Respiratory 2 Flashcards
1
Q
What are the effects of cigarette smoking on the lungs?
A
- Hyperplasia of goblet cells
- Lost ciliary activity
- Abnormal distal dilation and destruction of alveoli
- Chronic inflammation
- Carbon monoxide decreases O2 carrying capacity of Hgb (Hgb has a higher affinity for CO - 240x greater than for O2)
2
Q
What are the reasons for O2 therapy in COPD?
A
- Keep O2 saturation > 90% during rest, sleep, exertion
- Keep PaO2 > 60 mm Hg
- Long term O2 therapy improves survival, exercise capacity, cognitive performance, and sleep
3
Q
What is chronic bronchitis defined as?
A
Cough with sputum production for at least 3 months in each of 2 consecutive years
4
Q
What causes the excess mucous production in chronic bronchitis?
A
- Increased number of goblet cells
- Enlarged submucosal glands
- Dysfunction of the cilia (unable to move material)
- Stimulation from inflammatory mediators
5
Q
What is the definition of emphysema?
A
- Abnormal distention of the airspaces beyond the terminal bronchioles
- Destruction of the walls of the alveoli
- Increase in dead space
- Impaired oxygen diffusion
6
Q
What are the defining features of COPD?
A
- Chronic inflammation in the airways, parenchyma, and pulmonary blood vessels
- Not fully reversible airflow limitations
- Loss of elastic recoil
- Airflow obstruction due to mucous hypersecretion, mucosal edema, bronchospasm
7
Q
What are major risk factors for COPD?
A
- Cigarette smoking (80-90%)
- Secondhand smoke & e-cigarettes
- Occupational chemicals & dust
- Air pollution
- Severe recurring respiratory infections
- α1-antitrypsin deficiency.
- Low Socioeconomic Status (less access to healthcare)
8
Q
What is the primary cause of COPD?
A
Abnormal inflammatory response of lungs primarily caused by cigarette smoking and noxious particles or gases
9
Q
What are common clinical manifestations of COPD?
A
- Chronic cough
- Sputum production
- Dyspnea
- Weight loss
- Use of accessory muscles
- Inefficient breathing pattern
- Wheezes
- Decreased breath sounds
- Exercise intolerance
10
Q
What are the normal effects of aging on the Respiratory Tract?
A
- Gradual loss of elastic recoil of alveoli and lungs
- Stiffening of chest wall
- Decrease in exercise tolerance
- Lungs become rounder and smaller
- Number of functional alveoli decreases
11
Q
What diagnostic studies are used for COPD?
A
- Spirometry (FEV1/FVC ratio < 70%) (Gold standard)
- History and physical
- ABG
- CXR (may show flattened diaphragm) or CT
- Alpha1-antitrypsin screening
12
Q
What is FVC?
A
Forced Vital Capacity
The maximum amount of air out in a single breath
13
Q
What is FEV1?
A
Forced Expiratory Volume in 1 second
The first second of air in a single breath
14
Q
What is the FEV1-FVC ratio in a COPD patient?
A
Less than 70%
Both measures are reduced, FEV1 is often reduced more.
Ex: COPD patient
FVC = 4L
FEV1 = 2L
Ratio = 2:4 = 50%
15
Q
What is Noninvasive Positive Pressure Ventilation?
A
- Positive pressure ventilation given via facemasks
- Reduces the need for endotracheal intubation or tracheostomy
- CPAP
- BiPAP
- Allows for lower concentrations of oxygen to be used
16
Q
What is PEEP?
A
Positive End-Expiratory Pressure
The pressure in the alveoli above atmospheric pressure at the end of expiration
17
Q
What are complications associated with COPD?
A
- Acute Exacerbations
- Respiratory insufficiency
- Respiratory failure
- Pulmonary hypertension (Cor pulmonale)
- Pneumonia
18
Q
What is cor pulmonale?
A
Hypertrophy/dilation of the right side of the heart due to pulmonary arterial hypertension
- Eventually leads to Right sided Heart Failure
- Late manifestation of COPD
19
Q
What are common symptoms of chronic
cor pulmonale?
A
- Dyspnea (most common sign)
- Possible lung crackles
- JVD
- Hepatomegaly (w/RUQ tenderness)
- Peripheral edema
- Weight gain (due to fluid retention)
20
Q
What are common diagnostics for
cor pulmonale?
A
- Right sided cardiac catheterization (gold standard)
- Chest XR
- Echocardiogram
- BNP levels (may be elevated due to the stretching of the right ventricle)
21
Q
What treatments are used for cor pulmonale?
A
- Treat underlying cause (COPD?)
- Prescription medications to decrease BP
- Diuretics for fluid retention
- Continuous low-flow oxygen
22
Q
What triggers COPD exacerbations?
A
Bacterial and viral infections
23
Q
What signifies a COPD exacerbation?
A
Sudden worsening of COPD symptoms
* Lasts several days
* Use of accessory muscles
* Central cyanosis
* Change in usual dyspnea, cough, sputum volume
The more frequent the exacerbations, the poorer the prognosis
24
Q
What is included in the treatment for COPD exacerbations?
A
- Short-acting bronchodilators
- Oral systemic corticosteroids
- Antibiotics
- Supplemental oxygen therapy
25
What factors can lead to acute respiratory failure in **COPD** patients?
* Exacerbations
* Delayed contact with healthcare
* Discontinuing medications
* Overuse of sedatives *(pre-op or post-op)*
* Surgery or severe, painful illness involving chest or abdomen *(leading to ineffective ventilation)*
26
How should **COPD** related depression and anxiety be treated?
* Ask patient how they are feeling, how they are doing with ADLs, How is their family coping
* Medication: Buspirone *(doesn't affect respiratory drive)*
* Teach pursed breathing to relieve anxiety related to dyspnea
27
What is the role of bronchodilators in **COPD** management?
* Relax smooth muscle in the airway
* Relieve bronchospasm
* Improve ventilation
* Decreases dyspnea
* Increases FEV1
28
What are the types of oxygen delivery systems for **COPD**?
* Low-flow (e.g., nasal cannula, simple mask)
* High-flow (e.g., Venturi mask, heated high-flow nasal cannula).
29
What are complications of oxygen therapy?
* Combustion *(Keep away from heat/fire)*
* CO2 narcosis *(Keep O2 between 88-92%)*
* O2 toxicity
* Absorption atelectasis *(nitrogen is washed out of alveoli)*
* Infection *(heated nebulizers support bacterial growth)*
30
What is the purpose of humidification in oxygen therapy?
To counteract the drying effect of O2 on the mucosa
31
Why is nutritional therapy important in COPD patients?
**Malnutrition is multifactorial**
* Increased metabolic rate due to extra work of breathing
* lack of appetite
* Increased inflammatory mediators
* Altered taste caused by chronic mouth breathing
32
What are the nutritional therapy interventions for **COPD** patients?
* High protein, high calorie diet
* Rest at least 30 minutes before eating
* Avoid exercise for 1 hour before and after eating
* Use a bronchodilator before eating
* Eat 5-6 small meals to avoid bloating and early satiety
* Avoid foods that require a great deal of chewing
33
What are some breathing retraining techniques for **COPD** patients?
* Pursed Lip Breathing
* Diaphragmatic Breathing
## Footnote
Both techniques extend expiration time, keeping pressure in the alveoli, preventing collapse
34
What surgical therapies are available for **COPD**?
* Lung volume reduction surgery (LVRS)
* Bronchoscopic lung volume reduction surgery (BLVR) *(one way valves are placed in the airways leading to the diseased parts... allows air to leave but not go in)*
* Bullectomy
* Lung transplantation
35
How are airway clearance devices helpful for **COPD** patients?
* Provide positive expiratory pressure treatment
* Produces vibration in the lungs to loosen mucus for expectoration
36
How is a Flutter airway clearance device used?
* Patient must be **upright**
* Angle at which device is held is critical
37
How is an Acapella Airway Clearance Device used?
* Can be used in virtually any setting
* Patient is free to sit, stand, or recline
* Patient may inhale through it
* Nebulizers can be attached to it
38
What are nursing management interventions for **COPD** patients?
**Patient Education** *(to help reduce exacerbations)*
* Pulmonary rehabilitation
* Activity considerations *(exercise until tired, rest, repeat)*
* Encourage 15-20 minutes of exercise 2-3x per week
* Sexual activity *(listen to your body)*
* Sleep *(make sure to get enough, consider oxygen)*
* Psychosocial considerations
39
What are the end-of-life considerations for COPD patients?
**COPD cannot be cured. But, symptoms can be managed.**
Palliative care, advanced directives, and discussions about end-of-life care
40
What is important to remember about
**COPD with Chronic Bronchitis**?
**Excess mucous in the bronchioles**
* Wheezes and crackles
**Present with:**
* Hypoxemia & hypercapnia
**Due to:**
* Mucous plug in airway
* Increase in PaCO2 in lungs and
* Decrease in PaO2 in lungs
**Less O2 and more CO2 in bloodstream *(Respiratory acidosis)***
**Cyanosis occurs**: Blue Bloaters
41
What are the classifications of lung cancer?
* **Small-cell lung cancer** (SCLC) *(13% of cases)*
* **Non-small-cell lung cancer** (NSCLC) *(84% of cases)*
42
What is the primary risk factor for developing
**Lung Cancer**?
Cigarette smoking, accounting for 85-90% of cases.
43
What are risk factors for **Lung Cancer** *(other than smoking)*?
* Second hand smoke
* Pollution
* Radon
* Asbestos
* Industrial agents
* Radiation
44
What are common clinical manifestations of
**Lung Cancer**?
* Dyspnea
* Hemoptysis
* Chest or shoulder pain
* Persistent cough with sputum
* Pnemonitis *(Lobar pneumonia that does not respond to treatment)*
45
What is the initial diagnostic test for lung cancer?
Chest x-ray
46
Who should be screened for **Lung Cancer**, and with what diagnostic test?
* Adults age 55-80 with a history of smoking
* Quit less than 15 years ago
* Current smokers
**Completed with a Low Dose CT scan**
47
What are the different types of **Non-Small Cell Lung Cancer (NSCLC)**?
**Squamous Cell Carcinoma:**
* Slow growing
* Early symptoms
**Adenocarcinoma:**
* Moderate growing
* Most common in nonsmokers
**Large-Cell Carcinoma:**
* Rapid growing
* Highly metastatic
48
What are the characteristics of **Small Cell Lung Cancer (SCLC)**?
* Rarer in non-smokers
* **Very rapid growth**
* Most malignant
* Early metastasis
* Associated with endocrine disorders
* Poor prognosis
49
What is the typical progression of lung cancer tumors?
* Tumors take 8 to 10 years to reach 1 cm *(smallest size seen on Chest XR)*
* Primarily occur in segmental bronchi and upper lobes
50
What does a CT scan identify in lung cancer patients?
Location and extent of masses
## Footnote
CT scans provide detailed images that help in assessing lung cancer.
51
What is the purpose of fiberoptic bronchoscopy in lung cancer diagnosis?
To obtain lung biopsy for definitive diagnosis
## Footnote
Fiberoptic bronchoscopy allows for direct visualization of the airways and sampling of tissues.
52
What does the TNM system stand for in lung cancer staging?
Tumor, Node, Metastases
## Footnote
**The TNM system classifies the extent of cancer spread in NSCLC**
53
How is small cell lung cancer (SCLC) staged?
Limited or Extensive
## Footnote
**SCLC is always considered systemic and does not follow the TNM system.**
54
What is the treatment of choice for early stage non-small cell lung cancer (NSCLC)?
Surgical therapy
## Footnote
**Only indicated in SCLC if only in one lung with no metastisis**
55
What factors are related to survival in surgical treatment for NSCLC?
* Size of the primary tumor
* Co-morbidities
## Footnote
These factors significantly influence outcomes after surgery.
56
What is a pneumonectomy?
Removal of one entire lung
57
What is a lobectomy?
Removal of one or more lobes of the lung
58
What is the purpose of radiation therapy in lung cancer treatment?
* Curative therapy
* Palliative therapy *(relieve symptoms)*
* Adjuvant therapy *(Pre-op to reduce tumor size)*
* Used for both NSCLC and SCLC
* Primary therapy for those unable to tolerate surgery
59
What is Stereotactic Radiotherapy (SBRT)?
* High dose of radiation accurately delivered to tumor
* Given over 1-3 days
## Footnote
SBRT targets tumors with precision to minimize damage to surrounding healthy tissue.
60
What is the primary treatment for small cell lung cancer (SCLC)?
Chemotherapy
## Footnote
Chemotherapy is commonly used due to the aggressive nature of SCLC.
61
What role does immunotherapy play in lung cancer treatment?
* Targets programmed cell death proteins on T cells
* Prevents T cells from attacking other cells in the body
## Footnote
Immunotherapy enhances the immune response against tumor cells.
62
What is the aim of palliative care in lung cancer?
* Pain relief
* Symptom management
* Evaluation for hospice care
## Footnote
Palliative care focuses on improving quality of life for patients and their families.
63
What are the psychological considerations in lung cancer care?
* Poor prognosis
* Rapid disease progression
* Informed decision making
64
What is a nurse's role in *Acute Care* of a patient with **Lung Cancer**?
**Offer support during diagnostic evaluation**
**Monitor for stressors:**
* Procedures
* Symptoms
* Emotional
* Role performance *(how it may change)*
**Symptom Management**
**Patient Teaching**
**Pain relief**
**Monitor for side effects**
**Foster coping strategies**
**Smoking Cessation**
**Access resources**
* Case worker
* Social worker
65
What is a nurse's role in *Ambulatory Care* of a patient with **Lung Cancer**?
**Teach patient signs and symptoms to report:**
* hemoptysis
* Dysphagia
* Chest Pain
* Hoarseness
**Encourage a Smoke-free environment**
**Use of oxygen**
* Safety considerations
**Pain management**
**Palliative treatments**
**May need information about hospice**
* disability
* financial planning
* community resources
66
What is important to remember about
**COPD with Emphysema**?
**Smoking & inhaled chemicals cause a decrease in elastin & collagen**
**Normal exhalation causes decrease in pressure**
* With lost elastin, this causes airway to collapse, trapping air in the alveoli
**Reduced surface area for gas exchange**
* Results in dyspnea
**Increase in Hemoglobin:**
* Causes pinker hue
**Relief measures:**
* Pursed Lip Breathing
* Tripod position
**Increase in pressure causes barrel chest & flat diaphram**: Pink Puffers
67
What is **CPAP**?
**Continuous Positive Airway Pressure**
* Delivers PEEP and also maintains the set pressure throughout the respiratory cycle *(during both inspiration and expiration)*
68
What is included in Post-Operative management for a Lung Cancer patient?
* Frequent VS monitoring
* Head of Bed - up as HIGH as possible
* Oxygen delivery and ventilator management
* Frequent turning: supine to OPERATIVE side *(never to non-operative side after pneumonectomy)*; either side after lobectomy
* Chest tube management
* Pain control: PCA, splinting
69
What are Post Operative complications for a patient with Lung Cancer?
* Respiratory failure
* Pulmonary edema
* Arrhythmias
* Shock
* Infection
* Pneumothorax
* Hemothorax
70
What is **BiPAP**?
**Bilevel Positive Airway Pressure**
* On inspiration, BiPAP machines deliver more air pressure
* On expiration, the machine reduces the air pressure
71
**A diagnosis of mild COPD is confirmed. Which one of the following would be the best option to improve her symptoms and slow progression?**
**a.** Request inhaled medications to treat her pulmonary symptoms
**b.** Suggest counseling about the importance of tobacco cessation.
**c.** Offer to buy her a new telescope.
**d.** Begin smoking cessation counseling and request order for varenicline.
**d. Begin smoking cessation counseling and request order for varenicline**
72
**At her 6 month follow up appointment, she reports she still feels short of breath at the gym and is now very motivated to quit smoking. She has been taking her varenicline as ordered and asks if there is anything else that can be done to help her. Of the following, which order would you question?**
**a.** Enroll in the tobacco cessation group counseling program at your clinic.
**b.** Begin a short acting inhaled beta agonist to be used as needed.
**c.** Order for nicotine replacement therapy in addition to the varenicline.
**d.** Refer her to a quit line for further assistance.
**c. Order for nicotine replacement therapy in addition to the varenicline**
**Rationale:**
Varenicline is a partial nicotine receptor agonist, using nicotine replacement therapy provides no additional benefit and increases the risks of side effects. They should not be prescribed together.
73
**The nurse receives a change-of-shift report on the following patients with chronic obstructive pulmonary disease. Which patient should the nurse assess first? A patient:**
**a.** with loud expiratory wheezes
**b.** with a respiratory rate of 36 breaths/min.
**c.** who has a cough productive of thick, green mucus
**d.** with 4+ pitting, peripheral edema
**b. with a respiratory rate of 36 breaths/min**
**Rationale:**
Indicates severe respiratory distress, and the patient needs immediate assessment and intervention to prevent possible respiratory arrest.
74
**A patient with chronic obstructive pulmonary disesase has poor gas exchange. Which action by the nurse would support the patient's ventilation?**
**a.** Have the patient rest in bed with the head elevated to 25-35 degrees
**b.** Encourage the patient to sit up at the bedside in a chair and lean forward.
**c.** Ask the patient to rest in bed in a high-fowler's position with knees flexed.
**d.** Place the patient in the Trendelenburg position with pillows behind the head.
**b. Encourage the patient to sit up at the bedside in a chair and lean forward.**
75
**The nurse develops a teaching plan to help increase activity tolerance at home for an older adult with severe COPD. Which instructions would be appropriate for the nurse to include in the plan of care?**
**a.** Stop exercising when you feel short of breath
**b.** Walk until pulse rate exceeds 140 bpm
**c.** Limit exercise to ADLs
**d.** Walk 15-20 minutes a day at least 3 times/week.
**d. Walk 15-20 minutes a day at least 3 times/week.**
76
**Which instruction should the nurse include in an exercise teaching plan for a patient with chronic obstructive pulmonary disease?**
**a.** Avoid upper body exercise to prevent dyspnea.
**b.** Stop exercising if you start to feel short of breath.
**c.** Use your bronchodilator before you start to exercise.
**d.** Breathe in and out through your mouth while you exercise.
**c. Use your bronchodilator before you start to exercise.**
**Rationale:**
Use of a bronchodilator before exercise improves airflow for some patients and is recommended. Shortness of breath with exercise is normal and not a reason to stop. Patients should be taught to breathe in through the nose, and out through the mouth (using a pursed lip technique). Upper body exercise can improve the mechanics of breathing in patients with COPD.
77
**The nurse is caring for a patient with cor pulmonale. The nurse should monitor the patient for which expected finding?**
**a.** Chest pain radiating down the arm.
**b.** Weight loss
**c.** Peripheral edema
**d.** Elevated temperature
**c. Peripheral edema**
**Rationale:**
Cor pulmonale causes clinical manifestations of right ventricular failure, such as peripheral edema
78
**The public health nurse is presenting a health-promotion class to a group at a local community center. Which intervention most directly addresses the leading cause of cancer deaths in North America?**
**a.** Monthly self-breast exams
**b.** Smoking cessation
**c.** Annual colonoscopies
**d.** Monthly testicular exams
**b. Smoking cessation**
79
**The nurse is doing a preoperative assessment of an 87-year-old man who is slated to have a right lung lobe resection to treat lung cancer. What underlying principle should guide the nurse's preoperative assessment of an elderly client? Elderly clients:**
**a.** have a significantly smaller lung capacity than younger clients.
**b.** require higher medication doses than younger clients.
**c.** have less physiologic reserve than younger clients.
**d.** have more sophisticated coping skills than younger clients.
**c. have less physiologic reserve than younger clients.**
