COPD, asthma and pneumonia

Question 0

Why is asthma usually not listed under COPD?

Answer 0

Unlike emphysema and chronic bronchitis which are not reversible and increase in severity, asthma is considered an intermittent disease with reversible airflow obstruction and wheezing.

Question 1

Which diseases is the term COPD primarily used for?

Answer 1

Chronic bronchitis and emphysema

Question 2

What is the order of things that happen as emphysema disease progresses?

Answer 2

1. Loss of elastic recoil
2. Airway collapse
3. Alveolar hyperinflation
4. Bullae formation

Question 3

And emphysema, what happens as a result of the loss of elasticity?

Answer 3

It prevents for recoil so Air is trapped in the lungs.

Question 4

And emphysema, what causes some of the airways to collapse?

Answer 4

Forceful exhalation causes increased in intrathoracic pressure which collapses the terminal bronchioles, then the Alveoli expand or hyperinflate

Question 5

Why does cigarette smoking cause the person to be more susceptible to infections in the lungs?

Answer 5

Cilia die so mucus isnt moved out of the respiratory tree…. So dirt and everything inhaled gets stuck in the lungs.

Question 6

What are some symptoms of emphysema?

Answer 6

Barrel Chest 
Clubbing of fingers 
Hypercapnea
Decreased diaphragm excursion 
Respiratory acidosis 
Increased tactile fremitis

Question 7

What is the reason for the barrel chest and emphysema? And what happens to the diaphragm

Answer 7

Due to Lungs being over inflated and chronic use of accessory muscles

Diaphragm - It becomes flatten or has decreased excursion

Question 8

What is the swelling in the disco fingers caused by?

Answer 8

Chronic hypoxemia

Question 9

A patient with emphysema develops acidosis as a result of retention of?

Answer 9

CO2

Question 10

What triggers the respiratory drive and a healthy person?

Answer 10

High PaCO2

Question 11

What triggers the respiratory drive in a person with COPD?

Answer 11

High PaO2

Question 12

Why does the person with emphysema and chronic bronchitis have more severe hypercapnia and hypoxemia?

Answer 12

Mucus and swelling reduces the airway going through both the little and smaller airways. Also less gas exchange as decreased # of alveoli

Question 13

What are some other reactions to the stressors of COPD not mentioned in the film?

Answer 13

• Egophony
• hyperresonance on chest percussoon
• Cardiac symptoms
• respiratory tract infections

Question 14

What does Egophony mean?

Answer 14

E to A changes with auscultation

Question 15

Often, COPD patients in the later stages developed right-sided heart failure which leads to?

Answer 15

• increased heart rate

- swelling on the feet

Question 16

What are some reactions to stressors noted in diagnostic studies in COPD?

Answer 16

• besides the ABGs usually showing respiratory acidosis, the 02 sat is usually less than 90%
• polycythemia can occur which results from body’s attempts at compensation
• electrolyte disturbances
• abnormal pulmonary function test
• abnormal peak flow meter

Question 17

What are some changes that will happen in somebody’s daily life who has chronic respiratory disorder?

Answer 17

• activity intolerance
• sleep and eating is affected
• Weight loss as disease worsens

Question 18

“sonorous wheezes as air moves through mucus filled airways” describes breath sounds from which disease?

Answer 18

Chronic bronchitis

Question 19

This disease is a chronic inflammatory disorder of the airways which results in bronchospasms or bronchoconstriction in response to triggers from a variety of sources

Answer 19

Asthma

Question 20

Why is asthma called a reactive airway disease?

Answer 20

Due to damage from irritants which cause increased mucus production, the mucosal lining the bronchial tree becomes over reactive to triggers which leads to recurrent bronchoconstriction

Question 21

Which substances are responsible for some of the inflammation in asthma?

Answer 21

• histamine
• acetylcholine
• serotonin
• leukotrienes
• corticosteroids

Question 22

What contributes to airflow obstruction in acute exasperation of asthma?

Answer 22

Airway constriction
Airway inflammation
Alveolar hyperinflation

Question 23

In the early stages of an asthma attack the client may be experience respiratory ______? If airway bronchoconstriction is unrelieved, the client may move into respiratory _______ due to the retention of____?

Answer 23

Respiratory alkalosis

Respiratory acidosis

PaCO2

Question 24

A patient remains in the ED and is progressively getting worse with their asthma exasperation. What ABGs might reflect this?

Answer 24

The answer should indicate a rising CO2 level and a following O2. A person gets tired, making it more and more difficult to blow off the CO2

Question 25

Initially as the O2 drops what will happen to the respiratory rate and depth?

Answer 25

Increased rate and depth. As the person gets more and more fatigued with the labor of breathing, the respiratory rate will drop and thus so will the oxygen level

Question 26

Goals of treatment for asthma patients

Answer 26

Prevention is key - client will have fewer asthma exasperations - The client will maintain normal activity levels (especially important in children) - The client will maintain normal lung function - The client will have minimal or no side effects while receiving medications

Question 27

List some nursing diagnoses related to asthma

Answer 27

``` Ineffective breathing pattern Ineffective airway clearance Impaired gas exchange Activity intolerance Risk for suffocation Interrupted family processes – especially in children --see pages 1400 through 1402 of Ricci ```

Question 28

For asthma, the nursing interventions should be aimed at?

Answer 28

Prevention and symptom assessment and control It's important for the caregiver or the adult patient to know when they are getting into trouble with your asthma. Wait before having to go into the ED. A peak flow meter is a device that patients can use at home to determine if there respiratory disease is worsening.

Question 29

Special considerations in the asthmatic child

Answer 29

Be alert for other symptoms of respiratory distress, no position child chooses to remain in and that will usually be there more comfortable position for breathing, teach family to recognize and avoid triggers, support groups, exercise.

Question 30

What are some additional nursing diagnoses for asthma regarding children?

Answer 30

Altered family processes and risk for suffocation (due to narrowed airway)

Question 31

What are some causes of pneumonia?

Answer 31

Viral, bacterial, fungal, aspirated food, and inhaled fumes

Question 32

aspiration pneumonia is most common in.?

Answer 32

The elderly in and anyone who has upper body neuromuscular impairment Infants and children rarely get aspiration pneumonia unless they have neuromuscular impairments. Infants innately turn their heads to the side when they regurgitate or vomit

Question 33

What are some stressors that can lead to pneumonia?

Answer 33

``` Underlying chronic disease Compromised immune system Altered level of consciousness is Neuromuscular conditions Institutionalization (Nursing home) Existing infection elsewhere in body ```

Question 34

What are some nursing diagnoses for pneumonia?

Answer 34

impaired gas exchange ineffective airway clearance Risk for greater affection (sepsis) Risk for fluid volume deficit

Question 35

And children, viral pneumonia will usually cause?

Answer 35

Mild fever, nonproductive cough, and rhinitis. It is usually self-limiting

Question 36

In children, bacterial pneumonia, the child usually has?

Answer 36

High fever, productive cough and I'll appearance, retractions, grunting respirations, chills, chest pain, respiratory distress is significant and accompanied by restlessness

Question 37

For management of pneumonia and children, in addition to adult remedies, also use:

Answer 37

``` Cool mist Clear secretions with bulb syringe or deep suctioning on younger child or infant IV fluids Monitor for dehydration Anticipatory guidance Emotional support to caregivers ```