Respiratory Flashcards
this is the chronic destruction of the lungs resulting in decreased gas exchange, leading to chronic air trapping and high CO2 in the body
COPD
What are risk factors for COPD
smoking, car mechanic
how many years does a client need to smoke to be high risk for COPD
30 years
signs and symptoms of emphysema
pink skin, pursed lip breathing
barrel chest
no chronic cough
keeps tripoding
what is the pathophysiology of emphysema
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
signs and symptoms of chronic bronchitis
big & blue skin,
long term chronic cough and sputum
unusual lung sounds: crackles & wheezes
edema peripherally
what is the normal pulse ox of COPD pt
88-93%
true or false
COPD pts tend to be anemic due to low O2
false: anemia is not common with this pts, rather the blood count is increased
if pt has PaO2 of 32 - they are experiencing what
hypoxemia
if pt has high PaCO2 the pt is what
hypercapnic
if a pt has a PH less than 7.35 - they are
acidosis
If pt has PaCO2 over 45, they are what
acidosis
Memory trick: COPD = CO2 PrisoneD
Carbon dioxide is carbon diACID
partial pressure of PaCO2 is 65 this pt with bronchitis is experiencing what
hypercapnia
what is the priority if pt is in respiratory failure
BiPap
if a pt has high CO2 they’re experiencing what
hypercapnic respiratory failure
if pt has low O2, they’re experiencing what
hypoxemic respiratory failure
if hyperCAP - then give BiPap
what do you monitor for if pt has respiratory failure
- mental status change
look for: restless, decreased LOC, confusion
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
c. sit pt upright and apply Bilevel positive airway pressure BIPAP
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
b. hydromorphone
e. diazepam
if a pt has COPD exacerbation what do you not give
no opioids
no benzos
For COPD exacerbation - when giving meds, look for the O to know it’s a ——–
opioid. Don’t give!
say no to Benzos if pt has COPD exacerbation. these two drugs are
Diazepam and Lorazepam
our crazy pam and lam ending drugs
what is the correct huffing technique
- sit upright in a chair - feet shoulder length apart and lean forward
- deep slow inhalation through mouth using diaphragm muscle
- hold breath 2-3 secs and then forcefully exhale
- repeat HUFF 1-2x
- rest for 5-10 mins with normal breaths
what prevents airway collapse during expiration for COPD
pursed lip breathing
what is the purpose of pursed lip breathing
prevent air trapping
what to teach pt with COPD about diet - 7
- oral hygiene before meals
- eat small, frequent meals
- high calories and protein
- avoid eating high amts of carbs
- avoid gassy foods
- avoid exercise 1 hr before/after meals
- no carbonated rinks
- no high fiber foods
what to teach pt with COPD about fluid
increase fluid intake to thin mucus - 8 glasses/day
avoid drinking fluids while eating
what to teach pt with COPD about infections
report increase in sputum
fever, worsening dyspnea
what to teach pt with COPD about vaccines
get pneumococcal every 5 years
flu vaccine every year
what to teach pt with COPD about meds
albuterol if short of breath to vasodilate lungs and allow more air flow
what to teach pt to do before bed if have bronchitis
mobilize secretions
medication: guaifenesin
cool mist humidifier at night to make breathing easier
what to teach pt who has bronchitis about breathing
pursed lip breathing
-inhale 2 secs via nose
-exhale 4 secs w/ pursed lips
this is a chronic inflammatory disorder in the major pathways of the lungs. bronchi and bronchioles
this is reversible
asthma
signs and symptoms of asthma
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
if a pt has high CO2 they are in….
hypercapnic respiratory failure
how do you save a pt in status asthmaticus
endotracheal intubation
what do you want to teach an asthmatic pt about asthma attacks
anticipate a severe asthma attack before it happens
what is the peak expiratory flow rate of a normal asthma pt
80-100% - green
if a pt gets yellow on the peak expiratory flow rate, what does that mean and what should they do
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
if pt gets red on the peak expiratory flow rate meter - it means what
emergency treatment is needed immediately if level doesn’t go to yellow after rescue drugs are taken
what are asthma triggers
allergens - dust, pollen, dander
smoking
stress
sickness
cold weather
strenuous activity
what drugs do asthma pts avoid
NSAIDS - Naproxen, Aspirin, Ibuprofen —- not good for asthma
Beta Blockers - – Propranolol & Atenolol —–blocked HR and Lungs
how do you diagnose asthma
PFT - pulm function test
3 kinds of bronchodilators for lower respiratory
beta 2 agonist (alBUTEROL)
anticholinergics (ipraTROPLUM))
methylxanthines (theoPHYLLINE)
lower respiratory anti inflammatory drugs - 3
steroids (beclomethaSONE)
leukotriene inhibitor (montelUKAST)
mast cell stabilizers (cromyolyn)
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
albuterol inhaler
nebulizer ipratropium
IV methylprednisolone
client is receiving discharge instructions for inhaled corticosteroid metered dose inhaler. which teaching should nurse include?
- discard use of fluticasone if albuterol provides relief
- do not swallow the water as you wash your mouth after each use
- if taking albuterol, be sure to use after the steroid
- steroid inhaler should be used before beta 2 agonists
- do not swallow the water as you wash your mouth after each use
which statement requires further pt teaching
- i will use cromolyn to prevent activity induced asthma
- i will use montelukast to prevent asthma attacks
- i will use spacers to prevent oral thrush while using belomethasone
- i will take cromolyn 45 mins before physical activity
- i will take cromolyn 45 mins before physical activity
which medication prescribed for asthma causes tachycardia and dysrhythmias
phenobarbital
aminophylline
salmeterol
albuterol
aminophylline
what patient teaching should be included with new prescription of albuterol, ibuprofen, tiotrpoium and beclomethasone. select all that apply
- tinnitus is an expected side effect
- tachycardia is expected after albuterol
- report dark stool to the provider
- drink fluids to prevent dry mouth and throat
- ipratropium is used first during an attack
- tachycardia is expected after albuterol
- report dark stool to the provider
- drink fluids to prevent dry mouth and throat
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
- naproxen for an asthmatic patient
- ipratroplum for a pt with glaucoma
- theophylline for a pt taking cimetidine
- atenolol for a pt with asthma
this refers to the body producing an increased number of RBC due to hypoxia within the body
polycythemia
if there is severe hypoxia - how does the body compensate
polycythemia
why must we report any extremely high Hg levels
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
what are the key signs of right sided heart failure
edema, jvd, and weight gain
what diagnostics are used to find cystic fibrosis
sweat chloride test
DNA, stool test
common finds for cystic fibrosis
-recurrent lung infections
-blood tinged sputum
-weight loss
-loss of appetite
-constipation & loose, fatty stool
what nursing care is for cystic fibrosis
- diet - high calories, enzymes with meals
- mucus - increase fluid intake, exercise, chest physiotherapy, postural drainage
- financial counseling
what medication is used for cystic fibrosis
acetylcysteine (mucomyst)
do you inhale or exhale on a peak flow meter
exhale
when using the peak flow meter you do it 3 times and then take the what number
highest number blown
this medication is for fight or flight. is short acting – for acute attacks
*know
abuterol
these medications force open the airways
beta 2 adrenergic agonist
these medications are not for acute attacks. these are long acting
*know
formoterol
salmeterol
this medication you need to document the HR afterwards
abuterol
this is a second line drug - short acting cholinergic antagonists
ipratropium
long acting second line drug - cholinergic antagonist
tiotropium
this stops the closing of the airway
cholinergic antagonist
this stops the inflammation of during persistent asthma and COPD
corticosteroids
what does a nurse need to check when giving pt corticosteroid
blood sugar – this will increase
fluticasone
budesonide
mometasone
prednisone
mehtylprednisilone are all what type of drug
corticosteroid
what medications do you use together for asthma
fluticasone/salmeterol
budesonide/formoterol
which type of medication do you need to rinse your mouth after admin to prevent thrush
corticosteroids
these are used for maintenence therapy to prevent asthma episodes
also used for exacerbations of COPD for short periods
corticosteroids
what are triggers for COPD
smoking, environmental exposure to irritants, alpha 1 antitrypsin deficiency
this is triggered by genetics, autosomal recessive trait
cystic fibrosis
this results in thick secretions which leads to organ failure. pancreas, lungs and intestine are affected
cystic fibrosis
the clinical manifestations are:
chest tightness
wheezing
sob
tachypnea
prolonged exhalation
diminished BS an ominous sign
asthma
clinical manifestations are:
productive cough
barrel chest
meconium ileus
clubbed fingers
diminished breath sounds/coarse crackles
cystic fibrosis
clinical manifestations are:
barrel chest
clubbed fingers
diminished breath sounds
peripheral edema present
tripod positon
anxiety
hypoxia
COPD
sweat test, elevated WBC, DNA test - diagnostic testing for
cystic fibrosis
-cxr hyperinflation and flattening of diaphragm
-partially or fully compensated respiratory acidosis
COPD
how do you manage asthma
-rescue inhaler
-leukotriene antagonist
-inhaled corticosteroid
-
-status asthmaticus use intubation and mechanical ventilation
nursing interventions for cystic fibrosis
-teach importance of airway clearance
-moderate fat, high calorie
-address psychosocial issues assoc with growth and development
-pursed lip breathing
-tripod breathing positsion
nursing interventions for COPD
-air way clearance strategies
-huff coughing
-small freq meals
-encourage pulmonary rehab as outpatient
-PEP therapy
-mucolytics
-pursed lip breathing
-tripod positoin
how to manage COPD
-oxygen therapy
-bronchodialtors
-corticosteroids for exacerbations
how to manage cystic fibrosis
-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
how to diagnose asthma
history
allergy testing
cxr
wbc differential
elevated IGE
pulmonary function test
nitric oxide levels
pt education for asthma mgmnt
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
what are complications of COPD
cor pulmonale
exacerbations of COPD
acute respiratory failure
GERD
Anxiety/depression
collaborative management goals for COPD
prevent disease progression
relieve symptoms
improve exercise tolerance
treat complications
prevent/treat exacerbation
what is the most common serious pulmonary and gastric diseae in children
cystic fibrosis
how are the lungs affected with cystic fibrosis
obstructed bronchioles
progressive copd
chronic infection
how is the pancreas affected by cystic fibrosis
malabsorption and may develop diabetes
clinical manifestations are:
infection
patchy atelectasis
hyperinflation of lung
impaired digestion
steatorrhea
impaired absorption of nutrient
cystic fibrosis
how to manage cystic fibrosis
chest PT
bronchodilators, mucolytics, expectorants, antibiotics
high calories, high protein and fluids
meds: pancrelipase and multivitamins
this medication is often prescribed to cystic fibrosis pts to clear mucus
**know
dornase alfa (Pulmozyme),
