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NURS783 Exam 4 > Respiratory Disorders > Flashcards

Respiratory Disorders Flashcards

1
Q

T or F: respiratory exchange is more efficient in pregnancy

A

true

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2
Q

T or F: respiratory disease (e.g. asthma, pneumonia) are typically improved in pregnancy

A

false

increased oxygen requirements and adaptations

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3
Q

What is the effect of estrogen and increased blood volume on respiration?

A

capillary engorgement –> swelling and increased mucous production

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4
Q

What is the effect of progesterone on respiration?

A

1) relaxation of veins –> increased pooling –> swelling of mucous membranes
2) hyperventilation
3) respiratory alkalosis w/ increased expired CO2

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5
Q

What is the effect of relaxin on respiration?

A

increased chest cartilage pliability –> increased chest circumference

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6
Q

What is the effect of the growing uterus on respiration?

A

diaphragm rises ~4cm + thoracic circumference increases ~6gm + costal angle widens –> increased thoracic breathing + diaphragmatic breathing

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7
Q

What is the effect of reduced PCO2?

A

helps move:

  • fetal CO2 waste to gestational carrier
  • O2 from gestational carrier to fetus
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8
Q

What is the cause of bronchitis?

A

usually viral

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9
Q

s/sx bronchitis

A

cough lasting median 18 days

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10
Q

bronchitis tx

A
  • supportive care

- sx management: humidifier, OTC cough suppressants, cough drops

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11
Q

s/sx flu

A
  • fever
  • HA
  • fatigue
  • body aches
  • malaise
  • cough
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12
Q

flu dx

A
  • clinical dx
  • flu swab
  • CXR, depending on sx
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13
Q

flu tx

A

1) tamiflu 75mg BID for 5 days

2) Zanamivor 10mg (2 inhalations) for 5 days

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14
Q

What is the most significant complication of pneumonia?

A

preterm delivery

  • outcome of hypoxemia and acidosis
  • also poor fetal growth and perinatal loss
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15
Q

T or F: pneumonia vaccine is not safe in pregnancy

A

false

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16
Q

s/sx pneumonia

A
  • productive, purulent cough
  • pleuritic chest pain
  • dyspnea
  • chills
  • fever! differentiate b/w bacterial and viral
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17
Q

What are maternal complications of pneumonia?

A
  • respiratory failure
  • mechanical ventilation
  • emphysema
18
Q

pneumonia dx

A
  • CXR* –> +lobular pattern
  • r/o flu w/ swab
  • do not need to identify microbe
19
Q

What are the 2 most common pneumonia pathogen?

A

1) streptococcus pneumoniae

2) H. influenzae

20
Q

How should pneumonia be managed?

A

AGGRESSIVELY

  • start abx w/in 4h of admission to hospital
  • macrolide for mild illness
  • add beta-lactam for severe illness
  • avoid quinolones* unless life-saving (fetal cartilage damage)
21
Q

pneumonia monitoring

A
  • maintain PO2 70mmHg (necessary level for fetal oxygenation)
  • no fever/sx for 48h
  • d/c IV –> 10-14 day course of PO tx (cephalosporin, macrolid)
22
Q

What tx of a pregnancy comorbidity can induce asthma?

A

aspirin for preeclampsia

23
Q

T or F: asthma meds are safe in breastfeeding

A

true

24
Q

T or F: fetal surveillance is necessary regardless of asthma control

A

false

not necessary if well-controlled; serial growth and NST in moderate to severe asthma

25
Q

What are the most significant poor outcomes of asthma in pregnancy?

A

1) PTB
2) increased preeclampsia if daily sx
3) increased c-section w moderate to severe disease

26
Q

What are objectives measures for assessment and monitoring of asthma?

A

1) Forced expiratory volume 1 (FEV1) = BEST measure of pulm function; <80% = poor pregnancy outcomes
2) self-monitoring using peak expiratory flow (PEF) w/ peak flow monitor; PEF does not change w/ pregnancy

27
Q

Describe monitoring w/ peak flow monitors

A
  • 380-550 L/min = typical in pregnancy
  • should achieve at least 80% of best PEF
  • moderate to severe disease should test BID
28
Q

List methods to avoid/control potential asthma triggers

A
  • use allergen-impermeable mattress and pillow covers
  • remove carpet
  • wash bedding weekly in hot water
  • avoid tobacco smoke
  • reduce humidity
  • leave house while being vacuumed
  • no pets/stuffed animals in bedroom
29
Q

Describe asthma rescue therapy

A

short-acting beta-agonist (e.g. albuterol)

1-2 inhalations q4-6h PRN

also available as nebulizer sol’n, syrup, tablet; prednisone also acceptable

30
Q

Describe long-term asthma control

A

inhaled corticosteroids (ICS); long-acting bronchodilators

  • if not well-controlled, start low/medium dose ICS and refer
  • can be advanced to ICS + LABA (mod-severe) or ICS + LABA + PO prednisone (severe persistent)
31
Q

What populations are at high risk for TB?

A
  • close contact w/ infected people
  • birth in country w/ high rate TB
  • low income
  • alcohol addiction
  • IV drug use
  • residency in long-term facility or prison
  • health professionals that work in these facilities
32
Q

What are risk factors for TB?

A
  • HIV
  • recent TB infection
  • IV drug use
  • solid organ transplant
  • chronic renal failure
  • DM
  • underweight by >15%
33
Q

s/sx TB

A
  • cough
  • weight loss
  • fever
  • malaise and fatigue
  • hemoptysis
34
Q

T or F: latent disease presents equal risk of poor pregnancy outcomes as active disease

A

false

carries no risk

35
Q

What values indicate a positive PPD?

A

high-risk population: >5

“normal” population: 10-15

36
Q

What is PP management of a pt w/ active TB?

A
  • separate mother from newborn

- CAN breastfeed

37
Q

What is management of a newborn born to parent w/ active TB?

A
  • require multivitamin supplement
  • must have PPD at birth and 3mo
  • isoniazid (INH) prophylaxis until maternal disease has been resolved for 3mo
    To add a row,
38
Q

What are risk factors for pulmonary embolism?

A
  • age > 35yo
  • obesity
  • trauma
  • immobility
  • infection
  • smoking
  • nephrotic syndrome
  • hyperviscosity syndrome
  • cancer
  • surgery, esp ortho
  • prior DVT or PE
  • hospital admission
39
Q

What are pregnancy-related risk factors for pulmonary embolism?

A
  • increased parity
  • PP endomyometritis
  • operative vaginal delivery
  • c-section
40
Q

PE dx

A
  • EKG
  • CXR - canNOT confirm dx!!
  • V/Q scanning = modality of choice
  • no role for D-dimer
  • ABGs and O2 sat = limited value in assessment
41
Q

What will be seen on CXR w/ PE?

A
  • pleural effusion
  • pulmonary infiltrates
  • atelectasis
  • elevated hemidiaphragm
42
Q

How is PE treated?

A

20wk heparin course, then prophylactic heparin PRN

NURS783 Exam 4 (11 decks)

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