Quiz #2 Respiratory Flashcards
COPD diagnosis
Productive cough for 3 months
Encompassing both: emphysema and bronchitis
Irreversible disease
COPD client education
Eat high calorie foods to promote energy
Rest as needed
Obtain immunizations to prevent infection
Ensure fluid intake of at least 2 L daily to thin secretions
Bronchitis
Inflammation of bronchi and bronchioles due to X chronic exposure of irritants
Examples: cigarette smoking and air pollution
Emphysema
Loss of lung, elasticity, and hyper inflation(air gets trapped into lungs when breathing out) of tissue
Also causes destruction of alveoli, leading to decrease the gas exchange carbon dioxide and respiratory acidosis
Normal O2 range for COPD
80-90%
Respiratory rate for pts with COPD
40-50 / min
Emphysema manifestations
P. I. N. K
P: pursed lip breathing
I: increased chest (barrel chest, clubbed fingers)
N: no chronic cough (dyspnea with productive cough)
K: keep tripoding (sitting, leaning forward with hands on knees to help with air exchange)
Bronchitis manifestations
B. L. U. E
B: blue (cyanotic due to lack of oxygen)
L: long term (cough lasting longer than 3 months)
U: unusual cough (productive cough, purulent, crackles, and wheezing)
E: edema (usually overweight)
Polycythemia
Usually occurs with bronchitis
A lot of extra RBCs are made due to hypoxia
Height hemoglobin levels —> therefore anemia is not common
PFT
Bronchodilators (inhalers)
Short acting
- albuterol, levoalbuterol
- salmeterol
cholinergic antagonists
- ipratropium
Methylxanthines
- theophylline
Anti-inflammatory agents
Glucocorticoids
- beclomethasone
- prednisone
Leukotriene antagonists
- montelukast
Monoclonal antibodies
- omalizumab
Client has emphysema and a new Rx for theophylline, which of the following instructions should the nurse provide?
Avoid caffeine because it’s a stimulant
A nurse is caring for a client who was hospitalized with acute pulmonary tuberculosis and has started ethambutol therapy the nurse should understand which of the following should be monitored
Visual acuity
Changes in vision should be reported immediately
Stop if ocular toxicity occurs
obtain baseline visual acuity tests, and complete monthly after starting treatment
Active pulmonary TB
TB can lie dormant for years before producing the disease
*individuals who have been exposed to TB but not have developed the disease can have latent TB.
if not treated, it can lie dormant for many years then become active as the individual becomes older or immunocompromised
*A chest X ray or QuantiFERON-TB gold can test for an active TB infection
TB expected findings
Purulent sputum
Cough lasting longer than 3 weeks
Fatigue
Hemoptysis- late sign (blood in sputum from forceful cough
Dyspnea (late sign)
Weight loss and anorexia
Night sweats
(Remember: people. Cough. Frequently. He. Doesn’t. Weigh. Nothing)
Older adult clients present with altered mental status, fever, anorexia, and weight loss
TB medications
R. I. P and E. S (RIPes)
Rifampin
Isonazid
Pyrazinamide
Ethambutol
Streptomycin sulfate
Rifampin client education
Urine and other secretions will be orange-red color
Immediately report pain or swelling of joints, loss of appetite, jaundice, or malaise
Interfere with oral contraceptives
nurse should observe for hepatotoxicity
Isoniazid client education
Do not drink alcohol with this—> can increase risk for hepatotoxicity
A nurse is instructing a client who is newly diagnosed with pulmonary TB about the use of anti tuberculosis medication, what should nurse include in teaching
A typical course treatment involves 6-9 months of consistent medication use
generally 6-12 months, medication adherence and follow up for one full year
Community-acquired pneumonia
Spread through droplets (streptococcus pneumoniae)
Is the most common type and often occurs as a complication of influenza
Immobility is a contributing factor in the development of pneumonia
A nurse in the emergency department is assessing an older adult client who has community-acquired pneumonia. Which of the following findings should the nurse expect?
Confusion
Beclomethasone purpose and considerations
A glucocorticoid (inhalation)
Anti inflammatory
Reduction in airway mucosa edema
Complications: difficulty speaking, hoarseness, and candidiasis
- use a spacer with inhaler
A nurse is providing teaching to a client who has asthma and a new prescription for inhaled beclomethasone. Which of the following instructions should the nurse provide?
Rinse mouth after administration
A nurse is providing instructions to a client who has a new prescription for albuterol and beclomethasone inhalers for the control of asthma. Which of the following instructions should the nurse include in the teaching?
Administer the albuterol inhaler prior to using the beclomethasone inhaler.
albuterol is a bronchodilator, so using this before can enhance absorption of glucocorticoid
Status Asthmaticus
Airway obstruction unresponsive to treatment
Involves extreme wheezing, labored breathing, use of accessory muscles, distended neck veins, and risk for cardiac or respiratory arrest
Status Asthmaticus Nursing actions
Prepare for emergency intubation
Administer IV fluids, oxygen, bronchodilators, and epinephrine
Rx for Fluticasone and salmeterol
Administer the bronchodilator first to increase absorption of anti-inflammatory agent
Ex: Salmeterol before Fluticasone
Salmeterol is bronchodilator
Fluticasone is corticosteroid
Asthma attack prevention medication
Salmeterol
Asthma attack medication uses and considerations
Albuterol: rapid relief of acute manifestations and exercise induced asthma
Ipratropium: Bronchospams and increased bronchodilation and decreased pulmonary secretions
Theophylline: narrow therapeutic and used when only other treatments are ineffective
COPD Plan of care
Position client into high-Fowler to maximize ventilation
Encourage coughing, or suction to remove secretions
Use of incentive spirometer
Oxygen levels should be maintained between 88% and 92%
Increased work of breathing increases caloric demands
Practice breathing exercises
**provide rest periods for older adults who have dyspnea, design the room with opportunities for relaxation
Aspiration pneumonia: what is it?
An infection caused by inhaling saliva, food, liquid, vomit, and foreign objects—> resulting in infection
- swollen bronchioles and fluid filled air spaces making breathing difficult
- oral or gastric material in lower airway
Trendelenburg position
Where feet and legs are above the level of the heart to redirect blood from lower extremities into central circulation
— increases lung compliance and delivers more tidal volume
— with patient with foreign material in lower right airway you would wanna place the patient on their left
Metered dose inhaler
Hold inhaler 1-2 inches 2-4 centimeters away from clients mouth
Ask client to take deep breath and exhale completely
Inhale slowly and deeply while pressing the inhaler
Breath in from 3-5 seconds then hold breath for 10 seconds
Medication reaches lower airways then the back of the throat
Findings for left sided heart failure
Hacking cough
A nurse is caring for a client who has emphysema and has difficulty with immobility. Client spends most of his days in reclining chair, which of the following physiological responses to prolonged immobility should the nurse expect?
Increased calcium excretion
Airborne precautions
Examples
Measles, Tuberculosis, and Varicella
N95 mask
Negative airflow room (6-12 exchanges per hour)
