concepts of care for pt. with noninfectious lower respiratory problems Flashcards
1
Q
asthma
A
- chronic disease that occurs intermittently
- inflammation and airway tissue sensitivity
2
Q
asthma symoms
A
- daytime symptoms of wheezing, dyspnea, coughing presents more than 2 a week
- waking from night sleep with symptoms of wheezing, dyspnea, coughing
- relieved drug needed more than twice weekly
- number of times per week activity was limited or stopped by symptoms
3
Q
asthma history
A
- history of dsypna, shortness of breath, chest tightness, coughing, wheezing, increased mucous production
- same pt. have symptoms 4-8 weeks after a cold or other upper respiratory infection
- pt. with atopic (allergic) asthma may have other allergic problems
4
Q
common symptoms with acute asthma
A
audible wheezing
increased respiraotry effort
5
Q
asthma attack cues
A
inflammation occurs, coughing may increase
- accessory muscle use
- breathing cycle is longer, prolonged exhalation and requires more effort
- unable to speak
- hypoxia
- poor o2 levels
- examine oral mucosa, nail beds, change in loc, & tachycardia
6
Q
pulmonary function tests
A
- forced vital capacity: total amount of air exhaled
- forced expiratory volume in first second- how much air a person exhale during forced breath
- peak expiratory rate flow- air flowing out of lungs
7
Q
asthma interventions
A
- control and prevent episodes
- improve air flow and gas exchange
- relieve symptoms
- self management education
- ASSESSMENT OF ASTHMA SEVERITY DAILY WITH A PEAK FLOW METER IS RECOMMENDED FOR PT. WHOSE ASTHMA IS NOT WELL CONTROLLED
8
Q
asthma drug therapy
A
- control therapy drugs
- reliever drugs
- bronchodilators
- anti-inflammatory agents
9
Q
control therapy drugs (used daily)
A
used to reduce airway sensitivity (responsiveness) to prevent asthma attacks from occurring and maintain gas exchange
- inhaled cortical steroid- reduce inflammation
10
Q
reliever drugs
A
used to stop an attack
- short acting bronchodilator
11
Q
bronchodilators
A
induce rapid bronchodilation through relaxing the smooth muscle
12
Q
what do anti-inflammatory agents do?
A
help to improve bronchiolar airflow and increase gas exchange
13
Q
high flow delivery cause
A
bronchospasms are severe and limit flow of oxygen through bronchiole tubes
14
Q
status asthmaticus
A
- severe life threatening acute episode of airway obstruction
- intensifies once it begins, often does not respond to common therapy
- can develop pneumothorax and cardiac or respiratory arrest
15
Q
treatment for status asthmaticus
A
Iv fluids potent systemic bronchodilator steroids epinephrine oxygen prepare for emergency intubation
16
Q
emphysema
A
destructive problem of lung elastic tissue that reduces its ability to recoil after stretching, leading to hyperinflation of the lung
- changes result in dyspna with reduced gas exchange and the need for an increased respiratory rate
17
Q
chronic bronchitis
A
inflammation of the bronchi and bronchioles caused by exposure to irritants, especially cigarette smoke
- trigger inflammation, vasodilation, mucosal edema, congestion, and bronchospasm
- affects airways not alveoli
18
Q
why is chronic bronchitis a blue bloater
A
- presence of cyanosis of skin and mucous membranes
- hypoxemia occurs early in disease
- c02 retention
19
Q
when does dyspnea occur for bronchitis
A
occurs later in disease
20
Q
when does hypoxemia and hypercapnia occur for chronic bronchitis
A
early in disease
21
Q
why is emphysema a pink puffer
A
- there color and the way they breathe through pursed lips on expiration
- hypoxemia occurs late in disease
- damage not in bronchioles therefore no c02 retention
- no cyanosis just pink
22
Q
when does dyspnea occur in emphysema
A
-occurs early
23
Q
when does hypoxemia and hypercapnia occur
A
later in disease
24
Q
complications of COPD
A
- hypoxemia
- acidosis: decreased 02, increased c02
- respiratory infection
- CARDIAC FAILURE: cor pulmonale- ride sides heart failure
- dysrhthmias: due to acidosis and perfusion
- respiratory failure: hypoxemia
25
copd history & risk factors
risk factors:
- age
- gender
- occupational history
- SMOKING
- breathing problems
- activity level
- weight
26
the general appearance of copd
- weight is proportionate to height, posture, mobility, muscle mass, and overall hygiene
- pt. with severe copd are THIN
- orthopneic or tripod position
27
respiratory changes in copd assessment
- assess chest size
- fatigue
- breathing rate and pattern
- chest for retractions and asymmetric chest expansion
- depth of inspiration
- abnormal breath sounds
- degree of dyspnea
- barrel chest
- cyanosis
28
cardiac changes
- assess heart rate and rhythm
- swelling of feet or ankles
- nail beds
- oral mucous membranes
29
copd assessment cues: lab
- abg value
- sputum specimens
- WBC count
- h&h serum
- electrolyte levels
30
copd assessment cues: imaging assessmenr
chest x ray
31
copd assessment cues: other test
- pulmonary function test: primary testing
- COPD assessment test
- lung volumes
- diffusion test
- oxygen saturation
- peal expiratory flow meter
32
COPD analysis
- decreased gas exchange
- weight loss
- decreased endurance
- potential for pneumonia
33
COPD planning and implementation
- improve gas exchange and reduction of carbon dioxide retention
- ensure consistent use of drug therapy, airway maintenance, monitoring, breathing techniques, positioning, effective coughing, oxyen therapy, exercise conditioning, suctioning, and hydration
- surgical intervention
- preventing weight loss
- minimizing anxiety
- improving endurance
- preventing respiratory infection
34
surgical intervention for copd
lung transplantation
| - lung volume reduction surgery
35
preventing weight loss for copd
dyspnea management
| food selection
36
improving endurance for copd
- energy conservation
37
what is common complication of COPD
- PNA is a common complication of COPD
| - teach pt. to reduce the risk of infection
38
COPD evaluating outcomes
- attain and maintain gas exchange at a level within his or her chronic baseline values
- achieve an effective breathing pattern that decrease the work of breathing
- maintain a patent airway
- achieve and maintain a body weight within 10% of his or her ideal weight
- have decreased anxiety
- increase activity to a level of acceptance to him or her
- avoid serious respiratory infections
39
Cystic Fibrosis
- autosomal recessive genetic disease
- diagnosed in early childhood
- blocked chloride transport in cell mebranes
- thick, sticky mucous
- affects lungs and non-pulmonary ograns and pancreatic function
- blocks chloride transport and cell membrane
- impaired gas exchange
40
cystic fibrosis assessment clues: nonpulmonary symtoms
- abdominal distension
- GERD, rectal prolapse, foul smelling stool, steatorrhea
- malnourishment
- DIABETES
- OSTEOPOROSIS, OSTEOPENIA
41
cystic fibrosis assessment clues: pulmonary symtoms
- respiratory infections
- chest congestion and sputum production
- limited exercise tolerance
42
cystic fibrosis interventions nonsurgical: nutrition management
- focus on WEIGHT maintenance (protein & fat intake), vitamin supplementation, diabestes management, and pancreatic enzyme replacement
43
cystic fibrosis interventions nonsurgical: preventitive/maintenance therapy
- use of positive expiratory pressure
- active cycle of breathing techniques
- indivdualized exercise program
- adn chest physiotherapy with postural drainage
44
cystic fibrosis interventions nonsurgical: drugs
bronchodilators
anti-inflammatories
mucolytics
antibiotics
45
cystic fibrosis interventions nonsurgical: exacerbation therapy
- increased chest congestion
- reduced activity
- onset of crackles
- 10% decrease in FEV1
- bipap for advanced disease 14-21 day course of antibiotics
46
cystic fibrosis interventions nonsurgical: gene therapy
- pt. with specific gene mutations
| - drug Ivacaftor aka CFTR modulator or potentiator is valuable to pt. with CF
47
cystic fibrosis interventions nonsurgical: surgical
lung transplantation
- does not cure
- extends life by 1-15 years
- transplant rejection is high
- continue for infections
