes a week
-More than 2 episodes a month nighttime
FEV1/PEFR is at least 80% of predicted
Moderate, Persistent
- Occurs every day
- More than once a week
- FEV1/PEFR Between 60-80% predicted
Severe, Persistent
- Continual Symptoms
- Frequently occurs at night
- FEV1/PEFR is < 60% predicted
What are signs of an asthma attack that should concern you?
- No Audible Wheezing indicates Reduction of Airflow
- Silent Chest is a sign of impending respiratory failure
What are signs of Hypoxia in an asthma attack?
What vital sign should you check and what do you want it to be?
- Restlessness
- Inappropriate Behavior
- Increased Anxiety
- INCREASED PULSE
- Check O2 Sat.
- > 90% to be effective
What should you find when percussing a patient with asthma?
Auscultation?
Hyperresonance- Higher Pitched Sounds
Inspiratory or Expieratory Wheezing (Tells us air is Moving)
What does Diminished or Absent Breath Sounds could indicate?
Atelectasis or Pneumonia
What should you do if a patient’s peak/flow reading is <75% of baselin in ER?
Give Bronchodilator
-Possibly give a short term coritcosteroid
What labs should you get to see if a patent has asthma?
What radiology labs should be done and what should they show if they have asthma?
- Serum IgE levels
- Eosinophil Count
-Chest X-Ray during an asthma attack shows Hyperinflation
What occurs with ABGs and O2 pressure during a MILD Asthma Attack?
What about a SEVERE Asthma Attack?
ABGs show Respiratory Acidosis with a PaO2 near normal
- Tachypnea to blow off some CO2
Respiratory and Metabolic Acidosis
-Hypercapnea
What is FEV1 and how is it measured?
What is PEFR and how is it measured?
Forced Expiratory Volume in 1 second- Measures amount of air you can force from your lungs in 1 second
- Measured by Spirometry Test
PEFR (Peak Expiratory Flow Rate)- Measures Maximum SPEED of expiration
-Measured by Peak Flow Meter
What should you do with someone who is having an acute asthma episode?
Start O2 Immediately and Monitor with Pulse Oximetry
-Give medications (Short Acting Bronchodilators and Long Acting, corticosteroids)
What are signs that things are going bad with someone having an acute asthma episode?
What should you do?
- Decreased Wheezing (less air flow)
- Call Doctor 1st for mechanical intubation
What is Status Asthmaticus?
Status Asthmaticus- A severe, life threatening complication of asthma that is refractory to usual treatment
-Places the patient at risk for respiratory failure
Signs of Status Asthamticus
- Hypertension
- Sinus Tachycardia
- Ventricular Arrhythmias
What should you do if a patient with status asthamticus doesn’t respond to Beta-Adrenergic Agonist?
IV AMINOPHYLLINE (Big Strong Drug)
What can you give someone with asthma going through metabolic acidosis?
NaHCO3 (Sodium Carbonate)
When should a patient use a long term Beta 2 Agonist?
Give one example of a Beta 2 Agonist
Only be used after client is using a long term inhaled corticosteroid
Salmeterol (Serevent)
What is a common side effect of a short acting Beta2 Agonist? Why is it a side effect?
Tremors because it is a sympathomnetic drug
What should you do for the following Peak Flow Results and describe these results?
Green Zone
Yellow Zone
Red Zone
Green Zone (80-100% of personal best) - Remain on medication and stick with plan
Yellow Zone (50-80% of personal best) -Use short acting Beta 2 Agonist (ex. Proventil)
Red Zone (50-80% of personal best) -Use short acting Beta 2 Agonist (ex. Albuterol) and CONTACT HCP
What medication interaction should the patient know if they are treating their asthma?
Beta Blockers (ex. proanolol) can cause bronchospasm in the patients with asthma
How do you use an inhaler?
- Shake inhaler
- Breathe out all the way
- Hold your inhaler the way your doctor prescribed and as you breath in slowly through your mouth press down on the inhaler one time
- Keep breathing in slowly as deeply as you can
- Hold your breath as you count to 10 slowly
- If using Beta 2 Agonists, wait 1 minute between each puff but only for these meds
What is emphysema?
Alveoli are damaged and over time, the inner walls of the alveoli weaken and rupture, creating larger air spaces instead of small ones
What is COPD?
What is the criteria for someone to be diagnosed with COPD?
Chronic airway obstruction resulting from chronic bronchitis and emphysema
-EXCESSIVE BRONCHIAL MUCUS with cough for at least 3 months during two successive years
What are some manifestations of COPD?
- Decreased compliance/elasticity
- Decreased expansion
- Increased Dead Air (Residual Volume)
How does a person with COPD compensate?
What happens to the lung tissues of COPD?
- Increased Respiratory Rate
- Breathes Harder
- Surface Area Decreases
- Disappearance of Cilia
- Narrowing of Small Airways
What is the difference bewteen Chronic Bronchitis and Emphysema?
-Alveolar Structure and Capillaries are Normal in Chronic Bronchitis
What are some complications that can occur with COPD?
- Peptic Ulcer
- GERD
- Pneumonia
What should you do in terms of O2 therapy for someone with COPD?
Usually 2-3 Liters of O2 unless otherwise ordered until O2 SATs are > 90%
What is Chest PT (Physiotherapy)?
Combines the Positioning of Postural Drainage with the Action of Percussion which Loosens Secretions
What are the steps for Chest PT (Physiotherapy)?
- Bronchodilateor to Open up Passages
- Cough up Loosen Secretions to mobilize them
- Remain in each postural position for a minimum of 5 minutes to get secretions up
What are some exercises a person with COPD can do to?
Pursed Lip Breathing- Inhale slowly through the nose, relax cheeks, and blows air out the mouth
Abdominal Breathing- Uses abdominal muscles to assist in Expiration; Lie down and place paperback book on their upper abdomen and halve abdominal muscles contract during Expiration
What are some symptoms of Cystic Fibrosis?
- Increasingly Recurring Lung Infections
- Productive Green Mucus Cough
