Exam #5 Respiratory Flashcards
(254 cards)
1
Q
What is rhinitis?
A
Inflammation of the nasal mucous membranes.
2
Q
What causes rhinitis?
A
Bacterial or viral. The release of histamines cause vasodilation and edema which is what causes the symptoms
3
Q
What is pharyngitis?
A
Inflammation of the pharynx
4
Q
What is sinusitis?
A
Inflammation of the sinus mucosa
5
Q
What is laryngitis?
A
Inflammation of the larynx
6
Q
What causes pharyngitis?
A
Most commonly caused by strep infection. Chronic: smoking, alcohol use, using voice excessively, dusty environments
7
Q
What causes sinusitis?
A
Bacterial or allergic
8
Q
What causes laryngitis?
A
Inflammation, vocal abuse, or occasionally GERD
9
Q
What are upper respiratory infections?
A
Infections, rhinitis, sinusitis (acute & chronic), pharyngitis (acute & chronic), tonsilitis, adenoiditis, and laryngitis
10
Q
What are the s/s of rhinitis?
A
Nasal congestion, itching, sneezing, nasal discharge (typically clear), edematous conchae; polyps may develop
11
Q
What additional s/s are seen in viral rhinitis?
A
Common cold. Accompanied by fever and malaise
12
Q
What are the s/s of pharyngitis (acute & chronic)?
A
Red, swollen, sore throat; pus may be present, dysphagia, fever, chills, and malaise
13
Q
What are the s/s of sinusitis (acute & chronic)?
A
Pain over affected sinus, fever, chills, thick mucous that occludes the sinus cavity preventing drainage
14
Q
What is tonsilitis and adenoiditis?
A
Inflammation or infection of the tonsils and adenoids
15
Q
What are the s/s of laryngitis?
A
Hoarseness and soreness in throat
16
Q
What is a peritonsillar abscess?
A
Forms in the tissues of the throat next to one of the tonsils. An abscess is a collection of pus that forms near an area of infected skin or other soft tissue
17
Q
What causes a peritonsillar abscess?
A
Strep bacteria most commonly cause an infection in the soft tissue around the tonsils (usually just on one side). The tissue is then invaded by anerobes (bacteria that can live without oxygen), which enter through nearby glands
18
Q
True or False. Acute pharyngitis of a bacterial nature is most commonly caused by group A, beta-hemolytic streptococci.
A
True
19
Q
What are some potential complications of pharyngitis?
A
Sepsis, meningitis, peritonsillar abscess, otitis media, and sinusitis
20
Q
What does sepsis mean?
A
Infection in the blood
21
Q
What can sepsis lead to?
A
Septic shock
22
Q
Why would you ask a patient if they have allergies?
A
Allergies can lead to upper respiratory infections
23
Q
What is included when inspecting the nose, neck and throat for an upper respiratory infection?
A
Include palpation of lymph nodes (neck, around ears, and face)
24
Q
What is most important nursing diagnosis for an upper respiratory infection?
A
Ineffective airway clearance
25
What are some goals when treating a patient with an upper respiratory infection?
Maintain patent airway, relieve pain, maintain effective communication, normal hydration, knowledge (how to prevent), and absence of complications
26
How do you promote comfort in a patient with an upper respiratory infection?
Analgesics, gargles for sore throat, and use of hot packs for sinus congestion or ice collar to reduce swelling
27
What is used to reduce swelling and bleeding post tonsillectomy and adenoidectomy?
An ice collar
28
Hot packs increase inflammation, why use them on a patient with an upper respiratory infection?
To decrease the pain and make the patient more comfortable
29
How much fluids do you encourage the patient to drink per day if they have an upper respiratory infection?
2-3 L/day
30
What education does the patient need for an upper respiratory infection?
Prevention, hand washing, when to contact doctor, complete anitbiotic therapy, and annual flu vaccine for those at risk
31
What is epistaxis?
Hemorrhage from the nose (nose bleed)
32
What are some common risk factors for epistaxis?
Severe HTN (biggest), dry environment, trauma to the nose, cocaine use
33
What is the most common site of epistaxis?
Anterior septum
34
What is the treatment for epistaxis?
Topical vasoconstrictors and packing of nasal cavity or balloon catheter
35
List some topical vasoconstrictors used to treat epistaxis.
Adrenaline, cocaine, and phenylephrine
36
What is "hurricaine spray"?
Cocaine spray used to treat epistaxis
37
How does cocaine treat epistaxis?
It is the only naturally occurring numbing medication and it vasoconstricts
38
Would you be able to use cocaine spray for treatment of epistaxis if the patient was a chronic cocaine user?
No, they would most likely use a different treatment
39
How is packing to control bleeding from the posterior nose done?
A catheter is inserted and packing is attached. Packing is drawn into position as the catheter is removed. Strip is tied over a bolster to hold the packing in place with an anterior pack installed "accordion pleat" style. Alternative method, using a balloon catheter instead of gauze packing
40
Why would a "nasal tampon" be used to treat epistaxis?
It absorbs the bleeding and provides compression to stop the bleeding
41
What do you need to consider when assessing the bleeding in a patient with epistaxis?
How much blood loss are you dealing with? Do you need to give blood products?
42
Why do you need to monitor the airway and breathing of a patient with epistaxis?
May need to intubate in order to maintain a patent airway
43
What do you need to watch for when monitoring VS in a patient with epistaxis?
Tachycardia and hypotension due to hypovolemic shock (which is due to blood loss)
44
What might a patient with epistaxis need so they don't dry out their nares?
Air humidification especially if they are on oxygen
45
How would you explain to a patient with epistaxis how to stop the bleeding?
Lean slightly forward and pinch the upper portion (not the tip) of the nose
46
When should a patient with epistaxis seek medical attention when bleeding doesn't stop?
After 15 minutes
47
What is atelectasis?
Collapse or airless condition of alveoli caused by hypoventilation, obstruction to airways, or compression
48
What causes hypoventilation?
Drug use (especially sedatives), pneumonia, bed ridden, immobility, COPD, loss of elasticity due to aging, can't inhale deeply and not doing CTDB
49
What causes atelectasis?
Bronchial obstruction by secretions due to impaired cough mechanism or conditions that restrict normal lung expansion on inspiration
50
Which patients are at high risk for atelectasis?
Postoperative patients
51
What are some symptoms of atelectasis?
Insidious, include cough, sputum production (big one), low-grade fever
52
Define insidious.
Slow to develop or see
53
What are some complications of atelectasis?
Respiratory distress, anxiety, symptoms of hypoxia occur if large areas of the lung are affected
54
What are some s/s of hypoxia?
Mental impairment (biggest one), cyanosis, pallor, and SOB
55
What is "lung toileting"?
Turn patients q2hrs to move secretions and cough it out
56
Which patients need frequent turning and early mobilization so they don't develop atelectasis?
Open heart surgery patients
57
How do you prevent atelectasis?
Frequent turning, early mobilization, improve ventilation and remove secretions
58
What is a PEP device used in patients with atelectasis?
Positive pressure to keep alveoli open as you exhale (blowing into)(oval, green, with mouthpiece)
59
What are some strategies to improve ventilation in patients with atelectasis?
Deep breathing exercises at least q2hrs, incentive spirometer
60
How often does a patient need to use an incentive spirometer?
10X/hr while awake
61
What are some strategies to remove secretions in a patient with atelectasis?
Coughing exercises, suctioning, aerosol therapy, and chest physiotherapy
62
What aerosol therapy is used in patients with atelectasis?
Nebulizer breathing treatments
63
What is the chest physiotherapy used in patients with atelectasis?
Percussion either by bed, vests, discs, or manually (by cupping the hand - done by respiratory therapists)
64
What is a strategy to improve ventilation in atelectasis?
Remove secretions
65
What is done to remove an obstruction in atelectasis?
Bronchoscopy
66
What are the 2 treatments for atelectasis?
PEEP (Positvie End-Expiratory Pressure) and IPPB (Intermittent Positive-Pressure Breathing)
67
What does PEEP stand for?
Positive End-Expiratory Pressure
68
What does IPPB stand for?
Intermittent Postive-Pressure Breathing
69
What does CPPB stand for?
Continuous Positive-Pressure Breathing
70
What does CPAP stand for?
Continuous Positive Airway Pressure
71
What does a CPAP do?
Uses mild air pressure to keep an airway open
72
What is the difference between PEEP and CPAP?
PEEP is an applied pressure against exhalation CPAP is a pressure applied by a constant flow
73
What is the function of a BIPAP machine?
Helps push air into the lungs and helps hold the lungs open to allow more oxygen to enter the lungs. Applies air and pressure during expiration in order to hold open the air sacs in the lungs
74
What does BIPAP stand for?
Bilevel Positive Airway Pressure
75
What is the difference between the CPAP and BIPAP?
CPAP only has one continuous pressure setting and BIPAP has a pressure setting for inhalation and another pressure setting for exhalation
76
What is a common BIPAP setting?
12/6
77
What is acute tracheobronchitis?
An acute inflammation of the mucous membranes of the trachea and the bronchial tree, often follows infection of the upper respiratory tract
78
What is one of the major factors in the prevention of acute tracheobronchitis?
Adequate treatment of upper respiratory tract infections
79
What causes the production of mucopurulent sputum in acute tracheobronchitis?
In response to infection by streptococcus pneumoniae, Haemophilus influenzae, or Mycoplasma pneumoniae. A fungal infection may also cause tracheobronchitis
80
Besides infection, what else might cause acute bronchial irritation?
Inhalation of physical and chemical irritants, gases, or other air contaminants
81
What are the 4 classifications of pneumonia?
Community-acquired pneumonia (CAP); Hospital-acquired pneumonia (HAP)(nosocomial); Pneumonia in immunocompromised host; Aspiration pneumonia
82
What is the pathophysiology of pneumonia?
Alveoli fill with exudate (any fluid released from the body with a high concentration of protein, cells, or solid debris) and increases exudate; Reduced surface area for gas exchange and decreases gas exchange; Obstruction of bronchioles
83
What is pneumonia?
Acute lung infection, inflammation and alveolar damage
84
When is pneumonia opportunistic?
In pneumocystitis (PCP), Carinii pneumonia, and Mycobacterium avium complex (MAC)
85
What is infectious pneumonia caused by?
Bacteria, viruses, fungi, protozoa, and other microbes
86
What is noninfectious pneumonia caused by?
Aspiration of gastric contents and inhalation of toxic or irritating gases
87
What are some underlying disorders that may cause pneumonia?
HF, diabetes, alcoholism, COPD, and AIDS
88
What are some s/s of pneumonia?
Cough (dry or productive), fever, chills, tachycardia, tachypnea or dyspnea, pleural pain, malaise, respiratory distress, and decreased breath sounds
89
What are some characteristics of sputum produced from a productive cough associated with infectious pneumonia?
Yellow, bloodstreaked, rusty sputum
90
How is pneumonia diagnosed?
Sputum gram stain and C&S, chest X-Ray, ABGs, CBC, pulse oximetry and fiberoptic bronchoscopy
91
What type of antibiotic therapy is used if the etiologic agent is not identified?
Utilize empiric antibiotic therapy (broad spectrum antibiotics)
92
What is the treatment for pneumonia?
Fluids, oxygen for hypoxia, antipyretics, antitussives, decongestants, antihistamines, and antibiotic therapy
93
How is the antibiotic therapy for pneumonia determined?
By the gram-stain results
94
Are antibiotics indicated for viral pneumonia?
No, but they are used for secondary bacterial infections
95
What are some nursing diagnoses for pneumonia?
Ineffective airway clearance r/t copious tracheobronchial secretions; Activity intolerance r/t impaired respiratory function; Risk for deficient fluid volume r/t fever and a rapid respiratory rate; Imbalanced nutrition: less than body requirements; Deficient knowledge
96
What assessments need to be done in a patient with pneumonia?
Temperature, apical pulse, secretions, cough, tachypnea, SOB, changes in physical assess and CXR, mental status and LOC, and hydration status
97
What changes in a physical assessment might you see in a patient with pneumonia?
Changes in respiratory status, including respiratory rate and depth, dyspnea, cough; symmetry of chest movements; lung sounds upon auscultation including any adventitious sounds; atelectasis
98
Why might you see changes in mental status in a patient with pneumonia?
Due to hypoxia
99
What type of HF is seen in patients with pneumonia?
Concomitant HF (transient)
100
What does concomitant HF mean in relation to pneumonia?
It means HF is naturally accompanying or associated with pneumonia (especially in the elderly)
101
What does transient HF mean in relation to pneumonia?
That HF is just during the period of pneumonia due to inability to get rid of secretions
102
What are some collaborative problems associated with pneumonia?
Continuing symptoms after initiation of therapy, shock, respiratory failure, atelectasis, pleural effusion, confusion, and superinfection
103
What type of shock is associated pneumonia?
Septic shock
104
What causes respiratory failure in patients that have pneumonia?
Atelectasis
105
What is a superinfection?
An acquired bacteria that is different than the bacteria that is currently being treated. Typically the new bacteria is resistant to the antibiotic taken for the original infection
106
What are the biggest causes of a superinfection that is associated with pneumonia?
Staph and Strep A
107
Why is nutrition important in a patient with pneumonia?
Need proper nutrition for appropriate healing to take place
108
What are some of the nursing goals for a patient with pneumonia?
Improved airway clearance; Maintenance of proper fluid volume and adequate nutrition; Patient understanding of treatment, prevention; Absence of complications
109
What steps are taken to improve airway clearance in patients with pneumonia?
Encourage hydration, humidification, coughing techniques, chest physiotherapy, position changes and oxygen therapy
110
Why and how is humidification used to improve a patient's airway clearance with pneumonia?
Loosens secretions and treats atelectasis by face mask or with oxygen
111
How much fluids are encouraged per day to improve a patient's airway clearance with pneumonia?
2-3 L/day
112
How is rest promoted in pneumonia?
Encourage rest, avoidance of overexertion and positioning to promote rest, breathing (Semi-Fowler's)
113
How do you promote fluid intake in a patient that has pneumonia?
Encourage fluid intake to at least 2 L/day
114
How do you maintain nutrition in a patient that has pneumonia?
Provide nutritionally enriched foods and fluids to promote healing
115
What is pleurisy?
Inflammation of both layers of pleurae
116
What is the pathophysiology of pleurisy?
Inflamed surfaces rub together with respirations, cause sharp pain intensified with inspiration
117
What is pleural effusion?
Collection of fluid in pleural space usually secondary to another disease process
118
Can you hear the rubbing sound upon auscultation of the lung sounds in pleurisy?
Yes
119
What causes dyspnea in pleural effusion?
Large effusions impair lung expansion causing dyspnea (SOB)
120
What is the treatment for a pleural effusion?
Find the underlying cause, thoracentesis, and chest tube if large amount
121
What is a thoracentesis?
Use a needle to aspirate the fluid out of the pleural space
122
What causes pleural conditions?
HF, TB, pneumonia, bronchogenic carcinoma
123
What are the s/s of pleural conditions?
SOB, difficulty lying flat, coughing, chest pain, fever, chills
124
What assessments are done on a patient with a pleural condition?
Absent lung sounds, decreased fremitus (palpable vibration), and tracheal deviation
125
How are pleural conditions diagnosed?
Chest X-Ray, CT, and then thoracentesis
126
Define loculation.
Having, formed of, or divided into small cavities or compartments
127
What is empyema?
Accumulation of thick, purulent (infection) fluid in the pleural space
128
What are the s/s of empyema?
Patient usually acutely ill; Fluid, fibrin development, loculation impair lung expansion
129
How is empyema resolved?
A prolonged process with weeks of antibiotic therapy
130
What does COPD stand for?
Chronic Obstructive Pulmonary Disease
131
What does GOLD stand for?
Global Initiative for Chronic Obstructive Lung Disease
132
What is COPD?
A disease state characterized by airflow limitation that is not fully reversible
133
Which disease process is currently the 4th leading cause of death and the 12th leading cause of disease?
COPD
134
Which diseases are included in COPD that cause airflow obstruction?
Emphysema and chronic bronchitis (may also be a combination of these disorders)
135
Is asthma considered to be part of COPD?
No (used to be), but can coexist with COPD
136
What is the pathophysiology of COPD?
Airflow limitation is progressive and is associated with abnormal inflammatory response of the lungs to noxious (harmful, poisonous) agents (within the bronchials)
137
Explain the inflammation cycle involved in COPD.
Inflammation leads to more damage (scar tissue), which in turn leads to more inflammation
138
What occurs in the airways in COPD?
Scar tissue and narrowing occurs
139
Where does the inflammatory response occur in COPD?
Throughout the airways, lung parenchyma, and pulmonary vasculature
140
What does substances activated by chronic inflammation damage in COPD?
The parenchyma
141
In COPD, what does the inflammation response cause changes in?
Pulmonary vasculature
142
Describe a common exercise done to feel how COPD feels.
Breath through a straw for 30 seconds
143
What is the difference between chronic and acute bronchitis?
Chronic is the presence of a cough and sputum production for at least 3 straight months in 2 consecutive years
144
What does irritation of the airways result in with chronic bronchitis?
Inflammation and hypersecretion of mucous
145
What increases in numbers with chronic bronchitis?
Mucous-secreting glands and goblet cells
146
What is a patient with chronic bronchitis more susceptible to?
Respiratory infections
147
What happens in chronic bronchitis?
Ciliary function is reduced, bronchial walls thicken, bronchial airways narrow, and mucous may plug airways; Alveoli become damaged, fibrosed, and alveolar machrophage function diminishes
148
What is bronchitis?
Inflammation inside the bronchial tubes
149
What does the tar from cigarette smoking cause?
It causes the cilia to stick
150
What is the pathophysiology of chronic bronchitis?
The bronchus is narrowed and has impaired air flow due to multiple mechanisms: Inflammation, excess mucus production, and potential smooth muscle constriction (bronchospasm).
151
What are the s/s of chronic bronchitis?
Wheezing, crackles; Chronic cough; Dyspnea; Thick, tenacious sputum; Increased susceptibility to infection; Mucous plugs
152
True or False. For patients with chronic bronchitis, the nurse expects to see the major clinical symptoms of tachypnea and tachycardia.
False. For patients with chronic bronchitis, the nurse expects to see the major clinical symptoms of sputum and productive cough, not tachypnea and tachycardia
153
What is emphysema?
Abnormal distention of air spaces beyond the terminal bronchioles with destruction of the walls of the alveoli
154
What is the difference between the types of COPD?
Destruction of the walls of the alveoli
155
What does the decrease in alveolar surface area cause in emphysema?
An increase in "dead space" and impaired oxygen diffusion
156
What does a reduction of the pulmonary capillary bed do in emphysema?
Increased pulmonary vascular resistance and pulmonary artery pressure; Can also cause right sided HF
157
What is a patient with emphysema not getting?
Full lung expansion or enough oxygen
158
What is the result of the pathologic changes in emphysema?
Hypoxemia
159
What might happen due to increased pulmonary artery pressure in emphysema?
Right-sided HF (cor pulmonale)
160
Define cor pulmonale.
Enlargement of the right ventricle of the heart due to disease of the lungs or of the pulmonary blood vessels
161
Why can a patient with emphysema not have more than 2L of oxygen?
Their main drive to breathe is CO2. For patients with COPD/emphysema, their drive to breathe is by oxygen. So if we saturate them with oxygen we will depress their drive to breathe (deprive them of inspiration and expiration)
162
What is the pathophysiology of emphysema?
Destruction of alveolar walls, loss of elastic recoil, damage to pulmonary capillaries, air trapping, impaired gas exchange
163
What are the s/s of emphysema?
Cough, sputum production, dyspnea, prolonged expiration, barrel chest, activity intolerance, and diminished breath sounds
164
What are the changes in the alveolar structure in panlobular emphysema?
The bronchioles, alveolar ducts and alveoli are destroyed, and the air-spaces within the lobule are enlarged; Occurs more in lower respiratory tract
165
What are the changes in the alveolar structure in centrilobular emphysema?
The pathologic changes occur in the lobule, whereas the peripheral portions of the acinus are preserved; Distal part of bronchial; Tends to occur in upper respiratory tract/airway
166
Why would a patient with emphysema have a barrel chest?
From the hyperexpansion of lungs
167
What is the primary clinical symptom of emphysema? A.) Chest pain; B.) Productive cough; C.) Sputum; D.) Wheezing
D.) Wheezing. The primary symptom of emphysema is wheezing. Sputum and productive cough are the primary symptoms of chronic bronchitis
168
What is the typical posture of a patient with COPD, primarily emphysema called?
"Tripodding" (orthopneic position) leaning forward
169
Describe the typical posture of a patient with COPD, primarily emphysema.
The patient tends to lean forward and uses the accessory muscles of respiratory to breathe, forcing the shoulder girdle upward and causing the supraclavicular fossae to retract on inspiration
170
What causes 80-90% of COPD cases?
Tobacco smoke
171
What are the risk factors of COPD?
Tobacco smoke, passive smoking, occupational exposure, ambient air pollution, and genetic abnormalities
172
What genetic abnormality can cause COPD, primarily emphysema?
A deficiency of alpha1-antitrypsin
173
What is alpha-antitrypsin?
Enzyme in which a deficiency in it can predispose a person to emphysema
174
What diagnostic test are reviewed during the assessment of a patient with COPD?
PFT (pulmonary function test), spirometry, ABGs, and oximetry
175
What nursing diagnoses might be used for a patient with COPD?
Impaired gas exchange, Impaired airway clearance, Ineffective breathing pattern, Activity intolerance, Deficient knowledge, and Ineffective coping
176
What are the s/s of COPD (including emphysema and chronic bronchitis)?
Digital clubbing, thin in appearance, wheezing, pursed-lip breathing, chronic cough, barrel chest, dyspnea, prolonged expiratory time, easily fatigued, frequent respiratory infections, use of accessory muscles to breathe, orthopneic, and cor pulmonale (late in disease)
177
What are some collaborative problems with COPD?
Respiratory insufficiency or failure, atelectasis, pulmonary infection, pneumonia, pneumothorax, and pulmonary HTN
178
What steps are taken in the planning stage with a patient that has COPD?
Smoking cessation, improved activity tolerance, maximal self management, improved coping ability, adherence to therapeutic regimen and home care, absence of complications
179
What is done to improve activity tolerance in a patient with COPD?
Physical therapy or cardiac rehab
180
What needs to be monitored for impaired gas exchange due to COPD?
Lung sounds, respiratory rate and effort; Dyspnea; Mental status; SaO2, ABGs
181
What positions do a patient with impaired gas exchange due to COPD need to be in?
Fowler's orthopneic, or good lung down
182
What assessments are done with ineffective breathing pattern due to COPD?
Monitor respiratory rate, depth, effort and ABGs, SaO2; Determine/treat cause; Position; Teach diaphragmatic breathing
183
True or False. A commonly prescribed methylxanthine is theophylline.
True
184
What percentage of oxygen saturation do patients with COPD typically live on?
80%
185
What is important with bronchodilators and corticosteroids when trying to improve gas exchange in a patient with COPD?
Proper administration
186
What is important to reduce while improving gas exchange in a patient with COPD?
Reduction of pulmonary irritants (what's causing it)
187
What types of coughing techniques are used to improve gas exchange in COPD?
Direct coughing and "huff" coughing
188
What is the purpose of coughing techniques when improving gas exchange in COPD?
To loosen secretions
189
What chest physiotherapy is done to improve gas exchange in COPD?
Percussion
190
What is diaphragmatic breathing?
Deep breathing with diaphragm without raising shoulders
191
What breathing exercises to reduce air trapping are used to improve gas exchange associated with COPD?
Diaphragmatic breathing and pursed lip breathing
192
When giving supplemental oxygen to improve gas exchange in a patient with COPD, how much oxygen is given and why?
No more than 2L. These patients have a hypoxic drive
193
What does it mean when a COPD patient has a hypoxic drive?
They retain CO2 because they can't always blow out enough CO2. They are driven to breathe by CO2 which tells them when and how much to breathe
194
Describe "huff" coughing.
Have patient take a few deep (not so deep that it makes them cough) breaths and exhale, after taking a deep breath stutter cough when exhaling. Do this 3X. When taking the 2nd breath, don't take as deep of a breath as you did in the 1st and the 3rd breath shouldn't be as deep as the 2nd was. Stuttered coughing should be done with every exhalation
195
How do you improve activity intolerance in a patient with COPD?
Focus on rehabilitation activities (respiratory and cardiac rehab) to improve ADLs and promote independence; Pacing of activities; Exercise training; Walking aids; Utilization of a collaborative approach
196
List some other interventions for a patient with COPD.
Set realistic goals, avoid extreme temperatures, enhancement of coping strategies, and monitor for and management of potential complications
197
Why should a patient with COPD avoid extreme temperatures?
If temperatures are too hot or too cold, it makes it hard for them to breathe
198
What patient teaching must be done with a patient that has COPD?
Disease process, medications, procedures, when and how to seek help, prevention of infections (hand washing), avoidance of irritants, and lifestyle changes
199
What is the biggest problem when teaching a patient the disease process of COPD?
That there is no cure
200
What is asthma?
A chronic inflammatory disease of the airways that causes hyperresponsiveness, mucosal edema, and mucous production
201
Why does hyperresponsiveness occur in asthma?
Because of the vicious cycle of edema
202
What does the inflammation associated with asthma lead to?
Hyperresponsiveness of airways, airflow limitation, and symptoms
203
What are they symptoms of asthma caused by inflammation?
Dyspnea, wheezing, cough, sputum, chest tightness, use of accessory muscles, and it may be worse at night
204
What is the most common disease of childhood?
Asthma
205
Can asthma occur at any age?
Yes, but most have an onset after age 12 years
206
What is the strongest predisposing factor for asthma?
Allergies
207
What are the 2 predisposing factors for asthma?
Atopy (genetic predisposition) and female gender
208
What are the 2 casual factors for asthma?
Exposure to indoor and outdoor allergens and occupational sensitizers
209
What are the contributing factors for asthma?
Respiratory infections, air pollution, active/passive smoking, and other (diet, small size at birth)
210
What are some risk factors for exacerbations in asthma?
Allergens; Respiratory infections; Exercise and hyperventilation; Weather changes; Exposure to sulfur dioxide; Exposure to food, additives, medications
211
What is a complication of asthma?
Status asthmaticus
212
What happens in status asthmaticus?
Severe, sustained asthma; Worsening hypoxemia; Respiratory alkalosis progresses to respiratory acidosis
213
Is status asthmaticus life threatening?
Yes, it may be life threatening
214
What are the s/s of hypoxemia?
Tachycardia, Increased restlessness and tachypnea
215
When is asthma an emergency?
If symptoms do not respond to usual treatment in 30 minutes, client should seek medical attention
216
What diagnostic tests are done for asthma?
Hx and physical exam, spirometry/PFTs, ABGs, and allergy skin testing
217
What outcomes show improved breathing patterns in patients with asthma?
Decreased respiratory rate and dyspnea, less nasal flaring, reduced use of accessory muscles; Return of ABGs to normal and oxygen saturation > 95%; Vital capacity with normal limits
218
What assessments are done to improve breathing patterns on a patient with asthma?
In high Fowler's position and compare pulmonary function tests with normal values
219
What outcomes show effective airway clearance in patients with asthma?
Decreased wheezing, decreased rhonchi, and drecreased dry, nonproductive cough
220
What assessments are done to monitor airway clearance in patients with asthma?
Effectiveness of cough, color and consistency of sputum, oral fluid intake, and mucous membranes for need for oral care
221
What outcomes show adequate gas exchange in patients with asthma?
Decreased wheezing, rhonchi, and cough; Oxygen saturation > 90%; pH of 7.35-7.45; PaO2 > 60 mm Hg; PaCO2 < 45 mm Hg; Usual skin color without cyanosis
222
Why would a spacer be used wit a metered dose inhaler?
More accurate dosing; More medication inhaled; Used frequently in children
223
What patient teaching needs to be done for asthma?
Disease process including definition of inflammation and bronchoconstriction; Purpose and action for each medication; Identify triggers and how to avoid them; Proper inhalation techniques; How to monitor peak flow and implement an action plan; When and how to seek assistance
224
What is a peak flow meter used for in patients with asthma?
Measures the highest volume of air flow during a forced expiration
225
What are the 2 general classes of asthma medications?
Quick-relief and long-acting
226
What is the purpose of a quick-relief asthma medication?
Immediate treatment of asthma symptoms and exacerbations
227
What is the purpose of a long-acting asthma medication?
To achieve and maintain control of persistent asthma
228
What are the 2 types of quick-relief asthma medications?
Short-acting beta2-adrenergic agonists and anticholinergics
229
What are the indications for inhaled short-acting beta2-agonists (SABAs) in patients with asthma?
Relief of acute symptoms and preventive treatment for exercise induced bronchospasm
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What is the mechanism of action of an inhaled short-acting beta2-agonists (SABAs) in patients with asthma?
Bronchodilation. Binds to the beta-2 adrenergic receptor; Producing smooth muscle relaxation and decreased bronchoconstriction
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List some inhaled short-acting beta2-agonists (SABAs) used to treat asthma?
albuterol (Proventil HFA, Ventolin HFA), levalbuterol HFA (Xopenex), pirbuterol CFC (Maxair), and metaproterenol sulfate (Alupent)
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What are the indications for anticholinergics in patients with asthma?
Relief of acute bronchospasm
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What is the mechanism of action of an anticholinergic medication in patients with asthma?
Bronchodilation. Inhibition of muscarinic cholinergic receptors. Reduction of vagal tone of airways. May decrease muscous gland secretion
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What is an anticholinergic medication that is used to treat asthma?
ipratropium (Atrovent)
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What are the indications for inhaled corticosteroids (ICs) in patients with asthma?
Long-term prevention of symptoms; Suppression, control, and reversal of inflammation. Reduce need for oral corticosteroid
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What is the mechanism of action of an inhaled corticosteroids (ICs) in patients with asthma?
Anti-inflammatory. Block late reactions to allergen and reduce airway hyperresponsiveness. Inhibit cytokine production, adhesion protein activation, and inflammatory cell migration and activation. Reverse beta-2 receptor down-regulation. Inhibit microvascular leakage
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List the inhaled corticosteroids (ICs) used to treat asthma.
beclomethasone dipropionate (QVAR), beclomethasone (Beconase-AQ), budesonide (Pulmicort), ciclesonide (Alvesco), flunisolide (AeroBid), fluticasone (Flovent), mometasone furoate (Asmanex), triamcinolone acetonide (Axmacort)
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What are the indications for systemic corticosteroids in patients with asthma for short-term (3-10 days) "burst"?
To gain control of inadequately controlled persistent asthma
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What are the indications for systemic corticosteroids in patients with asthma for long-term use?
Prevention of symptoms in severe persistent asthma: suppression, control, and reversal of inflammation
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What is the mechanism of action of a systemic corticosteroid in patients with asthma?
Anti-inflammatory. Block late reactions to allergen and reduce airway hyperresponsiveness. Inhibit cytokine production, adhesion protein activation, and inflammatory cell migration and activation. Reverse beta-2 receptor down-regulation. Inhibit microvascular leakage.
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List the systemic corticosteroids used to treat asthma.
methylprednisolone (Medrol), prednisolone (Prelone), and prednisone (Deltasone, Orasone)
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What are the indications for long-acting beta2-agonists (LABAs) in patients with asthma?
Long-term prevention of symptoms, added to ICs. Prevention of exercise-induced bronchospasm
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What does SABA stand for?
Short-acting beta2-agonists
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What does LABA stand for?
Long-acting beta2-agonists
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Compare SABA and LABA.
Salmeterol (but not formoterol) has slower onset of action (15-30 min). Both salmeterol and formoterol have longer duration (> 12 hr) compared to SABA
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What is the mechanism of action of long-acting beta2-agonists in patients with asthma?
Bronchodilation. Smooth muscle relaxation following adenylate cyclase activation and increase incyclic AMP, producing functional antagonism of bronchoconstriction
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List the inhaled long-acting beta2-agonists (LABAs).
salmeterol (Serevent Diskus) and formoterol (Foradil Aerolizer)
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List the oral long-acting beta2-agonists (LABAs).
albuterol (Proventil) sustained-release
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What are the indications for leukotriene modifiers in patients with asthma?
Long-term control and prevention of symptoms in mild persistent asthma. May also be used with ICs as combination therapy in moderate persistent asthma
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What does ICs stand for?
Inhaled corticosteroids
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What is the mechanism of action of leukotriene modifiers in patients with asthma?
Selective competitive inhibitor of CysLT1 receptor
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List the leukotriene modifiers used to treat asthma.
montelukast (Singulair) and zafirlukast (Accolate)
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What are leukotriene modifiers?
Leukotriene receptor antagonists
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What are the 3 types of long-acting asthma medications?
Corticosteroids, long-acting beta2-adrenergic agonists and leukotriene modifiers
