Pulmonary Disorders

Question 1

Pneumonia

Answer 1

Inflamm of lung parenchyma d/t bacterial, viral, fungal infection

Question 2

Pneumonia risk factors

Answer 2

• Advanced age
• Long-term care residents
• Smoking
• Chronic resp disease
• Immunocompromised
• Prolonged immobility
• Aspiration of stomach content (AMS can cause this)
• Prolonged NPO status
• Diminished consciousness, gag reflex, swallow reflex
• *Hospitalization longer than 48 hrs
• Recent abx therapy

Question 3

Pneumonia clinical manifestations

Answer 3

• *Fever
• Tachypnea
• *Chills
• Cough, non-prod/prod
• *Pleuritic chest pain
• *Fatigue
• *Myalgias, arthralgias

Severe: purulent/blood tinged sputum, hypotension, dysrhythmia

Question 4

Types of pneumonia

Answer 4

• Community-acquired
• MRSA community-acquired
• Hospital-acquired (occurs 48 hrs after admission)

Question 5

Pneumonia labs

Answer 5

• Elevated WBC (>10, 500)
• Elevated C-reactive Protein (>1)
• Elevated bands (>5%)

Question 6

Pneumonia nursing action

Answer 6

• Administer *humidifed O2 as ordered
• Administer meds: antibiotics
• *Pulmonary hygiene: incentive spirometer, ambulation, make sure pt coughing up secretions
• Pt positioning
• *Monitor intake & output
• *Ensure adequate nutritional support (most pts tired so don’t wanna eat + difficulty breathing)
• Activity

Question 7

Pneumonia pt teaching

Answer 7

• *Hand hygiene
• Adequate rest, nutrition, fluid intake
• *Understand S&S of worsening resp status
• Pneumonia vaccine

Question 8

Obstructive sleep apnea

Answer 8

Muscle tone relaxes during sleep –> can’t overcome increase in resistance –> airway collapse

• Hypoxia
• Hypercapnia
• Apnea

Question 9

OSA risk factors

Answer 9

• Male
• *Obesity
• Smoking
• Alc use
• *Age 40-45
• Craniofacial or upper airway abnormalities

Other:
- Menopause
- Atrial fibrillation
- Nocturnal dysrhythmia
- Type 2 DM
- HF
- Pulm hypertension

Question 10

OSA clinical manifestations

Answer 10

• Loud snoring
• Snorting
• Witnessed apnea
• Recurrent waking during sleep
• Choking

Question 11

OSA risks what?

Answer 11

Increased risk of CV disease bc excessive inflamm process d/t decreased blood flow. Also cause scarring.

Question 12

OSA treatment (supportive)

Answer 12

• CPAP (pressure keeps airway open)
• Nonsupine sleeping
• No alc or sedative before bed
• Oral appliance to forward tongue to keep airway open

Question 13

OSA treatment (surgery)

Answer 13

• Tonsillectomy
• Adenoidectomy
• Uvulopalatopharyngoplasty
• Septoplasty
• Nasal polypectomy
• Tongue reduction
• Epiglottoplasty
• Bariatric surgery (reduce weight)

Question 14

OSA pt teaching

Answer 14

• Disease process
• Instruct pt on CPAP + meds
• Instruct pt on weight reduction

Question 15

Asthma

Answer 15

• Affect bronchial airways, resulting in airway obstruction & bronchial hyperresponsive
• Cause bronchospasm or contraction of small airways –> inflamm
• Triggered by exposure to inhaled irritants

Question 16

Asthma clinical manifestations

Answer 16

• Chest tightness
• Wheezing (concern when on inspiration & expiration)
• Dyspnea
• Coughing
• Increased sputum
• *Inability to speak in full sentences bc not getting enough air
• Tachycardia, increased RR

Question 17

Asthma medications

Answer 17

• Inhaled corticosteroids (Flovent, Pulmicort) = long term
• Bronchodilator (Albuterol) = rescue
• Anticholinergics (Sprivia - tiotropium)
• Leukotriene receptor antagonist (Montelukast)

Question 18

Inhaled corticosteroid action

Answer 18

Anti-inflammatory
Decrease mucuous prod & swelling, airways becomes less sensitive to triggers

Question 19

Bronchodilator action

Answer 19

Eg. beta-2 adrenergic agonist
Relax bronchial smooth muscle leading to open airways & less obstruct

Question 20

Anticholinergic action

Answer 20

Relax muscle around larger airway

Question 21

Leukotriene receptor antagonist action

Answer 21

Block leukotriene

Question 22

COPD

Answer 22

Results in airflow limitations that are progressive and not fully reversible.

Question 23

Types of COPD

Answer 23

• Emphysema
• Chronic bronchitis

Question 24

Emphysema

Answer 24

• Alveolar destruction
• CO2 can’t leave and O2 can’t enter: ineffective gas exchange
• Loss of lung elasticity causes air trapping and distension in alveolar

Question 25

Chronic bronchitis

Answer 25

• Inflamm of bronchi and bronchioles
• Small vessels are affected first
• Increased mucus production, causing vessel wall thickening and airflow obstruction

Question 26

COPD nursing assess

Answer 26

• Vital signs
• *Lung sounds: crackles or wheezes
• Pursed lip breathing: keeps airways open for gas exchange
• *Cough
• Dyspnea (subjective finding)
• Weight loss d/t pt fatigue from breathing & not eating

Question 27

COPD nursing action

Answer 27

• Administer meds as ordered: bronchodilators, anticholinergics d/t keeping airway open
• Provide O2: maintain SpO2 > 90%, continuous O2 for SpO2 below 88% or PaO2 below 60 mmHg
• Position: semi-fowlers to maximize lung expansion
• Provide small frequent meals: less energy consumption, no distension of stomach which can prevent maximal lung expansion

Question 28

What to be careful about COPD O2 administration?

Answer 28

Don’t give too much O2 becuz used to O2 saturation in the 80s. High O2 will decrease respiration drive.

Question 29

COPD pt teaching

Answer 29

• Breathing technique: pursed lip
• Pacing of activities
• Smoking cessation
• Med regiment: inhaler use, regimen, schedule
• Vaccine prophylaxis: pneumococcal, influenza, covid
• Exacerbation recognition
• Coping: depression, social, isolation, lifestyle changes