WK 4: Respiratory Disorders A

Question 1

What are the three pathophysiological concepts of asthma?

Answer 1

1. Airway inflammation
2. Airway hyper responsiveness
3. Mucus hyper secretion

Question 2

Describe the pathophysiology of asthma

Answer 2

Airway inflammation, airway hype responsiveness and mucus hyper secretion result in airflow obstruction which leads to the clinical manifestations

Question 3

What are 3 types of triggers?

Answer 3

Allergens e.g. animal hair
Air pollution e.g. perfume, exhaust fumes
Oxidants e.g. cigarette smoking, aerosol

Question 4

What happens when a patient is exposed to a trigger?

Answer 4

A response is initiated which begins with mast cell degranulation and the release of inflammatory mediators `

Question 5

What are 5 key mediators release during an asthma attack?

Answer 5

• Histamine
• Interleukin
• Prostaglandin
• Leukotriene
• Nitric Oxide

Question 6

What can be seen within the inflammatory process of asthma?

Answer 6

Increased mucus production
Bronchial smooth muscle spasms
Thickening of airway walls
Increased bronchial hyper responsiveness

Question 7

Identify the 4 clinical manifestations of asthma

Answer 7

Wheeze
SOB
Chest tightness
Coughing

Question 8

Identify 3 clinical manifestations within a severe/exacerbation

Answer 8

Prominent inspiratory/expiratory wheezing
RR >30 bpm
Pulse rate >120 bpm

Question 9

Identify 2 examples of subjective data within asthma assessment

Answer 9

Past medical history?
Asthma management plan?
Medications?

Question 10

Identify 2 examples of objective data within asthma assessment

Answer 10

Is the patient restless? Cyanosis?

Vital signs

Question 11

Identify the 3 steps for acute management of asthma

Answer 11

1. Correct significant hypoxaemia
2. Reverse airflow obstruction quickly
3. Plan to prevent further events

Question 12

Outline how to correct significant hypoxaemia

Answer 12

Oxygen therapy e.g. hudson mask/simple face mask

Question 13

Outline how to reverse airflow obstruction quickly

Answer 13

Reliever medication e.g. immediate relief

Preventer medication e.g. inhaled corticosteroids

Question 14

Outline how to plan to prevent further events

Answer 14

DRSABCDE
Provide oxygen therapy/medications PRN
Esclate to Code blue PRN

Question 15

Identify 3 areas of education for asthma patients (Nursing intervention)

Answer 15

1. Identification of triggers/reducing exposure
2. Knowledge of early signs/symptoms
3. Proper inhalation technique

Question 16

What does COPD stand for

Answer 16

Chronic Obstructive Pulmonary Disorder

Question 17

What is COPD?

Answer 17

Slow progressive obstruction of the airways with periodic exacerbations/increased periods of dyspnoea and sputum production

Question 18

What is COPD the umbrella term for?

Answer 18

Chronic bronchitis

Emphysema

Question 19

Describe the pathophysiology of chronic bronchitis

Answer 19

Airway becomes narrowed due to the airway inflammation with neutrophils and macrophages causing bronchial oedema causing goblet cels to increase in size, thick mucus produced which cannot be cleared

Question 20

Identify the 2 causes of chronic bronchitis

Answer 20

Cigarette smoke

Inhalation of harmful particles

Question 21

What is Chronic bronchitis

Answer 21

Hyper secretion of mucus and productive cough that occurs for 3> months of the year and has occurred for at least 2 years

Question 22

Describe the pathophysiology of emphysema

Answer 22

Destruction of alveolar space leads to alveolar destruction and loss of elastic recoil. Decreased volume of air expired = decreased gas exchange and air trapped in lungs

Question 23

What is emphysema?

Answer 23

Abnormal and permanent enlargement of gas exchange airways accompanied by the destruction of alveolar walls

Question 24

Identify 3 clinical manifestations of COPD

Answer 24

Persistent cough
Dyspnoea
Digital clubbing
Fatigue

Question 25

Outline three areas of acute management for COPD

Answer 25

Oxygen therapy PRN Pt education/reassurance Airway clearance

Question 26

Outline 3 common goals of COPD

Answer 26

Improve gas exchange (Increased O2/Decraesed CO2 Improve airway clearance Improve breathing pattern/rate

Question 27

What is pneumonia?

Answer 27

Acute infection of the lung parenchyma caused by pathogens

Question 28

Outline the 3 organisms that cause pneumonia

Answer 28

1. Aspiration of normal flora from nasopharynx/oropharyna 2. Inhalation of microbes present in the air 3. Haemotogenous spread of infection from another area in the body

Question 29

Identify the 4 types of pneumonia

Answer 29

1. Community acquired pneumonia 2. Medical care associated pneumonia 3. Aspiration pneumonia 4. Opportunitic pneumonia

Question 30

Describe community acquired pneumonia

Answer 30

A lung infection that develops in people outside of hospital e.g. from bacteria viruses or fungi

Question 31

Describe medical care associated pneumonia

Answer 31

A lung infection that devleops 48hrs> hospital admission

Question 32

Describe aspiration pneumonia

Answer 32

Occurs when food, saliva, liquids or vomit is breathed into the lungs or airways instead of the stomach

Question 33

Describe opportunistic pneumonia

Answer 33

Patients who are immunocompromised or have an increased susceptibility to infection. Organisms cause infection when they typically wouldn't in a normal individual

Question 34

Describe the pathophysiology of pneumonia

Answer 34

Acute inflammatory response occurs due to a microorganism entering to Lower respiratory tract. This causes damage to the bronchial mucus membranes and an accumulation of WBC, cellular debris etc. impairing gas exchange

Question 35

Identify 3 clinical manifestations of pneumonia

Answer 35

``` Increased respiratory rate Increased WOB/SOB Accessory muscle use Cyanosis Productive cough ```

Question 36

Identify 3 areas of acute management in pneumonia

Answer 36

Correct hypoxia via oxygen therapy Maintain medication administration Encourage deep breathing/coughing exercises

Question 37

Identify 3 areas of acute management in severe life threatening exacerbations

Answer 37

DRSABCDE Oxygen therapy PRN Medication administration PRN

Question 38

Identify 3 nursing considerations of pneumonia

Answer 38

Be mindful of HAI Ensure pt has been provided with adequate education Support pt with ADL's

Question 39

What is tuberculosis?

Answer 39

An infection caused by mycobacterium tuberculosis which is a gram positive acid fast bacillus

Question 40

Describe the pathophysiology of TB

Answer 40

Spread by droplets and transmitted via inhalation, macrophages released to fight the bacilli. If it dights it off, TB is latent, if not, it can grow and destroy the macrophages. When it settles in the lung it causes inflammation and TB continues to multiply. WBC attempt to engulf bacteria and cause lesions called tubercles, dies and becomes necrotic

Question 41

Identify 3 clinical manifestations of an active infection

Answer 41

``` Chronic cough Sputum production Loss of appetite Weight loss Fever ```

Question 42

Identify clinical manifestations of latent infection

Answer 42

Usually asymptomatic

Question 43

What is the form of diagnosis for TB?

Answer 43

Positive tuberculin skin test (Many false positives) Interferon gamma release assay blood test Sputum culture Chest X ray

Question 44

Describe the treatment for TB

Answer 44

``` Antibiotic therapy for minimum 6 months Combination therapy (2> drugs) e.g. Rifampin, Ethambutol, Isoniazid ```

Question 45

Identify 3 nursing considerations of those with TB

Answer 45

Droplet precautions Adequate education Support pt with ADLs

Question 46

Identify the 4 areas of patient assessment for respiratory conditions

Answer 46

1. Apply appropriate assessment for relevant disorder 2. Primary assessment 3. Secondary assessment (Head to toe, VS, Pain assessment, general appearance) 4. Respiratory focused assessment