TOPIC 3 - asthma, COPD, CF

Question 1

manifestations of oxygen toxicity

Answer 1

non productive cough, substernal chest pain, GI upset, dyspnea
compliancy decreases = crackles, hypoxemia, atelectasis, pulmonary edema

Question 2

interventions for oxygen toxicity

Answer 2

use lowest level of O2 to treat condition, monitor vitals and respiratory assessment

request ABGs when declining

notify MD if PaO2 is greater than 90

Question 3

hypoxic drive

Answer 3

when PaCO2 increases gradually over time to 60-65, the CO2 receptors no longer function and do not stimulate breathing

Question 4

interventions for hypoxic drive

Answer 4

use lowest level of O2 (1-3L) with venturi mask
hyperventilation occurs in the first 30 minutes of O2 therapy

Question 5

oxygen toxicity is defined by

Answer 5

O2 level greater than 50% for more than 24-48 hours

Question 6

pathophysiology of asthma

Answer 6

reversible airway obstruction from bronchial smooth muscle contraction, vascular congestion, tenacious mucus, and mucosal edema

Question 7

triggers for asthma

Answer 7

inflammatory - allergies, resp infection, work
irritants - temp change, exercise, strong odors, stress, cold air
others - meds, tobacco, gastric reflux, pollutants, food additives

Question 8

symptoms related to asthma

Answer 8

labored breathing, wheezing, sleep problems, chest pain, frequent coughing, allergies, common cold, feeling tired

Question 9

mild asthma attack interventions

Answer 9

prompt relief with inhaled SABA such as albuterol - take 2 to 4 puffs every 20 min

Question 10

moderate to severe asthma attack interventions

Answer 10

may require ED visit, relief from SABA, oral systemic corticosteroids (oral if moderate, IV if severe), ipratropium, IV magnesium

Question 11

forced vital capacity

Answer 11

amount of air that can be quickly and forcefully exhaled after maximum inspiration

Question 12

stepwise approach for managing asthma

Answer 12

1 - quick relief : albuterol, Proventil, Ventolin
2 - flovent
3 - flovent and LABA

Question 13

controller vs reliever meds

Answer 13

controller - daily meds for persistent asthma, long term control, anti-inflammatory

reliever/quick relief - bronchodilators, used PRN and preventative, oral corticosteroid bursts

Question 14

long term control anti- inflammatory meds

Answer 14

corticosteroids (inhaled = flovent diskus or HFA) (oral = prednisone)

leukotriene modifiers (montelukast)

anti-IgE (omalizumab)

Question 15

long term bronchodilators

Answer 15

long acting inhaled B2 agonist (salmeterol)
long acting oral B2 agonist (albuterol)
methylxanthines (theophylline)

Question 16

quick relief bronchodilators

Answer 16

short acting inhaled B2 agonist (albuterol)
anticholinergics inhaled (ipratropium)

Question 17

quick relief anti-inflammatory drugs

Answer 17

systemic corticosteroids (prednisone)

Question 18

COPD

Answer 18

characterized by persistent airflow limitation that is usually progressive
associated with enhanced chronic inflammatory response in the airways and lungs

Question 19

interventions for COPD

Answer 19

Improve gas exchange & airway clearance
Administer O2
Facilitate deep breathing & coughing to remove secretions
Encourage hydration 2-3L/d
Chest physiotherapy
Prevent or treat infections
Administer bronchodilators, corticosteroids
Small volume nebulizer (SVN), Inhalers
Patient education
Improve nutrition
Improve sleep
Stop smoking

Question 20

pathophysiology of COPD

Answer 20

hyperplasia of goblet cells - increasing production of mucus
reduced airway diameter - difficulty clearing secretions
loss of ciliary activity
abnormal dilation of distal air space with destruction of alveolar walls
loss of elastic recoil and airflow obstruction

Question 21

risk factors for COPD

Answer 21

cigarette smoking
environmental exposure
occupational chemical and dusts
air pollution
infections: recurring RTI in childhood, TB
genetics
A1 antitrypsin deficiency

Question 22

signs and symptoms of COPD

Answer 22

chronic cough with sputum
cyanosis of mucosal membranes
barrel chest
increased resting resp rate
use of accessory muscles
shallow breathing
pursing lips during expiration

EXACERBATING SYMPTOMS
worsening dyspnea
chest tightness
malaise
fatigue
decreased exercise tolerance

Question 23

complications of COPD

Answer 23

cor pulmonale
acute exacerbations
acute respiratory failure

Question 24

goals of managing COPD

Answer 24

to alleviate breathlessness and other respiratory symptoms that affect daily activities;

to prevent and reduce the frequency and severity of acute exacerbations;

to minimize disease progression and reduce the risk of morbidity/mortality;

to optimally manage comorbidities (if present) to reduce exacerbations and COPD symptoms related to comorbidities.

Question 25

O2 sat goals for COPD

Answer 25

above 90%

Question 26

complications of O2 therapy

Answer 26

combustion - do not smoke
CO2 narcosis - assess mental status and VS before starting
O2 toxicity - high concentrations can result in severe inflammatory response resulting in severe pulmonary edema and hypoxemia

Question 27

interventions for nutritional therapy of COPD

Answer 27

Rest for 30 minutes before eating and use a bronchodilator before meals

Avoid exercise and treatments 1 hour before and after meals

Ensure O2 therapy is in use during eating

Encourage activity during the day to stimulate appetite (e.g., walking or getting out of be during the day)

If underweight, supply with protein and calories, moderate carbohydrate and fats
5-6 small meals a day

Question 28

chronic bronchitis

Answer 28

the presence of cough and sputum production for at least 3 months in each of 2 consecutive years, is an independent disease that may precede or follow the development of airflow limitation.

Question 29

emphysema

Answer 29

is the destruction of the alveoli and is a pathologic term that explains only one of several structural abnormalities in COPD patients.

Question 30

chronic bronchitis

Answer 30

inflammation of the bronchi and bronchioles caused by exposure to irritants, especially cigarette smoke.

The irritant triggers inflammation, vasodilation, mucosal edema, congestion, and bronchospasm.

Bronchitis effects only the airway, not the alveoli. Bronchial walls thicken and impair airflow.

This thickening along with mucous blocks some of the smaller airways and narrows larger ones.

Mucous provides a breeding ground for organisms and leads to chronic inflammation.

Question 31

ABG labs of chronic bronchitis

Answer 31

PaO2 levels decrease and arterial carbon dioxide level increases

Question 32

emphysema

Answer 32

Loss of lung elasticity and hyperinflation of the lung. These changes result in dyspnea and need for an increased respiratory rate.

The hyper inflated lung flattens the diaphram, weakening the effectiveness of the muscle. These patients need to then use more accessory muscles in the neck, chest wall, and abdomen to inhale and exhale. This increased workload increases the need for oxygen, making the patient have ‘air hunger’ sensation.

Question 33

cystic fibrosis

Answer 33

autosomal recessive disease

transport of Na and Cl in and out of epithelial cells
negative impact to lungs, GI tract, reproductive tract, and kidneys

Question 34

meconium ileus

Answer 34

bowel obstruction that occurs when themeconiumin your child’s intestine is even thicker and stickier than normalmeconium, creating a blockage in a part of the small intestine called the ileum. Most infants withmeconium ileushave CF

Question 35

med therapy for relieving obstruction

Answer 35

Aerosol and nebulization treatments to dilate airways, liquefy mucus and facilitate clearance

CPT (postural drainage with percussion and vibration)

Expiratory techniques: PEP devices (Flutter device)

O2 therapy in severe disease

Question 36

med therapy for controlling infection

Answer 36

long course of antibiotics

Question 37

med therapy for pancreatic insufficiency

Answer 37

Enzyme replacement: (Pancreaze, Creon, Ultresa) before each meal and snack

Vitamin supplement: (A, D, E, and K)

Diet: Adequate fat, calories, protein, and vitamins. Added salt with sweating is excessive

Diabetes: administer insulin

Question 38

complications of CF

Answer 38

Cystic Fibrosis Renal Disease
Bone disease
Sinus disease
Pancreas & Liver disease
Pneumothorax
Respiratory failure
Pulmonary hypertension