Week 2 Material Flashcards
1
Q
what is COPD?
A
- Encompasess emphysema and chronic bronchitis
- Irreversible
- Characterized by the loss of lung elasticity and hyperinflation of the lung tissue
2
Q
emphysema
A
- causes destruction of the alveoli leading to a decreased surface area of gas exchange, carbon dioxide retention and respiratory acidosis
3
Q
bronchitis
A
- An inflammation of the bronchi and bronchioles due to chronic exposure to irritants
4
Q
risk factors for COPD
A
- Advanced age: older clients have decreased pulmonary reserve due to normal lung changes
- Cigarette smoking is the primary risk factor for COPD
- Alpha 1 - antitrypsin (AAT) deficiency
- Exposure to environmental factors - air pollution
5
Q
health promotion and dz prevention for COPD
A
- Promote smoking cessation
- Avoid exposure to secondhand smoke
- Use protective equipment, such as a mask, and ensure proper ventilation while working in environments that contain carcinogens or particles in the air
- Influenza and pneumonia vaccinations are important for all clients who have COPD, but especially for older adults
6
Q
assessment of clients with COPD
A
- Dyspnea upon exertion
- Productive cough that is most severe in AM
- Hypoxemia
- Crackles and wheezes
- Rapid and shallow respirations
- Use of accessory muscles
- Irregular breathing pattern
- Thin extremities and enlarged neck muscles
- Dependent edema secondary to RHF
- Clubbing of fingers and toes - late stages
- Pallor and cyanosis of nail beds and mucous membranes - late stages
- Decreased O2
- Barrel chest or increased chest diameter (w/emphysema)
- Hyperresonance on percussion ( w/ emphysema)
7
Q
lab tests necessary for COPD
A
- Inc hematocrit due to low O2
- Use sputum cultures and WBC counts to diagnose acute respiratory infections
- ABGs
- Hypoxemia PaO2 < 80mmHg
- Hypercarbia PaCO2 >45 mmHg
- Serum electrolytes
8
Q
what are the diagnostic procedures used for COPD?
A
- pulmonary function tests
- chest x ray
- pulse oximetry (will be less than normal, <95%)
- alpha 1 antitrypsin levels
9
Q
pulmonary function test for COPD
A
- Forced expiratory volume (FEV) to Forced vital capacity (FVC) are used to classify COPD as mild to severe
- FEV to FVC ratio decreases over time
- Expected 100%
- Mild COPD <70%
- Moderate to severe COPD <50%
- FEV to FVC ratio decreases over time
10
Q
chest x ray for COPD
A
- Reveals hyperinflation of alveoli and flattened diaphragm in the late stages of emphysema
- Not useful for diagnosis of early or mod dz
11
Q
alpha 1 antitrypsin levels for COPD
A
- Used to assess for deficiency in AAT
- An enzyme produced by the liver that helps regulate other enzymes and help break down pollutants from attacking lung tissue
12
Q
nursing care for COPD
A
- High Fowler’s position
- Encourage effective coughing or suction to remove secretions
- Encourage deep breathing and incentive spirometer
- Breathing tx and meds
- Administer O2
- Monitor skin breakdown (especially nose and mouth for O2 devices)
- Promote adequate nutrition
- Monitor weight
- Use breathing techniques to control dyspneic episodes
- Breathe from diaphragm, lie on back with knees bent, rest hand over abdomen
- Pursed lip breathing
- COPD can need up to 4L/min of O2
- Provide support
- Teach about home care services esp home O2
- Encourage verbalization of feelings
13
Q
what is important to remember about promoting adequate nutrition for patients with COPD?
A
- Increased work of breathing = increase calories
- Proper nutrition prevents infection
- Encourage fluids to promote hydration
- Dyspnea dec energy available for eating
14
Q
incentive spirometer use for COPD
A
- Monitor optimal lung expansion
- Show client how to use it
- Tight mouth seal
- Inhale and hold breath for 3-5 seconds
- Promotes lung expansion
15
Q
list the classes of medications used to tx COPD
A
- bronchodilators
- anti-inflammatory agents
- mucolytic agents
16
Q
name the types of bronchodilators used for COPD
A
- short acting beta2 agonist
- cholinergic antagonists/anticholinergic medications
- methylxanthines
17
Q
short acting beta 2 agonists for COPD
A
- type of bronchodilator
- ie. albuterol: provides rapid release
- ADR: tremors and tachycardia
-
pt teaching:
- inc fluid intake
- report HA or blurred vision
18
Q
anticholinergic medications for COPD
A
- type of bronchodilator
- ie. ipratropium
- blocks the parasympathetic NS
- allows for sympathetic NS effects of inc bronchodilation and dec pulmonary secretions
- long term: prevent bronchospasms
-
pt edu:
- observe for dry mouth: can use hard candies to help relieve
- inc fluid intake
- report HA and blurred vision
- monitor HR and for palpitations (toxicity)
19
Q
methylxanthines for COPD
A
- type of bronchodilator
- ie. theophylline: relaxes smooth M of bronchi
- requires close monitoring of serum med levels b/c narrow therapeutic range
-
pt edu:
- inc fluid intake
- report HA and blurred vision
20
Q
name the types of anti-inflammatory agents used for COPD
A
- corticosteroids–fluticasone and prednisone
- leukotriene antagonists–montelukast
- mast cell stabilizers–cromolyn
- monoclonal antibodies–omalizumab
21
Q
what are ADRs to watch our for when administering corticosteroids?
A
- immunosuppression
- fluid retention
- hyperglycemia
- hypokalemia
- poor wound healing
22
Q
nursing considerations for anti-inflammatory agents given for COPD tx
A
- Watch for a decrease in immunity function
- Monitor hyperglycemia
- Have pt report black, tarry stools
- Observe for fluid retention and weight gain
- Check throat and mouth for aphthous lesions (canker sores)
- Omalizumab can cause anaphylaxis
23
Q
client education for anti-inflammatories given for COPD tx
A
- Encourage fluids
- Glucocorticoids taken with food
- Use medication to prevent and control bronchospasms
- Pt should avoid ppl with respiratory infections
- Mouth care
- Medication used prophylactically for COPD symptoms
- Do not discontinue suddenly
24
Q
mucolytic agents given to tx COPD
A
- Help thin secretions to expel easier
- Nebulizer tx - acetylcysteine and dornase alfa
- Guaifenesin is an oral agent
- Combo of guaifenesin and dextromethorphan - oral to loosen secretions
25
Q
therapeutic procedures to help tx COPD
A
- Chest physiotherapy uses percussion and vibration to mobilize secretions
- Foot of bed higher than head can facilitate optimal drainage via gravity
26
Q
interdisciplinary care involved with COPD
A
- Consult respiratory for inhalers, breathing tx and suctioning
- Contact nutrition for weight changes
- Consult rehab if prolonged weakness and needs assistance with increasing activity
27
Q
client education for those with COPD
A
- Can be debilitating - give contacts for services for food, home O2 etc
- Encourage high calorie foods
- Encourage rest periods when necessary
- Promote hand hygiene
- Reinforce importance of medications
- Promote smoking cessation if needed
- Encourage immunizations
- O2 as prescribed - it is flammable
- Support to family and client
28
Q
list the possible complications of COPD
A
- respiratory infection
- right sided HF (Cor Pulmonale)
29
Q
explain respiratory infection as a complication of COPD
A
- Result from increased mucus production and poor O2 levels
- Nursing actions
- O2 therapy and monitor
- Antibiotics
- Advise to avoid crowds and ppl with respiratory infections
- Pneumonia and flu immunization encouragement
30
Q
explain R sided HF as a complication of COPD
A
- Air trapping, airway collapse, and stiff alveoli lead to increased pulmonary
- Blood flow through the lung tissue is difficult → increased workloads → enlargement and thickening of rt atrium and ventricle
- Manifestations
- Low oxygenation levels
- Cyanotic lips
- Enlarged and tender liver
- Distended neck veins
- Dependent edema
- Nursing actions
- Monitor respiratory status and O2 therapy
- Monitor HR and rhythm
- Meds as prescribed
- IV fluids and diuretics to maintain fluid balance
31
Q
Patho of TB
A
- Infectious dz caused by mycobacterium tuberculosis
- Transmitted through aerosolization (airborne)
- Once in lungs, the body encases the TB bacillus with collagen and cells - can appear as ghon tubercle on xray
- Can lie dormant for years, not many people have active
- Primarily affects the lungs but can spread to any organ in the blood
- Risk of transmission decreases after 2-3 weeks of antituberculosis therapy
32
Q
risk factors of TB
A
- Frequent and close contact with untreated individual
- Lower socioeconomic status and homelessness
- Immunocompromised status
- Poorly ventilated, crowded environments - long term care or prisons
- Advanced age
- Recent travel to areas of TB endemic
- Immigration
- Substance use
- Health care occupation with high risk activities
33
Q
health promotion and dz prevention of TB
A
- Screen yearly if at high risk
- Family members of pt with TB should be screened
- Early detection and tx are vital
- TB should be considered for any client who has:
- Persistent cough, chest pain, weakness, weight loss, anorexia, hemoptysis, dyspnea, fever, night sweats or chills
- If exposed but not developed may have latent tb, needs to be treated
34
Q
expected subjective findings with TB
A
- Persistent cough longer than 3 weeks
- Purulent sputum, possibly blood streaked
- Fatigue and lethargy
- Weight loss and anorexia
- Night sweats and low grade fever in afternoon
35
Q
physical (objective) assessment findings with TB
A
- Older adults present atypical: altered mentation or unusual behavior, fever, anorexia, weight loss
36
Q
lab tests done for TB
A
- positive intradermal TB test w/in 2-10 weeks of exposure
- QuantiFERON-TB Gold
- Mantoux Test
- Chest X-Ray
- Acid Fast Bacilli Smear and Culture
37
Q
QuantiFERON TB Gold for TB
A
- Blood test that detects release of interferon gamma (IFN-g) in fresh heparinized whole blood from sensitized people
- Diagnostic for infection - active and latent
- Results within 24 hr
38
Q
Mantoux Test for TB
A
- Read in 38-72 hr
- Intradermal injection of an extract of tubercle bacillus
- Induration of 10mm or greater in diameter indicated positive skin test
- Induration of 5mm is considered positive for immunocompromised pt
- Positive = developed an immune response to TB does not mean active
- Clients tx for TB previously will always be +
- Latent TB and Positive test → receive tx
- Pt with Bacillus Calmette- Guerin vaccine in last 10 years will have false-positive and need chest xray
- Clients starting immunosuppressive therapy should be tested for TB prior to starting tx
-
Client ed:
- Return to get test read
39
Q
chest x ray for TB
A
- Prescribed to detect active lesions in the lungs
40
Q
acid fast bacilli smear and culture for TB
A
- Positive indicates active infection
- Diagnosis confirmed by a positive culture
- Nursing actions
- 3 early morning sputum samples
- PPE
- Samples obtained in a negative airflow room
41
Q
nursing care for TB
A
- Heated and humidified O2
- Prevent infection transmission
- N95 mask
- Negative airflow room
- Barrier protection when in contact
- Pt wear surgical mask for transportation
- teach pt to cough and expectorate sputum
- Administer medications
- Promote adequate nutrition
- Fluids
- Foods rich in protein, iron, vit C and B
- Provide emotional support
42
Q
explain how medications are used to treat TB
A
- Due to resistance combo therapy is most commonly used
- Meds taken for 6-12 months - noncompliance is a contributing factor to resistant TB
- Current medication regimen includes: isoniazid, rifampin, pyrazinamide, ethambutol
- Client Ed: complete entire series of medication
43
Q
Isoniazid (INH) to treat TB
A
- Bactericidal and inhibits growth of mycobacteria by preventing synthesis of mycolic acid in cell wall
- Nursing considerations
- Take on empty stomach
- Monitor hepatotoxicity
- Vit B6 used to prevent neurotoxicity
- Liver function testing prior and monthly
- Client Ed
- No alcohol
- Report manifestation of hepatotoxicity
44
Q
Rifampin (RIF) to treat TB
A
- Bacteriostatic and bactericidal antibiotic that inhibits DNA - dependent RNA polymerase activity in susceptible cells
- Nursing considerations
- Hepatotoxicity
- Liver function testing
- Client Ed
- Secretions with become orage
- Report s/s hepatotoxicity
- This can interfere with oral contraceptives
45
Q
Pyrazinamide (PZA) to treat TB
A
- Bacteriostatic and bactericidal
- MOA unknown
- Nursing considerations
- Hepatotoxicity
- Assess for gout hx - ADR of non gouty polyarthralgias
- Liver enzymes q2 weeks
- Client Ed
- Drink glass of water with each dose and increase fluids overall
- Report hepatotoxicity
- Avoid alcohol
46
Q
Ethambutol (EMB) to treat TB
A
- Bacteriostatic
- Works by suppressing RNA synthesis, subsequently inhibiting protein synthesis
- Nursing Considerations
- Obtain baseline visual acuity tests and complete monthly
- Determine color discrimination ability
- Do not give to kids under 8
- Stop immediately if ocular toxicity occurs
- Client Ed:
- Report changes in vision
47
Q
Streptomycin Sulfate to treat TB
A
- Aminoglycoside antibiotic
- Potentiates the efficacy of macrophages during phagocytosis
- Nursing considerations
- Only use for multidrug resistant TB b/c high level of toxicity
- Streptomycin can cause ototoxicity - monitor hearing fx and tolerance often
- Report significant changes in urine output and renal fx studies
- Client Ed
- Advise client to drink 2L + of fluid daily
- Notify provider if hearing declines
48
Q
Interdisciplinary Care involved in caring for clients with TB
A
- Social services for obtaining medications
- Refer client to community clinic for follow ups and monitor
49
Q
client education for those with TB
A
- TB is an at home tx
- Airborne precautions not needed in home b/c family has already been exposed
- Exposed family should be tested
- Educate on completing and complying with medication regimen
- Continue follow up care 1 full year after medication ends
- Sputum samples needed q 2-4 weeks to monitor effectiveness of therapy
- Encourage hand hygiene
- Cover mouth and nose when coughing or sneezing
- Contaminated tissues disposed of in plastic bag
- Wear mask in public or contact with crowds
50
Q
list possible complications involved with TB and explain
A
- Miliary TB
- Organism invades bloodstream and can spread throughout body
- Headaches, neck stiffness, and drowsiness can be life threatening
- Pericarditis: dyspnea, swollen neck veins, pleuritic pain, hypotension due to an accumulation of fluid in pericardial sac that inhibits the heart’s ability to pump effectively
- Nursing actions: Tx is same for pulmonary TB
51
Q
Patho and Manifestations of Asthma
A
- chronic inflammatory disorder of the airways
- Results in intermittent and reversible airflow obstruction of the bronchioles
- Obstruction occurs either by inflammation or airway hyperresponsiveness
- manifestations:
- Mucosal edema
- Bronchoconstriction
- Excessive mucus production
52
Q
risk factors for asthma
A
- Older adults: have decreased pulmonary reserves due to physiologic aging process
- Family hx of asthma
- Smoking or 2nd hand smoke exposure
- Environmental allergies
- Exposure to chemical irritants or dust
- GERD
53
Q
why are older adults at higher risk for asthma?
A
- More susceptible to infection
- Sensitivity of beta adrenergic receptors decreases with age
- As the beta receptors age and lose sensitivity, they are less able to respond to agonists, which relax smooth muscle and can result in bronchospasms
54
Q
health promotion and dz prevention for asthma
A
- Promote smoking cessation
- If working in environment that contains carcinogens or air particles, advise client to use protective equipment (mask) and ensure proper ventilation
- Influenza and pneumonia vaccines: for older adults and clients with asthma
- Teach client how to recognize and avoid triggering agents:
- Teach client how to administer meds (nebulizers and inhalers)
- Teach client about infection prevention
- Encourage regular exercise to:
- Promotes ventilation and perfusion
- Maintains cardiac health
- Enhances skeletal muscle strength
- Clients may require pre-medication
- Instruct client to use hot water to eliminate dust mites in bed linens
55
Q
what are likely triggering agents for asthma?
A
- Environmental factors (changing in temp (esp warm to cold) and humidity)
- Air pollutants
- Strong odors
- Seasonal (grass, tree, weeds) and perennial (mold, feathers, dust, roaches, animal dander) allergens
- Stress and emotional distress
- Meds: aspirin, NSAIDs, beta blockers, cholinergics
- Enzymes, esp those in laundry detergents
- Chemicals
- Sinusitis w/ postnasal drip
- Viral respiratory tract infection
56
Q
diagnosis of asthma is based on 4 categories?
A
- Mild intermittent: symptoms less than 2x/week
- Mild persistent: symptoms arise more than 2x/week but not daily
- Moderate persistent: daily symptoms occur in conjunction with exacerbations 2x/week
- Severe persistent: symptoms occur continually, along with frequent exacerbations that limit physical activity and quality of life
57
Q
expected (subjective) findings with asthma
A
- Dyspnea
- Chest tightness
- Anxiety or stress
58
Q
physical (objective) assessment findings with asthma
A
- Coughing
- Wheezing
- Mucus production
- Use of accessory muscles
- Prolonged exhalation
- Poor oxygen saturation (low SaO2)
- Barrel chest or inc chest diameter
59
Q
lab tests and their findings for asthma
A
- ABGs:
- Hypoxemia: dec PaO2 less than 80 mmHg
- Hypocarbia: dec PaCO2 less than 35 mmHg; early in attack
- Hypercarbia: inc in PaCO2 greater than 45 mmHg; later in attack
- Sputum cultures:
- Bacteria can indicate infection
60
Q
what is the most accurate diagnostic procedure to diagnose asthma and its severity?
what are the findings seen with asthma?
A
- pulmonary function test
- For clients with asthma, we expect a decrease in FEV1 by 15-20% below the expected value.
- Diagnostic for asthma: increase in these values by 12% following admin of bronchodilators
61
Q
which diagnostic procedure is used to diagnose changes in chest structure overtime assoc with asthma?
A
chest x ray
62
Q
nursing care for asthma
A
- Position client in high-Fowler’s (maximize airflow)
- Administer O2 therapy
- Monitor cardiac rate and rhythm for changes during an acute attack (can be irregular, tachy, PVCs)
- Start IV access
- Maintain a calm and reassuring demeanor
- Provide rest periods for older adult clients who have dyspnea
- Design room and walkways with opportunities for rest
- Incorporate rest into ADLs
- Encourage prompt medical attn for infections and appropriate vaccines
- Administer meds
63
Q
list the classes of medications used to tx asthma
A
- bronchodilators
- antiinflammatory agents
- combination agents
64
Q
name the types of bronchodilators used to treat asthma
A
- short acting beta 2 agonists
- anticholinergic meds
- methylxanthines
- long acting beta 2 agonists
65
Q
short acting beta 2 agonists used to treat asthma
A
- type of bronchodilator
- ie. albuterol
- Watch for tremors and tachycardia
- Provide rapid relief of acute symptoms and prevent exercise induced asthma
66
Q
anticholinergic meds used to treat asthma
A
- type of bronchodilator
- Ie. ipratropium
- Nursing Considerations:
- Observe for dry mouth
- Client Education:
- Advise client to suck on hard candy to relieve dry mouth
- Inc fluid intake
- Report HA, blurred vision, palpitations (indicate toxicity)
- Monitor HR
- Block the parasympathetic NS
- Allows for sympathetic NS effects of inc bronchodilation and dec pulmonary secretions
- Long acting
- Used to prevent bronchospasms
- Nursing Considerations:
67
Q
methylxanthines used to treat asthma
A
- type of bronchodilator
- Ie. Theophylline
- Nursing Considerations:
- Monitor serum levels for toxicity
- SEs: tachycardia, nausea, diarrhea
- Require close monitoring of serum medication levels due to narrow therapeutic range
- Use only when other tx are ineffective
- Nursing Considerations:
68
Q
long acting beta 2 agonists
A
- Ie. Salmeterol
- Client Education:
- Advise client to use to prevent an asthma attack and NOT at the onset of attack
- Primarily used for asthma attack prevention
- Client Education:
69
Q
types of anti-inflammatory agents used to treat asthma
A
- Corticosteroids: ie fluticasone and prednisone
- Client Edu: take with food
- Leukotriene antagonists: ie montelukast
- Mast cell stabilizers: ie cromolyn
- Monoclonal antibodies: ie omalizumab
- Nursing Considerations: Can cause anaphylaxis
70
Q
anti-inflammatory agents used to tx asthma:
indication
nursing considerations
A
- used for prophylaxis, used to dec airway inflammation
- Nursing Considerations:
- Watch for dec immune function
- Monitor for hyperglycemia
- Report black, tarry stools
- Observe for fluid retention, weight gain (common)
- Monitor throat and mouth for aphthous lesions (canker sores)
71
Q
client education for anti-inflammatory agents used to tx asthma
A
- Drink fluids and promote hydration
- Take to PREVENT asthma attack, NOT at onset of attack
- Avoid ppl with respiratory infections
- Use good mouth care
- Warn client not to d/c abruptly
72
Q
combination agents used to treat asthma
A
- bronchodilator + anti-inflammatory
- Administer bronchodilator FIRST in order to inc absorption of anti-inflammatory agent
- Ipratropium and albuterol
- Fluticasone and salmeterol
73
Q
interdisciplinary care involved with asthma
A
- Respiratory Services: consult for inhalers and breathing tx
- Nutrition: contacted for weight loss/gain related to meds
- Rehab Care: consulted if client has prolonged weakness and needs assistance with inc level of activity
74
Q
list the possible complications associated with asthma
A
- respiratory failure
- status asthmaticus
75
Q
explain respiratory failure as a complication of asthma
A
- persistent hypoxemia related to asthma can lead to respiratory failure
- Monitor oxygenation levels and acid base balance
- Prepare for intubation and mechanical ventilation
76
Q
explain status asthmaticus as a complication of asthma
A
- life threatening episode of airway obstruction that is often unresponsive to common tx
- S/S: extreme wheezing, labored breathing, use of accessory Ms, distended neck veins, creates a risk for cardiac and/or respiratory arrest
- Prepare for emergency intubation
- Administer IV fluids, oxygen, bronchodilators, and epi
- Initiate steroid therapy
