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AE3 Exam 2 > Week 5 > Flashcards

Week 5 Flashcards

(66 cards)

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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
Examples of asthma rescue drugs
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.
26
Examples of preventative asthma drugs
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
27
Pt education about inhaled corticosteroids (e.g. Fluticasone (Flovent))
 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
Pt education about long acting beta2 agonists (LABA) (e.g. Salmeterol (Serevent))
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
Example of a leukotriene receptor antagonist (asthma drug)
Singulair
30
How to use a metered dose inhaler
 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
ways to administer asthma medications (4)
```  Metered dose inhaler (MDI)  Dry powder inhaler (DPI)  Autohaler  Nebulizer - Pills (Singulair) ```
32
Why is exercise and activity recommended to an asthma pt?
promotes ventilation and perfusion
33
Other non-drug Tx for asthma pt?
- exercise | - O2 therapy (delivered via mask, nasal cannula, or endotracheal tube in an acute attack)
34
what is status asthmaticus
- severe, life-threatening, acute episode of airway obstruction - If condition is not reversed, pt may develop pneumothorax and cardiac or respiratory arrest
35
What is the treatment of status asthmaticus?
IV fluids, potent systemic bronchodilator, steroids, epinephrine, and oxygen
36
Signs and Sx of status asthmaticus?
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
COPD includes what 2 diseases
emphysema and chronic bronchitis
38
What is COPD?
 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
What are the 2 major changes occurring the lungs of an emphysema patient?
loss of lung elasticity and hyperinflation of the lung
40
What is emphysema?
 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
What part of the airways does emphysema affect?
- ALVEOLI! | - affects smaller airways/alveoli get hyperinflated and lose their ability to recoil
42
Does chronic bronchitis affect the alveoli?
Nope, only the airways
43
What is chronic bronchitis?
 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
what's the number 1 risk factor for COPD?
cigarette smoking!
45
How could someone who is a non-smoker develop COPD?
 Alpha1-antitrypsin (AAT) deficiency (we need AAT to help us get rid of the proteases that are detrimental to lungs)
46
Potential complications of COPD?
 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
Lab assessment for a COPD patient?
 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
What are the non-surgical interventions for COPD r/t Impaired Gas exhange?
 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
What is the drug therapy for COPD?
``` -same as for asthma, w/ addition of mucolytics:  Beta-adrenergic agents  Cholinergic antagonists  Methylxanthines  Corticosteroids  Mucolytics ```
50
Are there surgical options for a severe COPD patient?
 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
A pt has a Dx of Ineffective Airway Clearance. What are the interventions?
```  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
A pt has a Dx of Imbalanced Nutrition. What are the interventions?
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
What is the leading cause of cancer deaths worldwide?
lung cancer
54
typical survival rate of lung cancer pts?
5 years (prognosis is poor bc it's usu diagnosed late)
55
What are the warning signs of lung cancer?
```  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
What is the nonsurgical management of lung cancer?
 Chemotherapy  Targeted therapy  Radiation therapy  Photodynamic therapy (don’t need as frequent of sessions as radiation)
57
Surgical options for lung cancer?
 Wedge resection; lobectomy; pneumonectomy (removing diseased portion of the lung or all of lung)
58
What health problems can lead to respiratory alterations?
o DM; COPD; kidney disease; V/D; tissue hypoxia from any cause may alter the acid-base balance
59
3 examples of respiratory alterations are:
sleep apnea; respiratory failure; and mechanical ventilation
60
Why are older adults at a great risk for respiratory alterations?
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
and ABG analysis provides info about what? (4 things)
 Acid-base status  Underlying cause of imbalance  Body’s ability to regulate pH  Overall oxygen status
62
Acidosis pH 45 mmHg these values indicate...?
respiratory acidosis
63
Respiratory acidosis is
- 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
Respiratory acidosis can be caused by...?
``` 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
What is the Tx of respiratory acidosis?
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
what is the most reliable way to distinguish asthma from COPD?
pulmonary function test

AE3 Exam 2 (1 decks)

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