Week 4: Respiratory Flashcards

Question

Dx: bronchitis & emphysema

Answer 1

PFTs: Forced expiratory volume (FEV) with bronchodilator has no improvement with emphysema ABGs: Chronic bronchitis- hypoxemia & hypercapnia Emphysema- little hypoxemia & hypercapnia (hyperventilate to compensate) CBC: compensate for hypoxemia (HGB & HCT)

Answer 2

Right sided ❤️ failure as a result of pulmonary disease ⬆️pulmonary vascular resistance

Answer 3

Antibiotics to treat acute infections Bronchoactive drugs to help relax and open up air passages in the lungs Anticholinergics for mucous gland secretions Beta-agonists for bronchodilation Methlxanthines (like theophylline) to increase muscle strength Corticosteroids Mucolytics Eliminate sources of irritation and infection in the nose, throat, mouth, sinuses, and bronchial tubes Avoid polluted air & dusty working conditions Give up smoking

Answer 4

Bronchodilators: Beta-2 agonists- short acting with effects lasting from 3-6 hours including: ``` Albuterol (Proventil, Ventolin) Metaproterenol (Alupent, Metaprel) Pirbuterol (Maxair) Terbutaline (Brethine, Brethaire, Bricanyl) Bitolterol (Tomalate) Salmeterol (Serevent) ``` Theophylline (Theodur, Slo-bid, Uniphyl, Theo-24) Ipratropium (Atrovent) [anticholinergic drug] acts to relax the bronchial muscles. It is a slow-acting drug with virtually no side effects Corticosteroids (inhaled or oral) Oxygen

Answer 5

●Quitting smoking ●Bronchodilator drugs ●Antibiotics ●Exercise: including breathing exercises to strengthen the muscles used in breathing as part of a pulmonary rehabilitation program ●Treatment: with Alpha 1-Proteinase Inhibitor ●Only if a person has AAT deficiency-related emphysema A1PI not recommended for those who develop emphysema as a result of smoking or other environmental factors ●Lung transplantation ●Lung volume reduction surgery ●A surgical procedure – resection of most severely diseased portions of the lung - to allow the remaining lung & breathing muscles to work better

Answer 6

Impaired gas exchange: low flow O2 Ineffective airway clearance: bronchodilators, use of MDI, coughing Ineffective breathing pattern: positions to improve breathing, exhale with exertion Activity intolerance: exercise training, pulmonary rehab, muscle reconditioning, sleep history Imbalanced nutrition (less than body requirements): frequent small meals, low CHO Risk for infection: respiratory infection=most common cause for admission; PT-family teaching (avoid crowds, get vaccinated, look for changes in sputum, etc.) Ineffective coping: individual & family

Answer 7

Low flow O2 Positioning: forward leaning, abdominal breathing with legs raising exercises to strengthen abdominal muscles Muscle reconditioning exercises: start with 10 minutes BID & work up to 20 minutes Postural drainage, percussion & vibration (CPT) Improve nutrition, prevent infection Environmental control: cool temp, low humidity Assist with sleep, relaxation, and fear reduction

Answer 8

A multidisciplinary continuum of services directed to those with pulmonary diseases & their families, usually by an interdisciplinary team of specialists, with the goal of achieving & maintaining the individual’s maximum level of independence & functioning in the community

Answer 9

Reduce work of breathing Improve pulmonary function Normalize ABGs Alleviate dyspnea ⬆️efficiency of energy use Correct poor nutrition Improve exercise performance & ADLs Restore a positive outlook Improve emotional status Lengthen survival

Answer 10

Chronic inflammatory airway disorder; reversible reduction in airway diameter & airway resistance r/t: Acute bronchoconstriction Airway edema Chronic mucus plug formation Airway remodeling

Answer 11

~1 in 12 people have asthma (25 million) & numbers are increasing every year Asthma costs the US ~$56 billion in medical cost, lost school, and work days, and early deaths in 2007 Adults-4th leading cause of lost work Asthma accounts for ~1.8 million ER visits, 10 million doctor visits, &~1/2 million hospitalizations per year

Answer 12

Quick relief (rescue); maintenance Bronchodilators: theophylline, Beta-2 agonists Antiinflammatories: nonsteroids like Cromolyn (nasalcrom), corticosteroids Leukotriene inhibitors/ receptor antagonists (block the stimulation of inflammation): accolate, singulair, zyflo

Answer 13

Step 1: mild intermittent (Sx<2x/week) Rescue: prn short acting inhaled B2 agonist (bronchodilator) Step 2: mild persistent (Sx>2x/week, <1x/day) Daily & rescue: step 1 & long-term inhaled steroid low dose daily or cromolyn (trade name nasalcrom) Step 3: moderate persistent (daily Sx) Daily & rescue: step 1 & long-term inhaled medium dose steroid daily plus bronchodilator Step 4: severe persistent (continual) Daily & rescue: step 3 long acting bronchodilator

Answer 14

Daytime symptoms less than or equal to 2 weeks Nighttime symptoms less than or equal to 1 month PEF (prediction) greater than or equal to 80%

Answer 15

Daytime symptoms 2-4 weeks Nighttime symptoms 2-4 months PEF (predicted) greater than or equal to 80%

Answer 16

Daytime symptoms Greater than 4 weeks Nighttime symptoms Greater than 4 months PEF (predicted) 60-80%

Answer 17

Daytime symptoms continuous Nighttime symptoms frequent PEF (predicted): less than 60%

Answer 18

Sometimes called a “compressor”” Changes liquid medication into fine droplets you inhale through a mask Can be useful if you find it hard to use an inhaler Useful for high doses of medications Used in the hospital, especially the ED Often used at home now

Answer 19

Identify triggers and avoid irritants Use of peak flow meter Use of inhalers- spacers, rinsing, timing, order Pursed lip breathing Cool air may help, avoid warm moist air Environmental control: carpets, blinds, pillows, mattresses, pets, smoke, foods: nuts, milk, seafood, kiwi, avocados, air filters, shelf’s

Answer 20

Measures maximum speed of exhalation

Answer 21

“Fast blast” Teaching Zones (green, yellow, and red)

Answer 22

80-100% of your usual or “normal” peak flow- signals all clear

Answer 23

50-80% of your usual or “normal” peak flow Caution- your airways are narrowing and may require extra treatment Your symptoms can get better or worse depending on what you do, or how & when you use your prescribed med To be safe, call your doctor

Answer 24

<50% of your usual or “normal” peak flow Signals a medical alert Immediate decisions and actions need to be taken Severe airway narrowing may be occurring, contact your doctor now. The doctor can tell you what treatment to start

Answer 25

Status asthmaticus Respiratory failure

Answer 26

An asthma attack that cannot be controlled with the usual meds Ongoing attack➡️exhaustion of respiratory muscles & severe V/Q mismatch ➡️ respiratory failure & hypoxia Unable to talk, moving very little air➡️barely/no audible wheezing or adventitious breath sounds; cyanotic; sensorium changes and pulses paradoxus Treatment: medical emergency

Answer 27

It’s primarily an inflammatory disease that includes smooth muscle spasm, airway edema, and mucous plug ``` Cough Wheezing Anxiety Restlessness Oxygen desaturation Increased work of breathing ```

Answer 28

Findings consistent with impending respiratory failure: ``` Altered level of consciousness Absent breath sounds Central cyanosis Diaphoresis Inability to lie down Inability to speak ```

Answer 29

Beta receptor agonists stimulate beta-2 receptors on bronchial smooth muscle and mediate muscle relaxation Epinephrine/Isoproterenol➡️significant beta1 cardiovascular effects Terbutaline/Albuterol➡️relatively selective beta2

Answer 30

Methylprednisolone 2mg/kg x1, then 0.5-1mg/kg every 4-6

Answer 31

Early status asthmaticus: hypoxemia, hypocarbia Late: hypercapnia Decision to intimate should not depend on ABG, but on clinical assessment

Answer 32

Medical: previous attack with rapid/severe deterioration or respiratory failure or seizures/loss of consciousness Psychosocial: denial/non-compliance, depression or other psychiatric disorder, dysfunctional family, inner city resident Ethnic: non-white child Up to 1/3 of children who die from asthma have only had mild asthma before and had not been classified as “high risk” until then

Answer 33

Humidified oxygen-to max saturation Inhaled short-acting beta-2 agonists: large and frequent doses Subcutaneous epinephrine-rescue if unresponsive to beta-2 agonist Continuous bronchodilators (via MDI & nebulizers) until effective or reaching toxicity Delay intubation for as long as possible Corticosteroids: methylprednisolone 40 mg Q6h Theophylline as it is an anti inflammatory med and has diaphragmatic effects

Week 4: Respiratory Flashcards

(57 cards)