Exam #4 Flashcards
(102 cards)
1
Q
Upper Resp System
A
- nose
- mouth
- pharynx
- epiglottis
- larynx (vocal chords)
- trachea
2
Q
lower resp system
A
- bronchi
- bronchioles
- alveolar ducts
- alveoli
- lung lobes
3
Q
alveoli and surfactant
A
- o2 and co2 exchange
- primary gas exchange site
- surfactant: lipoprotein that decreases surface pressure
4
Q
blood supply to the lungs
A
1) pulmonary: provides lungs with blood that participates in gas exchange
2) bronchial: provides oxygen to the bronchi and other pulmonary tissues
5
Q
chest wall
A
- ribs
- pleura
- parietal: lines chest cavity
- visceral: lines lungs
- space in between is called the intrapleural space: provides lubrication, facillitates expansion
- diaphragm: contraction decreases intrathoracic pressure allowing air to enter the lungs
6
Q
physiology of respiration
A
- ventilation involves inspiration
- expiration is passive and depends on elastic recoil
- compliance: ease of lung expansion
- diffusion: movement of gases from the area of higher concentration to area of lower
- arterial blood gases measure oxygen saturation and acid-base balance
- pulse oximetry is read as SpO2: less accurate when spo2 is less than 70, hemoglobin variants and other factors can give an inaccurate reading
7
Q
PaO2
A
- lung’s ability to oxygenate arterial blood = partial pressure oxygen
- PaO2 decreases with age and varies with distance above sea level
- for patients with impaired CO or hemodynamic instability, mixed venous blood gases obtained from a pulmonary artery catheter
8
Q
control of respiration
A
- chemoreceptors respond to changes in paco2 and ph
- mechanical receptors respond to a variety of physiologic factors
9
Q
respiratory defense mechanisms
A
- filtration of air
- mucociliary clearance system
- cough reflex
- reflex bronchoconstriction
- alveolar macrophages
10
Q
resp gerontologic considerations
A
- structural changes:
- stiffening of chest wall
- decrease in elastic recoil and compliance (hinders exhalation)
- AP diameter increases (barrel chested)
- chest is barrel-shape, may need accessory muscles to breathe
- less tolerance for exertion leading to dyspnea
- defense mechanisms: less effective, less forceful cough, fewer cilia, higher risk of aspiration
- respiratory control: more gradual response to changes in PaO2 and PaCo2
- SOB changes gradyally and can lead to severe hypoxia
11
Q
subjective resp assessment
A
- frequency of upper respiratory problems and seasonal effects
- meds
- cough - secretions, force, acute, chornic
- sputum: amount, color, consistency, odor
- wheezing
- travel
- smoking and tobacco products
- vaccination against influenza and pneumonia
- inhalers, demonstrate use
- weight loss (illness) and fluid intake (secretion thickness)
- ADLs, dyspnea
- sleep apnea signs: snoring, insomnia, daytime drowsiness, early am headaches
- night sweats
- neurologic symptoms
- pain with breathing
- anxiety: stress management
12
Q
objective resp assessment
A
- some nasal deviation is normal
- nasal discharge
- small, mobile, nontender nodes (shotty) are normal; tender, hard or fixed are not
- begin auscultation on posterior especially for females - better info on back if pt tires
- AP diameter should be less than 1:2
- inspiration should be half as long as expiration
- skin color
- clubbing
- femitus
13
Q
abnormal breath sounds
A
- adventitious sounds
- fine crackles
- coarse crackles
- rhonchi
- wheezes
- stridor
- pleural friction rub
14
Q
resp lab and diagnostic studies
A
- labs
- arterial blood gases
- hemoglobin: O2
- hematocrit: RBC vs plasma ratio
- pulse ox
- sputum studies: induced (given something to make them cough) vs exporated (cough)
- TB skin test
- allergy testing
- pulmonary function tests - spirometer used during different activities to evaluate air flow
15
Q
resp radiologic studies
A
- chest xray
- CT
- MRI
- ventilation perfusion VQ scan: identified areas of lungh not getting enough o2
- pulmonary angiogram: ask about idodine
- PET scan: radioisotope, benign vs. malignant lesions
16
Q
resp diagnostic procedures
A
- mediastinoscopy: OR biopsy
- lung biopsy
- bronchoscopy
- thoracentesis: aspirate or drain fluid
17
Q
bronchoscopy
A
- looks for tumors or abnormalitis
- NPO status prior to procedures
- blood tinged mucous is not abnormal
18
Q
trachesostomy
A
- surgically created stoma in trachea
- care: changes ties and dressings when soiled
- check for skin integrity
19
Q
rhinoplasty
A
- outpt procedure using regional anesthesia
- stop taking nsaids to reduce risk of bleeding
- internal nasal packing and or nasal septal splints may be removed by the surgeon the day after surgery
- external plastic splints are molded to the nose and removed 3-5 days after surgery
- keep head elevated to decrease nasal swelling
- will have edema and bruising for a short period before achieving the final cosmetic result
20
Q
epitaxis (nosebleed)
A
- anterior bleeding usually stops spontaneously, posterior bledding may require tx
- keep the pt quiet and in a sitting position
- apply direct pressure by pinching the lower part of the nose for 10-15 minutes
- partially insert a gauze pad into the nostril
- if bleeding doesnt stop, will ned a vasoconstrictor, cauterization, or packing
- packing can alter respiratorys status and increase risk of aspiration in older adults
- packing is painful because of the pressure and increase risk of infection
- may leave packing in for days
- painful to remove, premedicate
- no vigorous nose blowing, strenuous actibity, lifting, stratining for 4-6 weeks
21
Q
allergic rhinitis
A
- S/S: sneezing itchy eyes/nose, watery nasal discharge, nasal decongestion
- most important treatment is to identify and void triggers
- antihistamines (non-sedating) claratin, syrtex, need lots of fluids
- intranasal corticosteroids (rhinocort, flonase), decrease local inflammation w/o systemic effects, start 2-3 weeks before allergy season
- leukotriene receptor antagonists (singulair)
- allergy shots if nothing else works
22
Q
acute viral rhinitis (common cold)
A
- S/S: sneezing, nasal congestion, watery eyes, fever, malaise, headache
- rest
- increase fluids
- decongestant nasal sprays for no more than 3 days
- antipyretics and analgesics (tylenol)
- no abx unless complications (high fever, purulent nasal drainage, tender/swollen glands, sore/red throat, sputum changes, SOB, chest tightness) or it lasts longer than 7 days
23
Q
concerns with common illnesses
A
- dyspnea, crackles - pulmonary complications
- symptoms lasting longer than 7 days - bacterial infection
- purulent, foul smelling nasal drainage - foreign body
- inadequate treatment of strep - rheumatic heart disease or glomerulonephritis
- high fever, muffled “hot potato” voice - peritonsillar absceses (life threatening airway obstruction)
24
Q
tracheostomy
A
- indications: bypass an upper airway obstucton, facilitate removal of secretions, permit long term ventilation, permit oral intake and speech in pts who reuire long term mechanical ventilation
- Better than endotracheal tube: less risk of longer tem damage to airway, increased patient comfort, can eat with it b/c its lower in the airway, trach is more secure so mobility can be increased
25
tracheostomy safety
- be very careful first 5-7 days of a new trach
- HCP performs first tube change after new trach
- keep replacement tube of equal or smaller size at bedside
- humidified air to warm and moisten secretions (trach collar)
- change tubes once a month
- review suction technique
- change trach
26
cuffed tracheostomy tube
- use dif pt as risk for aspiration or needs mechanical ventilation
- cant speak while inflated
- inflate using minimal leak technique then verify pressure with manometer
- check cuff pressure q 8 hours
- before deflation: have pt cough, suction trach and mouth
- deflate during exhalation, reinflate during inspiration
27
speaking with a trach tube
- fenestrated trach: when inner cannula is removed, cuff deflated, and decnnaulation plug inserted, air flows around the tube, through the fenestration in outer cannula and up over the vocal chors so pt can speak
- talking trach tube: allows speech while cuff is inflated by connecting a port to an ar source so air can flow up over the vocal chords
- speaking valves: must be cuffless trach or delate the cuff
28
permanently removing a trach
- close stoma with steri strips and cover with an occlusive dressing
- keep dressng clean and dry
- have pt splint the stoma when coughing, swallowing, or speaking
- opening will close in several days
- no surgery is needed to close the trach opening
29
head and neck cancers
- risk factors: tobacco and alcohol use, diet poor in fruits and veggies, HPV infection
- S/S: painless growth/ulcer that doesnt heal, persistent unilateral sore throat or ear pain, hoarseness; pain, dysphagia, airway obstruction are late symptoms
- tx: radiation, surgery, chemo; very difficult to treat; cordectomy (chricoid), hemilaryngectomy (hald larynx), supraglottic laryngectomy, radical neck dissection, modified neck dissection; not a good cure rate even with tx
- speaking anddisfigurement are biggest issues
- nutrition: enternal nutrition may be needed, closely observe for choking when taking by mouth, avoid thin liquids, thick it, bland foods, give antiemetics before meals, add calories by adding dry milk, add sauces and gravies to food
30
head and neck cancer radiation therapy
- xerostomia: dry mouth, increased fluid intake, salagen to increase saliva production, chew sugarless gum or candy, use non-alcoholic mouth rinses, always keep a water bottle with them
- fatigue: take frequent rest periods, regular, light exercise
- stomatitis: soft, bland foods; sore mouth, oral sores, very sore, no mouthwash or spicy foods; use benadryl, maalox, lidociane swish/spit
- skin: no lotions within 2 hours of tx, avoid sun, call if moist skin reaction occurs
31
head and neck cancer surgical care
- expect a change in speech
- #1 priority is to maintain patent airway
- laryngectomy tube will be in place
- semi-fowler's position decreases edema and stress on suture lines
- may have surgical drain
- trach secretions will be bloody changing to thicker secretions
- no saline to this secretions
- exercise neck and shoudlers to prevent limitation in motion
32
laryngectomy stoma care
- wash around the stoma daily
- if pt has a laryngectmy tube, remove and clean daily
- can wear a scarf to shield the stoma
- cover the stoma when coughing and during actibities where something might be inhaled
- use a plastic collar when showering
- no swimming
- bedside humidifier
- wear a medic alert bracelet that says I am a neck breather - NEVER use mouth to mouth
- can't smell smoke so need smoke detectors
33
head and neck voice rehab
- voice prosthesis: device that is inserted into a fistula between esophagus and trachea; pt has to manually block the stoma with the finger unless they have a valve
- esophageal speech: involves swallowing air, trapping it in the esophogus and releasing it to create sound
- electrolarynx: handheld device that creates speech with sound waves, takes practice to learn how to use it
34
lower respiratory problems
- acute bronchitis: occurs after an URI; persistent night time cough with clear sputum, self limiting, supportive tx, no abx
- pertusis: whooping cough, tdap; highly contageous, paroxysms of coughing followed by inspiratory gasps, vomiting; cough lasts 6-8 weeks; treat with zithromax (zpack); adolescents and adults need booster immunizations
35
Pneumonia
- acute infection of the lung parenchyma (lung lining)
- associate with significant morbidity and mortality rates
- community aquired is 6th leading cause of eath in people 65+
36
Pneumonia etiology
- results when defense mechanisms become incompetent or overwhelmed
- decreased cough and epiglottal reflexes may allow aspiration- mucociliary mechanisms impaited: pollution, smoking, upper resp infections, tracheal intubation, aging
- chronic diseases supress immune system
3 ways organisms reach lungs:
1) aspiration from nasopharynx or oropharynx
2) inhalation of microbes present in the air
3) hematogenous spread from primary infection elsewhere in body
37
types of pneumonia
- Community aquired
- hospital aquired: 48 hours after hosp admint
- ventilator associated: 48 hours after endotracheal intubation
- health care associated: new onset of pt hospialized 2+ days, in long term care or attended a clinic
- aspiration
- opportunistic: immunocompromised, jiroveci, cytomegalovirus
38
pneumonia tx
- based on: known risk factors, early versus late onset, probable organism
- multidrug resistant organisms are major problem in treating HCAP
- pneumocystis jiroveci: trimethoprim/sulfamethoxazole (bactrim, septra), IV or orally
- cytomegalovirus: antiviral medications and high dose immunoglobin
39
pneumonia clinical manifestations
- sudden onset of fever, chills
- cough with purulent sputum
- may have pleuritic chest pain
- confusion or stupor
- breath sounds: increased fremitus, crackles, wheezing, dull to percussion (inflammation)
- viral pneumonia symptoms are highlt variable, self limiting
40
pneumonia complications
- pleurisy = inflammation of the pleura, common
- pleural effusion = fluid in the pleural space resulting in decreased breath sounds
- atelectasis = collapsed alveoli
- bactremia: bacterial infection in the blood
- empyema: accumulation of purulent exudate in the pleural cavity
41
pneumonia diagnostic studies
- history and physical exam
- chest xray: shows a typical pattern consistent with organism
- sputum culture before beginning abx
- ABGs, WBCs, blood cultures
- thoracentesis
- bronchoscopy with washings, fluid samples taken
42
pneumonia tx
- prompt abx tx (3-5 day response); start with IV then switch to oral when stable; minimum 5 day therapy
- supportive tx: oxygen, analgesics, antipyretics
- no tx necessary if viral
- adequate nutrition and hydration
43
acute care interventions for pneumonia
- Turn, Cough, Deep Breath
- o2
- bronchodilators
- positioning
- pain meds
- put good lung down when laying
- walk
- incentive spirometer
44
prevent pneumonia in at risk pts
- pain mngmt
- strict medical aspesis
- hand hygeine
- clean respiratory devices
- strict sterile aspetic technique when suctioning
- avoid unnecessary antibiotic usage
45
TB
- infectious disease caused by mycobacterium tuberculosis
- any organ can be infected but lungs most common
- primary cause of death worldwide
- leading cause of deat in pts with HIV/AIDS
- greater than 2 billion people infected worldwide
46
multidrug resistent TB
- MDR TB
- occurs when a strain develops resistance to two of the most potent first line anti TB drugs
- several causes for resistence occur: incorrect prescribing, lack of public health case management, poor patient comliance to prescribed drug regimen and follow up care
47
at risk for TB
- immunocompromised pts
- HIV
- homeless
- elderly
- institutionalized
- IV drug users
- increased in asian americans
48
TB etiology and patho
- spread via airborne droplets
- can be suspended in air for minutes to hours
- transmission requires close, frequent, or prolonged exposure
- NOT spread by toughing, sharing food utencils, kissing or other physical contact
49
TB classification
- latent TB infection - positive skin test, normal chest xray, not sick cant spread it to others, but needs to be treated
- TB disease: clinically active disease, positive sputum culture, can spread it to others, needs tx
- 9 month tx with INH
50
TB clinical manifestations
- LTBI: asymptomatic w/ positive skin test
- pulmonary TB: takes 2-3 weeks to develop symptoms, initial dry cough that becomes productive (with blood), constiutional symptoms (fatigue, malaise, anorexia, weight loss, low grade fever, night sweats), dyspnea and hemoptysis late symptoms
51
TB CX: miliary TB
- miliary TB: large #s of organisms spread via the bloodstream to distant organs, fatal if untreated, manifestations progress slowly and vary depending on which organs are infected, can include hepatomegaly, splenomegaly, generalized lymphadenopathy
52
TB CX: Pleural TB
- pleural effusion: bacteria in pleural space cause inflammation, pleural exudates of protein-rich fluid
53
TB CX: empyema
- large numbers of TB organisms in pleural space
54
TB CX: TB Pneumonia
- large amts of bacili discharged from granulmoas into lung or lymph nodes
- manifests as bacterial pneumonia
55
other acute and long term cx
- spinal destruction
- bacterial meningitis
- periotonitis
56
TB diagnostic studies
- TB skin test (mantoux test): induration > 10mm (not redness) means exposure to TB and presence of antibodies; if positive once, will be positive for life; immunocompromised pt if > 5mm; exposure to BCG vaccine will make it +; two step testing recommended for health care workers getting
- interferon release assay (IGRAs): quantiferon TB or TSPOT; blood test not affected by BCG vaccine or reader bias; measures immune response to TB proteins, rapid results bu expensive
- CXR: can not diagnose with this alone
- sputum smear for acid fast bacilli AFB: 3 consecutive sputum specimens collected on different days; confirmed giadnosis can take 8 weeks; treat if high suspicion
57
collaborate care for TB
- hospitalization not necessary for most patients
- infecitous for first 2 weeks after starting tx if sputum positive
- drug herapy used to prevent or treat active disease
- need to monitor compliance
58
TB drug thearpy
- active disease four drug regimen
1) INH - avoid alcohol, can cause hepatotoxicity
2) rifampin - causes orange discoloration or urine, sweat, tears, sputum
3) pyrazinaminde
4) ethambutol - can cause vision changes
* major side effects are hepatitis, must monitor liver fxn!
* directly observed therapy DOT
59
latent TB drug therapy
- treat with INH for 6-9 monhts
| - HIV pts should take INH for 9 months
60
TB nurse intervention
- airborne isolation - 6-12 airflow exhcanges/hour
| - HCP wear high efficiency particulate air HEPA filtration masks
61
pulmonary fungal infection
- caused by inhalation of spores (ground dirt)
- more common in immunocompromised pts
- amphotericin B standard tx
62
lung abscess
- bacteria aspirated from GI tract or oral cavity (in pts with periodontal disease)
- necrosis of lung tissue, causing cough and foul smelling sputum
- CXR or CT scsan
- IV clindamycin is first line therapy
63
environmental lung diseases
- penumoconiosis: inhalation and retention of mineral or metal dust particles, dust in the lings
- chemical pneumoitis: exposure to toxic chemical fumes resulting in pulmonary edema
- hypersensitivity pneumonitis: allergix alveolitis, inhales antigens
* S/S - new onset asthma
* tx: prevent exposure, follow OSHA guidelines
64
lung cancer
- leading cause of cancer related deaths
- high mortality rate
- smoking!
- quitting reduces risk
- advances in tx improving response
65
lung cancer etiology
- other carcinogens posing risk for developing lung cancer
- pollution, radiation, asbestos, indurstrial agents, arsenic
- genetics
- gender differences: females have higher risk of lung cancer
66
non small cell lung cancer NSCLC
- squamous cell carcinoma: early symptoms of cough and hemoptysis, surgery, chemo, radiation
- adenocarcinoma: most common in non smokers and women, surgery, doesnt respond well to chemo
- large cell cardinoma: rapid growing, highlt metastatic, no surgery, radiation sensitive bur recurs
67
small cell lung cancer SCLC
- very rapid growth
- response well to tx but recurs quickly
- brains metastasis common
- associated with endocrine disorders: paraneoplastic syndrome
- treat with chemo
- poor prognosis
68
paraneoplastic syndrome
- caused by factors produced by tumor cells - hypercalcemia, SIADH, adrenal hypersecretion, hematologic disorders, neurologic syndromes
- stabilize with tx of neoplasm
- symptoms can appear prior to CA diagnosis
69
lung cancer metastasis
by: direct extension, blood circulation, lymph system
to: liver, brain, bones, lymph nodes, adrenal glands
70
lung cancer clinical manifestations
- S/S: symptomatic until late in the disease process
- persistent cough with sputum is first sign, hemotysis is later sign
- anorexia, fatigue, wt loss, n/v, hoarseness
71
lung cancer diagnostic studies
- chest xray
- CT
- PET scan
- lung biopsy for definitive diagnosis
72
lung cancer staging
- NSCLC: Tumor, Node, Metastases
| - SCLC: systemic so stages as limited or extensive
73
lung cancer surgical therapy
- tx of choice for early stage NSCLC
- pneumonectomy, lobectomy, segmental, wedge resections
- VATs for tumors near outside lung (thoracic surgery with video)
- not indicated for SCLC
74
lung CA radiation
- used as curative therapy, palliative, or adjuvant
- primary thearpy for those unablet o tolerate surgery
- palliative to relieve symptoms such as dyspnea and pain
- preop to reduce tumor mass
- monitor for cx
75
Lung CA CHemo
- primary tx for SCLC
| - tx of non resectable tumors or adjuvant to surgery in NSCLC
76
biologic and targeter therapy
- block tumor growth
- less toxic than chemo
- tyrosine inase inhibitor (erlotinib, tolerated well)
- kinase inhibitor (crizotinib, NSCLC)
- angiogenesis inhibitor (bevacizumab)
77
Obstuctive pulmonary disorders
- asthma
- cystic fibrosis
- bronchiextasis
- COPD (emphysema, chronic bronchitis)
78
asthma
- chronic inflammatory disorder of the airways
- risk factors: genetics, immune response, allergens, exercise, air pullutants, occupation, respiratiry infections, nonse/sinus problems, drugs/food additives, GERD, extremes of emotion, obestiy
79
asthma patho
- airway inflamm resulting in bronchoconstriction, hyper reactiity, airway edema
- also includes mucus production
- chronic inflamm leads to structural changes
- in acute attack, the pt hyperventilates and becomes hypoxic, this makes the pt have to work harder to breathe, which leads to fatigue and respiratyr failure
- usually reversible either spontaneously or with tx
80
asthma s/s
- unpredictable and variable
- recurrent episodes of wheezing, breathlessness, chest tightness, cough
- worse at night and in the early am
- may be asymptomatic between attacks
- prolonged expiration 1:3 or 1:4
- wheezing is an unreliable sign of severity of attack
- anxiety is common if having difficulty breathing
81
asthma signs of distress
- unable to speak in complete sentences
- use of accessory muscles
- RR > 30, HR > 120
- dyspnea at rest
- tripod position
- peak flow
82
asthma diagnostic studies
- pupm fxn tests
- allergy skin testing
- CXR
- pulse ox and or ABGs
- rarely do sputum cultures
- peak flow is used to manage asthma, prevent attacks, judge severity of attack
83
astham tx
- SABAS, rescue inhalers
- persistent must also be on long term or controller medication
- persistent asthma needs daily long term therapy with a controller medication such as inhaled contricosteroids
- mild to moderate exacerbation: PFR > 50%, SABA every 20 minutes, 3 times; may need oral corticosteroids short term; oxygen if sats
84
acute asthma drug therapy
- bronchodilators: beta adronergic agonists --> albuterol, metaprolenol, xopenex, adrenalin
- anti-inflammatories: corticosteroids --> prednisone
85
chronic asthma drug thearpy
- bronchodilators: beta adrenergic agonists (serevent), methlxanthine (theophyline), anticholinergics (atrovent)
- anti-inflammatorites: corticosteroids (flovent), mast cell stabalizers (cromolyn), leukotryine modifiers (montelukast)
86
bronchodilators
* Beta adrenergic agonists (SABAs): short acting
- albuterol, maxair
- rescue drugs, work within minutes
- cause tremors, anxiety, tachycardia
- overuse can cause rebound bronchospasm
- should be used in combo with corticosteroids
- goal is to never need to use these for rescue
* Best-adrenergic agonists (LABAs): long acting
- serevent, foradil
- never use as a monotherapy
- only use if a pt is taking an ICS
- dont use as recue (only give q 12 hours)
- combos (advair, symbicort)
* methylxanthines
- theophyline, ampuphyline
- used only as an alternative thrapy in step 2
- hig incidence of side effects and toxicity (monitor blood levels)
* anticholinergics
- ipratropium
- less effective than beta adrenergic agonists
- used for quick relief if pt cant tolerate SABAs
- may be nebulized with a SABA
- primary side effect is dry mouth
87
anti inflammatories
* corticosteroids:
- flovent
- for prevention, not rescue
- take 1-2 weeks to really work
- use a spacer and rinse your mouth after use (thush)
- ICS does not have systemic effects like oral corticosteroids
- sometimes need short oral courses
* leukotrienes
- SIngulair, accolate
- oral pills
- prevention , not rescue
* anti ige
- xolair
- moderate to severe asthma
- SQ every 2-4 weeks
- risk of anaphylaxis
88
inhalation devices
- MDIs
- DPIs Dry powder inhalers
- nebulizers
89
COPD risk factors
- smoking
- industrial pollutants
- history of respiratory infections
90
chronic bronchitis
- females 2x more likely than males
- recurrent inflamm of bronchi, mucus production produces blockage and evenual scarring that restricts flow
- S/S: increased mucus production, SOB, wheezing, chronic productive cough
- can lead to emphysema
91
emphytsema
- alveoli are irreversibly destoroyed; lungs lose elasticity; air comes trapped in alveolar sacs resulting in co2 retention and impaired gas exchange
- males more than females
- S/S: SOB, decreased exercise tolerance, cough
92
COPD Diagnosis
- PFTs
- 6 minute walk test
- ABGs
- CXR not very helpful
- several questionaires
- consider it pt is >40 with 10 pack year history, chornic cough, sputum production, dyspnea
93
COPD s/s
- chronic, intermittent cough with or without mucus
- progressive dyspnea every day
- increased effort to breathe
- chest breather instead of abdominal breather
- fatigue, weight loss, anorexia
- prolonged expieratory wheezes
- decreased breath sounds
* blue bloated = chronic broncitis
* pink puffer = emphysema
- barrel chest
- accessory muscles
- pursed lip breathing
- hypoxemia
- hypercapnia
- polycythemia causes blueish, res skin tone
94
COPD cx
- core pulmonale: r sided heart failure
- pulm htn
- hypertrophy of the right side of heart
- depression
- weight loss
- muscle wasting
- CV problems
- diabetes
95
COPD interventions
- postural drainage: bronchodilators before drainage; maintain position 5 monites, 2-4 times/day, complete 1 hr before meals or 3 hrs after meals
- vibration done after postural drainage to loosen secretions
96
COPD nutritional thearpy
- supplement if BMI
97
cystic fibrosis
- autosomal recessive disease that causes dysfunction of the exocrine glands esp lungs, pancreas, and sweat glands
- avg life expectancy 37 yrs
- occurs more often in whites
98
CF patho
- mucous plugs in organs
- pancreatic enzymes needed
- DM
99
CF S/S
- occurs because of thick, sticky mucous
- kids - meconium ileus (bowel obstruction from intestinal mucus)
- FTT, clubbing, cough, tachypnea, large BMs, frequent resp illnesses
- grequent cough with green sputum
- low BMI
- frequent, bulky, oily foul smelling stools
- males are sterile
- females have delayed menarche, difficulty conceiving
100
CF CX
- pneumothorax from bullae and bleb
- hemoptysis
- DM
- Liver disease
- clubbing
- resp failure and cor pulmonale caused by pulmoary HTN
101
CF diagnosis and tx
- sweat choloride test
- genetic testing
- green sputum = infection
102
CF nutrtition
- pancreatic enzymes
- fat soluable vitamins ADEK
- supplments
- detary salt
- insulin
- ghih calorie diet
