Chap 24: Mgmt. of patients with chronic pulm. disease

Question 1

what does a rapid assessment of respiratory status include?

Answer 1

Assessment of airway and breathing, O2 sat and O2 delivered, BP, HR, work of breathing, lung and heart sounds, LOC

Question 2

what is the nursing management for Asthma?

Answer 2

Monitor: severity of symptoms, breath sounds, peak flow, pulse ox, and V/S.
Interventions: obtain a hx of allergies, identify meds that patient is taking, admin. fluids if needed.

Question 3

what is the pharmacologic steps given in their order for asthma?

Answer 3

1. SABA, PRN
2. Low dose ICS: inhaled cortico steroid
3. Low dose ICS and LABA OR medium dose ICS
4. preferred medium-dose: ICS + LABA
5. preferred: high dose ICS + LABA AND consider omalizumab
6. preferred: high dose ICS + LABA + oral corticosteroid and consider omalizumab.

Question 4

What medications are used in Asthma and what are their effects?

Answer 4

Bronchodilators: 1. beta agonists: epi, albuterol, isoetharine.

2. anticholinergics: block Parasymp. nerv. syst. and promote bronchodilation.
3. xanthines: decrease bronchospasm
4. antiinflammatory agents: cromolyn sodium: decreases airway inflammation, decrease edema, inhibit release of histamine, prev. mast cells from opening, and increase permeability. (5-15mcg/mL)

Question 5

what are the treatment steps of acute exacerbation?

Answer 5

oxygen, SABA (inhaled or IV), High dose syst. corticosteroids (PO or IV)
Monitor: VS. Pulse ox, ABGs IF o2 sat is <94% and symptomatic OR if sat is < 90% regardless of symptoms

Question 6

what are the risks of Long acting asthma medications?

Answer 6

ICS: cough, dysphonia, oral thrush, H/A. high doses: systematic effects, adrenal suppression, osteoporosis, skin thinning, easy bruising
Systematic CS: Short-term: increase in appetite, fluid retention, wt.gain, mood alteration, HTN, peptic ulcer, aseptic necrosis.
Long term: adrenal suppression, growth suppression, dermal thinning, HTN, diabetes, Cushings, cataracts, musc. weakness, impaired immune function
LABA: decreased prot. from EIA, tachy, musc. tremor, hypokalemia, ECG changes, seizure, fatal/life threatening exacerbation.
Xanthines: tachy, N/V, tachyarrhythmia, CNS stim, HA, seizures, hemataemesis, hyperglycemia, hypokalemia, insomnia, GI upset,
Leukotriene Receptor Agonists: Smooth muscle relaxation

Question 7

What are the short term meds for asthma and risks?

Answer 7

Inhaled SABA: tachy, muscle tremor, hypokalemia, increase lactic acid, ha, hyperglycemia
Anticholinergics: dry mouth, increased wheezing, does not stop EIB.
Corticosteroids: blood glucose anomalies, increase in appetite, wt. gain, HTN, mood alt., fluid retention, peptic ulcer.

Question 8

how does the WBC differentiate between bacterial and viral PNA? What does the WBC indicate about asthma control?

Answer 8

Bacterial PNA: increased neutrophils: bandemia
Viral PNA: increased lymphocytes
Asthma: increased WBC is the A1C of asthma. eosinophils.

Question 9

what is the asthma action plan?

Answer 9

Green Zone: 80%+ peak flow, can do usual activities, no symptoms. NO INTERVENTION
Yellow Zone: asthma is getting worse, symptoms present, waking d/t asthma, cant do some of act. peak flow 50-79% of base peak flow. INTERVENTION: 1st SABA- 2-4puffs q20min up to 1hr. Neb. once
2nd: take SABA 2-4 puffs, neb, add oral CS for _ #of days.
Red Zone: Very SOB, no effect with SABA, cant do usual activities, symptoms same or worse p 24hrs in yellow zone. Peak flow: < 50% of best peak flow. INTERVENTION: SABA: 2-4puffs, or neb, oral CS, CALL DR. NOW. Call ambulance if you are still in Red Zone after 15m or DR. has not been reached.

Question 10

What are some causes of asthma?

Answer 10

constriction of bronchioles, swelling of bronchial membranes, increased mucous production.

Question 11

What is the pathophysiology of an asthma attack?

Answer 11

Bronchiole muscles enlarge, thick mucous is produced, airways are hyperinflated: air trapping. AG>AB response, mast cells release histamine, bradykinin, prostaglandins, and SRSA (slow reacting substance of anaphylaxis)
AG: antigen AB: antibody

Question 12

stimulation of alpha receptors cause?

stimulation of beta receptors cause?

Answer 12

alpha receptors: bronchoconstriction

beta receptors: bronchodilation

Question 13

what are some non-allergic triggers for asthma?

Answer 13

viral illnesses, common cold, cold air, infection, stress, and smoke

Question 14

how is sinusitis treated in patients who have asthma?

Answer 14

monitor closely for S/S of super infection, start with Amoxicillin, if no improvement after 5 days, switch to Augmentin for 10 days. May need CS.

Question 15

How can asthma exacerbations be prevented?

Answer 15

flu vaccines, exercise sleep and optimal nutrition are encouraged.

Question 16

What role might Magnesium play in asthma?

Answer 16

It may act as a bronchodilator. Beta 2 agonists may lead to Mg deficiency.

Question 17

What is included in resuscitation for status asthmaticus?

Answer 17

Oxygen therapy, admin of SABA, ICS, LABA, theophylline, hydration, monitor K and Ph, O2.

Question 18

what is the way to teach a patient to take a peak flow measurement?

Answer 18

stand up straight, indicator is at bottom of meter, take a deep breath, fill lungs completely, put mouthpiece in mouth, lightly bite, close lips, blast air out as hard and fast as poss. in a single blow. Record number on meter. Repeat three times, Record highest reading. Repeat test over 2-3 week period, to find personal best.

Question 19

what is PaO2/FiO2 ratio? what is normal and how is this number used?

Answer 19

amount of O2 in the blood in relation to the amount of inspired oxygen.
Normal: 380-476mmHg. Used to describe the degree of lung injury.

Question 20

What is the order of assessment in the diagnosis of COPD

Answer 20

Assess symptoms (mRC 0-1 or CAT <10) no to little symptoms. MrC >2 or CAT >10)
Airflow limitations: FEV1/FVC < 70
Risk of exacerbations: 0-1 exacerbation risk low, 2+ risk is high
Comorbidities: CV disease, osteoporosis, URI, DM, Lung Ca, anxiety/depression

Question 21

What are the Severity of airflow limitations using GOLD standards

Answer 21

Gold 1: Mild FEV1, > or = to 80% predicted
Gold 2: Moderate 50-80% predicted
Gold 3: Severe 30-50% predicted
Gold 4: Very severe, FEV1, < 30% predicted

Question 22

What are the treatment strategies for COPD?

Answer 22

Manage modifiable risk, Vaccinations: flu and pneumococcal, medications

Question 23

which meds are used for COPD

Answer 23

long acting inhaled bronchodilators: reduce exacerbations, hospitalizations, and improve symptoms.
Inhaled corticosteroids: improve symptoms, lung function, and quality of life and reduces exacerbations. CAN increase risk of PNA and withdrawal can cause exacerbations.

Question 24

Common cause and treatment of exacerbation?

Answer 24

Viral URI

Rx: SABAs, Systemic steriods (30-40mg/day) for 10days, O2 therapy maintain sat at >89%.