N233 Final Flashcards Preview

N233 > N233 Final > Flashcards

Flashcards in N233 Final Deck (34):
1

Dyspnea causes

COPD
Asthma
Pregnancy
MI
Panic Attack
Chocking/Obstruction
CHF
Age
Pulmonary embolism
Allergies
Pneumothorax
...

2

Dyspnea

Difficult or laboured breathing
Shortness of breath
A person's expression with dyspnea may not correlate with respiratory rate or oxygen saturation

3

Signs and symptoms of respiratory disease

- Dyspnea
- Sputum production
- Cough
- Chest pain
- Wheezing
- Clubbing of fingers
- Hemoptysis
- Cyanosis (late sign)

4

Risk factors for dyspnea

SMOKING
exposure to 2nd hand smoke
Family medical hx of lung disease - genetic
Allergens
Poor nutrition
Inadequate exercise
Substance abuse
Stress

5

Dyspnea: Subjective data questions

- Complaints of chest tightness, can's get air, air hunger
- Fatigue
- On exertion
- Cough
- When? Position? Worse when walking?

6

Dyspnea: Objective Data

Nasal Flaring
Increased RR
Chest symmetry
Rate and depth of respirations
Use of accessory muscles
Wheeze, creackles, decreased or absent LS
Vitals signs
Tracheal tug (https://www.youtube.com/watch?v=xM92cP5pE_Q)

7

Dyspnea: diagnostic tests

Oxygen sats
Hbg, RBCs, WBCs
ABGs
CXR
CT chest
Throat and sputum cultures
Bronchoscopy?
PFT - pulmonary function tests = aka Spirometry

8

Pulmonary Function Tests

Tidal volume
Forced vital capacity (FVC)
Forced Expiratory Volume (FEV1)
Used to assess respiratory function and stage COPD (obstructive or restrictive)
To determine if Tx is working

9

Restrictive Lung Disease

Lungs can't move well d/t fibrosis, scoliosis, pregnancy, obesity, pulmonary edema

10

Obstructive Lung Disease

Narrowing of the airways (COPD, Asthma)

11

Palliative Nursing Interventions for Dyspnea

Decrease anxiety
Treat underlying pathology
Reduce respiratory demand
Alter perception of breathlessness

12

Pneumonia

Inflammation of the lung parenchyma
Caused by many microorganisms

13

Pneumonia causes

Bacteria
Viruses
Parasites
Aspiration
Opportunistic - immunocompromised
..
Typical pneumonia - bacteria
Atypical pneumonia "walking pneumonia", less severe symptoms

Community acquired pneumonia (<48h)
Hospital acquired pneumonia/ Nosocomial (>48h)

14

Reasons why Pts develop HAP (Hospital acquired pneumonia)

Impaired defenses (skin, immune sys)
Highly virulent
Organisms reach lower respiratory tract

15

Aspiration Pneumonia

Pulmonary consequences of resulting from the entry of endogenous or exogenous substances into the lower airway.

16

Pneumonia- Objective data

Hx
Px (fever,chills, rigors, pleuritic chest pain - worsen by coughing or deep breathing, severily ill appearance)
Tachypnea (25-45)
SOB
Use of accessory muscles
Tachycardia, bounding pulse
Upper resp tract infection s+s (eg. runny nose)
Rash?
Pharyingitis
Mucoid or purulent sputum

17

Pneumonia diagnostics

Chest XRay
CT chest
CBC
Blood cultures
Sputum sample for C&S
ABGs
Oxygen saturation
VS

18

Pneumonia: Medical Treatments

Abx (if bacterial)
Bed Rest
Hydration (Oral or IV)
O2 & humidification ( to avoid hypoxemia and help break down sputum)
Supportive medication

19

Pneumonia: Gerontological considerations

Difficult to treat
Higher mortality rate
symptoms: weakness, abdominal symptoms, anorexia, confusion, tachycardia, tachypnea
Breath sounds are difficult indicators of pneumonia in elderly

20

Pneumonia: Nursing Diagnoses

- Ineffective airways clearance r/t copious tracheobronchial secretions
- Activity intolerance r/t impaired resp fx
- Risk for deficient fluid volume r/t fever and tachypnea
- Imbalanced nutrition (less than body requirements)
- Deficient knowledge about the treatment regimen and preventive health measures

21

Pneumonia: Nursing Assessments

In hospitalized pts:
- fever, chills, night sweats, pleuritic plain, tachypnea, accessory muscle use, coughing purulent sputum

Once diagnosed watch for:
- VS: temp, pulse, O2 sats
- amount, odour, and colour of secretions
- tachypnea and SOB?
- XRay changes
- fatigue
- knowledge deficit?

22

Pneumonia: Nursing Interventions

- Improve airway patency
- Rest to conserve energy - Bed rest
- Maintenance of proper fluid volume - Hydration (2-3L per day)
- Adequate nutrition
- Positioning
- Incentive Spirometry
- Deep breathing and coughing
- NG suctioning
- Humidification via face mask

23

Asthma Triggers

-Respiratory infections (use of more bronchodilators for relief)
-Aiway irritants (smoke, perfume, weather changes- heat or cold)
-Exercise
-Stress
-GI reflux (GERD)

24

Asthma: S+S

WHEEZING
COUGH
DYSPNEA
Chest tightness
May be abrupt
Increased effort with expiration
tachycardia
Severe hypoxia

25

Asthma: diagnostics

ABGs (after an acute episode)
Pulmonary function test
Labs - WBCs
Chest Xray
...

26

Asthma Complications

Status asthmaticus
Respiratory Failure
Pneumonia

27

Bronchiolitis

Inflammation of the fine bronchioles & small bronchi
Lower tract infection
Usually due to RSC (Respiratory synctial virus)

28

COPD

- Diseases that cause airflow obstruction (emphysema, chronic bronchitis) or combination
- Progressive associated with abnormal inflammatory response
- Preventable
- Airflow limitation is irreversible
Etiology: smoking or exposure to air irritants/pollutants, genetics

29

COPD: Risks and Causes

- smoke, air pollution, occupational dust and chemicals
- alpha-1 antitrypsin deficiency (genetic)
- premature infants

30

COPD Stages

Stage 1: FVE1 = 80%
Stage 2:FVE1 50%-80%
Stage 3:FVE 30%-50% > severe restraint of respiration, thightness of breath, COPD exacerbations
Stage 4:FEV1 <30% > very severe and risky, Low quality of life with vital COPD exacerbations

31

COPD: mnfts

Increasing DYSPNEA
COUGH and SPUTUM
Rigid chest, ribs fixed at joints
"barrel chest"
"Clubbed" fingers
Weight loss
Limited ADLs
Use of accessory muscles
Paradoxal respiration > https://youtu.be/8TnrNrrEjuE
Chronic Hypoxemia, hypercapnia, polycythemia
RHF > Cor Pulmonale

32

COPD specific assessments (tests, labs)

RBG > polycythemia vera?
ABGs > oxygenation levels, hypercapnia?
Exercise testing
Exacerbations? > spirometry
PFTs
Pulse oxymetry
CXR
CT

33

COPD Nursing Management

PATIENT EDUCATION: how to deep breathe and cough, pursed lip breathing
Oxygen therapy
Safety > DO NOT SMOKE w/ O2
Nutrition and hydration (high protein, high caloric meals)
Quality of life?
ADLs?

34

COPD: Pt education

Teach about:
- disease
- medications (how to take and when)
-When and how to seek help with exacerbations
- Infection control ( vaccinations)
- Avoid irritants
- Lifestyle changes (eg. smoking cessation, address anxiety)