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331: Exam 2 (Respiratory, GI,, and Cardiac) > Chronic Respiratory > Flashcards

Chronic Respiratory Flashcards

1
Q

Asthma is what type of hypersensitivity?

A

Type 1: IgE

-Mast cells release histamine + leukotrienes

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2
Q

Asthma RF:

A
  1. Age
  2. Genetics
  3. Gender (Boys until puberty’, then women)
  4. Obesity
  5. Ethnicity (African American)
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3
Q

Asthma Environmental Factors

A
  1. Allergens
  2. Infections
  3. Tobacco smoke
  4. Pollution
  5. Diet
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4
Q

Asthma: S/S

A
  • Dyspnea
  • Expiratory wheezing
  • Cough
  • Diaphoresis
  • Paroxysmal, hacking, -nonproductive cough at onset; becomes rattling and productive of clear sputum
  • Prolonged expiratory phase
  • Anxious expression, restlessness
  • Setting position
  • Coarse rhonchi
  • Signs of respiratory distress; nasal flaring, cyanosis, intercostal retractions
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5
Q

Asthma Diagnosis

A
  1. medial history
  2. physical exam
  3. lab results
  4. PFT helpful in confirming and evaluating response to treatment
  5. PEFR: Peak expiratory flow rate
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6
Q

Peak Expiratory Flow Rate

A

Peak expiratory flow (PEF): amount of air that can be forcefully exhaled in 1 second

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7
Q

Rescue Meds

A

–Short Acting Beta 2 adrenergic agonists/ Bronchodilators: Proventil, xopenex, albuterol

–Methylxanthines (not used much- theophylline b/c of easy toxicity)

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8
Q

Controller meds

A

•Controllers (Preventer medications)

–Corticosteroids: QVAR, pulmicort, flovent (first line)

–Long Acting Beta 2 adrenergic agonists: Advair, Serevent

–Mast cell stabilizers: Cromolyn

–Leukotriene inhibitors: Singulair

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9
Q

Corticosteroids

A

QVAR, pulmicort, flovent (first line)

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10
Q

LABAs

A

Advair

Serevent

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11
Q

Mast cells stabilizers

A

Cromolyn

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12
Q

Leukotriene inhibitors

A

Singulair

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13
Q

PEF

A

Green Zone: 80-100% of personal best

Yellow Zone: 50-79% of personal best (Give albuterol)

Red Zone: Below 50% of personal best (911, O2)

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14
Q

Asthma: Nursing interventions

A
  1. High fowler position
  2. O2
  3. Teach child to use diaphragm to pull in and expel air
  4. Control panic
  5. Administer rescue drugs
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15
Q

Most common lethal inherited disease in Caucasians

A

CF

-Autosomal Recessive disorder

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16
Q

CF: Etiology

A
  • Disruption of normal function of exocrine glands related to sodium + chloride transport via cystic fibrosis transmembrane regulator protein (CFTR)
  • Impaired fluid secretions cause very thick exocrine secretions (EVERYWHERE)
  • Gene mutations differ in severity
  • Life expectancy increasing
17
Q

CF: Lungs

A
  1. Repeated episodes of bronchitis (bronchial PNA)
  2. Generalized obstructive emphysema

•Signs/symptoms; wheezy cough, increasing dyspnea, thick rattling extremely productive cough, cyanosis, pneumonia, polyps in nose, clubbed digits, chronic sinusitis

18
Q

CF effects what organs?

A
  1. Respiratory
  2. GI
  3. Reproductive
  4. Hepatic
19
Q

CF: GI

A

Small intestines:

  • Obstructions
  • Meconium obstruction

Pancreatic Ducts:
-Pancreatic achylia: less digestive enzymes, malabsorption syndrome + diabetes

ADEK vitamin def (fat soluble)

20
Q

CF GI Symptoms

A
  1. Appetite changes
  2. Steatorrhea
  3. azotorrhea (fowl stools)
  4. weight loss
  5. tissue wasting (nutrition)
  6. Distended abdomen (ascites)
  7. sallow skin (not healthy in complexion)
  8. Anemia
21
Q

CF: Liver

A

Bile Ducts

  1. Biliary fibrosis
  2. Biliary cirrhosis
  3. Portal hypertension

S/S:

  • Ascites
  • GI bleeding
  • Jaundice
22
Q

CF: Major symptoms

A
  1. Delayed puberty
  2. Infertility
    - Male: Most
    - Female: 50%
  3. Salivary + sweat glands
    - Electrolyte loss
    - Salty sweat
    - Dehydration
    - Hyponatremia
    - Heat stroke
23
Q

Testing for CF

A

Newborn: Pilcarpine electrophoresis (chloride sweat test) >60mEQ
+stool for fecal FAT

Prenatal: DNA of chorionic villi or amitotic fluid

24
Q

CF: Ways to maximize health potential

A
  1. Pulm hygiene
  2. Nutrition
  3. Prevent/treat infection
25
Q

CF: gene therapy

A

Activation of mutant CFTR, protein replacement therapy

26
Q

TOP goals of CF

A
  1. Prevent infection

2. Nutrition

27
Q

CF: Treatment

A

•Aggressive airway clearance (BID)

  1. Percussion
    - Before eating, will decrease vomiting and increase appetite
  • Manual
  • Positive expiratory pressure (PEP mask + flutter valve)
  • High frequency chest percussion vest
  • Airway oscillators like the Flutter device.
  1. Postural drainage
  2. Breathing exercises
  3. Physical exercise
  4. O2 Therapy: Caution like COPD patient (dependency)
  5. Aerosols, Nebs
    - antibiotics nebs
28
Q

CF: drug therapy

A
  1. Bronchodilators
  2. Mucolytic
    - Dornase Alfa (Pulmozyme)
  3. Chloride channel activators + Sodium channel blockers
  4. Antibiotics
    - Therapeutic + Prophylactic (Z-pack)
29
Q

CF: drugs for GI

A
  1. Pancreatic enzymes
  2. Fat-soluble vitamins (A,D,E,K)
  3. Stool softeners
  4. NaCl tablets, in hot weather
  5. Oral Iron supplements
  6. Monitor blood glucose

*High fat diet

30
Q

CF: Other treatments

A
  1. Anti-inflammatory agents
  2. Protease inhibitors
  3. Immunizations including flu
  4. Lung transplant
31
Q

CF: Nursing

A
  • Careful respiratory assessment, vigilance on chest PT and respiratory treatments
  • Constant assessment of IV site and judicious administration of antibiotics
  • Enzyme replacement
  • Exercise and fun
  • Isolation?
  • High calorie, high protein, unrestricted fat foods and shakes, nutritional evaluation
  • Impact of chronic condition on the family

331: Exam 2 (Respiratory, GI,, and Cardiac) (2 decks)

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