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Adult Health I Test I > Week 2 Material > Flashcards

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
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2
Q

emphysema

A
  • causes destruction of the alveoli leading to a decreased surface area of gas exchange, carbon dioxide retention and respiratory acidosis
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3
Q

bronchitis

A
  • An inflammation of the bronchi and bronchioles due to chronic exposure to irritants
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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
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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
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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)
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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
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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
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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%
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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
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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
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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
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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
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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
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15
Q

list the classes of medications used to tx COPD

A
  • bronchodilators
  • anti-inflammatory agents
  • mucolytic agents
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16
Q

name the types of bronchodilators used for COPD

A
  • short acting beta2 agonist
  • cholinergic antagonists/anticholinergic medications
  • methylxanthines
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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
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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)
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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
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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
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21
Q

what are ADRs to watch our for when administering corticosteroids?

A
  • immunosuppression
  • fluid retention
  • hyperglycemia
  • hypokalemia
  • poor wound healing
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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
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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
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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
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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
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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
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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
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28
Q

list the possible complications of COPD

A
  • respiratory infection
  • right sided HF (Cor Pulmonale)
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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
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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
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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
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
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
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

Adult Health I Test I (5 decks)

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