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AE3 Exam 2 > Week 5 > Flashcards

Week 5 Flashcards

1
Q

Changes of Aging in the Respiratory System? (4)

A

 Decrease in number of alveoli
 Alteration of shape of alveoli which increases A-P diameter
 Deficiency in elastic recoil due to stiffening of elastin and collagen connective tissue
 Chest wall stiffness
 Decrease in vital capacity (amt of air that goes in and out w/ each breath)
 Decrease in the amt of oxygen carried in the blood

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2
Q

Other changes wtih old age (in addition to respiratory system changes) that affect Pulmonary Function (3)

A

 Loss of muscle tone
 Increase in thoracic rigidity
 Osteoporotic changes to the spine (kyphosis)
 Decrease in antibody production (this causes an increased susceptibility to infection)

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3
Q

why are older adults predisposed to lung problems?

A

 Age-related changes
 Exposure to pollutants (cigarettes, chemicals, pesticides, traffic fumes)
 Comorbidities (Chronic airflow limitation includes the chronic lung diseases: Asthma; Chronic bronchitis; Pulmonary emphysema)

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4
Q

What is asthma?

A

 Intermittent disease
 Reversible and temporary airflow obstruction and wheezing
 Hyperresponsiveness of airways that causes bronchospasm; obstruction d/t inflammation or increase in mucous production
 Typically occurs in response to some type of irritant

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5
Q

what are common asthma triggers?

A

cockroaches, dust, dry air, stress, exercise, aspirin/NSAIDS

food typically causes anaphylaxis Rx but not asthma

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6
Q

what happens to the beta-adrenergic receptors in older adults as they age? How does this impact asthma in older adults?

A

 Change (decrease) in sensitivity of beta-adrenergic receptors
 So some meds might not work as well in older pts
 Older adults w asthma (or respiratory problems in general) are at risk for having more serious breathing problems

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7
Q

are women or men more at risk for asthma?

A

women (35% higher incidence)

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8
Q

Physical assessment and clinical manifestations of asthma

A 
	Audible wheeze and increased respiratory rate
	Increased cough
	Use of accessory muscles
	”Barrel chest” from air trapping
	Long breathing cycle
	Cyanosis
	Hypoxemia
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9
Q

normal pH levels

A

7.35-7.45

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10
Q

normal CO2 levels

A

35-45mmHg

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11
Q

normal HCO3 levels

A

22-26mEq/L

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12
Q

normal O2 levels

A

80-100mmHg

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13
Q

What is the lab assessment you want to do in an asthma pt?

A

 ABGsl (need to find out if they’re going into respiratory acidosis. Hypercapnia can occur later in attack process but early on there may not be ABG changes)
 Arterial oxygen (may decrease in acute asthma attack)
 Arterial carbon dioxide (may decrease early in the attack and increase later, indicating poor gas exchange)

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14
Q

best way to diagnose asthma?

A

 **Most accurate measures for asthma are pulmonary function tests using spirometry including:
 Forced vital capacity (FVC)
 Forced expiratory volume in the first second (FEV1)
 Peak expiratory flow rate (PEFR)
 When pts do these tests, they’re compared to others of the same gender and age so there’s not just one “normal” score

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15
Q

Respiratory acidosis—

A

elevation of pCO2 as a result of ventilation depression

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16
Q

Respiratory alkalosis—

A

depression of pCO2 as a result of alveolar hyperventilation

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17
Q

Metabolic acidosis—

A

depression of HCO3– or an increase in non-carbonic acids

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18
Q

Metabolic alkalosis—

A

elevation of HCO3– usually caused by an excessive loss of metabolic acids

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19
Q

what lab values can help differentiate allergic asthma?

A

elevated serum eosinophil count and immunoglobulin E levels

 Sputum with eosinophils and mucous plugs will shed epithelial cells

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20
Q

How often should peak flow meters be used by asthma pts?

A

twice daily

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21
Q

what does it mean that asthma pts have an individualized drug therapy plan?

A

everyone has their own personal best

-green zone (50% (danger zone)

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22
Q

Patient education for an asthma pt?

A

asthma is often an intermittent disease; with guided self-care, patients can co-manage this disease, increasing symptom-free periods and decreasing the number and severity of attacks

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23
Q

General drug therapy for asthma (2 main categories)

A
  1. Preventive therapy drugs
     Used to change airway responsiveness to prevent asthma attacks
     Used daily, regardless of Sx
  2. Rescue drugs-used to actually stop an attack once it’s started
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24
Q

If a pt is on both rescue drugs (i.e. Albuterol) and maintenance drugs (inhaled steroids), which order do you give the drugs?

A

BRONCHODILATOR FIRST bc it will open up airway so that when they take the inhaled steroid it can get where it needs to go

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25
Q

Examples of asthma rescue drugs

A
  1. Short-acting beta2 agonists (SABA) – Salbutamol, Albuterol (most effective)
     Side effect can be tachycardia
  2. Anticholinergics – Atrovent (helps dry up mucous secretions)
  3. IV steroids can also be given in an acute attack.
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26
Q

Examples of preventative asthma drugs

A
  1. Inhaled corticosteroids (ICS) – Fluticasone (Flovent)
    tX
  2. Long-acting beta2 agonists (LABA) – Salmeterol (Serevent) (bronchodilators that last much longer)
  3. Leukotriene receptor antagonist (LTRA) - Singulair (pill, typically taken in evening)
    note: Some drugs are combined inhaled steroid + long-acting beta2 agonists
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27
Q

Pt education about inhaled corticosteroids (e.g. Fluticasone (Flovent))

A

 Long term effects of steroid use should be taught

 risk of fungal infections in mouth d/t inhaled steroids. ENCOURAGE PT TO ORALLY RINSE AFTER

28
Q

Pt education about long acting beta2 agonists (LABA) (e.g. Salmeterol (Serevent))

A

slow onset of action; must be shaken well bc it of tendency to separate easily. Poor technique on the pt’s part allows drug to escape through nose/mouth.

29
Q

Example of a leukotriene receptor antagonist (asthma drug)

A

Singulair

30
Q

How to use a metered dose inhaler

A

 Make closed seal with mouth around inhaler
 Take a couple of deep breaths first
 May take some coordination to learn how to pump and inhale at same time
 Teach to hold breath for 10-15 sec after inhalation so med has time to reach lungs
 Wait a few seconds to 1 min in between pumps
 Make sure to clean pump

31
Q

ways to administer asthma medications (4)

A 
	Metered dose inhaler (MDI)
	Dry powder inhaler (DPI)
	Autohaler
	Nebulizer 
- Pills (Singulair)
32
Q

Why is exercise and activity recommended to an asthma pt?

A

promotes ventilation and perfusion

33
Q

Other non-drug Tx for asthma pt?

A
  • exercise

- O2 therapy (delivered via mask, nasal cannula, or endotracheal tube in an acute attack)

34
Q

what is status asthmaticus

A
  • severe, life-threatening, acute episode of airway obstruction
  • If condition is not reversed, pt may develop pneumothorax and cardiac or respiratory arrest
35
Q

What is the treatment of status asthmaticus?

A

IV fluids, potent systemic bronchodilator, steroids, epinephrine, and oxygen

36
Q

Signs and Sx of status asthmaticus?

A

Person can’t really talk, they develop inspiratory wheezing (in addition to the expiratory wheezing), use of accessory muscles, tripodding, become very restless and agitated, tachypneic & tachycardic

37
Q

COPD includes what 2 diseases

A

emphysema and chronic bronchitis

38
Q

What is COPD?

A

 COPD includes: Emphysema and Chronic Bronchitis
 Characterized by bronchospasm and dyspnea
 Tissue damage is not reversible and increases in severity, eventually leading to respiratory failure

39
Q

What are the 2 major changes occurring the lungs of an emphysema patient?

A

loss of lung elasticity and hyperinflation of the lung

40
Q

What is emphysema?

A

 Dyspnea and the need for an increased respiratory rate
 Air trapping caused by loss of elastic recoil in the alveolar walls, overstretching and enlargement of the alveoli into bullae, and collapse of small airways (bronchioles)

41
Q

What part of the airways does emphysema affect?

A
  • ALVEOLI!

- affects smaller airways/alveoli get hyperinflated and lose their ability to recoil

42
Q

Does chronic bronchitis affect the alveoli?

A

Nope, only the airways

43
Q

What is chronic bronchitis?

A

 Inflammation of the bronchi and bronchioles caused by chronic exposure to irritants, especially tobacco smoke
 Inflammation, vasodilation, congestion, mucosal edema, and bronchospasm
 Production of large amounts of thick mucus

44
Q

what’s the number 1 risk factor for COPD?

A

cigarette smoking!

45
Q

How could someone who is a non-smoker develop COPD?

A

 Alpha1-antitrypsin (AAT) deficiency (we need AAT to help us get rid of the proteases that are detrimental to lungs)

46
Q

Potential complications of COPD?

A

 Hypoxemia
 Acidosis
 Respiratory infections- d/t destruction of cilia and increased mucous
 Cardiac failure (air trapping increases pressure in thoracic cavity, decreases venous return), esp cor pulmonale (R-sided failure)
 Cardiac dysrhythmias (d/t oxygenation or effects of drugs i.e. beta agonists)
-Acute respiratory failure (ventilatory or oxygenation failure, or combo of 2)

47
Q

Lab assessment for a COPD patient?

A

 ABG values for abnormal oxygenation, ventilation, and acid-base status (paying close attn. to CO2)
 Sputum samples- cultures to see if they have an infection
 CBC (hemoglobin/hematocrit)- polycythemia may occur d/t body trying to compensate for hypoxia)
 Serum electrolyte levels
 Serum AAT levels
 Chest x-ray
 Pulmonary function test

48
Q

What are the non-surgical interventions for COPD r/t Impaired Gas exhange?

A

 Airway management
 Cough enhancement-coughing and deep breathing, expectorants & mucolytics, DON’T GIVE COUGH SUPPRESSANT,
 Oxygen therapy (give O2 based on what they’re O2 sat is, try to keep in range of 88-92)
 Advise not to smoke! No open flames around O2
 Drug therapy
 Pulmonary rehabilitation

49
Q

What is the drug therapy for COPD?

A 
-same as for asthma, w/ addition of mucolytics:
	Beta-adrenergic agents
	Cholinergic antagonists
	Methylxanthines
	Corticosteroids
	Mucolytics
50
Q

Are there surgical options for a severe COPD patient?

A

 Lung transplantation for end-stage patients-problem with this is there is usu a very long wait
 Operative procedure through a large midline incision or a transverse anterior thoracotomy (surgical incision to chest wall)

51
Q

A pt has a Dx of Ineffective Airway Clearance. What are the interventions?

A 
	Assessment of breath sounds 
Interventions for compromised breathing:
	Careful use of drugs
	Controlled coughing
	Chest physiotherapy with postural drainage
	Suctioning
	Positioning
	Hydration via beverage and humidifier
	Flutter-valve mucus clearance devices
	Tracheostomy
52
Q

A pt has a Dx of Imbalanced Nutrition. What are the interventions?

A

Interventions to achieve and maintain body weight:
 Prevent protein-calorie malnutrition through dietary consultation (need more protein & calories)
 Smaller, more frequent meals throughout day
 Monitor weight, skin condition, and serum prealbumin levels
 Dyspnea management
 Food selection to prevent weight loss (avoid dry foods that may promote coughing, may need to avoid caffeine and alcohol bc it promotes urination and can cause dehydration)

53
Q

What is the leading cause of cancer deaths worldwide?

A

lung cancer

54
Q

typical survival rate of lung cancer pts?

A

5 years (prognosis is poor bc it’s usu diagnosed late)

55
Q

What are the warning signs of lung cancer?

A 
	Hoarseness
	Change in respiratory pattern
	Persistent cough
	Blood in sputum (this is typically a late sign)
	Chest pain/tightness
	Shoulder pain (referred pain)
	Recurrent pneumonia
	Dyspnea
	Wheezing
	Weight loss
56
Q

What is the nonsurgical management of lung cancer?

A

 Chemotherapy
 Targeted therapy
 Radiation therapy
 Photodynamic therapy (don’t need as frequent of sessions as radiation)

57
Q

Surgical options for lung cancer?

A

 Wedge resection; lobectomy; pneumonectomy (removing diseased portion of the lung or all of lung)

58
Q

What health problems can lead to respiratory alterations?

A

o DM; COPD; kidney disease; V/D; tissue hypoxia from any cause may alter the acid-base balance

59
Q

3 examples of respiratory alterations are:

A

sleep apnea; respiratory failure; and mechanical ventilation

60
Q

Why are older adults at a great risk for respiratory alterations?

A

Their kidneys are less able to compensate for an acidic load. They also have decreased respiratory Fx & decreased GFR, leading to impaired compensation for the acid-base imbalances

61
Q

and ABG analysis provides info about what? (4 things)

A

 Acid-base status
 Underlying cause of imbalance
 Body’s ability to regulate pH
 Overall oxygen status

62
Q

Acidosis pH 45 mmHg

these values indicate…?

A

respiratory acidosis

63
Q

Respiratory acidosis is

A
  • When a pt has a problem w/ hypoventilation, they’re breathing too slowly and retaining too much CO2
  • Hypoventilation and CO2 retention cause carbonic acid level to increase.
  • can lead to increased ICP.
64
Q

Respiratory acidosis can be caused by…?

A 
o	Asthma
o	CNS depression
o	Anesthesia
o	Alcohol
o	Aspiration of foreign body.
o	Pneumonia
o	Headache
o	Blurred vision
o	Restlessness
o	Anxiety
o	Tremors
o	Hypotension
o	Seizures
65
Q

What is the Tx of respiratory acidosis?

A

Treat underlying cause (i.e., drug reversal, decrease intracranial pressure, bronchodilators)!
o Correct respiratory state
o Hyperventilation (we increase their respiratory rate)
o May require mechanical ventilation
o Metabolic treatment as necessary (i.e., bicarbonate administration – rare)

66
Q

what is the most reliable way to distinguish asthma from COPD?

A

pulmonary function test

AE3 Exam 2 (1 decks)

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