Respiratory Disorders Flashcards
primary focus of the respiratory system
gas exchange
two parts of the respiratory system
upper and lower resp tract
physiology or purpose of respiration
oxygenation
ventilation -movement of air
elastic recoil
compliance and resistance
respiratory defense mechanisms
Filtration of air
Mucociliary clearance system
Cough reflex
Reflex bronchoconstriction
Alveolar macrophages
Acute infection of lung parenchyma (functional tissue)
pneumonia
8th leading cause of death in the US
why?
pneumonia and influenza
lack of care/ comorbidities
inflammatory response of pneumonia
attraction of neutrophils
release of inflammatory mediators
accumulation of fibrinous exudates, RBCs, and bacteria
inflammation leads to what patho in pneumonia
alveoli fill with fluid and debris (consolidation)
increased production of mucus (airway obstruction)
decreased gas exchange
patho resolution of pneumonia infection
macrophages in alveoli ingest and remove debris
normal lung tissue restored
gas exchange returns to normal
etiology of pneumonia
Likely to result when defense mechanisms become incompetent or overwhelmed
↓ Cough and epiglottal reflexes may allow aspiration
Mucociliary mechanism impaired
Chronic diseases suppress immune system
causes of mucociliary mechanism impaired
Pollution
Cigarette smoking
Upper respiratory infections
Tracheal intubation
Aging
clinical classification of pneumonia
causative organism
Community-acquired (CAP)
Hospital-acquired (HAP)
–Ventilator-associated (VAP) - oral care
Results from abnormal entry of secretions into lower airway
aspiration pneumonia
major risk factors for aspiration pneumonia
Decreased level of consciousness
Difficulty swallowing
Insertion of nasogastric tubes with or without tube feeding
most common clinical manifestations of pneumonia
Cough
Fever, chills
Dyspnea, tachypnea
Pleuritic chest pain
Green (bacterial), yellow (viral), or rust-colored sputum
Prolonged fatigue
Change in mentation for older or debilitated patients
physical examination findings of pneumonia
Fine or coarse crackles
Bronchial breath sounds
Egophony
↑ Fremitus
Dullness to percussion if pleural effusion present
complications from pneumonia
Atelectasis - collapsed alveoli
Pleurisy - chest pain
Pleural effusion - fluid in chest cavity
Bacteremia - bacteria in lungs
Pneumothorax - air between lung and chest - collpased lung
Meningitis
Acute respiratory failure
Sepsis/septic shock
Lung abscess
Empyema - abcess from dead lung tissue
diagnostic tests for pneumonia
History
Physical examination
Chest x-ray
Sputum analysis
CBC with differential
Pulse oximetry or ABGs
supportive care for pneumonia
Oxygen for hypoxemia
Analgesics for chest pain
Antipyretics - lowers temp
Individualize rest and activity
no definitive treatment for majority of viral pneumonias
antivirals for influenza pneumonia
nursing assessment factors for pneumonia
Crackles
Friction rub
Dullness on percussion
Increased tactile fremitus
Sputum amount and color
Tachycardia
Changes in mental status
possible nursing diagnoses for pneumonia
Impaired gas exchange
Ineffective breathing pattern
Acute pain (chest)
Activity intolerance
desired outcomes from pneumonia
Clear breath sounds
Normal breathing patterns
No signs of hypoxia
Normal chest x-ray
Normal WBC count
Absence of complications related to pneumonia
pt teaching for home care of pneumonia
Emphasize need to take full course of medication(s)
Drug-drug and drug-food interactions
Adequate rest
Adequate hydration
Avoid alcohol and smoking
Cool mist humidifier
Chest x-ray, vaccinations
evaluation of pneumonia
Effective respiratory rate, rhythm, and depth of respirations
Lungs clear to auscultation
Reports pain control
SpO2 ≥ 95
Free of adventitious breath sounds
Clear sputum from airway
other name for obstructive sleep apnea
obstructive sleep apnea-hypopnea syndrome (OSAHS)
what is obstructive sleep apnea
Partial or complete upper airway obstruction during sleep
Apneic period may include hypoxemia and hypercapnia
clinical manifestations of obstructive sleep apnea
Frequent arousals during sleep
Insomnia
Excessive daytime sleepiness
Witnessed apneic episodes
Snoring
Morning headache
Irritability
complications of sleep apnea can results in what conditions:
Hypertension
Cardiac changes
Poor concentration/memory
how to diagnose obstructive sleep apnea
sleep study
Nursing and Interprofessional Mgmt of mild sleep apnea
Sleeping on one’s side
Elevating head of bed
Avoiding sedatives and alcohol 3 to 4 hours before sleep
Weight loss
Oral appliance
Nursing and Interprofessional Mgmt of severe Sleep Apnea (>15 apnea/hypopnea events/hr)
CPAP
–Poor compliance
BiPAP
Surgery
Heterogenous disease characterized by a combination of clinical manifestations along with reversible expiratory airflow limitation or bronchial hyperresponsiveness
asthma
triggers for asthma
infection
allergens
exercise
irritants
Exercise
Pollutants and Irritants
Respiratory Infections
Food and Drug
Emotional Stress
early phase response of asthma triggered by allergen
allergens
B lymphocyte
plasma cells
IgE antibodies
mast cells
allergens
histamine and inflammatory mediators
clinical manifestations of asthma
Cough
Shortness of breath (dyspnea)
Wheezing
Chest tightness
Variable airflow obstruction
complications of asthma
Severe and life-threatening exacerbations
Respiratory rate >30/min
Dyspnea at rest, feeling of suffocation
Pulse >120/min
Too dyspneic to speak
Drowsy/confused
diagnostic studies of asthma
Detailed history and physical exam
Spirometry
Peak expiratory flow rate (PEFR)
Chest x-ray
Oximetry
Allergy testing
Blood levels of eosinophils
interprofessional care for intermittent and persistent asthma
Avoid triggers of acute attacks
Pre-medicate before exercising
Short-term (rescue or reliever) medication
Long-term or controller medication
drug therapy for asthma
Three types of antiinflammatory drugs
-Corticosteroids
-Leukotriene modifiers
-Monoclonal antibody to IgE
Three types of bronchodilators
-β2-Adrenergic agonists
-Methylxanthines
-Anticholinergics
pt teaching for drug therapy of asthma
Correct administration of drugs is a major factor in success
-Inhalation of drugs is preferable to avoid systemic side effects
-MDIs, DPIs, and nebulizers are devices used to inhale medications
Correct administration of drugs
-Using an MDI with a spacer is easier and improves inhalation of the drug
-DPI (dry powder inhaler) requires less manual dexterity and coordination
physical exam of asthma
Use of accessory muscles
Diaphoresis
Cyanosis
Lung sounds
nursing diagnoses of asthma
Ineffective airway clearance
Anxiety
Deficient knowledge
planning and overall goals of asthma
Have minimal symptoms
Maintain acceptable activity levels
Maintain >80% of personal best PEFR
Few or no adverse effects of therapy
No acute exacerbations of asthma
Adequate knowledge to participate in and carry out plan of care
nursing outcomes for asthma
Describe the disease process and treatment regimen
Demonstrate correct administration of inhaled drugs
Express confidence in ability for long-term management of asthma
Maintain clear airway with removal of excessive secretions
Experience normal breath sounds and respiratory rate
Report decreased anxiety with increased control of respirations
Airflow limitation not fully reversible
Usually progressive
Abnormal inflammatory response of lungs, primarily caused by cigarette smoking and other noxious particles or gases
COPD
description of COPD
Definitions previously included chronic bronchitis and emphysema
Chronic bronchitis is an independent disease
Emphysema is a pathologic term that explains only one of several structural abnormalities in COPD
cally significant airway obstruction develops in __% of smokers
15
COPD should be considered in any person ___
over 40 with smoking history of 10 or more pack-years
Considerable pathologic and functional overlap between asthma and COPD
Older adults may have components of both diseases
Asthma-COPD overlap syndrome
defining features of COPD
Not fully reversible airflow limitations during forced exhalation due to
-Loss of elastic recoil
-Airflow obstruction due to mucous hypersecretion, mucosal edema, and bronchospasm
primary process of inflammation in COPD
Inhalation of noxious particles and gases
Mediators released cause damage to lung tissue
Airways inflamed
Parenchyma destroyed
supporting structures of lungs are destroyed how:
Air goes in easily, but remains in the lungs
Bronchioles tend to collapse
Causes barrel-shaped chest
clinical manifestations of COPD
polycythemia and cyanosis
Prolonged expiratory phase
Wheezes
Decreased breath sounds
↑ Anterior-posterior diameter (barrel chest)
Tripod position
Pursed lip breathing
clinical manifestations of polycythemia and cyanosis
Hypoxemia
Increased production of red blood cells
Bluish-red color of skin
Hemoglobin concentrations may reach 20 g/dL (200 g/L) or more
diagnostic studies of COPD
History and physical exam
Diagnosis confirmed by spirometry
-FEV1/FVC ratio <70%
-Increased residual volume
Chest x-ray
6-minute walk test
COPD Assessment Test (CAT)
Clinical COPD Questionnaire (CCQ)
ABGs
mild classification of COPD
FEV1greater than 80%
moderate classification of COPD
FEV1 50-80%
severe classification of COPD
FEV1 30-50%
very severe classification of COPD
FEV1 less than 30%
complications of COPD
Cor pulmonale
Exacerbations of COPD
Acute respiratory failure
Peptic ulcer disease
Depression/anxiety
exacerbations of COPD signaled by change in usual:
dyspnea
cough
sputum
primary cause of COPD exacerbations
bacterial and viral infections
signs of severity for COPD exacerbations
use of accessory muscles
central cyanosis
treatment for COPD exacerbations
Short-acting bronchodilators
Oral systemic corticosteroids
Antibiotics
Supplemental oxygen therapy
interprofessional care for stable COPD
Treated as outpatients
Hospitalized for complications
-Acute exacerbations
-Acute respiratory failure
interprofessional care of COPD
Evaluate for environmental or occupational irritants
Influenza virus vaccine
Pneumococcal vaccine
Smoking cessation
Biggest impact in reducing risk of developing COPD
Accelerated decline in pulmonary function slows to almost nonsmoking levels
drug therapy for COPD
Commonly used bronchodilators
-β2-Adrenergic agonists
-Anticholinergics
-Methylxanthines
Anti-inflammatories
-Corticosteroids
O2 therapy is used in COPD to:
Keep O2 saturation > 90% during rest, sleep, and exertion, or
PaO2 > 60 mm Hg
COPD long-term O2 therapy improves:
Survival
Exercise capacity
Cognitive performance
Sleep in hypoxemic patients
COPD chronic O2 therapy at home reduces:
Hematocrit
Pulmonary hypertension
Periodic reevaluations are necessary to determine duration of use
COPD O2 delivery systems are high or low flow
Low-flow is most common
Low-flow is mixed with room air, and delivery is less precise than high-flow
High-flow fixed concentration
-Venturi mask
humidification in COPD treatment
Used because O2 has a drying effect on the mucosa
Supplied by nebulizers, vapotherm, and bubble-through humidifiers
physical and respiratory therapy for COPD
Breathing retraining
Effective coughing
Chest physiotherapy
-Percussion
-Vibration
-Postural drainage
Airway clearance devices
High-frequency chest wall oscillation
-The Vest
breathing retraining for COPD
Decreases dyspnea, improves oxygenation, and slows respiratory rate
-Pursed lip breathing (PLB)
-Diaphragmatic (abdominal) breathing
pursed lip breathing for COPD
Prolongs exhalation and prevents bronchiolar collapse and air trapping
Teach patients to use “just enough” positive pressure
chest physiotherapy is indicated in COPD for:
Excessive, difficult-to-clear bronchial secretions
Retained secretions in artificial airway
Lobular atelectasis from mucous plug
percussion for COPD
Hands in a cuplike position to create an air pocket
Air-cushion impact facilitates movement of thick mucus
If it is performed correctly, a hollow sound should be heard
vibration for COPD
Facilitates movement of secretions to larger airways
Mild vibration tolerated better than percussion
flutter mucus clearance device for COPD
Provides positive expiratory pressure (PEP) treatment
Produces vibration in lungs to loosen mucus for expectoration
Handheld device
acapella device for COPD
Vibrates lungs to shake free mucous plugs
Improves clearance of secretions
Faster and more tolerable than CPT
high frequency chest wall oscillation for COPD
Inflatable vest that vibrates the chest
Works on all lobes
More effective than CPT
nutritional therapy for COPD
Malnutrition in COPD patients is multifactorial
-Increased inflammatory mediators
-Increased metabolic rate
-Lack of appetite
Decrease dyspnea and conserve energy
High-calorie, high-protein diet is recommended
Eat five to six small meals to avoid bloating and early satiety
subjective nursing assessment data
health history
risk therapy
objective nursing assessment data
Integumentary
Respiratory
Cardiovascular
Gastrointestinal
Musculoskeletal
nursing diagnoses for COPD
Ineffective breathing pattern
Ineffective airway clearance
Impaired gas exchange
Imbalanced nutrition: Less than body requirements
Risk for infection
planning goals for COPD
Prevention of disease progression
Ability to perform ADLs
Relief from symptoms
No complications related to COPD
Knowledge and ability to implement long-term regimen
Overall improved quality of life
health promotion for COPD
Abstain from or stop smoking.
Avoid or control exposure to occupational and environmental pollutants and irritants.
Early detection of small-airway disease
Early diagnosis and treatment of respiratory tract infection
acute care of COPD
Required for acute exacerbations, pneumonia, cor pulmonale, or acute respiratory failure
Degree and severity of underlying respiratory problem should be assessed
COPD implementation designed to reduce symptoms and improve quality of life
pulmonary rehab
factors of pulmonary rehab
exercise training
smoking cessation
nutrition counseling
education
activity considerations for pulmonary rehab
Exercise training leads to energy conservation
Modify ADLs to conserve energy
Walk 15 to 20 minutes a day at least 3 times a week with gradual increases
COPD end-of-life considerations
Symptoms can be managed, but COPD cannot be cured
End-of-life issues and advanced directives are important topics for discussion
Palliative care, end-of-life and hospice care are important in advanced COPD
evaluation for COPD
Return to baseline respiratory function
Demonstrate an effective rate, rhythm, and depth of respirations
Experience clear breath sounds
Maintain clear airway by effective coughing
PaCO2 and PaO2 return to levels normal for patient
Maintenance of normal body weight
Normal serum protein levels
Feeling of being rested
Improvement in sleep patterAwareness of need to seek medical attention
Behaviors minimizing risk of infection
No infection
