Respiratory Disorders Flashcards

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1
Q

What are risk factors for COPD?

A
  • Irritant exposure (smoking, pollutants)
  • Recurrent/chronic respiratory infections
  • Genetic factors (Alpha1 Atitrypsin deficiency)
  • allergies
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2
Q

What changes occur with COPD?

A

Airways become inflamed and thickened, excessive mucous production, cilia become impaired (poor mucous clearance), walls of alveoli are damaged (decreased surface area) and airways and alveoli become less elastic. Old air gets trapped in the alveoli d/t narrowing.

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3
Q

Is inspiration or expiration more difficult with COPD?

A

Expiration

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4
Q

Symptoms of COPD

A
  • cough, sputum production
  • expiratory wheezing
  • barrel chest, accessory muscle use
  • dyspnea, orthopnea
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5
Q

Symptoms of COPD

A
  • cough, sputum production
  • expiratory wheezing, diminished breath sounds
  • barrel chest (AP to transverse ratio, normally 1:2), accessory muscle use, clubbing
  • dyspnea, orthopnea, cyanosis
  • tripod positioning, sleeping in a recliner
  • pursed lip breathing
  • RHF, increased red cells, ruddy skin color
  • fatigue, wt loss
  • tachypnea
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6
Q

Why can COPD lead to right sided HF (cor pulmonale)?

A

The changes in pulmonary function increase the pressure in the arteries of the lungs against which the right side of the heart has to pump.

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7
Q

How does the breathing pattern differ in a COPD patient in terms of inspiration and expiration vs. normal

A

Expiratory phase is prolonged. Normally it is shorter than inspiration.

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8
Q

Tests relevant to COPD

A
  • PFT (FEV1)
  • ABG
  • CXR
  • CBC
  • Sputum culture
  • ECG
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9
Q

Nursing Actions for COPD

A
  • Maintain airway patency
  • Administer SABAs and LABAs, inhaled glucocorticoids, mucolytics, corticosteroids, anticholinergics, and atropine as ordered
  • Administer O2 (start low)
  • small frequent feedings
  • encourage fluids
  • monitor breath sounds and ABGs
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10
Q

Client education for COPD

A
  • exposure to pollutants
  • smoking cessation
  • when to call health care provider
  • O2 therapy (risk of combustion and CO2 narcosis)
  • breathing retraining (pursed lip, helps open up alveoli)
  • coughing
  • vaccinations, reduce exposure to infections
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11
Q

When to contact the Dr. for COPD

A

Exacerbation: Increase in sputum, change in color of sputum, s&s of infection (ie fever)

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12
Q

What does forced expiratory volume (FEV) measure?

A

The amount of air a person can exhale during a period of time (FEV1=1st second, FEV2=2nd second…)

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13
Q

What does the forced vital capacity (FVC) measure?

A

the total amount of air exhaled in a forced expiration from a full inspiration

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14
Q

What is the predicted/normal value for the FEV1?

A

4-6L, should be 80% or more of predicted to be considered normal

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15
Q

Below 1.5L/second for forced expiration is symptomatic of

A

COPD

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16
Q

Common adverse effects of SABAs and LABAs

A

Palpitations, tachycardia, insomnia, irritability, tremors, hypokalemia

17
Q

Common adverse effects of anticholingergics

A

xerostomia, metallic taste, HA, cough

18
Q

Common adverse effects of theophylline

A

atrial and ventricular arrhythmias, grand mal convulsions, HA, nausea

19
Q

Common adverse effects of inhaled corticosteroids

A

Oral candidiasis, skin bruising

20
Q

Common adverse effects of Phosphodiesterase-4 inhibitor (PDE4)

A

Nausea, wt loss, diarrhea, headache, abd pain

21
Q

What drug class is Roflumilast in?

A

PDE4

22
Q

Drug classes used in COPD tx

A
  • bronchodilators (beta agonists), anticholinergics, steroids, PDE4 inhibitors, methylxanthines
23
Q

Discharge goals for COPD

A
  • ventilation/oxygenation adequate to meet self care goals
  • nutritional intake meeting caloric needs
  • infection treated/prevented
  • disease process/prognosis and therapeutic regimen understood
  • plan in place to meet needs after discharge
24
Q

Asthma definition

A

Chronic inflammatory disease of the the airways. Tracheobronchial tree has increased responsiveness to various triggers.

25
Q

Signs and Symptoms of Asthma

A
  • Expiratory wheezing, prolonged expiration
  • recurrent nonproductive cough
  • chest tightness
  • SOB with activity or at rest
  • diminished breath sounds
  • tachycardia, tachypnea
  • accessory muscle use
26
Q

Asthma treatment

A
  • Avoid triggers
  • Airway maintenance and coughing techniques
  • O2
  • Bronchodilators
  • Flu and pneumococcal vaccines
  • corticosteroids
  • luekotriene modifiers
  • Anti-IgE antibody
  • Allergen immunotherapy
27
Q

Asthma: Nursing Care

A
  • Educate pt about avoiding triggers
  • administer O2
  • increase fluids to thin secretions
  • teach cough enhancing techniques
  • teach about peak flow meter use
  • teach about use of metered dose or dry powder inhalers
  • anxiety reduction and rest during acute attacks
  • educate about exercise regimen
28
Q

Explain the pathophysiology of asthma

A

Hyperresponsiveness of the lower airways occurs as a result of an inflammatory response to a trigger. The inflammatory response causes the release of chemical mediators histamine, leukotrienes, and prostaglandins. It also leads to bronchoconstriction, vascular congestion, edema, and formation of thick mucous. This leads to airway obstruction. With long term inflammation airway remodeling occurs.

29
Q

Asthma: Diagnostic tests

A

ABGs, SpO2, Hgb, Hct, Chest radiography, sputum samples, PERF

30
Q

Asthma: Risk factors/Causes

A
  • genetic
  • allergen exposure
  • pollution
  • tobacco smoke
31
Q

Asthma: potential complications

A
  • respiratory acidosis
  • cardiac dysrhythmias
  • cardiopulmonary arrest
  • chronic obstruction to airflow