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respiratory tutoring Flashcards

1
Q

obstructive pulmonary diseaes

A

asthma
COPD
emphysema
chronic bronchitis

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2
Q

infectious diseases

A

TB and Pneumonia

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3
Q

is asthma reversible

A

YES

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4
Q

is COPD reversible

A

nope

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5
Q

asthma patho

A

chronic inflammatory disorder of airways

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6
Q

asthma symptoms

A

wheezing, breathlessness, tight chest, and cough

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7
Q

asthma triggers

A

smoke
cold
pollen
pets
dust
roaches
exercise
emotions
changes in weather
food allergies
mold

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8
Q

hallmark episodes of asthma

A
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9
Q

how long does an asthma attack last for

A

last for minutes to hours and it can be abrupt or gradual

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10
Q

what narrows the bronchioles in asthma

A

bronchospasm, edema, and mucus

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11
Q

what does an acute attack reveal

A

hypoxemia

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12
Q

signs and symptoms of asthma

A

restlesness
anxiety
pulse up
BP up
RR up
can’t speak
hyper-resonance
inspiratory and expiratory wheezes
silent chest

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13
Q

what drugs can trigger asthma

A

aspirin, NSAIDs and lisinopril

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14
Q

how do you know if the asthma is severe

A

No wheezing!

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15
Q

what is silent chest

A

breath sounds that are diminished

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16
Q

what is the PERF for asthma

A

40 percent

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17
Q

diagnostic studies

A
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18
Q

asthma pulse

A

more than 120

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19
Q

asthma RR

A

>30/min

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20
Q

under 8 years old asthma is called

A

reactive airway disease and you can grow out of it

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21
Q

if the asthma attack is gradual what should the nurse advise the patient

A

to use albuterol if they feel like an attack is going to come on

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22
Q

can wheezing determine the severity of asthma

A

no because in severe attacks patient is not even inhaling air

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23
Q

dx studies asthma

A

peak flow
pulmonary function test
chest x ray
ABGs
pulse oximetry
allergy
eosinophils
sputum

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24
Q

what does peak flow monitoring measure

A

how fast patient can exhale, lung capacity, i/e ratio. it classifies the asthma.

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25
Q

peak flow monitoring use

A

use everyday once a day

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26
Q

collab care

A

Global Initiative for Asthma (GINA). Current guidelines focus on:***
Assessing the severity of the disease at diagnosis and initial treatment
Monitoring periodically to achieve control of the disease

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27
Q

collab care for severe

A
  • IV corticosteroids q4h to q6 h, then orally.
  • Continuous monitoring.
  • In patients who are not responding to albuterol, IV magnesium sulfate can be used in this instance as a bronchodilator.
  • Mixture of helium and oxygen (Heliox), in severe life-threatening situations
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28
Q

care for acute asthma exacerbations

A
  • Respiratory distress
  • Treatment depends upon severity and response to therapy. Severity measured with flow rates.
  • Pulse oximetry or ABGs
  • Oxygen therapy - both mild and moderate exacerbations to maintain SpO2 at 90% or greater***
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29
Q

severe exacerbations nursing

A
  • Supplemental O2 by mask or nasal cannula for 90% O2 saturation.
  • Arterial catheter for frequent ABG measurement
  • IV fluids given because of insensible loss of fluids (in severe exacerbations, patient is profusely sweating)
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30
Q

what is bronchial thermoplasty

A
  • The catheter applies heat to reduce muscle mass in the bronchial wall.
  • With asthma recurring, there is a remodeling of the respiratory system, a lot of tissue that isn’t functioning properly. In the thermoplastic they can cauterize (burn the skin or flesh of (a wound) with a heated instrument or caustic substance, typically to stop bleeding or prevent the wound from becoming infected) tissues and save more of the functioning tissue.
  • Reverses accumulation of excessive tissue that causes narrowing of airway
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31
Q

quick relief med for asthma

A

albuterol 4-6 hours SABA

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32
Q

three types of anti-inflammatory drug

A

corticos, leukotriene and monoclonal antibody

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33
Q

corticos

A
  • Suppress inflammatory response
  • Inhaled form is used in long-term control (as opposed to systemic form of IV or IM administration)
  • Systemic form (IV or IM) to control exacerbations and manage persistent asthma
  • Reduce bronchial hyper responsiveness (because in asthma you see a hyper-responsiveness of the airway, for instance the goblet cells produce more mucous)
  • Decrease inflammation
  • Decrease mucous production
  • Are taken on a fixed schedule
  • Inhaled Corticosteroids SE:***
    • Oro-pharyngeal candidiasis, hoarseness, and a dry cough are local side effects of inhaled drug.
    • Can be reduced using a spacer or by gargling and rinsing mouth after each use
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34
Q

leukotriene

A
  • Block action of leukotrienes—potent broncho-constrictors…so they prevent broncho-constriction
  • Have both bronchodilator and anti-inflammatory effects
  • Not indicated for acute attacks
  • Used for prophylactic and maintenance therapy
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35
Q

monoclonal antibody

A
  • ↓ circulating free IgE levels
  • Prevents IgE from attaching to mast cells, thereby preventing release of chemical mediators that increase the inflammatory process, mucous production, and broncho-constriction
  • Subcutaneous administration every 2 to 4 weeks
36
Q

three types of bronchodilators

A

SABA

LABA

Methyzanthines

37
Q

how do anticholinergics help with asthma

A
  • Block action of acetylcholine
  • Usually used in combination with a bronchodilator
  • Most common side effect is dry mouth
38
Q

what are nonprescription drugs for asthma?

A

epinerphine

39
Q

steps on asthma management

A
  • Step 1: In intermittent asthma, SABA (Albuterol), is the drug of choice because it’s a rescue inhaler!
  • Step 2: Once the acute stage in under control, to maintain long-term control inhaled corticosteroids + Albuterol will be given OR they can add Leukotriene inhibitors or Methylxanthines
  • Step 3: They add LABA and inhaled corticosteroids
  • Step 5: In persistent asthma, to have better control, they give a high dose ICS and a LABA
  • Step 6: They add an oral corticosteroid
40
Q

Question: A patient with severe asthma attack & hypoxemia who is fail to respond to SABA. Which of the following is next line of action?

  1. Start IV/systemic corticosteroids
  2. Administer IV fluids
  3. Provide Albuterol & Ipratropium nebs
  4. Prepare for insertion of an arterial catheter
A

Start IV/systemic corticosteroids

41
Q

what should we teach patient related to drug therapy

A
  • Correct administration of drugs
    • Using an MDI (metered dose inhaler) with a spacer is easier and improves inhalation of the drug
    • DPI (dry powder inhaler) requires less manual dexterity and coordination
42
Q

nursing assessment for asthma

A
  • Health history
    • Especially of precipitating factors and medications (are they taking beta blockers like Propranolol, ACEI, or anti- inflammatory like Aspirin)
  • ABGs
  • Lung function tests
  • Physical examination
    • Use of accessory muscles
    • Diaphoresis
    • Cyanosis
    • Lung sounds
43
Q

NANDAs asthma

A
  • Ineffective airway clearance
  • Anxiety
  • Deficient knowledge
44
Q

asthma goals

A

Planning and Goals***

  • Few or no adverse effects
  • No recurrent exacerbations of asthma
  • Or decreased incidence of asthma attacks
  • Adequate knowledge to participate
  • Attain normal lung function.
  • Restore normal activities.
45
Q

how can we promote health for asthma

A

Health Promotion

  • Prompt diagnosis and treatment of upper respiratory infections and sinusitis may prevent exacerbation.
  • Fluid intake of 2 to 3 L every day
  • Avoid cold air (and other triggers)
  • Use dust cover
  • Use scarves or masks for cold air

Avoid aspirin, NSAIDs, and nonselective β-blockers***

46
Q

what are NI for acute asthma

A
  • Monitor respiratory and cardiovascular systems.
    • Lung sounds
    • Respiratory rate
    • Pulse & BP
  • To ↓ the patient’s anxiety
    • Stay with patient
    • Encourage slow breathing using pursed lips for prolonged expiration
    • Position comfortably
47
Q

what does peak flow green zone mean

A
  • Usually 80% to 100% of personal best
  • Remain on medications
48
Q

what does peak flow yellow zone mean

A
  • Usually 50% to 80% of personal best
  • Indicates caution, patient should be watchful
  • Something around them is triggering asthma.
49
Q

what does peak flow red zone results mean

A
  • 50% or less of personal best
  • Indicates serious problem
  • Definitive corrective action must be taken
50
Q

what are NI for teaching in asthma

A
  • Medical attention for bronchospasm/ severe side effects
  • Maintain good nutrition.
  • Exercise within limits of tolerance.
51
Q

what are two ways we can collect sputum studies

A

spontanous and induced

52
Q

what is a spontaneous sputum

A

when patient coughs spontaneously to collect specimen

53
Q

what is an induced sputum

A

patient’s sputum cough is induced with inhalant meds/irritating aerosol

54
Q

what are nursing interventions for bronchoscopy

A
  • NPO for 6-12hrs before the procedure*
  • Consent*
  • Give sedation if ordered*
  • After the procedure Keep NPO until gag reflex returns***
  • Blood tinged mucus not abnormal*
55
Q

why do we do bronchoscopy

A

to remove excess mucous

56
Q

what are intermittent and persistent asthma nursing care from tutoring

A
  1. avoid triggers like NSAIDs, lols, and aspirin
  2. teach patients how to treat URIs
  3. wash mouth after and use spacer to avoid thrush
  4. use SABA for quick relief
  5. ipratropium
  6. before exercise use SABA
  7. corticos
  8. LABA
  9. theophylline
57
Q

what is nursing care for acute asthma attack

A
  1. high fowlers to aid in breathing
  2. admin O2
  3. stay with client
  4. pursed lip breathing
  5. admin brochodilators
  6. arterial cath for frequent ABGs
  7. record sputum
  8. admin glucocorticos
  9. ausculate lungs before, during and after treatment
  10. monitor lung sounds, vitals, PERF, and ABGs
  11. IF SEVERE: IV CORTICOS!
58
Q

COPD and asthma airflow difference

A

COPD: limitation

asthma: obstruction

59
Q

COPD patho

A

Abnormal inflammatory response of lungs to noxious particles or gases

  • Irreversible airflow limitations during forced exhalation due to loss of elastic recoil of alveoli
  • Airflow obstruction due to mucous hyper-secretion, mucosal edema, and bronchospasm/constriction
60
Q

process of COPD

A
  • Inhalation of noxious particles, small irritants
  • Mediators released by mast cells causing damage to lung tissue.
  • Airways inflamed and mucous production rises.
  • Parenchyma destroyed
61
Q

common characteristics of COPD

A
  • Mucus hyper-secretion
  • Dysfunction of cilia
  • Hyperinflation of lungs, more gas is trapped in the alveoli/can’t escape
  • Gas exchange abnormalities, because elastic recoil of alveoli is impaired
62
Q

pulmonary vascular changes

A
  • Blood vessels thicken.
  • Surface area for diffusion of O2 decreases.
63
Q

pulmonary vascular changes results in

A
  • Results in pulmonary hypertension
  • COPD is a systemic disease as a result of chronic inflammation/chronic airway remodeling
  • Once pulmonary HTN develops, often coexists with right sided heart failure
64
Q

COPD clinical manifestations

A
  • Develops slowly
  • Diagnosis is considered with: (note that it mimics asthma)
    • Wet Cough
    • Sputum production
    • Exposure to risk factors
    • Dyspnea
      • Occurs with exertion in early stages (patient will become SOB when performing an activity)
      • Present at rest with advanced disease
      • Use of accessory & intercostal muscles
      • Chest tightness with activity
      • Chronic fatigue
      • Weight loss ( unplanned weight loss)
  • Physical examination will show:
    • Prolonged expiratory phase &wheezes
    • Decreased breath sounds
    • ↑ Anterior-posterior diameter (barrel chest) 1:1
    • Tripod position & pursed lip breathing at all times
    • Clubbing of the fingers
  • Bluish-red color of skin – purple color
    • Polycythemia (because of the hypoxemia, the body will compensates and produces more RBCs, resulting a more viscous blood/polycythemia)
    • Cyanosis
    • Emphysema & chronic bronchitis coexist
65
Q

COPD risk factors

A

susceptibility genes

exposure to inhaled (tobacco, dusts, air pollution)

female

age

respiratory infections

poor lung growth and developments

oxidative stress

poor nutrition

low SES

66
Q

COPD complications

A
  • Cor pulmonale (right-sided HF or abnormal enlargement of the right side of the heart as a result of disease of the lungs or the pulmonary blood vessels.)
  • Exacerbations of COPD
  • Acute respiratory failure
  • Peptic ulcer disease
  • Depression/anxiety
67
Q

COPD signs of severity

A
  • Use of accessory muscles
  • Presence of central cyanosis (O2 saturation will be low and bluish or purple discoloration of tongue and lips and mucous membranes of the mouth)
68
Q

COPD treatment

A
  • Short-acting bronchodilators (SABAs like Albuterol)
  • Corticosteroids – can be oral or inhaled
  • Antibiotics (because often the exacerbation is triggered by an infection)
  • Supplemental oxygen therapy to maintain saturation levels
69
Q

COPD Acute Respiratory failture is caused by

A
  • Exacerbations- usually bacterial or viral infections
  • Discontinuing bronchodilator or corticosteroid medication/not complying with med protocol
  • Overuse of sedatives, benzodiazepines & opioids causing a suppression of respiratory muscles
  • Surgery of or severe, painful illness involving chest or abdomen resulting in impaired breathing and only taking shallow breaths
70
Q

COPD dx studies

A
  • Diagnosis confirmed by:
    • Spirometry: Spirometry (meaning the measuring of breath) is the most common of the pulmonary function tests (PFTs), measuring lung function, specifically the amount (volume) and/or speed (flow) of air that can be inhaled and exhaled. A reduced FEV1/FVC ratio (This number represents the percent of the lung size (FVC) that can be exhaled in one second. For example, if the FEV1 is 4 and the FVC is 5, then the FEV1/ FVC ratio would be 4/5 or 80%. This means the individual can breath out 80% of the inhaled air in the lungs in one second).
    • Increased residual volume (more air is trapped in the lungs because of the loss of elasticity of the alveoli)
    • Chest x-ray
    • History & physical examination (especially smoking: smoking 1 pack/day for 10 years can cause COPD)
    • COPD Assessment Test (CAT)
    • Modified Medical Research Council (MMRC) Dyspnea Scale
  • 6-minute walk test to determine O2 desaturation in the blood with exercise, helps identify the functional capacity of patient w/COPD. So pre, during, and post VS are collected. It is a good method to assess progression of disease.
  • drug delivery device used to administer medication in the form of a mist inhaled into the lungs used for pulmonary disease (cystic fibrosis, asthma, COPD, etc.)- nebulizer Cystic fibrosis, COPD, Asthma
  • Bronchodilator administration
  • BODE index
  • ABG typical findings in later stages:
  • Low PaO2
  • ↑ PaCO2
  • ↓ pH
  • ↑ Bicarbonate level found in late stages of COPD
71
Q

COPD collab care

A
  • Evaluate for environmental or occupational irritants
  • Determine ways to control or avoid irritants
  • Influenza virus vaccine
  • Pneumococcal vaccine (Pneumovax)
  • Exacerbations (whenever there’s a change in their baseline) treated promptly
72
Q

COPD drug therapy

A
  • Bronchodilators
    • Relax smooth muscle in the airway, relaxes the bronchioles
    • Improve ventilation of the lungs
    • ↓ Dyspnea and ↑ FEV1
    • Inhaled route is preferred.
    • Commonly used bronchodilators: Β2 Adrenergic agonists, Anticholinergics, & Methylxanthines
    • Combivent Respimat (ipratropium and albuterol) works better
  • Antibiotic therapy
    • Azithromycin (Zithromax)
  • Long-acting anticholinergic- given to control COPD in a long-term basis/maintenance med
    • Tiotropium (Spiriva)
  • Inhaled corticosteroid therapy (ICS)
    • Used for moderate to severe cases

ICS combined with long-acting β2adrenergic agonists (e.g., fluticasone/salmeterol [Advair]- decreases inflammation and bronchodilator) It is very effective in controlling COPD. Important maintenance med***

73
Q

COPD oxygen therapy

A

Keep O2 saturation at 90% or more during rest, sleep, and exertion. In short, helps patient maintain quality of life

Helps to maintain PaO2 greater than 60 mmHg

74
Q

COPD humidification

A
  • Whenever patient is on supplemental O2, make sure they have a humidifier attached to it
  • Used because O2 has a drying effect on the mucosa – has a high risk for infection
  • Supplied by nebulizers, vapotherm, and bubble-through humidifiers
75
Q

impact of long term oxygen therapy

A

INCREASES INDEPENDENCE

  • Prognosis & quality of life
  • Exercise capacity/tolerance
  • Cognitive performance/mental acuity
  • Sleep in hypoxemic patients
  • Decreases cardiac workload
  • Decreases pulmonary HTN and Hct
76
Q

complications of oxygen therapy

A
  • Combustion- teach them to not smoke in vicinity of O2 to avoid causing a fire
  • CO2 narcosis – too much co2 in the lungs and will break down the lung
  • O2 toxicity- In COPD patients, the breathing drive is their O2/hypoxic drives their respirations, so if they get too much O2 their drive will diminish and they’ll be drowsy and this can result in death
  • Absorption atelectasis
  • Infection- make sure they clean the O2 tubing on a daily basis
77
Q

respiratory and physical therapy for COPD

A
  • Breathing retraining- by teaching them new breathing exercises
    • Decreases dyspnea, improves oxygenation, and slows respiratory rate (to maintain a normal RR)
    • Pursed lip breathing- prolongs exhalation and prevents bronchiolar and alveolar collapse and air trapping
    • Tripod position- an easy position for patient to breathe better
  • Effective coughing- to expectorate sputum
78
Q

chest physiotherapy for COPD

A
  • Chest physiotherapy- to help them drain their secretions
    • Percussion-
      • Hands in a cup-like position to create an air pocket
      • Air-cushion impact facilitates movement of thick mucus from lower lobes of lungs to help expectorate
      • No percussion over: kidneys, sternum, spinal cord, bony prominences, or tender or painful area because most of these patients are very debilitated and skinny, so it can really injure them
    • Vibration
    • Postural drainage-
      • Position/Gravity assists in bronchial drainage
      • Is done 2 to 4 times per day
      • Usually in immobilized patients
79
Q

nutrition for COPD

A
  • Important because they’re always fatigued and don’t have energy to eat
  • To decrease dyspnea and conserve energy:
    • Rest at least 30 minutes before eating.
    • Use bronchodilator.
  • High-calorie, high-protein diet

Supplemental O2 –smoking cessation-discharge teaching

  • Eat five to six small meals.
80
Q

COPD NANDAs

A
  • Ineffective airway clearance
  • Impaired gas exchange
  • Imbalanced nutrition: Less than body requirements
  • Risk for infection
  • Insomnia
81
Q

COPD planning

A
  • Prevention of disease progression or slow the progression
  • Ability to perform ADLs
  • Relief from symptoms
  • No complications related to COPD
  • Knowledge and ability to implement long-term regimen (because the disease will last forever)
  • Overall improved quality of life
82
Q

COPD nursing health promotion implementation

A
  • Early detection of small-airway disease
  • Early diagnosis & prompt treatment of URI (upper respiratory infections) when you have COPD
  • Awareness of family history of COPD & AAT deficiency
  • Abstain from or stop smoking
  • Avoid or control exposure to occupational & environmental pollutants and irritants.
  • Influenza and Pneumovax vaccines
83
Q

COPD ambulatory home care

A
  • Most important aspect is teaching.
    • Pulmonary rehabilitation- designed to reduce symptoms, patient taught breathing exercise, PT, and how to use their meds, etc.
    • Activity considerations- what activities can they perform?
      • exercise training- energy conservation. Upper extremities- improve muscle function and reduce dyspnea.
    • Sleep- Nasal saline sprays, decongestants, or nasal steroid inhalers can help get rid of secretions
    • Psychosocial considerations- usually are very depressed. Do they need a psychologist?
      • Healthy coping
      • Guilt, depression, anxiety
      • Social isolation, denial, and dependence
84
Q

COPD eval

A
  • Expected Outcomes:
    • Normal breath sounds
    • Effective coughing
    • Return of PaO2 to normal range for patient
    • Improved mental status/cognitive function
    • Maintenance of normal body weight
    • Normal serum protein levels
    • Feeling of being rested
    • Improvement in sleep pattern
    • Awareness of need to seek medical attention
    • Behaviors minimizing risk of infection
    • No infection
85
Q

COPD chest xray finding

A

congestion and hyperinflation of lungs;flat diaphagm

86
Q

COPD ABG finding

A

respiratory acidosis

low pH, high PaCO2

low PaO2

high bicarb in late stages

adult 2 (3 decks)

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