Respiratory - Unit 3 - Lower Airway Disorders (Part 1) Flashcards
What does nicotine cause? (Think vessels/vitals)
Constriction of blood vessels, increases HR and BP, curbs appetite and slows digestion, reduces body temp
Within 20 minutes of your last cigarette, your HR ___.
Drops
12 hours after quitting, the carbon monoxide level in your blood drops to ___
normal.
2 weeks –> 3 months after quitting, your heart attack risk begins to ____ & lung function begins to ___
Drop & improve.
1 to 9 months after quitting, coughing and shortness of breath ___.
decrease.
1 year after quitting, added risk of coronary heart disease is 1/2 that of a smoker’s. T/F?
True!
5 years after quitting, stroke risk is reduced to that of a ____.
Non-smoker’s.
10 years after quitting, lung cancer death rate is ___ that of a smoker’s.
Half!
15 years after quitting, risk of coronary heart disease is back to that of a normal nonsmoker T/F?
True!
What are some parts of smoking cessation?
Individual or group programs, coping strategies, avoid smokeless tobacco, medication therapies - also, relapses are common and NOT a failure.
What are the 5 A’s of smoking cessation?
ASK (About use)
ADVISE (inform of benefits of quitting, meds, etc.)
ASSESS (when ready/willing to begin)
ASSIST (Create a cessation plan, how to stay off)
ARRANGE (follow up, etc)
What are some side effects of nicotine replacement therapy (meds)?
Dry mouth, cough, scratchy throat and feeling on edge
What are some meds that reduce withdrawal symptoms?
Bubroprion/Wellbutrin, Varenciline/Chantix/Champix
How long is someone on buproprion? S/E?
7-12 weeks to 6 months, RX
How long is someone on varenicline/Chanix/champix? Is it long term? S/E?
3 mon-6 month, RX, S/E = Insomnia, GI upset, vivid dreams
What is the definition of COPD?
Airflow limitation disease - progressive and associated with abnormal inflammatory response of the lung. It is treatable and preventable
What are the two diseases that make up COPD?
Chronic bronchitis and pulmonary emphysema
COPD - ___th leading cause of death.
4th leading cause of death.
Women don’t get COPD more than men and then die from it. T/F?
False - more women die from it.
85-90% of deaths from COPD are DIRECTLY linked to _____.
Smoking
What are some COPD risk factors?
Smoking is #1, then 2nd hand smoke, occupational exposure (chemicals, smoke, etc), air pollution, deficiency of alpha 1 anitrypsin, history of childhood lung disease, etc.
What is chronic bronchitis?
Inflammation of the bronchi and bronchioles.
When is chronic bronchitis diagnosed?
Presence of cough and sputum production for at least 3 months in two consecutive years
Exposure to irritants triggers inflammatory response in chronic bronchitis, causing:
Vasodilation, congestion, mucosal edema, bronchospasm.
Chronic inflammation of the airways in chronic bronchitis causes:
thickened bronchial walls, increase in number and size of mucosal glands.
What are some classic assessment findings for chronic bronchitis?
Persistent cough, foul copious sputum, dusky color (blue bloater), dyspnea, tachypnea, overweight, early right sided heart failure
What is emphysema?
Abnormal permanent enlargement of airways/destruction of alveoli walls.
emphysema = loss of elasticity & hyperinflation of lung, along with trapped air. T/F?
True!
What are some classic assessment findings for emphysema?
Progressive, constant dyspnea, pink puffer skin color, increased AP diameter (barrel chest), tachypnea with difficulty exhaling, no cough, small amount of sputum, thin/wasted appearing
What are the three primary symptoms for COPD?
chronic cough, sputum production, dyspnea
What are some other parts of the COPD diagnosis?
ABG’s, sputum culture, HgB, HcT
What are some imaging tests done for COPD diagnosis?
Chest X-Ray, CT scan, lab tests, etc.
What is pulmonary function testing?
Comparison of FEV and FCV to classify mild to severe COPD.
Post bronchodilator FEV = best predictor of survival. T/F?
True
What are parts of the medical management for COPD?
Risk reduction, monitoring for the disease, prevent and treat exacerbations, pharmacologic therapy, etc.
What’s the goal of treatment for COPD?
Reduce mortality and improve quality of life
What are different bronchodilators?
Beta-adrenergic agonists (albuterol), cholinergic antagonists (atrovent), methylxanthines (theophylline), combination drugs
What are some other meds for COPD?
corticosteroids (prednisone, short term & oral), pulmicort (inhaled).
Mast Cell Stabilizers (inhibit release of histamines),
leukotriene antagonists (decrease inflammation and edema) - singulair
mucolytic agents (for chronic bronchitis, thins secretions, give and encourage water!!!!!), mycomist, guafenisin)
Hypoxemia and Acidosis - two major complications of COPD. T/F?
True!
Why are we hesitant to put a COPD patient on too much 02?
Because if they have too much, they might stop breathing - a COPD patient’s drive to breathe comes from hypoxia
Hypoxia =
Hypoxemia =
Hypoxia = low O2 in body.
Hypoxemia = low O2 in blood.
Should a COPD patient wear a mask in cold weather, have a humidifier at home, and stop smoking?
YES
Are COPD patients at a high risk for infection?
Yes, due to increased mucous production and poor oxygenation.
Should COPD patients be around a lot of people and not get the flu shot?
NO FUCKING WAY! haha
Do COPD patients have a risk for cardiac failure?
Yes, it’s called cor pulmonale - air trapping/collapsed airways cause alveolar wall increase, which makes the right side of the heart work harder. The right heart then enlarges…..which causes systemic edema.
What are some nursing interventions for COPD?
position patient to maximize ventilation, instruct on breathing patterns (diaphragmatic/pursed lip), monitor respirations ever 2 hours, monitor effectiveness of O2 therapy, low-flow oxygen 1-3 liters, rest between activities, drink 2-3 liters daily, pulmonary rehab, etc.
What is one of the big assessment findings on a X-Ray of someone with emphysema?
A flattened diaphragm
What is acute bronchitis?
Diffuse inflammation of the mucosal lining of the bronchial tree and excess mucous production (after infection, typically).
Acute Bronchitis is usually bacterial based. T/F?
FALSE - it’s 90% viral.
What are some symptoms of acute bronchitis?
Cough that begins dry/non-productive that progresses to productive with clear or purulent sputum, low grade fever, substernal chest burning, wheezing or crackles, malaise, head ache.
What is a good way to diagnose acute bronchitis?
Chest X-Ray
What are some treatments for acute bronchitis?
Bed rest, nutrition, humidification, antipyretic, expectorant, antitussive (robitussin, tessalon, codiene), antibiotics IF BACTERIAL, STOP SMOKING
Flu - often leads to pneumonia or death in:
elderly, debilitated, chronic respiratory disease patients, immunocompromised patients
How do we prevent influenza?
Handwashing, cover mouth/nose when sneezing/coughing, avoid ill persons, avoid contact with others when sick.
Influenza Vaccine =
IM (what ages) and intranasal (what ages?)
IM = 6 months and above…but intranasal = 2-8 years.
Who should get the flu vaccine?
Patients with COPD, asthma, COPD, are in long-term care, those at risk or those who work with sick patients.
What are the common symptoms of a cold?
Sneezing more, sore throat, minor aches and pains, , hacking, develops over a period of a few days, clogged nose
What are the common symptoms of the flu?
Headaches, fever, chills, aches, develops quickly, tired feeling, cough, severe chest discomfort
What are some treatment options for antiviral agents?
Flumadine, Relenza, Tamiflu (administer 24-48 hours of symptoms
Rest, drink fluids, saline gargles, antihistamines, watch for complications, avoid infecting others, etc.
What is atelectasis?
Collapsed lung.
Who is at risk for atelectasis?
Elderly, immobile patients, etc.
How do we prevent atelectasis?
Avoid oversedating, encourage fluids, prevent abdominal overextension, etc.
Pulmonary Tuberculosis - caused by mycobacterium tuberculosis bacillus. T/F? What happens?
True! It leads to necrosis and calcification.
Is TB highly communicable?
YES
How is TB transmitted?
Airborne
What are some risk factors for TB?
Excess alcohol use #1, homelessness #2, non-injecting drug use #3, then injecting drug use, long term care resident, correctional facility
In TB, they have a cough usually in the ___.
Morning (non-productive).
TB patients can have a purulent, blood tinged sputum. T/F?
True
What’s the difference between TB latent infection and TV active disease?
Latent = exposed to TB, may get ill in future but not now, CANNOT spread TB to others, positive mantoux but x-ray and sputum negative. Needs drug treatment to prevent active TB
ACTIVE = has symptoms (fever, weight loss, etc), CAN spread to others, positive mantoux (unless HIV+), or positive blood test, positive chest x-ray, sputum culture positive, etc.
What’s the BCG vaccine?
Vaccine for TB, does NOT always protect people, not used in USA - usually used for young children in other countries, needs chest x-ray to assess
Once positive, mantoux test is always positive. T/F?
True
Positive mantoux indicates what?
exposure to TB or dormant disease.
sputum culture = 2=8 weeks (or bactec 1-3 weeks) - T/F?
True
3 positive cultures = TB.
3 Neg = non contagious.
T/F?
True
For TB, drug therapy is easy and you don’t have to adhere to it. T/F?
FALSE - you MUST adhere.
What are the four meds used for Active TB?
Isoniazid (INH), Rifampin (RIF), Pyraxinamide (PZA), Ethambutol (EMB) or Streptomycin
What is the schedule for the four meds with active TB?
Isoniazid - kills active cells (start immediately)
Rifampin - kills slower growing cells (start immediately)
Pyraxinamide (added after 2nd month)
Ethambutol (added 4th month)
Isoniazid - take on full stomach. T/F?
FALSE - you take on empty stomach, Vit B 12 can help with the hepato/neuro toxicity this can cause.
Rifampin - what color does it turn your secretions/ee?
ORANGE
PZA - should we take it with lots of water?
YES - DO NOT DRINK BOOZE
What are some other S/E’s of the 4 TB meds?
Anorexia, N/V, abd pain, fever, rash, bleeding/bruising, aching joints, dizziness, blurred vision, females (oral birth control NOT effective!!!)
