exam 4 Flashcards
(62 cards)
1
Q
Collapse of the alveoli – leads to loss of lung volume
A
atelectasis
2
Q
caused by surfactant inactivation
Causes: Acute respiratory distress syndrome (ARDS) most common condition that causes decreased surfactant
Reduces alveoli surface tension, collapses alveoli
A
absorptive atelectasis
3
Q
external forces compress lung tissue
Causes: pleural effusions: fluid around lungs (fluid compresses lungs os it doesn’t expand well), lung tumors, pneumothorax, hemothorax, abdominal distention
A
Compressive atelectasis
4
Q
mechanical obstruction of airway
Causes: secretions, tumors foreign body
A
obstructive atelectasis
5
Q
Postoperative patients especially abdominal or thoracic surgery related to:
• Anesthetic or narcotic induced hypoventilation
• Incisional pain
• Abdominal distension
• Immobility
COPD Obesity (puts compression on lungs) CVA Smoking and lung cancer Pleural effusions
A
Risk factors of Atelectasis
6
Q
Dyspnea Cough Leukocytosis Sputum production Breath sounds •Crackles/ Diminished Obstruction-wheezing and stridor Large areas: • Dyspnea • Tachycardia • Tachypnea • Anxiety • Restlessness • Hypoxemia
A
Manifestations of Atelectasis
7
Q
Chest x-ray/ CT scan and hypoxia (detected by oxygen saturation and arterial blood gases)
A
Diagnosis of atelectasis
8
Q
- Prevention is key!
- Patient education
- Turn immobile patients frequently
- Ambulate surgical patients-improves lung expansion and mobilizes secretions
- Expand lungs-cough and deep breathe/incentive spirometer
- COPD, asthma, lung cancer-nebulized bronchodilators & chest physiotherapy
A
nursing management of atelectasis
9
Q
helps inflate lungs (slow and controlled)
• Stimulates alveolar cells to secrete surfactant – decrease the surface tension in alveoli, improves muscle performance
A
incentive spirometer for atelectasis
10
Q
- Dispenses aerosolized medications to lungs via hand held or face mask devices
- Medication injected with compressed air or oxygen
- Breathe through mouth
- Coughing during treatment-promotes secretion expectoration
A
nebulizer therapy for atelectasis
11
Q
- Includes postural drainage and chest percussion
- Goal-remove bronchial secretions, improve ventilation, increase efficiency of the respiratory muscles
- Postural drainage-uses positioning that allow gravity to aid in the removal of pulmonary secretions
- Percussion or vibration is used to loosen secretions-either manually or with a vest
A
chest physiotherapy for atelectasis
12
Q
Cough, ciliary clearance & alveolar macrophages prevent potentially infectious particles from reaching the lower respiratory tract
Bacteria may be inhaled
Aspirated
From contaminated water sources or respiratory equipment
From blood-borne organisms that enter the pulmonary circulation
Inflammatory response-alveolar edema and lung tissue consolidation
Consolidation seen on x-ray
Toxins and inflammatory mediators interfere with exchange of oxygen and carbon dioxide
A
patho of pneumonia
13
Q
mismatching of lung ventilation in relation to perfusion that results in deoxygenated blood reaching systemic circulation and lowering oxygen supply to tissues
A
ventilation perfusion mismatch of pneumonia
14
Q
Fever Cough • Productive • Non productive Dyspnea Pleuritic chest pain Tachypnea Tachycardia Fatigue May be proceeded by upper respiratory infection Onset of symptoms may be gradual & non specific Crackles Dullness on percussion
A
manifestations of pneumonia
15
Q
History Physical examination Chest x-ray Blood culture (bloodstream invasion-bacteremia) Can get by suctioning or bronchoscopy Sputum (gram stain and culture) • Obtain in morning • Rinse mouth • Breathe and cough deeply • Expectorate into sterile container
A
diagnosis of pneumonia
16
Q
Antibiotic therapy-5-10 days of therapy Take all required doses Increase fluids-thin out secretions Antipyretics-treat fever and body aches Oxygen-to correct hypoxia Nebulizer treatments/inhalers Rest
A
nursing management of pneumonia
17
Q
Primary diagnosis or complication of chronic illness Symptoms: • Weakness • Abdominal symptoms • Anorexia • Confusion • Tachycardia • Tachypnea Pneumococcal vaccine- ages 2-64 with chronic illness and for >65 yr old
A
pneumonia in elderly
18
Q
in hospital less than 48 hours
A
community acquired pneumonia CAP
19
Q
occurs more than 48 hours of being in hospital
A
hospital acquired / nosocomial pneumonia HAP
20
Q
on ventilators at least 48 hours
A
ventilator associated pneumonia VAP
21
Q
nursing home, chemo patients get it
A
health care associated pneumonia HCAP
22
Q
AIDS, chemo, long term steroids use, home ventilator patients
A
pneumonia in an immunocompromised pateitn
23
Q
destruction of Alveoli
Abnormal enlargement of air spaces, destruction of walls of alveoli
Dyspnea
Scant sputum
A
Emphysema
24
Q
inflammation of bronchioles
Bronchus is narrowed, inflamed
Cough
Copious sputum production
A
Chronic Bronchritis
25
Increase in mucus producing cells
Inflammation in parts of lung
Structural changes
• Due to continuous cycle of destruction and repair
Patho of COPD
26
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Tobacco smoke-cigarettes, pipe, cigar
2nd hand smoke
Occupational dust/chemicals
Indoor/outdoor air pollution
Infection-history of TB
Deficiency of alpha-anti-trypsin (enzyme in body that protects lung tissue)
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Risk factors of COPD
27
Diagnosed based on history/physical exam
Progressive dyspnea, chronic cough, sputum production
Dyspnea interferes with ADLS
Smoking history
• Numbers of packs per day smoked time the amount of years they smoked gives the average of how many packs per day they smoke
Barrel chest (hyperinflation)
Diminished breath sounds, rhonchi, wheezes
Pulmonary function test-confirms diagnosis, determines severity
Arterial blood gases (gives us base line oxygen status – you will see a CO2 retention and that shows what kind of gas exchange they have)
manifestations of COPD
28
Stabilize, manage and monitor disease
Reduce symptoms-maximize pulmonary function
Reduce exacerbation risk
Assist patient to adapt to the handicap/limited prognosis
Smoking cessation is key
• Smoking cessation classes, nicotine replacement, antidepressants, varenicline (Chantix)
goal of treatment for COPD
29
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Bronchodilators: albuterol
• Relieve bronchospasms
• Reduce airways obstruction
• Aid in secretion clearance
Sympathomimetics (cause bronchodilation)-also called beta adrenergic: sudafed
Anticholinergic: atrovant
Delivered by
• metered dose inhalers (MDI)
• Dry powder inhaler (DPI)
• Nebulizer
Long acting beta adrenergic & anticholinergic bronchodilators are used for maintenance
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meds for COPD
30
* Inhaled: Flovent
* Oral: Prednisone
* IV: Methylprednisolone – patient co2 levels high, hard to breath so give this
* What are side effects of long term treatment? Immunosuppression, hypoglycemia, osteoporosis
corticosteroids for COPD
31
* May be used during an acute exacerbation
* Long term continuous therapy for chronic hypoxemia
* Used with sleep
* Goal: Maintain tissue oxygenation, Decrease the work of the cardiopulmonary system, Maintain oxygen saturation level above 90%
oxygen therapy for COPD
32
Some patients with COPD and chronic hypercapnia are at risk for respiratory failure if they receive too high an O2 concentration
Lose their ‘drive to breathe’
At risk for respiratory failure
O2 should be at 1-2L/min
• Observe for changes in mental status: drowsiness, fatigue
• Assess lung sounds, monitor pulse oximetry
nursing alert of COPD
33
Goal of treatment: reduce symptoms, improve quality of life, and increase participation in ADLs
Assessment of client
Breathing exercises
Learn how to pace activities-energy conservation skills
Physical exercise-increase endurance
Nutritional counseling – eating small, frequent meals with lots of protein
pulmonary rehabilitation
34
o Common with patients with moderate to severe COPD
o Dyspnea occurs when the patient says it does and it is as bad as the patient says it is!
o Administer bronchodilators, O2 as needed
o Assist with ADLs
o Teach strategies: Pursed lip breathing (control breathing) and Tripod Positioning (expands lungs)
manage chronic dyspnea
35
Genetic pre-disposition
Chronic exposure to airway allergens sensitizes antibodies
Exposure to environmental factors, airborne allergens, viral respiratory infections
Exposure to tobacco smoke, air pollution
risk factors of asthma
36
History of cough, especially at night
Wheeze and diminished lungs sounds
Chest tightness and/or difficulty breathing
Symptoms occur or worsen with exercise, exposure to allergens, irritants, weather changes or stress
Exercise induced asthma
Occupational asthma
Intercostal retraction
manifestation of asthma
37
Spirometry and chest X-ray
| Categorized as intermittent, mild, moderate or severe
diagnosis of asthma
38
Prevent symptoms, maintain normal pulmonary function tests and normal activity, prevent exacerbations
medication management goals of asthma
39
Severe episode that is not responding to initial therapy – airway management*
status asthmaticus
40
Pressure in arteries during contraction of heart muscle
diastolic
41
Pressure in arteries between beats; filling/resting
systolic
42
Based on the average of two or more accurate blood pressure measurements taken during two or more contacts with health care provider
hypertension
43
95%; unidentifiable cause
primary hypertension - essential/idiopathic
44
5%; pregnancy, renal artery disease, kidney/renal failure and meds
secondary hypertension
45
o Age – baby boomers getting older
o Obesity
o Often coexists with dyslipidemia, diabetes mellitus, sedentary lifestyle & metabolic syndrome
o African Americans-especially males
o Oral contraceptive use-when accompanied with obesity and smoking
o Metabolic syndrome: (when 3 of these are present)
o -BP > 130/85
o -insulin resistance
o -dyslipidemia
o -abdominal obesity
risk factors for hypertension
46
o Lifestyle modifications-exercise & diet changes
o Medications- start low & go slow
o Compliance
o Nursing interventions – pill box
treatment of hypertension
47
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o Coronary artery disease with angina
o Myocardial infarction (heart attack)
o Left ventricular hypertrophy
o Heart failure (90% of the time HTN precedes congestive heart failure)
o Changes in kidneys
o Stroke/TIA
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manifestations of hypertension
48
o Goal-BP
Nursing management for hypertension
49
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o Support patient-education
o Thiazide diuretic-Hydrochlorothiazide (HCTZ)
Potassium wasting
o Beta blockers -
o ACE inhibitors – “prils”
o ARBs – “tans”
Angion reception 2 blocker
o Calcium Channel Blockers
o Always ask about OTC meds the patient takes
o Can decrease medications when BP is
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medications for hypertension
50
o SBP >180 or DBP >120
o Poorly controlled hypertension
o Stopped taking their meds
o Goal is to decrease blood pressure immediately
o MI, dissecting aortic aneurysm, intracranial hemorrhage
o Shouldn’t lower too quickly-can reduce tissue perfusion
hypertensive crisis/emergency
51
o BP is severely elevated but no organ damage suspected. However, organ damage can occur if left untreated.
o Severe headaches, epistaxis (nose bleeds), anxiety
o Goal is to decrease blood pressure SOON
hypertensive urgency
52
Alteration in ventricular contraction by weakened heart muscle
systolic heart failure
53
stiff heart muscle - ventricle can't fill properly
diastolic heart failure
54
o EF is normal in diastolic heart failure
| o EF reduced in systolic heart failure
determined by measure ejection fraction
55
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o Age
o Males
o Hypertension
o Left ventricular hypertrophy
o Myocardial infarction
o Valvular heart disease
o Obesity
o Dyslipidemia
o Smoking
o Chronic kidney disease
o Sedentary lifestyle
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risk for heart failure
56
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o Long standing heart disease
Dyspnea at rest
Cyanosis
Cachexia (muscle wasting)
o Tachycardia
o Murmur due to mitral and tricuspid regurgitation that happens
o Crackles in lungs, wheezes due to aioli filling with fluid
o Edema in extremities
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manifestations of heart failure
57
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o Pulmonary Congestion due to impaired left ventricle
o Dyspnea
o Cough
o Crackles
o Decreased O2 sats
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left sided heart failure
58
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o Hepatomegaly
o Edema in lower extremities
o Weight gain
o Anorexia, nausea
o JVD – jugular vein distention
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right sided heart failure
59
o Chest Xray-determines cardiac enlargement and/or pulmonary congestion
o 12 lead EKG-presence of cardiac arrhythmias, left ventricular hypertrophy, MI
o Echocardiogram-outlines the heart and measures EF*
o Lab tests-blood cell count, electrolytes, liver and kidney enzymes, BNP
o BNP-B type or brain natriuretic peptide
Hormone that is released from ventricles in response to fluid overload
Should be 500 diagnosed with heart failure
diagnostic tests for heart failure
60
o PREVENTION! Identify at risk patients
o Goals after diagnosis
Relieve patient symptoms
Improve functional status/quality of life
Extend survival
o Treatment is aimed at
Reducing contributing factors: HTN, arrhythmias, etc.
Reduce workload on heart, optimize therapeutic regimens
Prevent exacerbations of heart failure
medical management of heart failure
61
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o Patient education. Support groups for patients & families
o Diet-limit sodium. 1500 gm
o Decrease alcohol and smoking
o Weight reduction
o Regular exercise
o Recognize signs & symptoms to report to the doctor
Weight gain
Shortness of breath
Fatigue
Edema
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life style changes for elderly with heart failure
62
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o Diuretics-promote excretion of NA, Chloride and H2O to reduce fluid volume
Furosemide (Lasix)
Torsemide (Demadex)
Bumetadine (Bumex)
Spironolactone (Aldactone)
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pharmacologic therapy of heart failure
