respiratory, fluid/electrolyte, anemia

Question 1

two most common types of respiratory disorders

Answer 1

COPD (Chronic Obstructive Pulmonary disease)

and Asthma

Question 2

general terms used to describe the type of COPD

Answer 2

Emphysema and chronic bronchitis

Question 3

what is COPD

Answer 3

respiratory disorder that is progressive, partially reversible airway obstruction and increases frequency and severity of exacerbations

Question 4

describe emphysema

Answer 4

tiny air sacs (alveoli) become enlarged and the wall are damaged so they lose their elasticity and air become trapped in the lungs making them less efficient

Question 5

describe chronic bronchitis

Answer 5

A persistent chronic cough and sputum production, usually for at least three months each year for at least two consecutive years. The cause is unknown

Question 6

COPD can be caused by

Answer 6

cigarette smoking
workplace exposure (mining, asbestos)
repeated respiratory infections
chronic airflow limitation that progresses slowly over a period of years and is IRREVERSIBLE

Question 7

list the characteristics of asthma

Answer 7

paroxysmal (sudden attack)
dyspnea, chest tightness, wheeze and cough
variable airflow limitation
airway hyper-responsiveness to a variety of stimuli

Question 8

describe physiological changes with respect to asthma

Answer 8

inflammation - irritation and swelling produces a sticky mucuc or phlegm in the air ducts

broncho-constriction - tightens the mucsles and constricts the airway

Question 9

Causes of development of asthma

Answer 9

Pollen, dust mites, mold, pet dander.
chroninc condition that can develop at any age
most common in children, about 10%
varies in degree from very mild to severe.

Question 10

asthma and COPD compared

Answer 10

ASTHMA - non-smokers, before age 40, intermittent attacks, night-time symptoms common, asymptomatic between attacks, exercise may affect symptoms
COPD - smokers, after age 40, persistent and progressive difficulty, night-time symptoms uncommon, symptoms are always there, symptoms worsen with exercise.

Question 11

COPD pharmacotherapy ( slowly increase interventions)

Answer 11

0. at risk = avoid risk factos
1. Mild = FEV >80% - plus short-acting bronchdilator
2. moderate = FEV 50-79% - regular treatment plus long acting bronchodilators: Add rehabilitation
3. Severe = FEV 30-49% - Add inhaled corticosteriods if repeated exacerbation
4. Very Severe = FEV <30% add long term oxygen and consider surgical treatment

Question 12

asthma pharmacotherapy (hit early, hit hard!)

Answer 12

step 1 = beta 2 agonist PRN (bronchdilators)
step 2 = add inhaled corticosteriods (200-500 units
step 3 = add long acting beta agonist or SR theophylline OR inhaled corticosteroids 500-1000 units. 
step 4 = inhaled 500-1000 and LA beta agonists AND/OR SR theophylline. PLUS refer to pulmonologist.
step 5 (severe) = inhaled 1000 units/day, oral corticosteroids, long acting beta agonist, SR theophylline, pulmonologist. plus orginal bronchodilator from step 1 − 4-6 times/day

Question 13

Beta2 Agonists

Answer 13

Fast/Short acting:
Salbutamol
Fenoterol
Formoterol
Terbutaline

Slow/Long acting:
Salmeterol

Question 14

Beta agonist mechanism of action

Answer 14

bind to the beta receptors in the body
Lungs - bronchdilate (good)
Heart - tachycardia (bad adverse effect)

Question 15

COPD and asthma symptoms

Answer 15

shortness of breath, wheezing, coughing

Question 16

Beta2 agonists adverse effects

Answer 16

tachycardia

tremors

Question 17

beta2 agonists administration and nursing implications

Answer 17

inhalation via inhaler or nebulization (oral/parental not used often - too many A/E)
nursing: use appropriate technique, monitor effectiveness. remember: Salmeterol = long acting AND you need Salbutamol for fast relief

Question 18

Anticholinergics - relievers/bronchodilators

Answer 18

Ipratropium (fast/short acting)

Tiotropium (slow/long acting)

Question 19

anticholinergics mechanism of action

Answer 19

acetylcholine causes bronchconstriction, so the anti-cholinergic agents cause bronchdilation as it blocks the muscarinic (M3) receptors thus producing decreased mucus
NOTE: may be more effective for COPD than asthma

Question 20

anticholinergics adverse effects

Answer 20

dry mouth

urinary retention

Question 21

anticholinergics administration and nursing implications

Answer 21

inhalation via inhaler or nebulization

nursing: use appropriate technique

Question 22

corticosteroids (aka. glucocorticosteroids or steroids)
last choice for COPD
drug of choice for asthma

Answer 22

Oral: prednisone
Parenteral: methylprednisone and hydrocortisone
Inhaled: Fluticasone and Budesonide
Combined inhaled: 
-Fluticasone + Salmeterol
-Budesonide + Formoterol

Question 23

cortocosteroids adverse affects

Answer 23

inhaled: oral thrush (rinse and spit or may get yeast infection), potential for growth abnormalities, voice hoarseness
Systemic: ulcers, fluid retention (hypertension), osteoporosis

Question 24

Theophylline mechanism of action and A/E’s

Answer 24

stimulates bronchdilation by: inhibiting phosphodiesterase and adenosine, and improves diaphragmatic fatigue

A/E: (Caffeine) - tachycardia, headache, nausea, loss of appetite, tremors, restlessness and seizures.

Question 25

Theophylline disong and nursing implications

Answer 25

oral or parental (aminophylline) | monitor for A/E's and blood levels require monitoring

Question 26

Leukotriene antagonists

Answer 26

Monteleukast | Zafirleukast

Question 27

Leukotriene antagonists mechanism of action and A/E

Answer 27

inhibits Leukotriene production Leukotriene is a substance correlated with the pathophysiology of asthma. Mucus secretion, airway edema, bronchoconstriction. A/E: upper respiratory infections, sedation, and headaches

Question 28

Cromolyn and Nedocromil use, M/A's and A/E's

Answer 28

Mast-cell stabilizers that prevent the release of histamines from sensitized mast cells. histamine instigate inflammation, therefore the inflammation does not occur that blocks the airways. used primarily for asthma A/E - hoarseness, dry throat

Question 29

types of inhalers

Answer 29

aerochambers - spacers diskhaler - circular disc that punctures medication turbuhaler - cylinder, twist to medicate and then inhale nebulizer - compressor, mouthpiece and nebulizer cup

Question 30

COPD and asthma diagnosing and monitoring

Answer 30

Spirometry - measures the amount and rate of air a person breathes

Question 31

what is hay fever

Answer 31

its a type 1, IgE mediated allergy | immune system reaction to airborne allergens

Question 32

symptoms of hay fever

Answer 32

repetitive sneezing, runny, itchy and/or congested nose decreased sense of smell and taste eyes become itchy, red, watery, or swollen with crusty eyelids inflamed sinuses headaches, irritability, and fatigue

Question 33

first generation antihistamines

Answer 33

``` diphenhydromine chlorpheniramine hydroxyzine brompheniramine clemastine ```

Question 34

second generation antihistamines

Answer 34

Cetirizine Loratidine Desloratidine Fexofenidine

Question 35

first generation versus second generation

Answer 35

drowsiness and dry mouth multiply daily doses less expensive

Question 36

intranasal corticosteroids for hayfever

Answer 36

Fluticasone and Beclomethasone

Question 37

why are intranasal corticosteroids used

Answer 37

helps prevent inflammation of nasal passage | may be more effective than oral antihistamines

Question 38

decongestants - nasal and oral

Answer 38

nasal: Xylometazoline (Otrivin) oral: Pseudoephedrine (Sudafed)

Question 39

what is rebound congestion

Answer 39

abnormal swelling and enlargement of the nasal mucosa, which blocks the nasal airway completely and causes extreme discomfort. - this cycle repeats as the releif from dose wears off and then the swollen mucosa blocks the airway again and another dose is required

Question 40

Dextromethorphan

Answer 40

DM cough syrup

Question 41

symptoms of cough and cold

Answer 41

``` cough: dry (hacky) or wet (loose) nasal congestion watery eyes sneezing headaches inability to sleep ```

Question 42

I cause insomnia (non-drowsy), hypertension, and clear nasalcongestion and fluids in ear

Answer 42

Decongestants

Question 43

I cause sneezing and watery eyes | Can be drowsy or nondrowsy

Answer 43

Antihistamines

Question 44

What are intracellular electrolytes

Answer 44

Liquid within the cell membrane 2/3 of body fluids intracellular electrolytes: K+, Mg2+, Ca2+

Question 45

What are extracellular electrolytes

Answer 45

Liquids outside the cell membranes 1/3 of body fluids Extracellular electrolytes: Na+, Cl-

Question 46

what do electrolytes do

Answer 46

Conduct energy Regulate fluid balance and transport nutrients Support proper muscle function and mental function Help convert calories into energy Regulate pH and much, much, much more

Question 47

Gain and loss of electrolytes and water. regulation by...

Answer 47

dehydration, diarrhea, vomiting, sweating, fluid retention regulated by: Kidneys (primary), skin, and respiratory system

Question 48

types of IV fluids that replace electrolytes

Answer 48

``` Crystalloids - fluids that maintain a balance between the extravascular and intravascular compartments Most commonly used: -normal saline 0.9% -hypertonic saline 3% -D5W (Dextrose 5% in water) -Lactated Ringers Solution ```

Question 49

what are Colloids

Answer 49

``` IV fluids that move fluid from the interstitial space to the plasma space by pulling the fluid into the blood vessels Colloids are: -Dextran -Hetastarch -Albumin ```

Question 50

what is dehydration, some common causes, and signs and symptoms

Answer 50

A condition caused by the loss of too much water from the body Common causes: diuretic therapy, vomiting, diarrhea, hemorrhage, decreased fluid intake, excess urination signs/symptoms: hypotension, weak and rapid pulse, decreased skin turgor, dry mucus membrane, low urine output

Question 51

Management and prevention of dehydration

Answer 51

``` Replace fluids Replace electrolytes Treat underlying causes if possible Patient education Prevent recurrences ```

Question 52

normal electrolyte blood concentrations for Sodium

Answer 52

135 − 145 mmol/L

Question 53

normal electrolyte blood concentrations for Chloride

Answer 53

100 − 106 mmol/L

Question 54

normal electrolyte blood concentrations for Potassium

Answer 54

3.5 − 5.0 mmol/L

Question 55

normal electrolyte blood concentrations for Magnesium

Answer 55

0.7 − 1.5 mmol/L

Question 56

normal electrolyte blood concentrations for Phosphate

Answer 56

0.8 − 1.5 mmol/L

Question 57

normal electrolyte blood concentrations for Calcium

Answer 57

2.2 − 2.6 mmol/L

Question 58

causes of elevated sodium

Answer 58

Hypernatremia | Excessive loss of water through G.I. system, lungs, or skin.

Question 59

Causes of decline in sodium

Answer 59

Hyponatremia Congestive heart failure, cirrhosis, nephrosis, excess fluid intake. Loss of body fluids without replacement, diuretic therapy and laxatives

Question 60

Causes of elevated potassium

Answer 60

Hyperkalemia | Aldosterone deficiency, sodium depletion. hemolysis of RBC's

Question 61

causes of decline in potassium

Answer 61

Hypokalemia Lack of dietary intake of potassium Vomiting, nasogastric suctioning, kidney disease, major G.I. surgery.

Question 62

Causes of elevated Calcium

Answer 62

hypercalcemia | excessive vitamin D, immobility, poptassium sparring diuretics, ACE inhibitors

Question 63

causes od declined calcium

Answer 63

hypocalcemia | inactive or excessively low vitamin D, diuretic therapy, gastric surgery

Question 64

signs and symptoms of hyponatremia

Answer 64

anorexia, nausea, lethargy, disorientation, agitation, depressed reflexes, seizures, coma (sodium <120) Cerebral edema - osmotic gradient causes water to flow into the brain Mortality rates from 5-50% depending on how rapidly the sodium levels decrease

Question 65

management of hyponatremia

Answer 65

- replace sodium and water as required - replace underlying causes or remove precipitating agent if possible - sodium must be replaced at a certain rate or else central pontine myelinolysis. a severe damage to myelin sheath that causes paralysis, dysarthria, dysphagia. some patients may experience locked in syndrome, cognotive function intact, but all muscles are paralyzed with the exception of eye blinking

Question 66

Fluids for hyponatremia

Answer 66

Oral: Pedialyte. Gatorade, sodium chloride IV Fluids: normal saline 0.9%, 3% saline in extreme cases, 1 mL/kg/hr

Question 67

signs and symptoms of hypernatremia

Answer 67

lethargy, weakness, irritability, hyperreflexia, seizures, coma and potentially death

Question 68

management of hypernatremia

Answer 68

-lower the serum sodium concentration by about 0.5 mmol/L per hour -rapid correction should be avoided to avoid cerebral edema remove excess source of salt, use diuretics to increase salt excretion and increase water consumption

Question 69

signs and symptoms of hypokalemia

Answer 69

heart arrhythmias, muscle weakness, confusion, thirst, low blood pressure and vomiting

Question 70

management of hypokalemia if no cardiac symptoms (K+ = 2.5 − 3.5 mEq)

Answer 70

``` potassium supplementation IF NO CARDIAC SYMPTOMS: -potassium chloride Micro K capsules or tablet 600mg (8mEq) -monitor potassium frequently -food supplementation ```

Question 71

management of hypokalemia if any cardiac symptoms or if K+ <2.5 mEq

Answer 71

IF ANY CARDIAC SYMPTOMS - <2.0 mEq -potassium chloride (avail in 20 or 40 mEq IV bags) -MAX IV rate of 40 mEq/hr (any rate faster requires continuous cardiac monitoring MAX. 40mEq/L in peripheral arm MAX. 80mEq/L in central line (by neck)

Question 72

Signs and symptoms of hyperkalemia

Answer 72

Frequently patients are asymptomatic | Nausea, irregular heartbeat, slow/weak pulse

Question 73

Management of hyperkalemia

Answer 73

Reverse the underlying cause If K+ >6 or any ECG changes: -insulin and D5W. insulin will push the K+ back into the cell -Salbutamol "pushes potassium back into the cells" -diuretics -sodium polystyrene. Binds to K+ to increase excretion via GI tract.

Question 74

what are common anemias and how are they defined

Answer 74

microcytic (iron-deficiency) macrocytic (megaloblastic) defined as a hemoglobin vakue that is two standard deviations below the mean average, according to gender, age and sometimes race

Question 75

therapeutic goals for enemia

Answer 75

alleviate sign and symptoms determine and address the underlying issue restore normal or adequate Hgb levels avoid transfusions

Question 76

what is ferritin

Answer 76

intracellular protein that stores iron and releases it in a controlled fashion. the amount of ferritin stored reflects the amount of iron stored.

Question 77

what are the 3 main classifications of enemia

Answer 77

1. Blood loss 2. Impaired production (hypoproliferative) 3. increase destruction (Hemolytic)

Question 78

causes of anemia

Answer 78

``` medications diet GI loss/malabsorption alcohol use cancer renal disease menorrhagia ```

Question 79

symptoms of anemia

Answer 79

fatigue, dizziness, yellowing of eyes/skin, dyspnea, muscle weakness, low BP, rapid HR., enlargement of spleen (kills RBC's) SEVERE: fainting, chest pain, angina, heart attack

Question 80

What is MCV and the ranges for anemia

Answer 80

Mean cell volume MCV 100 = macrocytic - decreased B12 and folic acid. MCV 80-100 = normocytic

Question 81

dietary intake for iron deficiency anemia

Answer 81

foods rich in iron. fruits, veggies, greens, fish

Question 82

oral supplements for iron deficiency anemia

Answer 82

"elemental iron" in a variety of forms 'salts' 1. Ferrous Gluconate 2. Ferrous Sulfate 3. Ferrous Fumarate Target dose: 100-200 mg/day in divided doses

Question 83

A/E for iron deficiency

Answer 83

constipation and black tarry/sticky stool

Question 84

Parenteral therapy for iron deficiency anemia

Answer 84

-Iron Dextran -Sodium Ferric Gluconate -Iron Sucrose parenteral reserved for Pt's with malabsorption or true intolerance t oral therapy. Anaphylaxis is a risk Adding parenteral to oral therapy does not lead to more rapid resolution.

Question 85

mechanism of action for macrocytic anemia

Answer 85

impaired DNA synthesis from deficiences in cobalamin (vitamin B12) or folic acid. note: cobalamin deficiency can also lead to degenration of spinal cord (spinabifida)

Question 86

dietary therapy for macrocytic anemia (vitamin B12 deficiency)

Answer 86

meat and dairy products are the only dietary sources of cobalamin. - Cobalamin stored in body is usually sufficient to last several years - strict vegans are at risk unless they take supplements

Question 87

most common causes and treatments of macrocytic vitamin B12 deficient anemia

Answer 87

CAUSES: -Pernicious anemia (defect with production of 'intrinsic factor') -gastrectomy -inflammatory bowel disease TREATMENTS: oral supplementation or IM (most common 1xmonth) or subcutaneous

Question 88

causes and treatments for marcocytic folic acid deficiency anemia

Answer 88

CAUSES: dietary deficiency and alcoholism (alcohol inhibits folate absorption. TREATMENTS: Folate in food is destroyed by cooking. Generally take 1mg PO daily NOTE: increase Folic acid in pregnancy to prevent neural tube defects and when certain other medications are taken (methotrexate and phenytoin)