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NUS 210 Oxygenation & Cardiac - Test 1 > Respiratory > Flashcards

Respiratory Flashcards

1
Q

this is the chronic destruction of the lungs resulting in decreased gas exchange, leading to chronic air trapping and high CO2 in the body

A

COPD

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2
Q

What are risk factors for COPD

A

smoking, car mechanic

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3
Q

how many years does a client need to smoke to be high risk for COPD

A

30 years

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4
Q

signs and symptoms of emphysema

A

pink skin, pursed lip breathing
barrel chest
no chronic cough
keeps tripoding

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5
Q

what is the pathophysiology of emphysema

A

damage to alveoli results in loss of lung elasticity and loss of inflation of lung tissue, resulting in loss of lung tissue recoil and air trapping

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6
Q

signs and symptoms of chronic bronchitis

A

big & blue skin,
long term chronic cough and sputum
unusual lung sounds: crackles & wheezes
edema peripherally

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7
Q

what is the normal pulse ox of COPD pt

A

88-93%

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8
Q

true or false
COPD pts tend to be anemic due to low O2

A

false: anemia is not common with this pts, rather the blood count is increased

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9
Q

if pt has PaO2 of 32 - they are experiencing what

A

hypoxemia

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10
Q

if pt has high PaCO2 the pt is what

A

hypercapnic

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11
Q

if a pt has a PH less than 7.35 - they are

A

acidosis

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12
Q

If pt has PaCO2 over 45, they are what

A

acidosis

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13
Q

Memory trick: COPD = CO2 PrisoneD

Carbon dioxide is carbon diACID

A
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14
Q

partial pressure of PaCO2 is 65 this pt with bronchitis is experiencing what

A

hypercapnia

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15
Q

what is the priority if pt is in respiratory failure

A

BiPap

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16
Q

if a pt has high CO2 they’re experiencing what

A

hypercapnic respiratory failure

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17
Q

if pt has low O2, they’re experiencing what

A

hypoxemic respiratory failure

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18
Q

if hyperCAP - then give BiPap

A
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19
Q

what do you monitor for if pt has respiratory failure

A
  1. mental status change
    look for: restless, decreased LOC, confusion
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20
Q

an elderly client with worsening COPD present to ER with fatigue and altered level of consciousness. Upon assessment the nurse finds O2 saturation of 8\% and ABG: ph 7.21, PaCO2 75, and PaO2 55. which intervention is best immediatly

a. apply oxygen 4 L via nasal cannula
b. call respiratory for STAT abuterol treatment
c. sit pt upright and apply Bilevel positive airway pressure BIPAP
d. start looking for other jobs in cosmetic surgery

A

c. sit pt upright and apply Bilevel positive airway pressure BIPAP

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21
Q

82 year old client with COPD presents with dyspnea, restlessness, pursed lips & in tripod position complaining of anxiety, pain and not being able to breathe. nurse should question which order. select all that apply
a. ipratropium
b. hydromorphone
c. rescue inhaler
d. oxygen via nasal cannula 3L
e. diazepam

A

b. hydromorphone
e. diazepam

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22
Q

if a pt has COPD exacerbation what do you not give

A

no opioids
no benzos

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23
Q

For COPD exacerbation - when giving meds, look for the O to know it’s a ——–

A

opioid. Don’t give!

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24
Q

say no to Benzos if pt has COPD exacerbation. these two drugs are

A

Diazepam and Lorazepam

our crazy pam and lam ending drugs

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25
Q

what is the correct huffing technique

A
  1. sit upright in a chair - feet shoulder length apart and lean forward
  2. deep slow inhalation through mouth using diaphragm muscle
  3. hold breath 2-3 secs and then forcefully exhale
  4. repeat HUFF 1-2x
  5. rest for 5-10 mins with normal breaths
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26
Q

what prevents airway collapse during expiration for COPD

A

pursed lip breathing

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27
Q

what is the purpose of pursed lip breathing

A

prevent air trapping

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28
Q

what to teach pt with COPD about diet - 7

A
  1. oral hygiene before meals
  2. eat small, frequent meals
  3. high calories and protein
  4. avoid eating high amts of carbs
  5. avoid gassy foods
  6. avoid exercise 1 hr before/after meals
  7. no carbonated rinks
  8. no high fiber foods
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29
Q

what to teach pt with COPD about fluid

A

increase fluid intake to thin mucus - 8 glasses/day
avoid drinking fluids while eating

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30
Q

what to teach pt with COPD about infections

A

report increase in sputum
fever, worsening dyspnea

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31
Q

what to teach pt with COPD about vaccines

A

get pneumococcal every 5 years
flu vaccine every year

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32
Q

what to teach pt with COPD about meds

A

albuterol if short of breath to vasodilate lungs and allow more air flow

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33
Q

what to teach pt to do before bed if have bronchitis

A

mobilize secretions
medication: guaifenesin
cool mist humidifier at night to make breathing easier

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34
Q

what to teach pt who has bronchitis about breathing

A

pursed lip breathing
-inhale 2 secs via nose
-exhale 4 secs w/ pursed lips

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35
Q

this is a chronic inflammatory disorder in the major pathways of the lungs. bronchi and bronchioles

this is reversible

A

asthma

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36
Q

signs and symptoms of asthma

A

accessory muscle use
sob and dyspnea
tight chest and tachypnea
high pitched wheezing
minimal diminished breath sounds
3 As - absent breath sounds, acidosis, air trapping

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37
Q

if a pt has high CO2 they are in….

A

hypercapnic respiratory failure

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38
Q

how do you save a pt in status asthmaticus

A

endotracheal intubation

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39
Q

what do you want to teach an asthmatic pt about asthma attacks

A

anticipate a severe asthma attack before it happens

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40
Q

what is the peak expiratory flow rate of a normal asthma pt

A

80-100% - green

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41
Q

if a pt gets yellow on the peak expiratory flow rate, what does that mean and what should they do

A

means asthma is not under control.

use additional medication:
1. rescue drug every 4 hours for 1-2 days
2. call PCP - need additional meds or change of treatment

42
Q

if pt gets red on the peak expiratory flow rate meter - it means what

A

emergency treatment is needed immediately if level doesn’t go to yellow after rescue drugs are taken

43
Q

what are asthma triggers

A

allergens - dust, pollen, dander
smoking
stress
sickness
cold weather
strenuous activity

44
Q

what drugs do asthma pts avoid

A

NSAIDS - Naproxen, Aspirin, Ibuprofen —- not good for asthma
Beta Blockers - – Propranolol & Atenolol —–blocked HR and Lungs

45
Q

how do you diagnose asthma

A

PFT - pulm function test

46
Q

3 kinds of bronchodilators for lower respiratory

A

beta 2 agonist (alBUTEROL)
anticholinergics (ipraTROPLUM))
methylxanthines (theoPHYLLINE)

47
Q

lower respiratory anti inflammatory drugs - 3

A

steroids (beclomethaSONE)
leukotriene inhibitor (montelUKAST)
mast cell stabilizers (cromyolyn)

48
Q

patient with severe asthma:
tachycardia >120
tachypnea >30
O2 sat <90
Peak exp flow is <40%

which medication would you give:
inhaled salmetrol
albuterol inhaler
nebulizer ipratropium
IV methamphetamines
IV methylprednisolone

A

albuterol inhaler
nebulizer ipratropium
IV methylprednisolone

49
Q

client is receiving discharge instructions for inhaled corticosteroid metered dose inhaler. which teaching should nurse include?

  1. discard use of fluticasone if albuterol provides relief
  2. do not swallow the water as you wash your mouth after each use
  3. if taking albuterol, be sure to use after the steroid
  4. steroid inhaler should be used before beta 2 agonists
A
  1. do not swallow the water as you wash your mouth after each use
50
Q

which statement requires further pt teaching

  1. i will use cromolyn to prevent activity induced asthma
  2. i will use montelukast to prevent asthma attacks
  3. i will use spacers to prevent oral thrush while using belomethasone
  4. i will take cromolyn 45 mins before physical activity
A
  1. i will take cromolyn 45 mins before physical activity
51
Q

which medication prescribed for asthma causes tachycardia and dysrhythmias

phenobarbital
aminophylline
salmeterol
albuterol

A

aminophylline

52
Q

what patient teaching should be included with new prescription of albuterol, ibuprofen, tiotrpoium and beclomethasone. select all that apply

  1. tinnitus is an expected side effect
  2. tachycardia is expected after albuterol
  3. report dark stool to the provider
  4. drink fluids to prevent dry mouth and throat
  5. ipratropium is used first during an attack
A
  1. tachycardia is expected after albuterol
  2. report dark stool to the provider
  3. drink fluids to prevent dry mouth and throat
53
Q

which of the follow prescriptions should nurse question
select all that apply
1. naproxen for an asthmatic patient
2. ipratroplum for a pt with glaucoma
3. losartan for a pt with diabetes
4. theophylline for a pt taking cimetidine
5. atenolol for a pt with asthma

A
  1. naproxen for an asthmatic patient
  2. ipratroplum for a pt with glaucoma
  3. theophylline for a pt taking cimetidine
  4. atenolol for a pt with asthma
54
Q

this refers to the body producing an increased number of RBC due to hypoxia within the body

A

polycythemia

55
Q

if there is severe hypoxia - how does the body compensate

A

polycythemia

56
Q

why must we report any extremely high Hg levels

A

instead of RBC perfusing through the body, RBCs make blood very thick causing blood clots like traffic jams with blood vessels, mainly in brain casusing CVA - stroke

57
Q

what are the key signs of right sided heart failure

A

edema, jvd, and weight gain

58
Q

what diagnostics are used to find cystic fibrosis

A

sweat chloride test
DNA, stool test

59
Q

common finds for cystic fibrosis

A

-recurrent lung infections
-blood tinged sputum
-weight loss
-loss of appetite
-constipation & loose, fatty stool

60
Q

what nursing care is for cystic fibrosis

A
  1. diet - high calories, enzymes with meals
  2. mucus - increase fluid intake, exercise, chest physiotherapy, postural drainage
  3. financial counseling
61
Q

what medication is used for cystic fibrosis

A

acetylcysteine (mucomyst)

62
Q

do you inhale or exhale on a peak flow meter

A

exhale

63
Q

when using the peak flow meter you do it 3 times and then take the what number

A

highest number blown

64
Q

this medication is for fight or flight. is short acting – for acute attacks

*know

A

abuterol

65
Q

these medications force open the airways

A

beta 2 adrenergic agonist

66
Q

these medications are not for acute attacks. these are long acting

*know

A

formoterol
salmeterol

67
Q

this medication you need to document the HR afterwards

A

abuterol

68
Q

this is a second line drug - short acting cholinergic antagonists

A

ipratropium

69
Q

long acting second line drug - cholinergic antagonist

A

tiotropium

70
Q

this stops the closing of the airway

A

cholinergic antagonist

71
Q

this stops the inflammation of during persistent asthma and COPD

A

corticosteroids

72
Q

what does a nurse need to check when giving pt corticosteroid

A

blood sugar – this will increase

73
Q

fluticasone
budesonide
mometasone
prednisone
mehtylprednisilone are all what type of drug

A

corticosteroid

74
Q

what medications do you use together for asthma

A

fluticasone/salmeterol
budesonide/formoterol

75
Q

which type of medication do you need to rinse your mouth after admin to prevent thrush

A

corticosteroids

76
Q

these are used for maintenence therapy to prevent asthma episodes
also used for exacerbations of COPD for short periods

A

corticosteroids

77
Q

what are triggers for COPD

A

smoking, environmental exposure to irritants, alpha 1 antitrypsin deficiency

78
Q

this is triggered by genetics, autosomal recessive trait

A

cystic fibrosis

79
Q

this results in thick secretions which leads to organ failure. pancreas, lungs and intestine are affected

A

cystic fibrosis

80
Q

the clinical manifestations are:
chest tightness
wheezing
sob
tachypnea
prolonged exhalation
diminished BS an ominous sign

A

asthma

81
Q

clinical manifestations are:
productive cough
barrel chest
meconium ileus
clubbed fingers
diminished breath sounds/coarse crackles

A

cystic fibrosis

82
Q

clinical manifestations are:
barrel chest
clubbed fingers
diminished breath sounds
peripheral edema present
tripod positon
anxiety
hypoxia

A

COPD

83
Q

sweat test, elevated WBC, DNA test - diagnostic testing for

A

cystic fibrosis

84
Q

-cxr hyperinflation and flattening of diaphragm
-partially or fully compensated respiratory acidosis

A

COPD

85
Q

how do you manage asthma

A

-rescue inhaler
-leukotriene antagonist
-inhaled corticosteroid
-
-status asthmaticus use intubation and mechanical ventilation

86
Q

nursing interventions for cystic fibrosis

A

-teach importance of airway clearance
-moderate fat, high calorie
-address psychosocial issues assoc with growth and development
-pursed lip breathing
-tripod breathing positsion

87
Q

nursing interventions for COPD

A

-air way clearance strategies
-huff coughing
-small freq meals
-encourage pulmonary rehab as outpatient
-PEP therapy
-mucolytics
-pursed lip breathing
-tripod positoin

88
Q

how to manage COPD

A

-oxygen therapy
-bronchodialtors
-corticosteroids for exacerbations

89
Q

how to manage cystic fibrosis

A

-airway clearance CBT manually or by vest
-flutter valve device
-mucolytics
-nebulizer treatment with albuterol
-oxygen therapy
-pancreatic enzymes w/ all food
-fat soluable vitamin supplements

90
Q

how to diagnose asthma

A

history
allergy testing
cxr
wbc differential
elevated IGE
pulmonary function test
nitric oxide levels

91
Q

pt education for asthma mgmnt

A

goal is to prevent acute attack:
-avoid allergens
-knowledge of meds and use of MDI
-use peak expiratory flow meter
-know when to seek medical attention

92
Q

what are complications of COPD

A

cor pulmonale
exacerbations of COPD
acute respiratory failure
GERD
Anxiety/depression

93
Q

collaborative management goals for COPD

A

prevent disease progression
relieve symptoms
improve exercise tolerance
treat complications
prevent/treat exacerbation

94
Q

what is the most common serious pulmonary and gastric diseae in children

A

cystic fibrosis

95
Q

how are the lungs affected with cystic fibrosis

A

obstructed bronchioles
progressive copd
chronic infection

96
Q

how is the pancreas affected by cystic fibrosis

A

malabsorption and may develop diabetes

97
Q

clinical manifestations are:
infection
patchy atelectasis
hyperinflation of lung
impaired digestion
steatorrhea
impaired absorption of nutrient

A

cystic fibrosis

98
Q

how to manage cystic fibrosis

A

chest PT
bronchodilators, mucolytics, expectorants, antibiotics
high calories, high protein and fluids
meds: pancrelipase and multivitamins

99
Q

this medication is often prescribed to cystic fibrosis pts to clear mucus

**know

A

dornase alfa (Pulmozyme),

100
Q
A

NUS 210 Oxygenation & Cardiac - Test 1 (4 decks)

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