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Nursing Theory III > Respiratory Disorders > Flashcards

Respiratory Disorders Flashcards

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1
Q

Client with pneumonia

A

Infectious:
- Bacteria, viruses, fungi, protozoa, other microbes
Noninfectious:
- Aspiration of gastric contents, inhalation of toxic or irritating gases
Community- acquired:
- Streptococcus pneumoniae most common
Nosocomial (hospital acquired):
- Staphylococcus aureus, Klebsiella pneumoniae, Pseudomonas aeruginaosa, E. Coli
Opportunistic:
- Pneumocystitis carinii in immunocompromised persons

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2
Q

Collaborative Care:

A

Prevention if key component, especially with vulnerable populations

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3
Q

Immunization

A

Pneumococcal vaccine: antigens from 23 types of pneumococcus, imparts life-long immunity
Influenza vaccine: recommended for high-risk populations

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4
Q

Medications

A

Antibiotics: initially according to gram stain, pattern of lung involvement, then according to C&S results
Bronchodilators: improve ventilation, reduce hypoxia
Sympathomimetics: albuterol, metaproterenol
Methylxanthines: theophylline, aminophylline
Expectorants: Acetylcysteine (Mucomyst) as inhalation; guaifenesin

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5
Q

Respiratory Treatments

A

Incentive spirometry, suctioning

Oxygen: according to clients needs: range form cannula to intubation and mechanical ventilation

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6
Q

Chest Physiotherapy

A

Percussion: rhythmic clapping on chest wall to reduce lung consolidation, prevent atelectasis
Vibration: application of pressure with repeated tensing of hand over involved areas to facilitate movement of secretions into larger airways
Postural Drainage: positioning client to facilitate drainage of secretions from lung segment

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7
Q

Complementary Therapies

A

Herbs: echinacea, goldenseal, ma huang

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8
Q

Nursing Care/ Health Promotion

A 
Vaccinations against pneumonia
Preventive measures in high risk groups
- Increase mobility
- Good hydration, nutrition
- Prompt detection and prompt treatment of pneumonia
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9
Q

Nursing Diagnoses

A

Ineffective airway clearance
Ineffective breathing pattern
Activity intolerance

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10
Q

Home Care

A

Usually treated in community unless respiratory status compromised
Preventive measures
Recognition of manifestations
Supportive care to maintain clients health
Completion of any antibiotic therapy
Continue with medical appointments for follow-up

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11
Q

TB: Collaborative Care

A

Significant public health threat with development of drug-resistance strains; focus includes:
- Early detection
- Accurate diagnosis
- Effective disease treatment
- Prevention of spread of TB
Non-compliance with prescribed treatment is a major problem

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12
Q

TB: Treatment

A

Treatment usually lasts for many months and sometimes years
Successful treatment of TB:
- Depends on the compliance of the patient
- The failure of the patient to take the medications as prescribed is the most important cause of failure to cure TB
- Health department can demand direct monitoring of patient compliance with therapy

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13
Q

TB: Medications

A

Isoniazid (INH) antibiotic to prevent TB form becoming active
Rifampin (RMP) used for active TB
Pyrazinamide (PZA) used for active TB
Ethambutol (EMB) used for active TB

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14
Q

TB: Medications Prevention and Treatment

A

Prophylactic treatment to prevent active TB
- Clients with positive TB skin test
- Close contact of persons with positive sputum
6-12 months of Isoniazid orally (300 mg)
Bacilli Calmette -Guerin (BCG) vaccine given to infants
Toronto researchers (October 2013) developed a booster that will reactivate immunity (still in trials)

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15
Q

TB: Treatment

A

Treatment for active disease uses 2 or more medications to prevent TB organism from mutating into drug-resistant forms
- Initial regimen is 2 months daily treatment with INH, Rifampin, Pyrazinamide, Ethambutol to kill any resistant strains
- 4 more months (or depending on compliance) of two meds depending on C&S
May use Streptomycin if compliance is an issue as it is an injection

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16
Q

TB

A

Baseline testing prior to antituberculosis drug therapy

  • Liver function tests before Isoniazid (INH)
  • Vision examination before ethambutol
  • Audiometric testing before streptomycin therapy
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17
Q

TB

A

Twice weekly therapy administered under direct supervision of public health personnel if non compliant
Effectiveness of therapy assessed by repeat sputum specimens and chest x-rays

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18
Q

TB

A

With adherence to treatment

- negative sputum specimens within 3 months; relapse rate with current treatment is

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19
Q

Nursing Care TB: Assessment

A 
Risk for infection
- Negative flow room
- HEPA-filtered respirator
- Respiratory isolation
Deficient knowledge
Ineffective therapeutic regimen management
20
Q

TB: Continuing Care

A

Teaching to reduce spread
Regular screening of high-risk individuals
Medication Administration

21
Q

COPD: Collaborative Care

A

Smoking abstinence is key to prevention and slowing progression
Treatment focuses on symptom relief, minimizing obstruction, slowing disability

22
Q

COPD: Treatment

A 
Medications
Oxygen
Smoking cessation
Fluid and nutritional support
Airway clearance procedures
Breathing exercises
Lung transplant or lung reduction surgery
23
Q

COPD: Medications

A

Immunization against pneumococcal pneumonia
Antibiotics for infection
Bronchodilators: improve airflow and reduce air-trapping (Adrenergic stimulants, anticholinergics, methylxanthine)
Corticosteroids if asthma component of COPD
Alphal - antitrypsin replacement therapy, if emphysema due to genetic defect; given IV on weekly basis

24
Q

COPD: Treatment

A

Remain inside during times of significant air pollution; air filters and air conditioning
Pulmonary hygiene measures:
- Hydration
- Effective cough: “huffing” between relaxed breathing
- Percussion and postural drainage
Avoiding cough suppressants and sedations
Regular exercise program:
- Improve tolerance
- Improve ability for ADLs
- Prevent physical deterioration
Breathing exercises to slow respiratory rate and relieve accessory muscle fatigue
- Pursed lip breathing
- Abdominal breathing

25
Q

COPD: Oxygen

A

Long term therapy used for severe, progressive hypoxemia
Intermittent or continuous, only at night
If oxygen administered without intubation and mechanical ventilation, be cautious
- Clients have chronic elevated carbon dioxide levels and do not respond to that as a stimulus to breath
- Client only responds to low levels of oxygen as stimulus to breathe; giving high flow rates of oxygen will reduce stimulus to breathe

26
Q

COPD: Surgery/ Complementary Therapies

A 
Surgery
Lung transplantation may be only option if medical therapy not effective
Complementary therapies:
- Limit salt and dairy intake 
- Use of herbal teas
- Acupuncture

Stop or never start smoking

27
Q

COPD: Nursing Care

A 
Assessment of airway
Ineffective airway clearance
Imbalanced nutrition: less than body requirements
Ineffective coping
Decisional conflict: smoking
28
Q

COPD: Nursing Diagnoses

A

Ineffective Airway Clearance: prepare for intubation and mechanical ventilation, if client status is deteriorating
Imbalanced nutrition: Less than body requirements
- Diet high in protein and fats without excess carbohydrates to minimize carbon dioxide
- Specific oral supplements
Compromised family coping
Decisional conflict: Smoking

29
Q

COPD: Home Care

A

Education focuses on:

  • Effective coughing and breathing techniques
  • Preventing exacerbations
  • Managing prescribed therapies
30
Q

COPD: Continuing Care

A

Effective coughing and breathing exercises
Nutrition and fluid intake
Exercise and activity
Avoid crowds and infection exposure risks
Stress reduction
Recognition of symptoms
Medication administration

31
Q

SELF DIRECTED

A

Epiglottis
Croup
RSV - Respiratory syncytial virus

32
Q

Asthma

A 
Chronic inflammatory disorder
Recurrent episodes of:
- Wheezing
- Breathlessness
- Chest tightness
- Coughing
Common in children and adults
33
Q

Asthma: Treatment

A 
Treatment goals are to control symptoms, prevent acute attacks
- Teaching PEFR monitoring
Medications
- Anti-inflammatory agents
- Rapid and long-acting bronchodilators
- Leukotriene modifiers
- Anticholinergic drugs
Complimentary therapy
Prevention
34
Q

Client with Asthma: Disease Monitoring

A 
Peak expiratory flow rate (PEFR)
Used on day to day basis
Evaluates:
- Severity of bronchial hyperresponsiveness
- Severity of airway obstruction
35
Q

Client with Asthma: Preventive Measures

A

Avoidance of allergens and triggers

  • Modification of home environment (eliminate dust, install air filters)
  • Removal of pets
  • Eliminate all tobacco smoke
  • Wear mask during exercise in cold weather
  • Early treatment of respiratory infections
36
Q

Asthma: Medications

A 
Anti-inflammatory agents
- Corticosteroids: block late response to inhaled allergens, reduce bronchial hyperresponsiveness
- Inhaled or systemic
Non-Steroidal Anti-inflammatory Agents
- Inhibit release of mediator substance
- Cromolyn sodium, nedocromil
37
Q

Asthma: Medications (Bronchodilators)

A

Adrenergic Stimulants
- Relax smooth muscle and bronchodilation
- Oral or inhaled (metered dose inhaler); albuterol
Methylxanthines
- Theophylline (oral), aminophylline (IV)
- Serum theophylline levels: Therapeutic 10-20 ug/mL
Anticholinergic Agents
- Ipatropium bromide (metered dose inhaler)
Leukotriene modifiers
- Reduce inflammatory response in asthma
- Oral medications: zafirlukast, zileuton

38
Q

Asthma: Complementary Therapies

A 
Herbal
Biofeedback
Yoga
Breathing techniques
Acupuncture
Homeopathy
Massage
39
Q

Asthma: Nursing Diagnoses

A

Ineffective airway clearance
Ineffective breathing patterns
Anxiety
Therapeutic Regimen Management

40
Q

Asthma: Home Care

A

Educate Client to:

  • Promote good health
  • Manage acute episodes
  • Eliminate triggers
  • Use PEF meter
  • Followed prescribed medications
41
Q

Asthma: Nursing Care

A 
Assessment of airway
Ineffective airway clearance
Fatigue
Anxiety
Ineffective Therapeutic Regimen Management
42
Q

Cystic Fibrosis: Medications

A

Dornase alfa enzyme to liquefy secretions
Immunizations against respiratory infections, influenza vaccine
Medications to reduce inflammation and treat infection
- Bronchodilators
- Antibiotics

43
Q

CF: Nursing Care

A

Similar to care of other clients with COPD
DB&C exercises
Percussion

44
Q

CF: Nursing Diagnoses

A

Ineffective airway clearance
Imbalanced nutrition: less than body requirements
Interrupted family process

45
Q

CF: Home Care

A

Extensive education and support for client and family in maintaining pulmonary function

Nursing Theory III (17 decks)

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