RESPIRATORY Flashcards
What is chronic bronchitis?
when bronchial tubes become inflamed and excessive mucous production occurs as a result of irritants or injury.
What is emphysema?
when air sacs in the lungs are damaged, losing elasticity, leading to hyperinflation
Complications of COPD?
hypoxemia, respiratory acidosis, respiratory infection, cardiac failure especially cor pulmonale, dysrhythmias, and respiratory failure.
How does diaphragmatic breathing, tripod positioning, and pursed lip breathing help?
increases airway pressure and keeps air passages open promoting maximal CO2 expiration
What medications can be used for COPD tx?
- bronchodilators
- steroids for exacerbations
- mucolytic to thin secretions
- abx for infection
What labs should we check when assessing COPD?
ABGs, sputum cultures, WBC, and Hgb and Hct for polycythemia.
How will the CXR look in a patient with emphysema?
flat diaphragm and hyperinflated lungs
What are the sx of cor pulmonale (R sided HF)?
- Hypoxia and hypoxemia
- Increasing dyspnea
- Fatigue
- Enlarged and tender liver
- Warm, cyanotic hands and feet, with bounding pulses
- Cyanotic lips
- Distended neck veins
- Right ventricular enlargement (hypertrophy)
What are interventions to prevent infection in COPD patients?
Avoid crowds and get the flu and PNA vaccine
What nutritional advice can we give to COPD patients?
- Eat high calorie and high protein foods.
- eat multiple smalls meals per day instead of 3 large meals.
- Meals on wheels can be helpful.
- Avoid gas-producing, spicy, or extremely hot or cold foods, or dry foods (can stimulate coughing).
What are other respiratory diagnostics available?
Bronchoscopy and thoracentesis
What are the common sx of COPD?
SOB, wheezing, cough, heart issues like developing heart failure.
What causes a spontaneous pneumothorax in COPD patients?
overstretching and enlargement of alveoli turns into small sacs of air called blebs (or bullae) which form on the lung tissue and can rupture allowing air to leak into the pleural space.
How is gas exchange affected with emphysema?
increased work of breathing and the loss of alveolar tissue
T/F. Bronchitis only affects the airways not the alveoli.
True
What effects does chronic inflammation of the airways cause?
increased mucous production → infection
How is gas exchange affected with chronic bronchitis?
mucus plugs and inflammation narrow the airways.
What is alpha 1 antitrypsin deficiency
genetic condition that raises your risk for lung disease and other diseases.
-protein that protects lungs from harmful irritants and infections
If chronic bronchitis is an airway problem, emphysema is a …?
alveolar problem
What are some visual respiratory changes that occur with COPD?
rapid, shallow respirations, with sucked in abdomen
How high can the RR get with COPD exacerbation?
40-50 bpm
Is fremitus increased or decreased with COPD?
Hint: think trapped air
Decreased
How are percussion sounds on a COPD patient?
Hyperressonant
What signs will indicate chronic hypoxemia?
cyanosis, delayed capillary refill, and finger clubbing
What are some signs of late-stage emphysema?
pallor or cyanosis and usually underweight
What is a normal WBC range?
5000-10,000/mm3 (5.0-10.0 × 109 cells/L)
What is a normal H/H range?
Hemoglobin
Females: 12-16 g/dL (7.4-9.9 mmol/L)
Males: 14-18 g/dL (8.7-11.2 mmol/L)
Hematocrit
Females: 37%-47% (0.37-0.47 volume
fraction)
Males: 42%-52% (0.42-0.52 volume frac.)
What is a normal platelet range?
150,000-400,000 mm3 (150-400 × 10 9L)
What is normal Mg level?
1.8-2.6 mg/dL
What are 5 priorities for nursing intervention for COPD?
- Decreased gas exchange
- Weight loss
- Anxiety
- Decreased endurance
- Potential for PNA
What is the most important focus of intervention to improve gas exchange?
airway maintenance
How does accessory muscle use contribute to increase respiratory rate?
It is less efficient than the abdominal muscles so they have to breath faster
What is the focus of drug therapy with COPD?
longer term control therapy with longer acting drugs
How often should we assess a COPD patient?
Q2h
How does coughing improve gas exchange?
It increases airflow in the large airways
How much water should a COPD pt drink?
At least 2L/day
What should we advise the pt if early satiety is a problem?
advise him or her to avoid drinking fluids before and during the meal and to eat smaller, more frequent meals.
How is asthma characterized?
airway inflammation and hyperresponsiveness
What is status asthamticus?
Severe life threatening asthma episode that is refractory to tx and may result in pneumothorax, acute cor pulmonale, or respiratory arrest.
Silent breath sounds associated with acute asthma exacerbation can indicate what?
impeding respiratory failure d/t diffuse bronchospasms. Life threatening condition.
What meds are given to pt’s with acute asthma episodes?
bronchodilators first then steroids
What medications can be asthma triggers?
ASA, beta blockers, and NSAIDs
Education for asthma patients?
- intermittent nature of sx and need for long term management
- identify triggers
- medication management
- correct use of peak flow meter
- plan in case asthma episode occurs
What is the goal of asthma interventions?
to control and prevent episodes, improve airflow and gas exchange , and relieve symptoms
How often should asthma patients take their medications?
Preventative medications should be taken as prescribed regardless of sx and rescue or reliever meds whenever they have an exacerbation.
When should inhalers be used with exercise induced asthma?
30 min before
What are some complications of PNA?
septicemia and sepsis, empyema, atelectasis
What SPO2 level in an asthma patient, otherwise healthy, is an emergency?
<91%
What happens physiologically when the SPO2 is less than 85% in asthma patient?
body tissues have a difficult time becoming oxygenated.
When is SPO2 in asthma patients considered life threatening?
<70%
What is the most common sx of PNA in the elderly?
Change in cognition
Sx of PNA in the older adult?
weakness, fatigue (which can lead to falls), lethargy, confusion, and poor appetite
What PNA sx may be absent in the older adult?
Fever and cough
T/F. WBC count may not be elevated in the elderly until the infection is severe.
True
What labs are assessed for PNA?
- gram stain, culture and sensitivity sputum
- CBC
- blood cultures
- ABGs
- serum electrolytes, BUN, creatinine
- lactate level
What are 4 nursing priorities we are concerned about w/ PNA?
- Decreased gas exchange
- Potential for airway obstruction
- Potential for sepsis
- Potential for pulmonary empyema
What are expected outcomes after PNA tx?
- adequate gas exchange
- patent airway
- no infection
- no empyema
- Return to pre-pneumonia health status
How often should PNA pts be coughing and deep breathing to prevent airway osbtruction?
Q2h
What can a rapid pulse indicate w/ PNA?
hypoxemia, dehydration, or impeding sepsis and shock.
Which labs may be elevated with PNA?
ESR and WBC
