Diseases Flashcards
(81 cards)
1
Q
Cystic Fibrosis
When is it dx?
What causes?
A
Present from birth dx as a child
It is a recessive gene that must be given by both parents.
2
Q
Cystic Fibrosis
What is the mechination?
What does it effect?
A
Chloride transport is blocked and produces thickened mucous
Effects lungs, liver, pancreas, salivary glands and testes
3
Q
Cystic Fibrosis
So what? What is the big deal?
A
Most serious is airway obstruction due to thickened secretions.
4
Q
Cystic Fibrosis
Diagnostic test - lab values
A
Chloride sweat: 5-35 mEq/L is normal a positive for cystic fibrosis is 60-200mEq/L (Pilocarpine is given to cause pt to sweat) done twice
5
Q
Cystic Fibrosis:
Assessment findings- General
A
Severe GERD ABD distension Fatty Stools (Steatorrhea) Vitamin deficiencies (at risk for Osteoporosis) Small body build Liver cirrhosis Sterility
6
Q
Cystic Fibrosis
Assessment - Lungs
A
Frequent respiratory infections Chest congestion Limited exercise tolerance Cough Sputum production Sinus infection Decreased pulmonary function Crackles Hemoptysis Dyspnea Acidosis
7
Q
Cystic Fibrosis
Tx
A
Cure=none daily pulmonary interventions to loosen secretions Vitamin replacement Pancreatic replacement Draining positions Chest percussion Medications Heliox Antibiotics
8
Q
Cystic Fibrosis
Exacerbation
A
Increased chest congestion Increased coughing ***Crackles*** Increased mucous 10% decrease in FEV1 Weight loss & fatigue Ventilatory muscle retraction
9
Q
Cystic Fibrosis
Tx of exacerbation
A
Improve airway clearance- medications, precussion
Prevent infection- antibiotics(Burkholderia cepacia
Increase o2- supplement Heliox
10
Q
Cystic Fibrosis
Pt. education
A
Avoid others bodily fluids
Avoid contact with others(shaking hands, kissing)
Wash hands often
Adhere to medication
11
Q
Cystic Fibrosis
Surgical Tx
A
lung or pancreatic transplant
double lung transplant
12
Q
Cystic Fibrosis
not a candidate for lung transplant
A
Hx of noncompliance Self harm behaviors 5 yr hx of cancer Irreversible damage to kidney, heart, liver Systemic infection >55y.o
13
Q
Lung Transplant
A
intubated for <48hrss prevent infection monitor for bleeding, infection, rejection Anti-rejection meds for life Avoid corticosteroids for 10-14 days Prophylactic antibiotics
14
Q
Head and Neck Cancer
etiology
A
Slow growing squamous cells
Curable early on
Risks: pollution smoking
Spread to lymph nodes, muscle, bone, lungs, liver
Effects breathing, eating, facial appearance, self image speech and communication
15
Q
Head and Neck Cancer
locations
A
Mouth Throat Larynx Salivary Glands Thyroid Paranasal sinuses Lymph nodes in upper neck
16
Q
Head and Neck Cancer
risks
A
Alcohol and Tobacco
Men
>60
North America
17
Q
Head and Neck Cancer
warning signs
A
Pain Shortness of breath difficulty swallowing change in mouth oral lesion that wont heal numbness change of denture fit burning sensation with eating ear pain voice change persistent sore throat late stage= anorexia
18
Q
Head and Neck Cancer
testing
A
Physical Lab tests- CBS, urinalysis, liver, kidney Panendoscopy X-rays, skull, neck, sinuses, chest CT scan MRI PET Biopsy
19
Q
Head and Neck Cancer
Nursing priorities
A
Maintain patent airway
Decrease anxiety
Pt. will have body image disturbance
20
Q
Head and Neck Cancer
Tx
A
Radiation(small cancer) S/E skin redness, edema, xerostomia, dehydration NOT done before surgery
Chemotherapy- used before and after surgery or radiation, decreases WBC, dehydration, hypotension
Surgery
21
Q
Supraglottic method of swallowing
A
Pt. siting upright Clear throat take deep breath 1/2 teaspoon to 1 teaspoon of food per bite hold breath and bear down swallow twice breathe normally
22
Q
Communication Post laryngectomy
A
Esophageal- burping
Mechanical-battery powered uses air
Tracheoesophageal- puncture b/w trachea and esophagus covering of stoma to create words
23
Q
Lung Cancer
Etiology
A
Poor survival rate, high rate metastasis
Occurs as a result of inhaled substances Tobacco, smoke, dusts
24
Q
Lung Cancer
Risk Factors
A
Cigarette smoke
Inhaled irritants
Air pollution
Tp53 gene
25
Lung Cancer
| Bronchogenic Carcinomas
```
small cell:
rapid growth
spread easily
secretes hormones
non-small
adenocarinoma
squamous cell
large cell
```
26
Lung Cancer
| Assessment
```
Smoking hx
Sputum
Chronic cough
hemoptysis
wheezing
shortnes of breath
dull, aching chest pain
pain!
hoarseness
dysphagia
finger clubbing
weight loss
```
27
Pulmonary Arterial Hypertension
| pathophysiology
Cause unknown
occurs in the absence of other lung diseases
found most often in women between the ages of 20-40
28
PAH
| assessment findings
Dyspnea
Fatigue
Chest Pain
Syncope
29
Cor Pulmonale
| What is it?
Right sided heart failure
S&S dependent edema, engorged jugular veins, enlarged liver.
results in: Death or heart transplant
30
PAH
| Diagnosis
```
Right side heart cath to measure pulmonary pressure
normal pressure 8-25 mm Hg PAH >25mmHg
Ventilation Perfusion scans
Pulmonary Function Test reduced capacity
CT
```
31
PAH
| Tx
Drug therapy CA Channel blockers(procardia, cardizem, endothelin receptor antagonist[relax blood vessels--> hypotension], IV prostacyclins[ decrease pulmonary pressure, increase blood flow to lungs IV or SQ], Coumadin)
Digoxin and Diuretics can be used due to hypertrophy
With these drugs monitor Hypertension and Syncope(fainting)
Heart or lung transplant
INR theraputic 1.5-2.0
Use K with Lasix and Demadex
32
Flolon Therapy for PAH
IV or SQ
Continuous infusion, have back up batteries, go to ER immediately is interruption occurs
Use aseptic technique(central line)
CBC q 7days
33
Interstitial pulmonary disease
| includes:
Sarcoidosis
| Pulmonary Fibrosis
34
Interstitial pulmonary disease
| pathophysiology
Restrictive, decrease in expansion and recoil
35
Sarcoidosis
| pathophysiology
```
cause unknown
growth of granulas(collection of immune cells)
affects mostly young adults
first indication abnormal chest x-ray
can lead to cor pulmonale
```
36
Sarcoidosis
| Assessment
```
Dyspnea!
Enlarge lymph nodes in hilar area
Eye lesions(Hypercalcemia)
Cough
Abnormal PFTs
Hemophotysis
```
37
Sarcoidosis
| dx
Abnormal chest x-ray
Bronchoscopy and biopsy to rule out cancer
Sarcoidosis is staged according to amount of fluid in lungs
38
Sarcoidosis
| tx
Tx to lessen symptoms and prevent fibrosis of lung tissue
if PFTs are not affected it is unlikely that anything will be done
Decrease in TLC or FVC= involvement of other organs so tx will occur
Corticosteriods 6-12 month maintenance dose
Thalomid or Remicade
Not usually lethal but can lead to pulmonary fibrosis
39
Pulmonary Fibrosis
```
restrictive pulmonary disease
over-healing of scar tissue
High mortality rate
less than 5yr survival rate
Impaired gas exchange
```
40
Pulmonary Fibrosis
| pathophysiology
Occupational hazards(inhaled)
genetic components
chronic lung disorder
41
Pulmonary Fibrosis
| Dx/Assessment
```
CT
Mild dyspnea
Decreased FVC
Hypoximia
Rapid shallow breathing
```
PFTs
Chest x-ray
CT scan
Onset of symptoms may occur many years after damage has been done
42
Pulmonary Fibrosis
| Tx
```
Corticosteroids
Immunosuppresants
Reduce anxiety
O2 therapy
Pt and family support
Curative tx is lung transplant( not likely because these pts are older and generally have a hx of smoking)
```
43
BOOP Bronchiolitis Obliterans Organizing Pnuemonia
```
resembles respiratory infection
fibroblast occlude airways
cancer tx may be a cause
30-60 persons most likely to have it
can be chronis
Dyspnea
Fever
Crackles
Mild Fever
Flu-like symptoms
Biopsy is what diagnosis this disease
Tx corticosteroids
```
44
Lower Respiratory medication of choice?
Corticosteroids
45
Lung Cancer
| Dx
```
Sputum testing
CXR nodule
Bronchoscopy
CT Scan MRI
Video assisted thoracospoy
CBC
Liver function studies
Serum electrolytes
```
46
Lung Cancer
| Nonsurgical Management
Chemo
Targeted therapy- antibodies destroy cancer cell division
Raiation
Photodynamic therapy light up cancer cells, use laser on cancer cells
47
Lung cancer
| chemo
Chemotherapy- small cancer
side effects nausea, vomiting, alopecia, mucositis, immunosuppression, anemia, thrombocytopenia, peripheral neuropathy
Antiemtics are usually used with chemo
48
Lung Cancer
| radiation
Used prior to surgery to shrink tumor
daily 5-6x a week
side effects: skin irritation, peeling, fatigue, nausea, taste changes
do not scrub off markings
49
Lung cancer
| Photodynamoc therapy
remove small brinchial tumors
injected to sensitizes cells to light
side effects blocked airway from sloughing of cells, bronchial hemorrhage, fistula, super sensitivity to light not sunlight exposure for 30-90 days post treatment
pt. is intubated during procedure
50
Lung cancer
| surgical
Remove all tissue involved, maitain function of lung
| can be removal of tumor, lobe or lung
51
Post thoracotomy
pain management!
assess O2 sat, cap refill, lung sounds
chest tubes: drain air and blood
52
Chest tube
| assessment
Pt. breath sounds, RR, depth effort, SpO2, VS, anxiety, pain
Entry site: dressing? crepitus?
Tubing: tight, kinks, compressions
Water seal: 2cm of fluid, never should buble- bad
Drainage: below heart, upright
NEVER milk the tubing
53
Chest tube
| removal
Physician, PA, NP
chest x-ray post removal
premidcate
cut suture
54
Palliation care
```
Humidified air
Bronchodilators
Corticosteroids
Mucolytics
Radiation therapy
THoracentesis(fluid removal)
Pleurodesis(relieve pleural effusion)
Dyspnea control(position, morphine, O2)
Pain control
Hospice
```
55
Pulmonary Embolism
| risk factors
```
Prolonged bed rest
CV cath- flush freq, never force
Major surgery
Obesity
Advanced age
```
56
Pulmonary embolism
| Clinical finding
sudden dyspnea
sharp chest pain
feeling of impending doom
cough
57
PE lab test
ABGs 7.35 Co2 decreases
| derum D detects fibrin
58
PE
| dx
CT scan
59
PE tx
```
improve lung perfusion
monitor VS
anitcoagulants
fibrinolytic- large PEs
INR - coumadin 2.0-3.0
```
emboectomy- surgical removal
inferior vena cave filter- filter placed in heart to catch emolus
60
PE teaching
Adhere to medication!!
| prevention of further PE
61
asthma
genetic factors
environmental
allergies
Reversible inflammatory airway obstruction
bronchial hyperactivity
mast cell degranulation
Inflammation
Increased mucous production
Bronchospasm and constriction)less room air in pt. lungs
62
Astma triggers
stress
exercise
medications: asprin of NSAIDs
respiratory infection
63
Asthma S&S
```
intermitten dyspnea
tightness of chest
increased coughing
wheezing
increase mucous production
```
64
Asthma dx
ABGs and Oximetry measure during an acute attack
| PFTs during attck (PEFR, FVC, FEV1)
65
Acute Asthma
```
audible wheezes
accessory mucles
inc. cough mucous
dec. ability to speak
chest tightness
```
66
Severe Asthma
Atelectasis
Pneumothorax
Cor Pulmonale
Status asthmaticus
67
Status Asthmaticus
```
severe asthma
does not respond to typical medication
severe hypoxia
hypercapnea
acidosis
respiratory failure
CAN BE LIFE-THREATENING
```
68
Goals for pts. with Asthma
No limitations to daily life
| Control of asthma through use of medications(little to no daily symptoms, normal PFTs, infrequent exacerbation)
69
Asthma pt. education
avoid triggers
maintain >80% best PEFR
USE meds
Measure peak flow 2x a day
70
Asthma colors
Green- >80% personal best
Yellow 50-80% if continues in yellow after administration of drug contact physician
Red- <50% serious airway obstruction seek immediate help
71
COPD
```
includes emphysema and chronic bronchitis
is NOT reversible
loss of lung elasticity
hyper inflates lungs
S&S dyspne incr RR
```
72
COPD Etiology
Traps air in aveoli causes tissue damage and the diaphragm becomes weak
Less surface area more work inc RR
73
COPD risks
Smoking and chronic exposure to inhaled irritants
74
Chronic bronchitis
inflamed bronchi- vasodilation occurs, congestion, mucosal edmea, bronchospasms
Mucus plug constricts airway
Dx productive cough 3 months of the yr 2 consecutive yrs
75
COPD
| assessment
```
Hypoximia- NO air exchange low PO2
Acidosis O2 dec CO2 inc
Respiratory infection
Cardiac failure- cor pulmoale
Dysrhythmias
Dyspnea
Productive cough
Rapid shallow breaths
Tri-pod position
Later Stage:
weight loss
clubbing
edema
```
76
COR PULMONALE
right side heart failure
manifestations: dyspnea, S3, loud pulmonic S2, increase P wave, R axis dev., JVD, RUQ tenderness, ascites, weight gain, edema, hypoxia
Tx O2 vasodilator, diuretics
77
COPD prevention
Vaccinate! Flu! Pneumococcal
| Discontinue brochodilators or corticosteroids
78
COPD dx
```
H&P
lab testing
X-ray
EKG- ectopic beat
Stress test
```
79
COPD lab results
high WBC & RBC inc
| ATT- genetic?
80
COPD goals
```
improve O2
reduce CO2 retention
relieve symptoms
prevent weight loss
minimize anxiety(4th leading death in US)
long term knowledge and use of meds
```
81
COPD interventions
Huff cough
High fowlers
Pursed breathing
O2 therapy
