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Med Surg II > Respiratory and Cultural Competency review > Flashcards

Respiratory and Cultural Competency review Flashcards

1
Q

Chronic lung disease includes:

A

Chronic bronchitis, pulmonary emphysema, and asthma. (CAL- Chronic Airway Limitation

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2
Q

COPD

A

A group of pulmonary diseases of a CHRONIC nature characterized by INCREASED resistance to airflow. Consists of EMPHYSEMA and BRONCHITIS

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3
Q

T or F. Emphysema and bronchitis are characterized by bronchospasm and dyspnea. The damage to the lung is REVERSIBLE and decreases in severity.

A

False. The damage is NOT reversible and increases in severity

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4
Q

Asthma, unlike COPD is an intermittent disease with REVERSIBLE airflow obstruction and wheezing?

A

TRUE

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5
Q

Emphysema

A

A breakdown of elastin and collagen fiber network of alveoli whereby alveoli ENLARGE or walls are destroyed. Leads to formation of LARGER than normal air spaces.

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6
Q

In regards to Emphysema, what causes air trapping in lungs and airway collapse?

A

Loss of elastic recoil from destruction of elastin and collagen fibers causes air trapping in lungs and airway collapse.

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7
Q

Air trapping results in hyper-inflated lungs, causing a ___________ appearance.

A

Barrel chest appearance; Emphysema.

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8
Q

Pink Puffers

A

Indicative of Emphysema; PT maintains ABGs by HYPERVENTILATING and has a PINK appearance to their skin early in the disease. They’re working harder to breathe, but the amount of O2 taken in is adequate to oxygenate the tissues.

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9
Q

Chronic Bronchitis

A

An inflammatory response in small and large airways l/t vasodilation, congestion, mucosal edema, and bronchospasm.

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10
Q

T or F. In regards to Chronic Bronchitis, a chronic cough and productive sputum are present for a minimum of 6 MONTHS in one year?

A

False, 3 months.

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11
Q

T or F. Airflow is impeded as bronchial walls thicken in Chronic Bronchitis patients?

A

TRUE

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12
Q

Like Emphysema, a patient with bronchitis can increase breathing efforts to maintain normal ABGs?

A

FALSE

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13
Q

Blue Bloaters

A

Insufficient oxygenation occurs with chronic bronchitis and leads to generalized cyanosis and often R sided heart failure (cor pulmonale). Term used to describe patients with bronchitis. They usually have a presence of cyanosis and edema.

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14
Q

Asthma

A

Chronic airway disorder resulting in reversible bronchoconstriction and AIR HUNGER in response to triggers from a variety of sources.

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15
Q

Asthma Mechanism

A

When exposed to a trigger, hyperactivity of medium-sized bronci causes release of leukotrienes, histamine, and other substances from mast cells; these agents intensify inflammatory process and cause bronchospasm (smooth muscle constriction, degranulation of mast cell, mucus accumulation, hyperinflation of alveoli).

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16
Q

Status asthmaticus

A

An emergency situation when an asthma attack is prolonged and not responding to usual meds or when a patient has one asthma attack after another. Prompt treatment is needed to avoid respiratory failure.

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17
Q

Nail beds that demonstrate “clubbing” indicate?

A

Chronic hypoxia

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18
Q

T or F. A patient with COPD can tolerate high levels of oxygen (O2)?

A

False, patients with COPD cannot tolerate high levels of O2. Limit flow or their drive to breathe will reduce.

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19
Q

T or F, Hypercapnia is typical of a patient with COPD along with Hypoxemia?

A

True. As COPD worsens, the amount of O2 in the blood decreases (HYPOXEMIA) and the amount of carbon dioxide (CO2) in the blood increases (HYPERCAPNIA), causing chronic respiratory acidosis (increased arterial carbon dioxide [PaCO2], which results in metabolic acidosis (increased arterial bicarbonate) as compensation).

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20
Q

T or F. Not all patients with COPD are CO2 retainers, even when hypoxemia is present?

A

True, because CO2 diffuses more easily across lung membranes than O2.

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21
Q

Hypercapnia is a problem for patients with bronchitis, rather than in advanced emphysema?

A

False, in advanced emphysema, d/t alveoli being affected, hypercapnia is a problem, rather than in bronchitis where the airway are affected.

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22
Q

Bronchitis Mechanism

A

Mucus accumulation, enlarged submucosal gland, inflammation of epithelium, hyperinflation of alveoli, mucus plug. HINT- patient develops chronic mucus plug

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23
Q

Emphysema Mechanism

A

Alveoli is hyperinflated

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24
Q

Cor pulmonale

A

Right- sided heart failure d/t pulmonary causes. Air trapping, airway collapse and stiff alveolar walls increase the lung tissue pressure, making blood flow through the lung vessels more difficult. The increased pressure makes the workload heavy on the right side of the heart. Often associated with chronic bronchitis or Emphysema.

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25
Q

In this condition, accessory muscles and distended neck veins are present. If condition is not reversed, patient may develop pneumothorax or cardiac arrest.

A

Status asthmaticus

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26
Q

In patients with Emphysema, how is the patient’s expiration impaired and airway patency reduced?

A

In healthy patients, expiration is easy d/t normal elastic recoil of alveolus and open bronchiole. In patients with Emphysema, expiration is difficult d/t decreased elastic recoil of alveolus and narrowed bronchiole.

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27
Q

What assessment findings would you expect from a patient with Asthma?

A

Dyspnea, wheezing, chest tightness

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28
Q

Pink Puffers,” barrel chest appearance, pursed-lip breathing, distant/ quiet breath sounds, wheezing, and pulmonary blebs on radiograph are common assessment findings for which condition?

A

Emphysema

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29
Q

Identify 6 common assessment findings for Chronic Bronchitis?

A

Generalized cyanosis, “Blue Bloaters,” Right-sided HF, Distended Neck Veins, Crackles, Expiratory Wheezing

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30
Q

3 ways to treat COPD include?

A

1) Improve ventilation 2) Promote secretion removal 3) Prevent complications

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31
Q

A patient has just been diagnosed with COPD and asks you how they can improve their breathing. What suggestions would you make to help improve their ventilation?

A

Use bronchodilators as prescribed to maintain patency in bronchi and promote breathing exercises.

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32
Q

2 ways to promote secretion removal include?

A

Hydration (thins out trapped mucus, facilitating expectoration) and humidification.

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33
Q

H1 Antihistamines, Leukotriene Antagonists, and Theophylline are all examples of what?

A

PO medications for Asthma

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34
Q

For acute asthma attacks, Cromolyn should be administered?

A

False Cromolyn is a prophylactic/ maintenance inhaler used to prevent an asthma attack. Do not use for acute asthma attacks.

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35
Q

Albuterol, Servent, and Spiriva are all examples of what kind of inhaler used for Asthma?

A

Selective B2 Agonists/ Adrenergic Stimulants

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36
Q

Identify 2 types of Anticholinergic inhalers used to treat Asthma?

A

Atrovent, Combivent

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37
Q

What’s the difference between rescue inhalers and maintenance inhalers?

A

Rescue inhalers are used for an acute attack and maintenance inhalers are used to prevent an attack and include Cromolyn, Servent, Atrovent

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38
Q

T or F. Corticosteroid inhalers are used to treat Asthma?

A

True, drugs such as dexamethasone may be used on SHORT-term basis when exacerbation of attacks occur or as a maintenance inhaler to suppress inflammatory process.

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39
Q

Common side effects for Corticosteroids include which of the following? Hyperglycemia, Na/ H2O retention, Psychosis, Blocks protein synthesis, Weight gain, Cardiac dysrhythmias (LT)?

A

All of the above.

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40
Q

Name 3 things acute exacerbation of chronic conditions can lead to?

A

Respiratory failure, Status asthmaticus, Acute infections (pneumonias [hymophylous, strep], Respiratory decompensation

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41
Q

What are common nursing plans and interventions for both Chronic Bronchitis and Emphysema?

A

1) Lowest FiO2 possible to prevent CO2 retention 2) Monitor for S/S 3) Maintain PaO2 between 55 and 60 4) Teach pursed-lip breathing 5) Admin. Bronchodilators and Anti-inflammatory agents.

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42
Q

Normal PH (blood gas)

A

7.35- 7.45

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43
Q

Normal PCO2

A

35-45

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44
Q

Normal PO2

A

80-100

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45
Q

Normal HCO3 (BiCarb)

A

21-28

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46
Q

Normal O2 saturation (SaO2)

A

95-100

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47
Q

Assessment should include patient reports of air hunger, chest tightness, anxiety, use of accessory muscles, tachypnea (increased RR), tachycardia (increased HR), and altered lung sounds (wheezing, long expiratory effort, diminished breath sounds in lower airways

A

Nursing assessment for Asthma.

48
Q

When assessing a COPD patient, your nursing assessment for should include?

A

Cough eval- Productive cough (bronchitis) and a dry cough (emphysema), dyspnea, pursed-lip breathing, use of accessory muscles, orthopnea, nasal flaring, cachectic appearance, adventitious breath sounds (wheezing, rhonchi, or crackles, prolonged expiration, increased anterior-posterior diameter (barrel chest-emphysema), skin color (pink-early emphysema, blue- chronic bronchitis), air hunger, fever, chest pain, r-sided HF symptoms (cor pulmonale).

49
Q

Identify 8 primary pulmonary symptoms?

A

Dyspnea, Cough, Hemoptysis (coughing up blood), Clubbing, Abnormal sputum, Paroxysmal Nocturnal Dyspnea (awakening from sleep with severe SOB), Orthopnea (inability to lie flat), Wheezing (inspiratory- emphysema).

50
Q

Dx tests for Asthma include?

A

Pulmonary function tests (PFTs)

51
Q

Dx tests for COPD include?

A

ABGs, CXR, MRI, Ultrasound, CT

52
Q

Dx tests used to assess respiration and oxygenation include?

A

X-ray, MRI, Ultrasound, CT, Bronchoscopy, PFTs, Tb tests to R/O chronic Tb in lungs (PPD, Mantoux).

53
Q

Why is important to use low flow O2?

A

It prevents depression of respiratory drive.

54
Q

Administering bronchodilators, fluids, and humidification, as well as providing education (causes, medications) are important nursing interventions for which condition?

A

Asthma

55
Q

T or F. Early signs of hypoxia are Confusion, Irritability, and Restlessness/ Anxiety?

A

TRUE, it indicates that the patient’s brain is not receiving enough O2.

56
Q

In regards to interventions, what EDUCATION can be provided to patients with COPD

A

Teach patient to sit upright in a Forward- leaning position to promote breathing, Teach pursed-lip breathing, Health promo activities- Teach prevention of secondary infections (avoid crowds, tobacco smoke), Teach about medication regimen, Encourage patient to hydrate well (health promo), Encourage flu and pneumonia vaccines (health promo), Encourage adequate dietary and fluid intake, Smoking cessation.

57
Q

What features would indicate Cor Pulmonale?

A

Hypoxia & Hypoxemia, Increasing dyspnea, Fatigue, Enlarged & tender liver, Warm, cyanotic hands & feet, w/ bounding pulses, Cyanotic lips, Distended neck veins, Right ventricular enlargement(hypertrophy), Visible pulsations below the sternum, GI disturbances (nausea, anorexia), Dependent edema, Metabolic & respiratory acidosis, Pulmonary hypertension

58
Q

IV fluids, bronchodilators, steroids, epinephrine, O2 and emergency intubation are treatment measures for which condition?

A

Status Asthmaticus

59
Q

Anxiety concerning breathing is usually manifested by?

A

Fear, Fear of being alone, fear of not being able to catch breath.

60
Q

Priority Nursing Diagnosis include all of the following EXCEPT? Ineffective Airway Clearance, Ineffective Breathing Pattern, Impaired Gas Exchange, Activity Intolerance, Anxiety

A

All are priority Nursing Diagnoses

61
Q

3 common Nursing Diagnosis for Respiratory Decompensation include?

A

Inadequate airway, Inadequate ventilation, Impaired gas exchange.

62
Q

T or F. Chronic low O2 (Hypoxia) can lead to dehydration?

A

True, with severe hypoxia, kidneys increase production of RBCs in an attempt to bring more oxygenated blood to body cells, thus causing polycythemia, increased blood viscosity, and a higher risk for blood clots.

63
Q

T or F. PH increases with CO2 retention?

A

FALSE. If CO2 retention occurs, PH and PaO2 will decrease.

64
Q

Stridor, Noisy breath sounds, Retractions, Flaring Nares, and Labored breathing with use of accessory muscles are all indications for ____________?

A

Inadequate Airway (Respiratory Decompensation)

65
Q

Your patient, Kyle seems anxious and confused. During your initial assessment, you note central cyanosis, minimal chest wall movement, decreased breath sounds, and absence of air exchange. What is his priority nursing diagnosis?

A

Inadequate Ventilation. Absence of air exchange, Minimal or absent chest wall movement, Signs of an obstructed airway, Central cyanosis, Decreased or absent breath sounds, Anxiety, and confusion.

66
Q

What would indicate Impaired Gas exchange (Respiratory Decompensation)?

A

Tachypnea, Increased dead space, Cyanosis (late sign), Chest infiltrates.

67
Q

Impaired gas exchange r/t?

A

Alteration in supply of oxygen or inability to transport oxygen or changes in alveolar- capillary membranes AEB hypoxemia and cyanosis

68
Q

Ineffective breathing pattern r/t?

A

Secretions in respiratory track AEB cough evaluation

69
Q

Ineffective airway clearance r/t obstruction of…

A

AEB use of accessory muscles

70
Q

Sleep deprivation r/t?

A

Inability to breathe AEB by orthopnea or PND.

71
Q

Acute confusion r/t decreased supply to the brain AEB..

A

Restlessness and irritability.

72
Q

Other common nursing diagnosis for respiratory. disorders include?

A

Pain, altered comfort r/t cough, fluid deficit, hyperthermia, activity intolerance, safety (transmission of infection).

73
Q

T or F. Productive cough and comfort can be facilitated by semi-Fowler or high-Fowler position, which lessens pressure on diaphragm by abdominal organs.

A

True, Gastric distention becomes a priority in COPD patients because it elevates the diaphragm and inhibits full lung expansion.

74
Q

During your evaluation of your patient’s medications, you note the following: Bronchodilators, anticholinergics agents, steroids/ anti-inflammatory agents, antibiotics, and expectorants (to loosen cough). These meds are common for patients with which condition?

A

COPD

75
Q

If a patient’s secretions are thick, what collaborative care can be implemented?

A

Pulmonary/ bronchial hygiene may be needed if secretions are thick. Coughing, deep breathing, chest percussion (clapping on chest to loosen), postural drainage, vibration, suctioning, and respiratory treatments promote pulmonary care and can be a collaborative approach with the RT.

76
Q

In addition to IC, bronchial toilet is an appropriate intervention to improve bronchial hygiene. What is this?

A

Turn, cough, deep breathing.

77
Q

in regards to OXYGEN, an important nursing intervention is to always administer it?

A

False. It’s important to maintain O2 delivery and monitor its effectiveness to determine if its working or not.

78
Q

Appropriate oral hygiene interventions include the following?

A

Instruct the patient to avoid glycerin swabs or mouthwash that contains alcohol, assess mouth for ulcers, bacterial growth, or infections.

79
Q

In regards to asthma interventions, what EDUCATION can you provide to your newly diagnosed patient?

A

Teach them how to identify what triggers an attack and how to avoid triggers, recommend yearly influenza vaccines, Explain disease process and how to avoid anxiety during an attack, Teach them to carry a rescue inhaler at all times. Call MD or seek medical attention if rescue inhaler doesn’t work or status asthmaticus occurs.

80
Q

A collaborative care plan for a patient with COPD and Asthma includes?

A

Collaboration with the RT, nurse, and case manager during the evaluation of medications, pain, and triggers.

81
Q

Identify nursing care priorities when caring for a patient with lung cancer?

A

Nursing interventions are similar to those implemented for COPD- place patient in semi- Fowlers, teach pursed-lip breathing to improve gas exchange, teach relaxation techniques to decrease anxiety about breathing difficulty, Admin. O2 as indicated by pulse oximetry or ABGs, give patient as much control (allay anxiety), Decrease pain as needed.

82
Q

Bronchodilators (Beta2-adrenergic receptors and cholinergic agents):

A

Increase bronchiolar smooth muscle relaxation; they have no effect on the inflammatory process

83
Q

Anti-inflammatory Agents (corticosteroids):

A

Help decrease the inflammatory responses in the airways. Corticosteroids are preventative; they DO NOT reverse the effects of an acute asthma attack, and should not be used as a rescue drug

84
Q

Inflammation of the lower respiratory tract causing excess fluid in lungs. Older “adults symptoms include weakness, fatigue, lethargy, confusion. May not have fever or cough, but confusion from hypoxia is common manifestation.

A

Pneumonia

85
Q

Identify proper use of chest tube drainage systems

A

Keep all tubing coiled loosely below chest level, with connections tight and taped; Keep water seal and suction control chamber at appropriate water levels; Monitor fluid drainage, and mark the time of the measurement and fluid level; Observe for bubbling in the water seal chamber and tidaling; Do not empty, replace unit when full; Do not strip or milk chest tube

86
Q

Discuss proper preparation for assisting a physician during initiation or removal of a chest tube

A

2 clamps, vaseline gauze pads, and sterile water/saline at bedside; Equipment setup, positioning of patient, and monitoring. Confirm consent on file.

87
Q

Discuss OVERALL nursing plans and interventions that should be implemented for patients with COPD and Asthma

A

Teach patient to sit upright in a forward- leaning position to promote breathing; Teach diaphragmatic and pursed-lip breathing, Teach prolonged expiratory phase to clear trapped air, Admin. O2 at 1 to 2L per NC, Pace activities to conserve energy; Maintain adequate dietary intake (small frequent meals, increase calories and protein using patients favorite meals); Provide adequate fluid intake (min 3L per day) and encourage fluids between meals instead of with meals

88
Q

Instructing the patient to participate in relaxation techniques, smoking cessation, and prevention of secondary infections are all examples of additional interventions for which condition?

A

COPD and Asthma

89
Q

T or F. Any kind of plan for cessation program needs to include a support system?

A

TRUE

90
Q

T or F. There are more people with chronic bronchitis, but higher mortality is associated with emphysema?

A

True, emphysema causes the MOST mortality.

91
Q

T or F. More men are diagnosed with chronic bronchitis and emphysema and die from these diseases than women?

A

False, more women die from and are twice as likely to get diagnosed with these COPD.

92
Q

Number of visits to physician offices with asthma as primary diagnosis?

A

14.2M

93
Q

Number of visits to emergency departments with asthma as primary diagnosis:

A

1.8M

94
Q

Expected findings from Dx tests for COPD would show?

A

ABGs- hypercapnia and hypoxemia; Forced Expiratory Volume (FEV1)- decreased; CXR- flattening of diaphragm; CBC- polycythemia

95
Q

Expected findings from an Asthma Dx test would show?

A

PFTs- decreased expiratory flow of air; Forced Expiratory Volume (FEV1) shows amount of expired air (should be about 80 percent of the patient’s potential and less than 20 percent variation over time. Eval- Measure PEF and FEV1 before and after therapy. An increase in these values after therapy is expected

96
Q

Competence

A

Implies having the capacity to function effectively as an individual and an organization within the context of the cultural beliefs, behaviors, and needs presented by consumers and their communities

97
Q

Providing patients with health care that is sensitive to the values that emerge out of their particular background

A

Culturally Competent Care (definition)

98
Q

Diversity

A

An all-inclusive concept, and includes differences in race, color, ethnicity, national origin, and immigration status (refugee, sojourner, immigrant, or undocumented), religion, age, gender, gender identity, sexual orientation, ability/disability, political beliefs, social and economic status, education, occupation, spirituality, marital and parental status, urban versus rural residence, enclave identity, and other attributes of groups of people in society

99
Q

Health care organizations should ensure that patients/consumers receive from all staff members effective, understandable, and respectful care that is provided in a manner compatible with their cultural health beliefs and practices and preferred language.

A

Standard 1

100
Q

Standard 4

A

Health care organizations must offer and provide language assistance services, including bilingual staff and interpreter services, at no cost to each patient/consumer with limited English proficiency at all points of contact, in a timely manner during all hours of operation.

101
Q

Standard 6

A

Health care organizations must assure the competence of language assistance provided to limited English proficient patients/consumers by interpreters and bilingual staff. Family and friends should not be used to provide interpretation services (except on request by the patient/consumer).

102
Q

Campinha-Bacote Model of Cultural Competence; Giger and Davidhizar’s Model of Transcultural Nursing; Jeffreys’ Cultural Competence and Confidence (CCC) Model; Leininger’s Cultural Care Diversity and Universality Theory/Model; Spector’s Health Traditions Model

A

Examples of Nursing Models

103
Q

A lifelong process of self-reflection and self-critique. It does not require mastery of lists of “different” or peculiar beliefs and behaviors supposedly pertaining to certain groups of patients. Rather, the provider is encouraged to develop a respectful partnership with each patient through patient-focused interviewing, exploring similarities and differences between his own and each patient’s priorities, goals, and capacities.

A

Cultural Humility as described by Melanie Tervalon and Jann Murray-Garcia

104
Q

In this model, the most serious barrier to culturally appropriate care is not a lack of knowledge of the details of any given cultural orientation, but the providers’ failure to develop self-awareness and a respectful attitude toward diverse points of view.

A

Cultural Humility

105
Q

Campinha-Bacote Model of Cultural Competence:

A

ASKED” model. Awareness-are you aware of personal biases and prejudices towards cultures different than yours? Skill-do you have the skill to conduct a cultural assessment and perform a culturally based physical assessment? Knowledge-Do you have the knowledge of the patient’s worldview? Encounters-How many face to face encounters have you had with patients from diverse cultural backgrounds? Desire-What is you desire to be culturally competent?

106
Q

Promotes better understanding of both the universally held and common understandings of care among human culture groups. The model guides the identification of patterns of human behavior in relationship to care and caring, guiding nurses in the assessment, planning, implementation, and evaluation of their care?

A

Leininger’s Cultural Care Diversity and Universality Theory/Model

107
Q

Giger and Davidhizar’s Model of Transcultural Nursing

A

Each individual is culturally unique and should be assessed according to six cultural phenomena: communication, space, social organization, time, environmental control and biological variations

108
Q

Interrelates concepts that explain, describe, influence, and/or predict the phenomenon of learning (developing) cultural competence and incorporates the construct of transcultural self-efficacy (confidence) as a major influencing factor

A

Jeffreys’ Cultural Competence and Confidence Model

109
Q

Spector’s Health Traditions Model:

A

The HEALTH Traditions Model (Spector, 2004) explores what people do to maintain, protect, or restore health by showing the interrelated phenomena of physical, mental, and spiritual health and the methods people use to maintain, protect, and restore health.

110
Q

Common clinical issues concerning diverse patients include?

A

Infant mortality, cancer screening and management, DM, Cardiovascular disease.

111
Q

Strategies to address common clinical issues concerning diverse patients:

A

Communication barriers-get a translator (not child of patient), use pen and paper, speak directly to patient when using translator (say “you” instead of “he” or “she” when using interpreter with patient. Be sure to use appropriate nonverbal communication (eye contact, touching by strangers, etc). Assess who makes the decisions for the family. Biological ecology: Ethnopharmacology-how drugs work on the body in different ethnicities. For example, some ACE inhibitors for HTN are not as effective for African-Americans. Also, consider cultural factors when teaching patient about drug therapy.

112
Q

Define the term “vulnerable populations”

A

At risk populations for health disparities. CDC defines as race/ethnicity, socio-economic status, geography, gender, age, disability status, risk status related to sex and gender

113
Q

An obstructive airway disorder where narrowing and inflammation of airways cause respiratory distress.

A

Asthma (def)

114
Q

Inflammation of mucus membranes of bronchial airways; also termed “blue bloater” (chronic) because of hypoxemia that leads to cyanosis.

A

Bronchitis (def)

115
Q

A group of pulmonary diseases involving obstruction of airflow that is chronic and recurrent. Usually associated with emphysema and chronic bronchitis

A

COPD (def)

116
Q

Cor Pulmonale (def)

A

A disorder manifested by hypertrophy of right ventricle caused by pulmonary hypertension; manifests as right heart failure.

117
Q

A chronic disorder of lungs resulting in overinflation of air spaces, loss of elasticity, and decreased gas exchange. Also termed “pink puffer” because patient does not become cyanotic until end stages of disease.

A

Emphysema/ Barrel Chest (def)

Med Surg II (12 decks)

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