Clients w/ Respiratory Alterations - Exam 2

Question 1

Condition characterized by excessive mucous production resulting in chronic productive cough for at least 3 months in each of 2 consecutive years

Answer 1

Chronic bronchitis

Question 2

Why is mucous production increased in bronchitis?

Answer 2

-increased number and size of goblet cells
-enlarged submucosal glands
-dysfunction of cilia
-stimulation from inflammatory mediators

Question 3

Condition characterized by abnormal distention of airspaces beyond the terminal bronchioles and destruction of the walls of alveoli

Answer 3

Emphysema

Question 4

The physiologic changes of emphysema lead to what?

Answer 4

Increase in dead space lead to impaired oxygen diffusion - hypoxemia and hypercapnia

Question 5

Where is inflammation found in COPD?

Answer 5

airways
lung parenchyma
pulmonary blood vessels

Question 6

COPD is an air _____ disease

Answer 6

Trapping

Question 7

Airflow is not fully what in COPD?

Answer 7

Reversible

Question 8

What does it mean for airflow to not be ‘fully reversible’ in COPD?

Answer 8

Air gets trapped in the bottom of the lungs during exhalation

Question 9

What causes airflow limitations in COPD patients?

Answer 9

loss of elastic recoil

Question 10

Airflow obstruction in COPD is due to what factors?

Answer 10

Hypersecretion of mucous
Mucosal edema
Bronchospasm

Question 11

Risk Factors for COPD

Answer 11

Smoking
Occupational chemicals and dust
Air pollution
Recurring respiratory infections
Alpha-antitrypsin deficiency
Low SES

Question 12

What diagnosis should be considered with any patient who is over 40 years old with a history of 10 or more pack years OR after 20 pack years?

Answer 12

COPD

Question 13

How does nicotine affect the body?

Answer 13

Stimulates SNS
Decreases amount of functional hemoglobin
Increases platelet aggregation
Compounds CAD complications

Question 14

How does smoking effect the respiratory tract?

Answer 14

Hyperplasia of goblet cells
Lost/decreased ciliary activity
Destruction and dilation of alveoli
Inflammation
Decreases oxygen carrying capacity

Question 15

Effects of Aging on Respiratory System

Answer 15

Loss of elastic recoil in lungs
Stiffening of chest wall
Decreased exercise tolerance
Lungs are smaller and rounder
Number of functional alveoli decreases

Question 16

COPD Clinical Manifestations

Answer 16

Chronic cough
Sputum production
Dyspnea
Accessory muscle use
Inefficient breathing pattern
Weight loss
Exercise intolerance
Wheezing
Decreased breath sounds
Crackles
Tripod position
Pursed lip breathing
Prolonged expirations (blowing off CO2)

Question 17

What COPD manifestation usually prompts patients to seek care?

Answer 17

Dyspnea

Question 18

COPD Assessment and Diagnostics

Answer 18

H&P
ABG
CXR or CT
Alpha-antitrypsin screening
PFTs

Question 19

Patients with COPD have an increased ______ volume

Answer 19

residual

Question 20

The FEV1 FVC ratio must be what percent to diagnose COPD?

Answer 20

<70%

Question 21

What will a CXR or CT show in a patient with COPD?

Answer 21

flattened diaphragm

Question 22

COPD can lead to what complications

Answer 22

Exacerbations
Respiratory insufficiency
Respiratory Failure
Pulmonary hypertension
PNA

Question 23

The result of pulmonary hypertension in which the right side of the heart is dilated or hypertrophied

Answer 23

Cor pulmonale

Question 24

Cor pulmonale is a result of what?

Answer 24

PAH

Question 25

Cor pulmonale eventually leads to what?

Answer 25

R sided HF

Question 26

What 3 muscles are involved in breathing?

Answer 26

1. Diaphragm 2. Rib cage muscles 3. Abdominal muscles

Question 27

What is responsible for the act of breathing?

Answer 27

Pressure gradient

Question 28

Clinical manifestations of cor pulmonale

Answer 28

Dyspnea with possible crackles JVD Hepatomegaly w/ RUQ tenderness Peripheral edema Weight gain

Question 29

When pt's with COPD are experiencing difficulty in breathing, what is the best position?

Answer 29

Tripod

Question 30

Susie presents to the ER complaining of severe dyspnea and weight gain of 5 lbs in the last 4 days. She has a history of COPD, HTN, and diabetes. Auscultation of her lungs reveals crackles and she displays obvious signs of JVD. Her RUQ is tender upon light palpation, what do you as the nurse think Susie may be experiencing?

Answer 30

Cor pulmonale

Question 31

In patients that have chronic COPD, what lab value can be elevated due to the lack of O2?

Answer 31

Hemoglobin

Question 32

What diagnostics would be performed on Susie to confirm our diagnosis of cor pulmonale?

Answer 32

CXR R sided cardiac cath (gold standard) Echo BNP levels

Question 33

How is cor pulmonale treated?

Answer 33

Tx underlying cause (COPD) Meds to decrease BP Diuretics to reduce fluid retention Oxygen

Question 34

A patient with COPD is experiencing sudden dyspnea with SOB, cough, and increased sputum with purulence - what is this?

Answer 34

An exacerbation

Question 35

What system is activated due to pH changes in COPD, in response to decreased left ventricular output? And what is the result?

Answer 35

RAAS causing fluid retention

Question 36

How do you determine the severity of a COPD exacerbation?

Answer 36

Use of accessory muscles Central cyanosis

Question 37

Definition: When your body makes too many RBC's, thickening your blood, making you more susceptible to blood clots.

Answer 37

Polycythemia

Question 38

How do you treat a COPD exacerbation?

Answer 38

Short-acting bronchodilator or nebulizer Steroids Abxs Oxygen

Question 39

Type of ventilation that on inspiration delivers more air pressure, on expiration, the machine reduces the air pressure.

Answer 39

BIPAP

Question 40

COPD acute respiratory failure is caused by

Answer 40

Exacerbations Overuse of sedatives, opioids, or benzos Surgery or painful illness

Question 41

Type of ventilation that delivers PEEP (positive end-expiratory pressure) but also maintains the set pressure t/o the respiratory cycle.

Answer 41

CPAP

Question 42

What should a patient with COPD experiencing anxiety r/t SOB do?

Answer 42

Pursed lip breathing

Question 43

What condition causes reduced FVC & FEV1?

Answer 43

COPD

Question 44

What do bronchodilators specifically allow to be increased in COPD patients?

Answer 44

FEV1

Question 45

What is the goal of oxygen therapy in a COPD patient?

Answer 45

Keep sats above 90% or PaCO >60 mmHg

Question 46

What are the GOLD classifications of COPD?

Answer 46

GOLD 1: Mild FEV1 >= 80% pred GOLD 2: Moderate 50% <= FEV1 <80% pred GOLD 3: Severe 30%<= FEV1 <50% pred GOLD 4: Very Severe FEV1 <30% pred

Question 47

Long-term oxygen therapy improves what for COPD patients?

Answer 47

Survival Exercise capacity Cognitive performance Sleep in hypoxemic patients

Question 48

What ventilator support is used when a pt. has acute respiratory failure?

Answer 48

Intubation

Question 49

If incubation lasts longer than 7-10 days, what should be inserted?

Answer 49

Trach

Question 50

How can low-flow oxygen been delivered to patients?

Answer 50

Nasal cannula Non-rebreather Simple mask

Question 51

What are some examples of subjective data in pts with lung cancer?

Answer 51

-Fatigue -Dyspnea -Pain (chest, shoulder, arm, bone) -HA -Smoking hx (pack years) -Family hx of lung cancer -Dysphagia -Weight loss (unintended) -Anorexia, nausea, vomiting -Exposure to carcinogens -Secondhand smoke, asbestos, radon

Question 52

How can high-flow oxygen been delivered to patients

Answer 52

Venturi mask Heated high flow nasal cannula Trach mask

Question 53

How is humidification supplied in oxygen?

Answer 53

Nebulizer Vapotherm bubble-through humidifier

Question 54

How are pack years calculated?

Answer 54

of years smoking X # of packs per day

Question 55

Why do we maintain COPD patients oxygen sats between 88%-90% and not 100%?

Answer 55

If oxygen is at 100%, it will decrease the patient's respiratory drive meaning they cannot breathe on their own

Question 56

Complications of oxygen therapy

Answer 56

Combustion CO2 narcosis O2 toxicity Absorption atelectasis Infection

Question 57

What are examples of objective data for pts with lung cancer?

Answer 57

-Fever -Lymphadenopathy -Jaundice -Edema -Clubbing -Adventitious breath sounds -Pleural effusions

Question 58

If nitrogen is depleted from the alveoli, what can develop?

Answer 58

Absorption atelectasis

Question 59

What are some health promotions for pts with lung cancer?

Answer 59

-Avoid smoking -Promote smoking cessation programs -Support education & smoking policies -Smoke-free environments -Model health behavior by not smoking

Question 60

Surgical therapy options for COPD pts

Answer 60

Lung volume reduction surgery (LVRS) Bronchoscopic lung volume reduction surgery Bullectomy Lung transplantation

Question 61

A large air sac that forms from destroyed alveoli

Answer 61

Bullae

Question 62

Surgery in which diseased lung is removed to enhance performance of remaining lung tissue

Answer 62

LVRS

Question 63

What are some post operative complications for lung cancer pts?

Answer 63

-Respiratory failure -Pulmonary edema -Arrhythmias -Shock -Infection -Pneumothorax -Hemothorax

Question 64

Surgery in which one-way valves are placed in the airways to the diseased parts of the lung

Answer 64

BLVR

Question 65

What is the most important aspect of nursing management with COPD patients?

Answer 65

Teaching / pt education surrounding: -pulmonary rehab -activity -sexual activity -sleep -psychosocial

Question 66

What positioning should a post-op lung cancer pt be placed in?

Answer 66

Supine or operative side Either side after lobectomy

Question 67

Comorbid conditions characterized by excessive mucous in the bronchioles

Answer 67

COPD with chronic bronchitis

Question 68

What will lung sounds be in a COPD with bronchitis?

Answer 68

Wheezes and crackles Rales

Question 69

What diagnosis do patients have when they are called "blue bloaters"

Answer 69

COPD with bronchitis

Question 70

What diagnosis do patients have when they are called "pink puffers"

Answer 70

COPD w/ emphysema

Question 71

What is the most common type of lung cancer in non-smokers?

Answer 71

Non-small-cell lung cancer specifically Adenocarcinoma

Question 72

What is the most common type of lung cancer?

Answer 72

Adenocarcinoma

Question 73

Condition characterized by a decreased in elastin and collagen causing decreased pressure during exhalation leading to lung collapse and trapped air with reduce surface area for gas exchange

Answer 73

COPD w/ emphysema

Question 74

What is the most deadly type of lung cancer?

Answer 74

Small-cell lung cancer

Question 75

What are the 3 ways that lung cancer can metastasize?

Answer 75

1. Direct extension 2. Blood circulation 3. Lymph system

Question 76

Where can lung cancer metastasize to?

Answer 76

-Lymph nodes -Liver -Brain -Bones -Adrenal glands

Question 77

What type of breathing can a patient use to prevent lung collapse with COPD/emphysema>

Answer 77

pursed lip breathing

Question 78

Where is the most common place for lung metastasis?

Answer 78

Brain- b/c of the flow of blood

Question 79

When is a barrel chest most common?

Answer 79

COPD with emphysema (all COPD patients can develop barrel chest though)

Question 80

What are clinical manifestations of lung cancer?

Answer 80

-Dyspnea -Hemoptysis -Chest or shoulder pain -Pneumonitis -Persistent cough with sputum

Question 81

Where does lung cancer primarily occur?

Answer 81

Segmental bronchi and upper lobes

Question 82

How long does a patient have to be smoke-free to be considered back to 'nonsmoker' status?

Answer 82

10-15 years

Question 83

Lung Cancer Risk Factors

Answer 83

Smoking Exposure to smoke

Question 84

How is lung cancer initially diagnosed?

Answer 84

CXR- takes years to show up

Question 85

If there is a suspicion of lung cancer, what diagnostic is performed?

Answer 85

CT scan

Question 86

Who should receive a lung cancer screening?

Answer 86

Patients 55-80 with a hx of smoking Anyone who has smoked >1 pack/day for 30 years Anyone who currently smokes Anyone who quit less than 15 years ago

Question 87

How is a lung cancer screening completed?

Answer 87

low dose CT

Question 88

What types of diagnostics can be performed on pts with lung cancer?

Answer 88

-CXR -CT scan -Fiberoptic bronchoscopy -PET scan -Lung biopsy for definitive diagnosis

Question 89

Most lung cancers are what type?

Answer 89

Non-small-cell lung cancer

Question 90

Two types of lung cancers

Answer 90

Small-cell lung cancer Non-small-cell lung cancer

Question 91

How many stages of NSCLC are they and how are they determined? (acronym)

Answer 91

4 T-TUMOR size, location, & degree of invasion N-extent of lymph NODE invasion M-presence/absence of METASTASES

Question 92

What is the treatment of choice for NSCLC?

Answer 92

Surgery - lobectomy or removal of entire side of lung

Question 93

Removal of one entire lung

Answer 93

Pneumoectomy

Question 94

How many stages of SCLC are there? & what are they?

Answer 94

Limited Extensive

Question 95

Removal of one or more lobes of the lung

Answer 95

Lobectomy

Question 96

How is immunotherapy used to treat lung cancer?

Answer 96

Targets programmed cell death proteins and prevents T cells from attacking other cells in the body in order to mount a better immune response