Respiratory 1 Flashcards
What is asthma
intermittent and reversible airway obstruction releated to inflammation and airway hyperresponsiveness -
what age does asthma occur
can occur at any age
what are the manifestations of asthma
hypertrophy, edema, thick mucus, bronchoconstriction
what is athma health promotion
stop smoking, decrease exposure to irritants, get vaccines, avoid triggers, teach how to use meds, regular exercise, hot water to wash sheets
what do ABGs look like for someone with asthma
hypoxemia = less then 80
early in attack = hypocarbia = PaCO2 less then 35, Late in attack = hypercarbia= PaO2 over 45, increased ETCO2
how to confirm asthma with pulmonary function test
if measurements increase by 12% after treatment with bronchodilator, pts usually have 15-20% decrease in one of FVC, FEV, PEA, airway responisveness
Asthma risk factors
family history, smoking (2nd hand too), environmental allergies, chemical irritants, GERD, older adult
Respiratory changes in older adults
decrease pulmonary reserve, more susceptible to infection, decrease sensitivity to beta receptors causes an increased risk for bronchospasms
diagnostic imaging for asthma
chest X-ray, immunoglobulin
SS of asthma
wheezing on exhale, cough, mucus production, increased respirations, accessory muscle use, barrel chest, cyanosis, decreased SP O2, hypoxemia increased heart rate
what changes are seen in eosinophils with asthma
increased with allergies too
what will you find in a sputum culture for asthma
curshman spirals
what is the treatment goal for asthma
to control asthma, guided self-care patient active and managing their care
what is an individual asthma action plan
developed by patient and PCP, tailored to meet personal triggers, asthma symptoms, and drug response
what is intermittent asthma classification
signs and symptoms less than two days a week
what is mild persistent asthma classification
signs and symptoms over two days a week
what is persistent asthma classification
signs and symptoms daily
what is severe asthma classification
signs and symptoms continuous
what is the nursing care for asthma
position for maximum ventilation, give O2, monitor heart, initiate IV, provide rest, teach infection prevention, encourage vaccinations
what are asthma symptoms of determining control
daytime wheezing, dyspnea, coughing more than two times per week, waking from sleep with wheezing/dyspnea/coughing, rescue drug used over two times per week, activity limited or stopped by symptoms over two times weekly
what are some complications that can occur from asthma
respiratory failure caused by persistent hypoxemia related to asthma
what is the hospital admin criteria for an acute asthma attack
FEV1 = less than 30% of predicted no improvement in one hour
what is the SS for an acute asthma attack
respiratory distress at rest, difficulty speaking, diaphoresis, accessory muscle use, respirations over 30, heart rate over 120
what are the signs and symptoms of an emergency asthma attack
absent breath sounds, cyanosis, inability to lie down, abdominal breathing
what is status asthmaticus
severe life threatening emergency, acute episode of airway obstruction, intensifies once it begins, often does not respond to common treatments, patient can develop a new thorax or cardiac arrest
what are the interventions for an acute asthma attack
hydration, supplemental O2 or by mask or nasal cannula, high flow with severe bronchospasms
what is COPD
chronic inflammation of the Airways, lung parenchyna and blood and vessels irreversible changes may lead to respiratory failure
what is the health promotion for COPD
stop smoking, decrease exposure to irritants, get vaccines, avoid and recognize triggers, exercise regularly, infection prevention
what are the risk factors for COPD
old age because of decreased pulmonary reserve, smoking over 10 packs per year, air pollution, occupational exposure, genetics (ATT deficiency)
what are long changes caused by COPD
loss of elastic recoil, air flow obstruction, hyper exertion of mucus, edema, bronchospasms
what are the signs and symptoms of COPD
dyspnea on exertion, chest tightness, productive cough in the morning over three months, crackles, wheezing, rapid and shallow respirations, using accessory muscles, irregular breathing pattern, tripod, thin extremities, dependent edema
what are the late signs of COPD
clubbing of toes and fingers, palar, cyanosis
what does a chest X-ray show you for COPD
hyperinflation of alveoli, ID’s blebs or infection, not helpful in diagnosing early or moderate disease, flattened diaphragm and light disease because of emphysema
what are the long term medications used for COPD
arfermoterol, indacaterol, tiotropium, aclidinium, bromide, olodaterol
What is the gold classification for COPD
evidence based strategy for COPD diagnosis and management based on class signs and symptoms and history
what is mild gold classification for COPD
FEV over 80%
what is moderate gold classification for COPD
50-80%
what is severe gold classification for COPD
30-50%
what is very severe gold classification for COPD
below 30%
what does pulse ox show you for COPD
hypoxia
what does ET CO2 show you for COPD
hypercarbia
what do ABG’s show you for COPD
hypoxemia – PAO2 less than 80 and hypercarbia over 45 because of increased etco 2
what does the CBC show you for COPD
increase hematocrit, decreased O2
what does a pulmonary function test show you for COPD
decreased fev and FVC not reserved with bronchodilator
What is the client education for COPD
increase calorie, washed hands, rest periods, stop smoking, vaccines, use O2
how does acidosis happen for COPD
because of obstructed airway leads to poor gas exchange resulting in respiratory acidosis
what are the interventions for hypoxemia and tissue anoxia
encourage using O2, promote pulmonary toilet
how does someone with COPD get respiratory infections
secondary to increased mucus production and poor oxygenation
what are some cardiac complications that can occur because of COPD
failure especially in cor pulmonale (increased pulmonary pressure equals increased cardiac workload), dysrhythmias related to acidosis, fluid imbalances, poor oxygenation and increased cardiac workload
what are the manifestations of cor pulmonale
decreased O2, circumoral cyanosis, enlarged and tender liver, JDV, dependent edema
what should you monitor with someone with cor pulmonale
respiratory status, heart rate and rhythm, acid base balance
what are the signs and symptoms of COPD exacerbation
increase dyspnea, increase sputum production and its purulent
what is the treatment for COPD exacerbation
supplemental O2 limit is one to two liters or 24 to 28%, goal spo 2 is 90 to 92%, short acting beta 2 agonist, corticosteroids, methylxathines
What are the signs of bronchitis in COPD
intermittent mild to moderate dyspnea, onset after 35 years old, increased hematocrit, hypercarbia and hypoxemia
what happens in the lungs for bronchitis
inflation of bronchi and bronchioles, congestion, mucosal edema, bronchospasm, purulent and copious secretions
what are the signs of emphysema
progressive constant dyspnea, onset after 50 years, normal hematocrit, thin waisted
what happens in the lungs for emphysema
clear sputum, hyperinflation of lungs total lung capacity increased on pulmonary function test, air trapping causes diameter of chest to increased looks barrel chested, loss of lung elasticity
what is a transmembrane conductance regulator for cystic fibrosis
mutation that results in excessive thick, tenacious mucus lined airway causing blocked chloride transport leading to thick mucus with decreased water content, decreased resistance to infection, air trapping related to mucus plugs obstructing airway
what are the problems noticed with exocrine glands with cystic fibrosis
decreased pancreatic enzymes and hypersecretion of gastric acids
what is noticed in exocrine glands in the late stage cystic fibrosis
insulin production in the islets of langerhans affected, electrolyte change and secretion of sweat glands
what happens in the male exocrine glands for cystic fibrosis
reproductive issues plugging vans deferens related to thick seminal fluid
what happens in the female exocrine glands for cystic fibrosis
thick vaginal secretions limit sperm motility
what do you notice in a pulse ox for cystic fibrosis
02 saturation may be decreased especially during pulmonary exacerbation
what is sweat sodium test and cystic fibrosis considered diagnostic
consider diagnostic if level over 90
what is the chest radiography show you for cystic fibrosis
might reveal hyperinflation, bronchial wall thickening, atelectasis or infiltration
GI enzyme tests show you for cystic fibrosis
evaluation shows pancreatic enzyme deficiency
how do you diagnose cystic fibrosis
made by respiratory symptoms like coughing, wheezing, dyspnea, meconium ileus, failure to thrive
what are the signs and symptoms of cystic fibrosis
salty tasting skin, chronic respiratory symptoms, frequent lung infections because of thickened mucus pools and bronchioles, poor growth, Constipation, greasy and bulky stools
what does a sweat chloride test show you for cystic fibrosis
considered suspicious at the level of chloride in the collected sweat is over 50 and diagnostic if the level is over 60
what would a pulmonary function test reveal for someone with cystic fibrosis
decreased in FVC and FEV with increased residual volume
what are the common organisms found with cystic fibrosis
staph aureus, pseudomans, H. flu
What is an airway clearance treatment for cystic fibrosis
percussion, vibration, huff coughing, PEP devices
what is the education for cystic fibrosis
increase calorie increase protein, monitor weight, positive expiatory devices, exercise conditioning
how long does a lung transplant extend your life
1-15 years
What is pulmonary arterial hypertension
blood vessels constriction and increased vascular resistance in the lung deficiency of prostacyclin 1
what are the risk factors for pulmonary arterial hypertension
exposure to drugs, more common in women ages 20 to 40, autosomal dominant, if left untreated patients die within two years of diagnosis
what are the signs and symptoms of pulmonary arterial hypertension
dyspnea, fatigue and otherwise healthy adult, angina
what meds are used for pulmonary arterial hypertension
warfarin - clot prevention related to vessel constriction and a calcium channel blocker to dilate blood vessels
how do you diagnose pulmonary arterial hypertension
made an absence of other lung disorders common most often diagnosed late stage when damage is already done, pulmonary function test, right sided heart Cath showing increased pulmonary pressure
what are occupational lung alterations
extent of damage secondary to toxicity, duration and amount of inhaled substances, fibrosis and inflammation
what are the signs and symptoms of occupational lung alterations
10 to 15 years after exposure, dyspnea, coughing, wheezing, weight loss
what is chemical pneumonitis
inhalation of chemical irritants acute is pulmonary edema chronic is inflammation and fibrosis
what is pneumoconiosis
inhalation and retention of mineral or metal dust particles causes inflammation and fibrosis
what is hypersensitivity pneumonitis
inhalation of fungus spores from moldy hair, bird droppings, or other organic dust causes inflamed air sacs, fibrosis scar tissue, abnormal breathing
what are the complications of occupational long alterations
COPD, cancer, cor pulmonale
what is laryngeal cancer
originates at mucosal surface squamous cell carcinoma
how do you prevent laryngeal cancer
quit smoking, regular exams
how do you diagnose laryngeal cancer
visualization with laryngeal mirror, laryngeal scope, MRI, CT, PET to assess lymph node involvement, ultrasound, biopsy
what is the treatment for laryngeal cancer
depends on location and stage options are radiation therapy, chemo, minimally invasive laser, robotic surgery, surgical procedure to preserve laryngeal
what are the nursing considerations for someone with laryngeal cancer
allow time for communication come and use normal tournaments voice, address changes in self-image, provide social contact, educate on trade care and oral feedings
what are the risk factors for laryngeal cancer
smoking, secondhand smoke, some unknown
what are the early signs and symptoms of laryngeal cancer
referred ear pain
what are the late signs of laryngeal cancer
difficult or painful swallowing, dyspnea, noisy breathing, severe hoarseness, mass or growth on the neck
what is total laryngectomy
for severe cases separates trachea and esophagus, permanent tracheostomy, voice prosthesis, electrolarynx
what is the care for a total laryngectomy post-op
insure patent Airways, assess lung sounds, hourly respiratory assessment
what are the complications of a laryngectomy
stomal stenosis, infection, hematoma, carotid damage
