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Medsurg Exam 2 > Respiratory Disorders > Flashcards

Respiratory Disorders Flashcards

1
Q

primary focus of the respiratory system

A

gas exchange

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2
Q

two parts of the respiratory system

A

upper and lower resp tract

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3
Q

physiology or purpose of respiration

A

oxygenation
ventilation -movement of air
elastic recoil
compliance and resistance

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4
Q

respiratory defense mechanisms

A

Filtration of air
Mucociliary clearance system
Cough reflex
Reflex bronchoconstriction
Alveolar macrophages

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5
Q

Acute infection of lung parenchyma (functional tissue)

A

pneumonia

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6
Q

8th leading cause of death in the US
why?

A

pneumonia and influenza
lack of care/ comorbidities

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7
Q

inflammatory response of pneumonia

A

attraction of neutrophils
release of inflammatory mediators
accumulation of fibrinous exudates, RBCs, and bacteria

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8
Q

inflammation leads to what patho in pneumonia

A

alveoli fill with fluid and debris (consolidation)
increased production of mucus (airway obstruction)
decreased gas exchange

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9
Q

patho resolution of pneumonia infection

A

macrophages in alveoli ingest and remove debris
normal lung tissue restored
gas exchange returns to normal

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10
Q

etiology of pneumonia

A

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

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11
Q

causes of mucociliary mechanism impaired

A

Pollution
Cigarette smoking
Upper respiratory infections
Tracheal intubation
Aging

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12
Q

clinical classification of pneumonia

A

causative organism

Community-acquired (CAP)
Hospital-acquired (HAP)
–Ventilator-associated (VAP) - oral care

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13
Q

Results from abnormal entry of secretions into lower airway

A

aspiration pneumonia

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14
Q

major risk factors for aspiration pneumonia

A

Decreased level of consciousness
Difficulty swallowing
Insertion of nasogastric tubes with or without tube feeding

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15
Q

most common clinical manifestations of pneumonia

A

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

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16
Q

physical examination findings of pneumonia

A

Fine or coarse crackles
Bronchial breath sounds
Egophony
↑ Fremitus
Dullness to percussion if pleural effusion present

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17
Q

complications from pneumonia

A

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

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18
Q

diagnostic tests for pneumonia

A

History
Physical examination
Chest x-ray
Sputum analysis
CBC with differential
Pulse oximetry or ABGs

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19
Q

supportive care for pneumonia

A

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

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20
Q

nursing assessment factors for pneumonia

A

Crackles
Friction rub
Dullness on percussion
Increased tactile fremitus
Sputum amount and color
Tachycardia
Changes in mental status

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21
Q

possible nursing diagnoses for pneumonia

A

Impaired gas exchange
Ineffective breathing pattern
Acute pain (chest)
Activity intolerance

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22
Q

desired outcomes from pneumonia

A

Clear breath sounds
Normal breathing patterns
No signs of hypoxia
Normal chest x-ray
Normal WBC count
Absence of complications related to pneumonia

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23
Q

pt teaching for home care of pneumonia

A

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

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24
Q

evaluation of pneumonia

A

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

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25
Q

other name for obstructive sleep apnea

A

obstructive sleep apnea-hypopnea syndrome (OSAHS)

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26
Q

what is obstructive sleep apnea

A

Partial or complete upper airway obstruction during sleep
Apneic period may include hypoxemia and hypercapnia

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27
Q

clinical manifestations of obstructive sleep apnea

A

Frequent arousals during sleep
Insomnia
Excessive daytime sleepiness
Witnessed apneic episodes
Snoring
Morning headache
Irritability

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28
Q

complications of sleep apnea can results in what conditions:

A

Hypertension
Cardiac changes
Poor concentration/memory

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29
Q

how to diagnose obstructive sleep apnea

A

sleep study

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30
Q

Nursing and Interprofessional Mgmt of mild sleep apnea

A

Sleeping on one’s side
Elevating head of bed
Avoiding sedatives and alcohol 3 to 4 hours before sleep
Weight loss
Oral appliance

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31
Q

Nursing and Interprofessional Mgmt of severe Sleep Apnea (>15 apnea/hypopnea events/hr)

A

CPAP
–Poor compliance
BiPAP
Surgery

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32
Q

Heterogenous disease characterized by a combination of clinical manifestations along with reversible expiratory airflow limitation or bronchial hyperresponsiveness

A

asthma

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33
Q

triggers for asthma

A

infection
allergens
exercise
irritants
Exercise
Pollutants and Irritants
Respiratory Infections
Food and Drug
Emotional Stress

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34
Q

early phase response of asthma triggered by allergen

A

allergens
B lymphocyte
plasma cells
IgE antibodies
mast cells
allergens
histamine and inflammatory mediators

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35
Q

clinical manifestations of asthma

A

Cough
Shortness of breath (dyspnea)
Wheezing
Chest tightness
Variable airflow obstruction

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36
Q

complications of asthma

A

Severe and life-threatening exacerbations
Respiratory rate >30/min
Dyspnea at rest, feeling of suffocation
Pulse >120/min
Too dyspneic to speak
Drowsy/confused

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37
Q

diagnostic studies of asthma

A

Detailed history and physical exam
Spirometry
Peak expiratory flow rate (PEFR)
Chest x-ray
Oximetry
Allergy testing
Blood levels of eosinophils

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38
Q

interprofessional care for intermittent and persistent asthma

A

Avoid triggers of acute attacks
Pre-medicate before exercising
Short-term (rescue or reliever) medication
Long-term or controller medication

39
Q

drug therapy for asthma

A

Three types of antiinflammatory drugs
-Corticosteroids
-Leukotriene modifiers
-Monoclonal antibody to IgE
Three types of bronchodilators
-β2-Adrenergic agonists
-Methylxanthines
-Anticholinergics

40
Q

pt teaching for drug therapy of asthma

A

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

41
Q

physical exam of asthma

A

Use of accessory muscles
Diaphoresis
Cyanosis
Lung sounds

42
Q

nursing diagnoses of asthma

A

Ineffective airway clearance
Anxiety
Deficient knowledge

43
Q

planning and overall goals of asthma

A

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

44
Q

nursing outcomes for asthma

A

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

45
Q

Airflow limitation not fully reversible
Usually progressive
Abnormal inflammatory response of lungs, primarily caused by cigarette smoking and other noxious particles or gases

A

COPD

46
Q

description of COPD

A

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

47
Q

cally significant airway obstruction develops in __% of smokers

A

15

48
Q

COPD should be considered in any person ___

A

over 40 with smoking history of 10 or more pack-years

49
Q

Considerable pathologic and functional overlap between asthma and COPD

A

Older adults may have components of both diseases
Asthma-COPD overlap syndrome

50
Q

defining features of COPD

A

Not fully reversible airflow limitations during forced exhalation due to
-Loss of elastic recoil
-Airflow obstruction due to mucous hypersecretion, mucosal edema, and bronchospasm

51
Q

primary process of inflammation in COPD

A

Inhalation of noxious particles and gases
Mediators released cause damage to lung tissue
Airways inflamed
Parenchyma destroyed

52
Q

supporting structures of lungs are destroyed how:

A

Air goes in easily, but remains in the lungs
Bronchioles tend to collapse
Causes barrel-shaped chest

53
Q

clinical manifestations of COPD

A

polycythemia and cyanosis
Prolonged expiratory phase
Wheezes
Decreased breath sounds
↑ Anterior-posterior diameter (barrel chest)
Tripod position
Pursed lip breathing

54
Q

clinical manifestations of polycythemia and cyanosis

A

Hypoxemia
Increased production of red blood cells
Bluish-red color of skin
Hemoglobin concentrations may reach 20 g/dL (200 g/L) or more

55
Q

diagnostic studies of COPD

A

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

56
Q

mild classification of COPD

A

FEV1greater than 80%

57
Q

moderate classification of COPD

A

FEV1 50-80%

58
Q

severe classification of COPD

A

FEV1 30-50%

59
Q

very severe classification of COPD

A

FEV1 less than 30%

60
Q

complications of COPD

A

Cor pulmonale
Exacerbations of COPD
Acute respiratory failure
Peptic ulcer disease
Depression/anxiety

61
Q

exacerbations of COPD signaled by change in usual:

A

dyspnea
cough
sputum

62
Q

primary cause of COPD exacerbations

A

bacterial and viral infections

63
Q

signs of severity for COPD exacerbations

A

use of accessory muscles
central cyanosis

64
Q

treatment for COPD exacerbations

A

Short-acting bronchodilators
Oral systemic corticosteroids
Antibiotics
Supplemental oxygen therapy

65
Q

interprofessional care for stable COPD

A

Treated as outpatients
Hospitalized for complications
-Acute exacerbations
-Acute respiratory failure

66
Q

interprofessional care of COPD

A

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

67
Q

drug therapy for COPD

A

Commonly used bronchodilators
-β2-Adrenergic agonists
-Anticholinergics
-Methylxanthines
Anti-inflammatories
-Corticosteroids

68
Q

O2 therapy is used in COPD to:

A

Keep O2 saturation > 90% during rest, sleep, and exertion, or
PaO2 > 60 mm Hg

69
Q

COPD long-term O2 therapy improves:

A

Survival
Exercise capacity
Cognitive performance
Sleep in hypoxemic patients

70
Q

COPD chronic O2 therapy at home reduces:

A

Hematocrit
Pulmonary hypertension
Periodic reevaluations are necessary to determine duration of use

71
Q

COPD O2 delivery systems are high or low flow

A

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

72
Q

humidification in COPD treatment

A

Used because O2 has a drying effect on the mucosa
Supplied by nebulizers, vapotherm, and bubble-through humidifiers

73
Q

physical and respiratory therapy for COPD

A

Breathing retraining
Effective coughing
Chest physiotherapy
-Percussion
-Vibration
-Postural drainage
Airway clearance devices
High-frequency chest wall oscillation
-The Vest

74
Q

breathing retraining for COPD

A

Decreases dyspnea, improves oxygenation, and slows respiratory rate
-Pursed lip breathing (PLB)
-Diaphragmatic (abdominal) breathing

75
Q

pursed lip breathing for COPD

A

Prolongs exhalation and prevents bronchiolar collapse and air trapping
Teach patients to use “just enough” positive pressure

76
Q

chest physiotherapy is indicated in COPD for:

A

Excessive, difficult-to-clear bronchial secretions
Retained secretions in artificial airway
Lobular atelectasis from mucous plug

77
Q

percussion for COPD

A

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

78
Q

vibration for COPD

A

Facilitates movement of secretions to larger airways
Mild vibration tolerated better than percussion

79
Q

flutter mucus clearance device for COPD

A

Provides positive expiratory pressure (PEP) treatment
Produces vibration in lungs to loosen mucus for expectoration
Handheld device

80
Q

acapella device for COPD

A

Vibrates lungs to shake free mucous plugs
Improves clearance of secretions
Faster and more tolerable than CPT

81
Q

high frequency chest wall oscillation for COPD

A

Inflatable vest that vibrates the chest
Works on all lobes
More effective than CPT

82
Q

nutritional therapy for COPD

A

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

83
Q

subjective nursing assessment data

A

health history
risk therapy

84
Q

objective nursing assessment data

A

Integumentary
Respiratory
Cardiovascular
Gastrointestinal
Musculoskeletal

85
Q

nursing diagnoses for COPD

A

Ineffective breathing pattern
Ineffective airway clearance
Impaired gas exchange
Imbalanced nutrition: Less than body requirements
Risk for infection

86
Q

planning goals for COPD

A

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

87
Q

health promotion for COPD

A

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

88
Q

acute care of COPD

A

Required for acute exacerbations, pneumonia, cor pulmonale, or acute respiratory failure
Degree and severity of underlying respiratory problem should be assessed

89
Q

COPD implementation designed to reduce symptoms and improve quality of life

A

pulmonary rehab

90
Q

factors of pulmonary rehab

A

exercise training
smoking cessation
nutrition counseling
education

91
Q

activity considerations for pulmonary rehab

A

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

92
Q

COPD end-of-life considerations

A

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

93
Q

evaluation for COPD

A

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

Medsurg Exam 2 (6 decks)

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