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Krystan: Semester Two Nursing School > 2800 Exam Two > Flashcards

2800 Exam Two Flashcards

(234 cards)

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1
Q

What are some consequences of untreated pain?

A

Increased ACH, cortisol, ADH, and epinephrine
Decreased insulin resistance
Increased heart rate, cardiac output, coagulation
Hypoxemia and decreased tidal volume
Decreased urine output and GI motility
Decreased immunity

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2
Q

What are the five dimensions of pain?

A 
Physiologic
Affective
Cognitive
Behavioral
Sociocultural
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3
Q

What is included in the physiologic dimension of pain?

A

Emotional responses to pain, like anxiety, depression, or frustration

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4
Q

Cognitive dimension of pain

A

Beliefs, attitudes, meanings, and thoughts attached to pain

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5
Q

Behavioral dimension of pain

A

Observable actions taken to express or control pain

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6
Q

Sociocultural dimension of pain

A

One’s culture impacts how one expresses and thinks about pain

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7
Q

What is nociceptive pain?

A

Pain at nocioceptor nerves caused by damage to somatic or visceral tissue

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8
Q

What are the two types of somatic pain?

A

Deep and superficial

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9
Q

What is somatic pain?

A

Pain originating from the skin, mucous membranes, subcutaneous tissues, muscles, bones, or tendons

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10
Q

What is visceral pain?

A

Pain from visceral organs

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11
Q

What are some common causes of visceral pain?

A

Swelling or ischemia of internal organs

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12
Q

What is neuropathic pain?

A

Pain from damage to peripheral nerves or CNS structures

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13
Q

How would a patient likely describe neuropathic pain?

A

Burning, shooting, or shock-like

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14
Q

Acute pain

A

Sudden onset
Usually lasts less than 3 months
Usually resolvable with care geared towards recovery
Precipitating event can usually be identidad

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15
Q

Chronic pain

A 
Gradual or sudden onset
Cause may not be known
Pain increases and decreases
Goal is pain control to maximize function
Behavioral manifestations likely
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16
Q

What is sciatica?

A

Pain following the course of the sciatic nerve

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17
Q

What is the most consistent pain indicator in infants?

A

Facial expressions

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18
Q

What are some other ways pediatric clients will express their pain?

A 
Crying
Pain facial expressions
Localized body response/withdrawal
Thrashing
Restlessness
Muscle rigidity
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19
Q

When should pain be reassessed? What are some dependent factors?

A

Frequently, especially after meds are given to gauge effectiveness. Assessment also depends on severity, the patient’s condition, the interventions taken, the risk of side effects, and institutional policy

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20
Q

Who might the nurse collaborate with to manage a patient’s pain?

A 
Anesthesiologist 
Nurse practitioner/doctor
Pharmacist
Psychologist 
PT/OT
Pain specialist
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21
Q

Planning for pain management should always include…

A

Patient goals

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22
Q

What is a multimodal approach to analgesic therapy?

A

Use of two or more classes of analgesics to take advantage of various mechanisms of action or to minimize the amount of narcotic medications needed

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23
Q

What are some barriers to effective pain management that could affect a patient?

A

Fear of addiction/tolerance
Desire to be stoic
Side effects
Inadequate assessment by the nurse

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24
Q

What is an important question to ask when assessing chronic pain?

A

How is the pain impacting patient functionality in day to day life?

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25
What are some ethical issues that arise from pain management?
Fear of hastening death by increasing doses of analgesics for terminally ill patients Assisted suicide requests Giving placebos Mismanagement of geriatric pain
26
Rule of double effect
If an unwanted consequence occurs as a result of an action taken to achieve moral good, the action is justified
27
What is the rule of double effect commonly applied to?
Giving increasing doses of pain medications to dying patients with the goal of relieving pain
28
What are some barriers to adequate gerontologic pain management?
Older adults believing pain is inevitable/normal Use of different descriptive language for pain Less ability to report pain Not being believed in their reports of pain
29
What are some things that could hinder clients from reporting pain?
``` Hearing/vision deficits Dementia Delirium Poststroke aphasia Communication barriers ```
30
What is a primary headache? What are the types?
A headache not caused by disease | Tension, migraine, and cluster headaches
31
What is a secondary headache? What could be some causative factors?
A headache caused by another condition or disorder, such as a brain tumor, injury, or sinus infection
32
Tension headache
A stress headache, the most common and least severe form of headache
33
What are clinical manifestations of a tension headache?
Bilateral pain with a pressing or tightening quality Mild to moderate pain Lasts for minutes to days Possible photophobia or photophobia
34
Photophobia
Light sensitivity
35
Phonophobia
Sensitivity to sound
36
What are premonitory symptoms?
Warning symptoms of an impending headache
37
Migraine headache
Recurrent headache characterized by unilateral throbbing
38
Clinical manifestations of a migraine headache?
Aura/premonitory symptoms Steady, pulsing pain that is usually unilateral Lasts for 4-72 hours
39
What is an aura?
A premonitory symptom of a migraine, with visual disturbances or experiencing sensory or motor phenomenon
40
What are cluster headaches?
Most severe form of primary headaches. Repeated headaches that occur in clusters, generally at the same time of day
41
Cluster headache: clinical manifestations
``` Intense pain lasting for minutes to 3 hours Sharp, stabbing pain located around the eye that can radiate Swelling Tearing Facial flushing Nasal congestion Agitation Possible aura Can occur up to 8 times per day ```
42
What are some Interprofessional cares for headaches?
``` Drug therapy Meditation Biofeedback Cognitive/behavioral therapy Relaxation training ```
43
What are goals for headache management?
Reduced/eliminated pain Understanding of triggers and treatments Using positive coping strategies Increased quality of life with decreased disability
44
What are some patient and caregiver teachings for patients with headaches?
``` Keep headache log Avoid triggers Learn purpose and side effects of drugs Exercise Stress management Med adherence Diet education ```
45
What is systemic lupus erythematosus?
Multisystem autoimmune inflammatory disease mainly affecting skin, joints, serous membranes, plus renal, hematologists, and neurological systems
46
Is there a characteristic disease progression for lupus?
No, it progresses and manifests differently for each patient
47
Dermatological findings with lupus
``` Butterfly rash over cheeks and bridge of nose Vascular skin lesions Photosensitive skin reactions Raynaud’s phenomenon Oral/nasopharyngeal ulcers ```
48
Musculoskeletal findings with lupus
Arthritis (95% of patients) Joint pain Swelling Bone loss
49
Cardiopulmonary findings with lupus
``` Lung disease Pleurisy Dysrhythmias Pericarditis Coagulation disorder (antiphospholipid syndrome) ```
50
Renal findings with lupus
Kidney damage (75% of patients)
51
Nervous system findings with lupus
Seizures Cognitive dysfunction (disorientation and memory deficits) Psychosis Higher stroke risk
52
Hematologic findings with lupus
Anemia Leukopenia Thrombocytopenia Coagulation disorders
53
What are some drug therapies used to treat lupus?
``` NSAIDs Antimalarials Immunosuppressants **limited corticosteroids ** Biologic response modifiers ```
54
What are some common comorbidities with lupus?
Depression Anxiety Sjögren’s syndrome Kidney failure
55
What are major teaching points for patients with lupus?
``` Disease process Drug treatment information Pain management Energy conservation Stress avoidance Relaxation therapy Counseling services Community resources Avoid sun exposure Self-esteem maintenance ```
56
Fibromyalgia
Chronic central pain syndrome marked by widespread, non-articular musculoskeletal pain and fatigue with pain at specific tender points
57
Assessment findings with fibromyalgia
Widespread burning pain that worsens and improves Pain with a location that is hard to pinpoint Head or face pain Migraines Memory lapses Concentration problems Pain and tender points
58
Complications of fibromyalgia
``` IBS Swallowing problems Sleep problems Urinary frequency/difficulty Painful menstruation with possible flare ups Sleep problems ```
59
Why is fibromyalgia so difficult to diagnose?
Lack of knowledge about disease and manifestations Need to rule out many other disorders No diagnostic test for it Manifestations unique to each person
60
Treatment for fibromyalgia
Drug therapy (often anti seizure meds, SSRI’s, pain management drugs) Stretching Hot and cold therapy Vitamin/mineral supplements
61
What nursing interventions might help with fibromyalgia?
Education Distraction Listening Hot/cold application
62
What are holistic therapies for pain relief?
``` Relaxation Biofeedback Heat/cold Massage Yoga Tai chi Distraction/meditation ```
63
Diet suggestions for fibromyalgia
Limit sugar, alcohol, and caffeine | Eat balanced, healthy diet
64
Chronic insomnia definition
Difficulty falling asleep or remaining asleep for at least 3 night a week for 3 months or longer, with daytime complaints of interrupted function
65
Who is most likely to suffer from insomnia?
Women Those divorced, widowed, or separated Low SES or education level
66
What are some factors that contribute to poor sleep hygiene?
``` Irregular sleep/wake schedules Drinking close to bedtime Smoking Medications Stress Psychiatric or medical conditions Jet lag Nightmares/PTSD Exercise close to bedtime Napping Genetics ```
67
What are clinical manifestations of chronic insomnia?
``` Difficulty falling asleep Frequent awakening Problems staying asleep Non-restorative sleep Forgetfulness Confusion Grumpiness ```
68
What are some nursing diagnoses for sleep disorders?
Insomnia Sleep deprivation Disturbed sleep pattern Readiness for enhanced sleep
69
What are some nursing interventions to help with insomnia?
Educate about sleep hygiene Teach relaxation techniques Education about sleep medications
70
What are important teachings related to chronic insomnia?
``` Don’t go to bed unless tired Regular sleep schedule Sleep rituals Quit drinking alcohol 4-6 hours before bed Cool, dark, quiet environment ```
71
Systematic exertion intolerance disease (SEID)
Formerly chronic fatigue syndrome | Multisystem disease in which any form of exertion can adversely affect multiple organs/systems
72
Who is most likely to suffer from SEID?
Women
73
What are assessment findings in SEID?
``` 6+ months of profound fatigue Postexertional malaise Un refreshing sleep Brain fog Orthostatic intolerance ```
74
Disease progression of SEID?
Does not progress, many often recover or gradually improve
75
What are complications of SEID?
``` Anger Pain Frustration Inability to do ADLs Loss of livelihood Depression Brain fog ```
76
What are some common comorbidities with SEID?
Fibromyalgia RA Depression
77
Why is SEID so difficult to diagnose?
No diagnostic test, so must be diagnosed by elimination. Also shares many symptoms with fibromyalgia
78
How is SEID treated?
No definitive treatment, but NSAIDS, antihistamines, antidepressants, and SSRIs can be used to manage symptoms Balanced diet and a carefully graduated exercise program are recommended
79
What nursing interventions might help with SEID?
Education Listening/saying you believe them Connect them to resources Discourage total bed rest
80
Define anemia
Deficiency in number of RBCs, quantity/quality of hemoglobin, or volume of packed red blood cells (hematocrit)
81
What are some causes of chronic anemia?
``` Iron deficiency Blood loss from trauma Inherited anemia Medications Folic acid or B12 deficiency Radiation Decreased RBC production Increased RBC destruction ```
82
What are some causes of decreased red blood cell production?
Decreased hemoglobin synthesis Defective DNA synthesis Decreased erythropoietin or iron Decreased number of RBC production precursors
83
What are some chronic causes of blood loss?
Gastritis Menstrual flow Hemorrhoids
84
What are some conditions that contribute to increased RBC destruction?
``` Sickle cell disease Enzyme deficiency Membrane abnormalities Trauma Incompatible blood transfusions ```
85
What are common assessment findings/manifestations/complications of anemia?
``` Palpitations Dyspnea Mild fatigue Pallor/jaundice Increased HR Systolic murmurs/bruits Angina/MI HF ```
86
Normal hemoglobin levels
Women: 12-16 g/dL Men: 14-18 g/dL
87
Normal hematocrit level?
Women: 37-48% Men: 45-52%
88
What is a good rule of thumb for determining hct?
Generally three times the hemoglobin amount
89
What are manifestations of mild anemia?
Palpitations Exertional dyspnea Mild fatigue
90
Manifestations of moderate anemia?
``` Palpitations Bounding pulse Dyspnea Fatigue Roaring in ears ```
91
Manifestations of severe anemia
``` Pallor Jaundice Blurred vision Tachycardia Angina HF Headache Vertigo Irritability Anorexia Weight loss Lethargy ```
92
Why is jaundice present in anemia?
Hemolysis of RBCs leading to increased concentration of serum bilirubin
93
What are potential nursing diagnoses related to anemia?
Fatigue Imbalanced nutrition Anxiety
94
What are goals for patients with anemia?
Assume normal ADLs Maintain adequate nutrition Develop no complications r/t anemia
95
What nursing interventions are appropriate for patients with anemia?
Diet changes Oxygen therapy RBC replacement/blood transfusion if severe Medication treatment
96
What would a nurse teach about activity and exercise r/t anemia?
Alternate rest and activity periods Prioritize activities Avoid activity right after meals
97
What are gerontologic considerations for anemia?
RBC mass changes with age | Anemia is not normal (usually has underlying cause)
98
What are some underlying causes for anemia in older adults?
``` Iron deficiency Bleeding Chronic disease/inflammation Renal insufficiency Blood cancer Decreased testosterone ```
99
What are some additional clinical manifestations of anemia in older adults?
``` Pallor Confusion Ataxia (impaired coordination) Fatigue Worsening cardiovascular or respiratory problems ```
100
How is hypertension defined?
Greater than 140/90 or a normal BP but on antihypertensive medications
101
Describe hypertension using normal language
Heart pumping with higher force, causing stress on vessels and the heart
102
Primary hypertension
No known cause
103
Secondary hypertension
Elevated blood pressure caused by an underlying condition (can be corrected)
104
Who is most likely to get hypertension?
``` African Americans Mexican Americans Middle aged men Women over 60ish Women on oral contraceptives Diabetics Those with family history of HTN/heart disease ```
105
Modifiable risk factors for hypertension
``` Alcohol intake Tobacco use Diabetes/blood sugar control Elevated serum lipids and cholesterol Excess sodium Sedentary lifestyle Stress ```
106
Non-modifiable risk factors for hypertension
Age Gender Family history Ethnicity
107
What are assessment findings in hypertension?
Usually none | If severe, can cause headache,fatigue, dizziness, palpitations, angina, dyspnea
108
Why is hypertension called the silent killer?
It is often asymptomatic until it is severe and begins to cause organ damage
109
What are potential complications with HTN?
``` CAD LVH Cerebrovascular disease PVD Nephrosclerosis Retinal damage ```
110
What are lifestyle modification recommendations for HTN?
``` Weight reduction DASH diet Sodium restriction Moderate alcohol intake Physical activity Tobacco avoidance/cessation Stress reduction ```
111
What is the DASH eating plan?
Dietary approaches to stop hypertension Less red meat, salt, sweets, and added sugars Increased fruits, veggies, whole grains, fish, low fat milk, legumes
112
What are physical activity recommendations for hypertension?
30 min/day at least 5 days a week. At least 150 minutes a week
113
What are some nursing diagnoses for patients with hypertension?
Ineffective health management Anxiety Risk for decreased cardiac tissue perfusion
114
What are goal for clients with hypertension?
Achieve and maintain goal blood pressure Follow treatment plan Experience minimal side effects Manage/cope with condition
115
What are some reasons clients do not adhere to teaching recommendations for hypertension?
``` Inadequate teaching Side effects of meds Cost Insurance issues BP returning to normal Lack of trust in healthcare workers ```
116
Describe coronary artery disease (CAD) in simple language
Hardening/narrowing of the coronary arteries
117
Who is most likely to get CAD?
``` Whites African Americans (earlier onset) Native Americans (earlier deaths) Men under 75 at higher risk, then risk becomes equal Women more likely to die from it ```
118
Non-modifiable CAD risk factors
Age Gender Ethnicity Genetics
119
Modifiable CAD risk factors
``` Serum lipids Blood pressure Diabetes control Tobacco use Inactivity Obesity ```
120
What are some other modifiable risk factors that contribute to CAD?
Fasting blood glucose greater than 100 mg/dL Depression Stress Elevated homocysteine
121
Metabolic syndrome
Central obesity + hypertension + abnormal serum lipids + elevated fasting glucose
122
Metabolic syndrome promotes the development of what alteration in tissue perfusion?
Coronary artery disease
123
CAD clinical manifestations
Often none, maybe chest pain
124
What are assessment findings with CAD?
High serum lipids
125
What is a normal total cholesterol level?
Less than 200 mg/dL
126
What is a potential complication of CAD?
MI
127
What does nursing and interprofessional care consist of for CAD?
Health promotion (screening!) Identifying and managing high risk individuals Physical activity/weight loss Nutrition therapy
128
What would be important information to collect in health screening for CAD?
``` Family history BP Cardiovascular symptoms Lifestyle habits Psychosocial history (stress) Employment Health beliefs Education level/background Cholesterol level ```
129
What are FITT recommendations?
Exercise recommendations for CAD. Stands for Frequency, Intensity, Type, and Time Involves 30 minutes of moderate activity most days of the week plus two days of weight training per week
130
What are nutrition recommendations for patients with CAD?
Decrease saturated fat and cholesterol Increase complex carbs and fiber Keep fat between 25 and 35% of total intake, mostly from mono/polyunsaturated fats Less alcohol and simple sugar intake
131
What are some patient teaching priorities for CAD?
``` Regular BP checks Reduce fat intake Stop smoking Exercise Be aware of stress/minimize stress Obesity reduction Diabetes control ```
132
Define Chronic Heart Failure in simple language
Heart being unable to provide sufficient blood to meet the oxygen needs of tissues and organs
133
Who is most likely to get CHF?
African Americans Asians Those with hypertension, CAD, COPD, or diabetes
134
What are assessment findings/manifestations for clients with left sided heart failure?
``` Increased heart rate Decreased 02 sats Increased arterial CO2 Crackles in lungs Extra heart sounds Weakness Fatigue Anxiety Dyspnea Dry, hacking cough ```
135
What are manifestations of right sided heart failure?
``` Murmurs Jugular venous distention Edema Weight gain Ascites Hepatomegaly Fatigue Anorexia Nausea GI bloating Tachycardia Nocturia Confusion Restlessness Stasis ulcers ```
136
What does the FACES acronym pertain to and stand for?
Pertains to signs and symptoms of heart failure | Stands for: Fatigue, Activity limitation, Chest congestion/cough, Edema, Shortness of breath
137
What are potential complications associated with heart failure?
``` Pleural effusion Dysrhythmias Left ventricular thrombus Hepatomegaly Renal failure ```
138
What is nutritional therapy for patients with heart failure?
Low sodium diet DASH diet Monitoring of fluid/daily weights
139
What are potential nursing diagnoses for patients with CHF?
Impaired gas exchange Decreased cardiac output Excess fluid volume Activity intolerance
140
What are goals for clients with heart failure?
Decreased symptoms and peripheral edema Increased exercise tolerance Treatment adherence No complications from disease
141
What do we teach CHF patients about activity programs?
Increase activity gradually Consider cardiac rehabilitation Avoid temperature extremes
142
What do we need to teach CHF patients about ongoing monitoring?
Know s/s of worsening heart failure (FACES) Monitor vital signs and daily weights Report: weight gain, SOB, dry/hacking cough, fatigue, edema, nausea, dizziness
143
What do we teach CHF patients about health promotion?
Flu and pneumonia vaccines | Reduction of risk factors
144
What do we teach CHF patients about rest?
Alternate rest and activity Rest after exertion Potentially take shorter work hours Avoid emotional upset
145
What do we teach CHF patients about nutrition?
Limit salt Follow good nutrition plan ( preferably DASH) Adhere to diuretics
146
What are guidelines for teaching related to drug adherence for CHF?
Follow regimen closely Develop system for adherence Check pulse before medications Know s/s of orthostatic hypotension and internal bleeding
147
What is tuberculosis?
A bacterial infection normally involving the respiratory system
148
How much of the world’s population has TB?
About 1/3
149
Who is at highest risk to get TB?
HIV/immunosuppressed patients Poor Underserved/minority/homeless patients Inner city people Those living in or working in institutions Those living/traveling to other countries
150
What problems have resulted in drug resistant TB?
Incorrect prescribing Lack of public health awareness/management of TB cases Non adherence to treatment
151
Primary TB
Bacteria are inhaled and start the inflammation reaction. May or may not progress to actual disease (usually doesnt in healthy people)
152
Latent TB
TB bacteria are present but disease is not active. Patient will test positive but is not contagious
153
Active TB
Patient is contagious and manifesting symptoms
154
Primary active TB
Patient gets sick immediately upon initial infection
155
Post-primary active TB
Patient has latent period before infection becomes active
156
Assessment findings/manifestations of TB
``` Dry cough that later becomes productive Fatigue Anorexia Night sweats Weight loss Fever Dyspnea Crackles Chills Blood in sputum (hemoptysis) ```
157
How long do TB symptoms take to develop?
2-3 weeks
158
How/where can extra-pulmonary TB manifest?
Renal TB Bone TB Meningitis TB
159
What are complications of TB?
Scarring Pulmonary damage Death
160
What is miliary TB?
Mycobacterium being systemically distributed in the bloodstream (leads to extra pulmonary TB)
161
What are potential long term complications of TB?
``` Death Hepatomegaly Splenomegaly Spinal destruction Peritonitis ```
162
What is the standard method to know if someone has been exposed to TB?
TB skin test
163
Induration
Palpable, raised, hardened area at site of TB injection (positive result)
164
Other diagnostic studies for TB
Chest x-ray | Interferon y blood tests
165
What is the only way to actually diagnose TB?
3 sputum cultures (smeared and cultured) collected on 3 different occasions
166
How long can bacteriological diagnosis of TB take?
Up to 8 weeks
167
Why is compliance such an issue in TB management?
Long duration of treatment | Side effects to meds
168
What are nursing interventions for health promotion related to TB?
Screening and follow up Addressing social and lifestyle factors of TB development Education
169
Is TB reportable?
Yes, it must be reported (public health concern)
170
Directly observed therapy for TB
Making sure patients actually take their meds
171
What precautions should be taken for TB patients in acute care settings?
Airborne isolation Drug therapy Hepa masks
172
What should patients be taught in acute care settings in regard to TB?
Cover nose and mouth with paper tissues when coughing Wash hands Wear mask when leaving the room Screen visitors and family members
173
What does ambulatory care consist of for TB patients?
Monthly culture and smear Drug adherence Reporting to public health department
174
What should ambulatory TB patients be taught?
Live in well-ventilated home Sleep alone while contagious Spend lots of time outside Minimize time in crowds or using public transportation
175
What is a reactivating factor for TB?
Smoking
176
Asthma definition
Difficulty breathing due to overreactive airways (happens in periods of flare ups)
177
Who is most likely to get asthma?
Boys before puberty Women after puberty African Americans Puerto Rican’s
178
What are some asthma triggers?
``` Mold Pollens Allergens Fumes Chemicals/agriculture/farming Exercise Smoking Stress Anxiety Smog ```
179
What is exercise induced asthma?
Asthma brought on by exercise (usually happens after exertion
180
What are general clinical manifestations of asthma?
Cough Respiratory symptoms Gastric reflux Heartburn
181
How could the cough in asthma be described?
Hacking Irritating Non productive Rattling
182
What are respiratory related signs in asthma?
``` SOB Prolonged exhalation Wheeze Dark red lips Cyanosis Restlessness/anxiety Chest tightness Positioning for optimal breathing ```
183
Lung sounds with asthma
Crackles | High pitched wheezes
184
What changes occur after repeated episodes of asthma?
Barrel chest Elevated shoulders/changed musculature Accessory muscle use Lung damage
185
What are potential complications with asthma?
Death | Permanent lung damage
186
What nursing interventions can help prevent asthma complications?
Inhaled medications Drug therapy Monitoring IV fluids
187
What do medication regimens look like for asthma patients?
Usually SABAs + long term controller medications (often corticosteroids)
188
What are goals for asthmatic clients?
``` Minimal symptoms Acceptable activity levels Avoidance of triggers Knowledge about action plan Maintain above 80% of best peak flow ```
189
Client teaching about avoiding asthma attacks
Know and avoid triggers Avoid cold Promptly treat URIs
190
What is included in an asthma action plan?
Using peak flow monitoring to determine what to do with medications
191
Why use a peak flow meter?
It can tell the patient about airway narrowing before symptoms begin Can help identify triggers Can let patient know when to take meds
192
What does the patient need to record with peak flow monitoring?
Peak flow numbers and respiratory symptoms
193
Peak flow green zone
80% or greater of personal best, take meds as normal
194
Peak flow yellow zone
50-80% of personal best, take SABA and call doctor
195
Red zone peak flow
Less than 50% of best, take SABA ASAP and call doc immediately
196
What holistic therapies can help with asthma?
Breathing techniques Relaxation Deep breathing Yoga
197
What do we teach asthma patients about exercise?
Use prophylactic treatment Do things requiring short bursts of energy Exercise inside if its cold
198
Define COPD
Chronic progressive inflammatory disease of the airways (chronic bronchitis + emphysema)
199
Chronic bronchitis
Bronchial inflammation defined as cough and sputum for at least 3 months of the last two consecutive years
200
Emphysema
Destruction of the alveoli
201
Most common etiology of COPD
Smoking
202
Non-modifiable COPD risk factors
``` Genetics Gender Aging Infection Asthma ```
203
What is alpha antitrypsin deficiency?
Autosomal recessive disorder that is a genetic risk for COPD
204
Modifiable COPD risk factors
Smoking Occupational exposure Pollution
205
Asthma versus COPD: age of onset
Asthma: younger than 40 COPD: usually between 40 and 60
206
Asthma vs COPD: dyspnea
Asthma: only during exacerbations or when poorly controlled COPD: during exertion
207
Asthma vs COPD: sputum production
asthma: infrequent COPD: often
208
What are assessment findings/manifestations of COPD?
``` Chronic cough with sputum production Dyspnea/air hunger Barrel chest Tripod positioning Polycythemia ```
209
What are chronic complications associated with COPD?
Cor pulmonale Acute exacerbations Acute respiratory failure
210
Cor pulmonale
Right sided heart failure due to pulmonary hypertension (often seen with COPD patients)
211
Cor pulmonale assessment findings?
``` Jugular venous distension Peripheral edema Poor GI drainage Weight gain Dyspnea ```
212
What are collective care therapies for COPD patients?
``` Spirometry Drug therapy Breathing techniques Immunizations (especially pneumonia) Oxygen therapy Hydration Infection prevention ```
213
How can a patient prevent COPD exacerbations?
Treatment adherence | Recognize symptoms of exacerbations
214
CO2 narcosis
Toxic accumulation of CO2 due to chemorecptor tolerance of CO2
215
With COPD, what should nurses teach in relation to breathing retraining?
Pursed lip breathing | Diaphragmatic breathing
216
Pursed lip breathing: how to teach
Inhale slowly through nose Exhale slowly through pursed lips Exhale for 3 times longer than inhalation Repeat 8-10 times, for 3 to 4 times per day
217
Why is effective coughing necessary with COPD?
To get excess secretions out of the lungs
218
What do we teach COPD clients about huff coughing?
Inhale through mouth using diaphragm Hold for 2-3 seconds Exhale forcefully like you’re fogging a mirror Do this until secretions feel looser, then cough normally to get secretions out
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Why do COPD patients often struggle to eat?
Difficulty eating and breathing at the same time | Diaphragm restricted by full stomach
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What are possible nutrition recommendations for COPD patients?
``` High calorie foods first 6 smaller meals per day (high cal + high nutrient) Limit fluids before meals Eat cold foods Rest for 30 minutes before eating Prepare foods in advance ```
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What are activity and exercise goals and recommendations for COPD patients?
Upper extremity training is good Regular exercise and developing endurance is important Take breaks Work up to walking for 15-20 minutes per day, 3 days a week)
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Define cystic fibrosis
Recessive genetic disease that causes excess mucous production in lungs, GI tract, and reproductive tract due to exocrine gland dysfunction
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Respiratory manifestations of CF
``` Wheezing respirations Dry, non-productive cough Finger clubbing Hemoptysis Dyspnea Frequent infections Difficulty breathing Cor pulmonale ```
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GI manifestations of CF
``` Bulky/loose/foul smelling stools Voracious appetite early in disease and no appetite as it progresses Weight loss Failure to thrive Abdominal distension Fat soluble vitamin deficiency Constipation Decreased albumin Hyponatremia ```
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Steatorrhea
Oily, fatty, foul smelling stools often seen in CF patients
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Azatorrhea
Excess discharge of nitrogenous substances in feces and urine due to decreased pancreatic enzymes (often found in CF)
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Reproductive changes in CF
Delayed puberty/infertility Normal sperm production but no vas deferens development Thickened cervical mucous leading to difficulty conceiving Irregular menstruation
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Complications associated with CF
``` Bone disease Sinus disease Liver disease Renal disease Lung infections Respiratory failure Diabetes Pneumothorax HTN ```
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Goal for client with CF
Adequate airway clearance Reduced respiratory infection risk factors Adequate nutrition (may need lots of calories) Ability to do ADLs Recognize and treat complications Active participation in treatment regimen
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What are treatments to manage respiratory complications of CF?
Aerosol/nebulizer treatment Bronchodilators Breathing exercises Percussion/pummeling to loosen secretions
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What do most CF patients die from?
Complications of respiratory infection
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What is an acapella?
Airway clearance device for CF patients
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What are treatments to mange GI complications of CF?
Pancreatic enzyme replacement Adequate nutrition intake Upright position after eating Fat soluble vitamin and salt supplementation
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What are nursing considerations/recommendations related to CF patients marrying and having children?
Genetic counseling is recommended Shorter life span Reduced ability to care for children

Krystan: Semester Two Nursing School (13 decks)

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