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N3102: Adult > Respiratory: Diseases > Flashcards

Respiratory: Diseases Flashcards

1
Q

Define asthma

A

chronic inflammatory disease of the airways that causes airway hyperresponsiveness, mucosal edema, and mucus production

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2
Q

What are some risk factors for asthma? (9)

A

seasonal allergies
airway irritants (smoke, pollutants, cold, heat, odours)
foods
exercise
resp tract infections
GERD
medications
hormonal factors
stress

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3
Q

What are the main manifestations of asthma?

A

cough, dyspnea, wheezing

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4
Q

asthma controlled or uncontrolled?
no nighttime asthma symptoms, daytime symptoms less than 4 times/week, can exercise w/ no symptoms, need reliever less than 4x/week

A

well controlled

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5
Q

What are signs that asthma is getting worse?

A

disturbed sleep due to symptoms

daytime symptoms 4 or more times/week

cannot exercise normally

need reliever more than 4 times/week

getting cold or flu

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6
Q

Define chronic pulmonary obstructive disease (COPD)

A

characterized by persistent airflow limitation that is progressive and associated w/ enhanced chronic inflammatory response in airways and lung to noxious particles or gases

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7
Q

What two conditions does COPD include?

A
  • chronic bronchitis
  • emphysema
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8
Q

Define chronic bronchitis

A

disease of the airways. Bronchial tubes become inflamed and excessive mucus production occurs as a result from irritants or injury. Mucus plugging, thickening of bronchial walls, damage to alveoli. Increased susceptibility to infection and obstruction of airflow

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9
Q

Why is chronic bronchitis considered a blue bloater?

A

hypoxemia = increase BP (hypertension) = heart works harder = fluid retention

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10
Q

What are the S&S of chronic bronchitis? (10)

A

excess body fluids (edemal plethora)
chronic cough (prominent in AM)
SOB on exertion
increased sputum
cyanosis (late)
chills
muscle aches
loss of libido
insomnia
fatigue

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11
Q

Define emphysema

A

impaired gas exchange results from destruction of walls of overdistended alveoli. Hyperinflation and breathlessness. Alveolar surface area in contact with capillaries continually decreases: increased dead space and impaired O2 diffusion.

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12
Q

Is emphysema blue bloater or pink puffer? why?

A

pink puffer: difficulty breathing, tripod position

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13
Q

What are S&S of emphysema? (8)

A

use of accessory muscles
purse-lipped breathing
minimal/absent cough
leaning forward to breathe
barrel chest
digital clubbing
dyspnea on exertion (late)
weight loss

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14
Q

What are the risk factors for COPD? (8)

A

smoking
asthma
occupational exposure (dusts, chemicals)
air pollution
age
genetics
alpha antitrypsin deficiency (genetic abnormalities)
infections (bacterial or viral)

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15
Q

T or F: Reduced FEV1 is seen in COPD

A

True

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16
Q

What are some complications of COPD? (8)

A

Pneumonia
Atelectasis
Pneumothorax
Pulmonary arterial hypertension
Cor pulmonale
Right ventricular failure
Respiratory failure
Undernutrition (especially in the late phases)

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17
Q

What is included in COPD treatment?

A
  • remove environmental exposures
  • medications
  • O2 therapy
  • pulmonary rehab
  • lung transplant
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18
Q

What is the Haldane effect? and why is it relevant to COPD?

A

high O2 will cause hemoglobin to dump CO2 into blood 🡪 increase PaCO2 = decrease pH = acidosis & hypercapnic hypoxemia (their lungs cannot exchange gas effectively)

  • COPD patients are CO2 retainers = should not be on high flow O2 unless emergent
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19
Q

What is included in nursing management for COPD? (8)

A
  • breathing exercises
  • inspiratory muscle training
  • activity pacing
  • self-care activites
  • physical conditioning
  • oxygen therapy
  • nutritional therapy
  • coping measures
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20
Q

What does diaphragmatic breathing do?

A

reduces respiratory rate, increases alveolar ventilation, and helps expel as much air as possible during expiration

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21
Q

What does purse-lipped breathing do?

A

slow expiration, prevents collapse of small airways, and helps control rate and depth of respiration. Also promotes relaxation

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22
Q

what medications are used for COPD?

A
  • beta2 adrenergic agonist (short and long)
  • anticholinergic (short and long)
  • leukotriene receptor antagonist
  • corticosteroids (inhaled and oral)
  • mast cell stabilizers
  • Phosphodiesterase-4 inhibitors
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23
Q

What is the role of beta2 adrenergic agonist?

A

Binds to beta adrenergic receptor and relaxes bronchial smooth muscle which stimulates bronchodilation

24
Q

Is short acting beta2 adrenergic agonist rescue or regular use for COPD? for asthma?

A

Asthma: Use as rescue, PRN

COPD: Symptom relief or regular use

25
Q

is long acting beta agonists rescue or regular use for COPD? for asthma?

A

Asthma: Add on therapy to ICS to achieve control,
Used in exercised induced asthma (EIA), Never used alone

COPD: Used in moderate to severe COPD

26
Q

What are signs of toxicity with beta2 adrenergic agonists? (5)

A

tachycardia, restlessness, nausea, vomiting, dizziness

27
Q

T or F: You can use beta agonists with MI and dysrhythmias

A

False

28
Q

What can reserve the effects of beta2 agonists?

A

beta blockers

29
Q

What is an example of a short acting beta agonist?

A

Salbutamol

30
Q

What is an example of a long acting beta agonist?

A

Salmeterol

31
Q

What is the action of anticholinergics?

A

Bronchodilation by blocking cholinergic receptors in smooth muscle, results in inhibition of PNS

32
Q

What are symptoms of toxicity for anticholinergics? (7)

A

inability to urinate or BM
severe headache
heart palpitations
difficulty breathing
changes in vision
eye pain
dry mouth

33
Q

is long acting anticholinergics rescue or regular use for COPD? for asthma?

A

asthma: Not used or Used in late stage asthma/if beta agonist not tolerated

COPD: Symptom relief or regular use

34
Q

What is an example of long acting anticholinergic?

A

Ipratropium (Atrovent)

35
Q

what is the action of inhaled corticosteroids?

A

Decrease immune system = decrease airway inflammation

prevent respiratory distress

36
Q

What should you monitor with corticosteroids?

A
  • infection
  • BG: long term use they may develop hyperglycemia
  • oral thrush: white patches, redness in mouth/throat, loss of taste or unpleasant taste, cracks in corner of mouth
37
Q

What is the role of oral corticosteroids for asthma and COPD?

A

Used primarily in severe exacerbations or in rare cases of severe asthma/COPD

38
Q

What are some complications of COPD?

A

Pneumonia
Atelectasis
Pneumothorax
Pulmonary arterial hypertension
Cor pulmonale
Right ventricular failure
Respiratory failure

39
Q

Define atelectasis

A

closure or collapse of alveoli. Caused by hypoventilation, obstruction of the airways, or compression

40
Q

What are symptoms of atelectasis? (9)

A

cough, sputum production, low grade fever

acute w/ large amount of lung tissue (lobar atelectasis): dyspnea, tachycardia, tachypnea, pleural pain, central cyanosis (late sign), difficulty breathing in supine

41
Q

Define cor pulmonale

A

condition where right ventricle of heart enlarges as a result of diseases that affect the structure or function of lung or its vasculature

42
Q

What is treatment for cor pulmonale?

A
  • oxygen
  • chest physical therapy and bronchial hygiene maneouvres
  • bed rest, sodium restriction, and diuretic therapy = reduce peripheral edema
43
Q

Define pulmonary artery hypertension

A

mean pulmonary artery pressure greater than 25mmHg at rest or systolic pulmonary artery pressure is more than 30 mmHg

44
Q

What is the treatment for pulmonary artery hypertension?

A
  • manage underlying pulmonary/cardiac condition, administration of O2, diuretics, digoxin, anticoagulants, calcium channel blockers, prostaglandin,
  • avoid factors like air travel, decongestant medications, NSAIDs, pregnancy, and tobacco use
45
Q

T or F: any condition that causes chronic hypoxemia can result in pulmonary artery hypertension

A

True

46
Q

Which patients are at high risk for pulmonary artery hypertension?

A

COPD, PE

47
Q

Define respiratory failure

A

Exists when exchange of O2 for CO2 in lungs cannot keep up with rate of O2 consumption and CO2 production by cells.

PaO2 less than 50 mmHg (hypoxemia) and rise in PaCO2 to greater than 50mmHg (hypercapnia)

48
Q

Define pneumonia

A

inflammation of the lung parenchyma .The edema associated with inflammation stiffens the lung, decreases lung compliance and vital capacity, and causes hypoxemia.

49
Q

what are some symptoms of pneumonia? (10)

A

pleuritic chest pain
confusion/changes in LOC
cough
fatigue
nausea & vomiting
chills or fever
SOB or tachypnea
purulent sputum production
flushed cheeks
crackles

50
Q

What are treatments/interventions for pneumonia? (4)

A
  • hydration to support fever and insensible fluid loss
  • bed rest until signs of infection clear up
  • Diet: high calorie, high protein diet with frequent and small meals
  • monitor for pleural effusion, chest tubes, shock, resp failure, hemodynamic status, delirium
51
Q

What medications would be used for pneumonia?

A

antipyretics to treat fever and headache
antitussives for cough
antihistamines for sneezing and congestion
antibiotics
mucolytic agents
bronchodilators

52
Q

Define pnuemothorax

A

accumulation of atmospheric air in the pleural space 🡪 causes intrathoracic pressure & reduced vital capacity (FVC). The loss of negative intrapleural pressure causes collapse of lung.

53
Q

Define a tension pneumothorax

A

STABBING. air is drawn into pleural space from lacerated lung or through small hole in chest wall, complication of other pneumothorax. air is trapped with each resp, tension increases with each breath, causes mediastinal shift

54
Q

What are symptoms in a simple pneumothorax? (7)

A

minimal respiratory distress
slight chest discomfort
tachypnea
midline trachea
decreased expansion of chest
diminished breath sounds
percussion is normal or hyperresonance

55
Q

How do you diagnose a pneumothorax?

A

chest x-ray

N3102: Adult (5 decks)

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