T1-Ch 27: Noninfectious LR Problems Flashcards
chronic lower respiratory disorder that causes inflammation that obstructs the airway via bronchoconstriction
asthma
Asthma triggers (4)
-specific allergens
-general irritants
(cold air, dry air, fine airborne particles, microorganisms)
-aspirin & other NSAIDs
-WBCs (eosinophils and neutrophils activated by IL-5 or IL-7)
Symptoms for asthma control scale: (4)
-Daytime: wheezing, dyspnea, coughing, present more than twice weekly
-Waking from night sleep with symptoms go wheezing, dyspnea, coughing
-Reliever drug needed more than twice weekly
-Activity limited or stopped by symptoms
Asthma control level:
no symptoms present
controlled
Asthma control level:
1-2 symptoms
Partly controlled
Asthma control level:
3-4 symptoms
uncontrolled
General asthma s/s (4)
-audible wheeze
-longer breathing cycle w/ prolonged and more effortful exhalation
-decreased ability to speak
-hypoxia
Asthma patients ABG will show:
decreased CO2
Asthma patients End-vital carbon dioxide levels _____ in later stages
rise
Asthma patients have _____ eosinophil count and IgE due to ________
elevated
allergen triggers
Most accurate test to diagnose asthma
pulmonary function test
How many steps are therein asthma step therapy?
5 steps
Asthma Therapy: Step 1
Albuterol PRN
Asthma Therapy: Step 2
Albuterol PRN
Daily dose ICS or Leukotriene modifier
Asthma Therapy: Step 3
Albuterol PRN
Daily low dose:
1) ICS + Laba
2) medium to high dose ICS
3) low dose ICS + Leukotriene modifier
OR
4) Low dose ICS + SR theophylline
Asthma Therapy: Step 4
Albuterol PRN
Daily Step 3 Treatment
Daily:
1) medium/high dose ICS + Laba
OR
2) Leukotriene modifier + SR theophylline
Asthma Therapy: Step 5
Albuterol PRN
Daily treatment with Step-4 options
Additional:
1) Oral glucocorticoid
OR
2) IgE antagonist (IL-5 or IL-7)
Emergency services are requires for asthma patients when: (5)
-Fingertips or lips are gray/blue
-Difficulty breathing, walking, or talking
-Retractions of the neck, chest, or ribs
-Nasal flaring
-Failure of drugs to control worsening symptoms
A destruction of lung’s elastic tissue that reduces its ability to recoil after stretching, leading to hyperinflation of the lungs
Emphysema
Hyper-inflated lungs ______ the diaphragm, weakening it
flatten
Patients with emphysema use accessory muscles of the ___, ___, and _____ to inhale and exhale
neck, chest wall, and abdomen
increased work to breath = increase in oxygen needed = _____
air hunger
ABGs of emphysema patients may show chronic ______ _______
respiratory acidosis
Emphysema causes include: (3)
-tobacco smoking
-marijuana use
-chronic inhaled particular matter exposure (wood smoke & biomass fuels)
Greatest risk factor for COPD
smoking
Other risk factors for COPD
-genetic
-environmental
complications of COPD (5)
-hypoxemia
-acidosis
-respiratory infection
-cardiac failure
-cardiac dysrhtymias
COPD is classified from mild to very severe on the basis of: (2)
-symptoms
-pulmonary function test changes
Decreased gas exchanges with COPD is due to: (8)
-alveolar-capillary membrane changes
-reduced airway size
-ventilatory muscle fatigue
-excessive mucus production
-airway obstruction
-diaphragm flattening
-fatigue
-decreased energy
Weight loss in COPD patients is due to: (4)
-dyspnea
-excessive secretions
-anorexia
-fatigue
Anxiety in COPD patients is often due to: (2)
-changes in health status
-situational crisis
Decreased endurance in COPD patients is due to: (3)
-fatigue
-dyspnea
-imbalance between oxygen supply and demand
COPD cues (5)
-decreased gas exchange
-weight loss
-anxiety
-decreased endurance
-pneumonia/respiratory infection
Before a nurse conducts an intervention on COPD patient they should assess (4)
-breathing rate
-rhythm
-depth
-use of accessory muscles
Nursing care for COPD patients
-assess breathing before interventions
-conduct interventions
-teach effective coughing & exercise conditioning
-Use oxygen therapy, suctioning, and ensure hydration
Nursing interventions for COPD patients
-ensure consistency prescribed drug therapy use for airway maintenance
-monitor for improvements
-use breathing techniques
-reposition patients
COPD severity classification:
FEV > 80% predicted
Gold 1: Mild
COPD severity classification:
FEV 50-79% predicted
Gold 2: Moderate
COPD severity classification:
FEV 30-49% predicted
Gold 3: Severe
COPD severity classification:
FEV < 30% predicted
Gold 4: very severe
Breathing techniques: (2)
-pursed-lip breathing
-diaphragmatic or abdominal breathing
Steps for diaphragmatic/abdominal breathing
-lie on you back with knees bent (or sitting in chair if unable to lie down)
-Place your hands or a book on your abdomen to create resistance
-begin breathing from your abdomen while keeping your chest still (look for rise/fall of book or hand)
Steps for Pursed-Lip Breathing (3)
-Close your mouth and breath in through your nose
-Purse your lips as you would to whistle; breath out slowly through your mouth, without puffing your cheeks; spend twice the amount of time it took you to breath in
-Use your abdominal muscles to squeeze out every bit of air possible
an autosomal recessive genetic disease that affects many organs with most impairment occurring to pancreatic and/or lung function
Cystic Fibrosis
Organs most commonly impaired in Cystic Fibrosis patients (5)
-pancreas
-lungs
-liver
-salivary glands
-testes
How are babies screened for Cystic Fibrosis?
Sweat test
In pts with Cystic Fibrosis, poor ______ transport causes the formation of mucus that has little water content and is _______
-chloride transport
-thick
Non-pulmonary problems of COPD patients include: (6)
-pancreatic insufficiency
-malnutrition
-intestinal obstruction
-poor growth
-male sterility
-cirrhosis of the liver
_____ & ______ are concerns of cystic fibrosis pts due to nutritional issues
-osteoporosis
-diabetes mellitus
Main cause of death for Cystic Fibrosis pts
Respiratory Failure
Cystic Fibrosis ABG
ABG shows _____ :
_____ arterial oxygen levels
_____ arterial carbon dioxide
_____ bicarb
acidosis
-greatly reduced arterial oxygen level
-increased arterial carbon dioxide levels
-increased bicarbonate
Cystic fibrosis management includes: (8)
-drug therapy
-infection prevention
-pulmonary hygiene
-nutrition & vitamin supplements
-Oxygen therapy
-treatment for respiratory infections
-gene therapy
-sometime surgery
Major issues of lung transplants in cystic fibrosis patients (3)
-bleeding
-infection
-transplant rejection
