Resp Disorder 2

Question 1

can asthma pts exercise

Answer 1

yes, uses SABA before

Question 2

describe what a peak flow meter is

Answer 2

-highest air flow at forced expiration
-2 times a day when asthma is controlled
*establish normal baseline
(green/good, yellow/reliever drug, red/serious emergency d/t obstruction)

Question 3

what are the drug therapy methods for asthma

Answer 3

preventative, rescue, combo

• adrenergic (Albuterold)
• steroids (inhaled unless for maintenence)
• theophylline (not used very often d/t SE)
• anticholinergic- dry pt up

Question 4

describe the asthma rescue drugs

Answer 4

• given d/t active asthma attack
• ***SABA (short acting beta agonist)- first line, acts as bronchodilator (Albuterol)
• Anticholinergics- take longer to work

Question 5

describe effect of steroids when they are inhaled

Answer 5

inhaled causes fewer side effects, not going through whole body

Question 6

what are the asthma preventative/maintenance drugs

Answer 6

• ICS: inhaled corticosteriods- decrease inflammatory response
• LABA: inhaled long acting beta agonist (Solumedrol)
• leukotriones (singulair)- not inhaled

Question 7

why do we want to hear wheezing during an asthma attack

Answer 7

means that air is getting in and out (even though its with difficulty)
*if there is no sound, may have complete air obstruction

Question 8

most severe form of asthma

severe, life threatening complication of asthma attack

Answer 8

status asthmaticus

Question 9

describe what occurs in status asthmaticus and what it can lead to

Answer 9

hypoxemia worsens
expiratory rate and volume decrease
may lead to rep failure or irreversible emphysemia

Question 10

what does status asthmaticus require

Answer 10

requires intubation and ventilator support

Question 11

leading cause of death worldwide

Answer 11

lung cancer

Question 12

what is the survival rate of lung cancer and main cause

Answer 12

survival rate is r/t staging and degree
cigarette smoking is cause
*more women die of lung than breast cancer

Question 13

primary and secondary prevention of lung cancer

Answer 13

primary: decrease smoking
secondary: screening (done early if avid smoker)

Question 14

lung cancer manifestations

Answer 14

nonspecific, appear late in disease process
dependent on type of lung cancer
extensive metastasis BEFORE symptoms appear
persistent cough (productive or not)
chest pain
dyspnea

Question 15

diagnosis of lung cancer

Answer 15

biopsy is most definitive
chest x ray
arterial blood gas (ABG) study

Question 16

when is a cure for lung cancer more likely

Answer 16

stage 1 or 2

stage 3 or 4 cure is more rare

Question 17

treatment for lung cancer

Answer 17

• chemo*treatment of choice (esp for small cell) used as adjunct
• radiation-currative approach
• surgery- main treatment for stage 1 nonsmall cell lung cancer

Question 18

lobectomy versus pheumonectomy

Answer 18

lobectomy- 1 part of lung removed
pheumonectomy- whole lung removed
*both will have chest tubes after surgery for some time

Question 19

broadly describe tuberculosis (TB)

Answer 19

communicable
chronic, infectious disease of lungs
slow growing, droplet transmitted
tissue inside dies, lung is non-functioning

Question 20

what precautions necessary for TB

Answer 20

airborne precautions

negative pressure room-pulls air into room

Question 21

describe patho of mycobacterium tuberculosis

Answer 21

sits in the air, can be inhaled by others
implants in upper lobes, multiplies and causes a local infection
develops lesion, tubercle

Question 22

what is a tubercle

Answer 22

sealed off colony of bacteria (body walls off bacteria to prevent spread)

Question 23

manifestations of active TB

Answer 23

fatigue, night sweats, fever, weight loss (involuntary)

purulent and blood tinges sputum

Question 24

describe what PPD is

Answer 24

screening test for TB

neg: does not rule out infection in older pop and immunocompromised pts

Question 25

what happens if positive PPS

Answer 25

determine if currently active TB?
ever been exposed to TB?
if positive but NOT active: prophylactic therapy to prevent active TB from occurring (INH med)

Question 26

diagnosis of TB

Answer 26

-sputum sample (take multiple times a day)
-looking for ACID FAST BACILLI
looking for excessive number of colonies (may take up to 4 wks to determine)
*MAY start treating TB before diagnosis is confirmed

Question 27

describe treatment of TB

Answer 27

• lasts 9 months (may feel better after 2 wks tho)
• DOT (directly observed therapy: combo of 4 drugs)
• take for first 4 months of treatment then 2 for remainder

Question 28

specific meds for TB

Answer 28

line of treatment every day!

• PZA (Pyrazinamide)
• INH (Isoniazid)
• Ehambutol
• Rifampin

Question 29

important education for TB meds!

Answer 29

drugs are liver toxic
NO DRINKING for 9 months
take at night to decrease nausea

Question 30

Rifampin common side effects

Answer 30

hepatitis, flu like, fever, body fluids are orange/red

Question 31

INH common side effects

Answer 31

peripheral neuropathy, hepatitis

Question 32

PZA common side effects

Answer 32

monitor uric acid levels if gout

Question 33

what regular checks do you need to do for TB

Answer 33

sputum sample every 2-4 wks

Question 34

describe pneumonia

Answer 34

inflammation of bronchitis and alveoli
8th leading cause of death
infectious: bacteria, virus, fungi, protozoa
noninfectious: gastric content, irritating gases

Question 35

what should you encourage pneumonia pts to do

Answer 35

cough to move air out of lungs regularly (perfect for bacteria)

Question 36

treatment goal for pneumonia

Answer 36

based on where presumed they acquired pneumonia (environment vs hospital)
goal: improve gas exchange with incentive spirometer

Question 37

s/s of pneumonia

Answer 37

rigors, crackles, rust/purulent colored sputum, chest aching, fever, decreased breath sounds, dyspnea, decreased O2 sat

Question 38

pleuritic pain often describe as

Answer 38

back pain

Question 39

older adult symptoms and prevention of pneumonia

Answer 39

confusion and mental status changes 
pneumococal vaccine (if >65 yrs)

Question 40

complications of pneumonia

Answer 40

• emphyema-large amount of exudate
• lung abscess
• atelectasis- areas of lung that have collapsed (candidate for chest tube)

Question 41

treatment for pneumonia

Answer 41

hydrate, cough, incentive spirometer every 2 hrs
bronchodilators
antibiotics
*often long recovery period

Question 42

diagnosis for pneumonia

Answer 42

sputum sample