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Medsurg Exam 2 > Respiratory Disorders > Flashcards

Respiratory Disorders Flashcards

(93 cards)

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1
Q

primary focus of the respiratory system

A

gas exchange

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2
Q

two parts of the respiratory system

A

upper and lower resp tract

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3
Q

physiology or purpose of respiration

A

oxygenation
ventilation -movement of air
elastic recoil
compliance and resistance

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4
Q

respiratory defense mechanisms

A

Filtration of air
Mucociliary clearance system
Cough reflex
Reflex bronchoconstriction
Alveolar macrophages

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5
Q

Acute infection of lung parenchyma (functional tissue)

A

pneumonia

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6
Q

8th leading cause of death in the US
why?

A

pneumonia and influenza
lack of care/ comorbidities

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7
Q

inflammatory response of pneumonia

A

attraction of neutrophils
release of inflammatory mediators
accumulation of fibrinous exudates, RBCs, and bacteria

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8
Q

inflammation leads to what patho in pneumonia

A

alveoli fill with fluid and debris (consolidation)
increased production of mucus (airway obstruction)
decreased gas exchange

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9
Q

patho resolution of pneumonia infection

A

macrophages in alveoli ingest and remove debris
normal lung tissue restored
gas exchange returns to normal

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10
Q

etiology of pneumonia

A

Likely to result when defense mechanisms become incompetent or overwhelmed
↓ Cough and epiglottal reflexes may allow aspiration
Mucociliary mechanism impaired
Chronic diseases suppress immune system

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11
Q

causes of mucociliary mechanism impaired

A

Pollution
Cigarette smoking
Upper respiratory infections
Tracheal intubation
Aging

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12
Q

clinical classification of pneumonia

A

causative organism

Community-acquired (CAP)
Hospital-acquired (HAP)
–Ventilator-associated (VAP) - oral care

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13
Q

Results from abnormal entry of secretions into lower airway

A

aspiration pneumonia

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14
Q

major risk factors for aspiration pneumonia

A

Decreased level of consciousness
Difficulty swallowing
Insertion of nasogastric tubes with or without tube feeding

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15
Q

most common clinical manifestations of pneumonia

A

Cough
Fever, chills
Dyspnea, tachypnea
Pleuritic chest pain
Green (bacterial), yellow (viral), or rust-colored sputum
Prolonged fatigue

Change in mentation for older or debilitated patients

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16
Q

physical examination findings of pneumonia

A

Fine or coarse crackles
Bronchial breath sounds
Egophony
↑ Fremitus
Dullness to percussion if pleural effusion present

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17
Q

complications from pneumonia

A

Atelectasis - collapsed alveoli
Pleurisy - chest pain
Pleural effusion - fluid in chest cavity
Bacteremia - bacteria in lungs
Pneumothorax - air between lung and chest - collpased lung
Meningitis
Acute respiratory failure
Sepsis/septic shock
Lung abscess
Empyema - abcess from dead lung tissue

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18
Q

diagnostic tests for pneumonia

A

History
Physical examination
Chest x-ray
Sputum analysis
CBC with differential
Pulse oximetry or ABGs

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19
Q

supportive care for pneumonia

A

Oxygen for hypoxemia
Analgesics for chest pain
Antipyretics - lowers temp
Individualize rest and activity

no definitive treatment for majority of viral pneumonias
antivirals for influenza pneumonia

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20
Q

nursing assessment factors for pneumonia

A

Crackles
Friction rub
Dullness on percussion
Increased tactile fremitus
Sputum amount and color
Tachycardia
Changes in mental status

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21
Q

possible nursing diagnoses for pneumonia

A

Impaired gas exchange
Ineffective breathing pattern
Acute pain (chest)
Activity intolerance

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22
Q

desired outcomes from pneumonia

A

Clear breath sounds
Normal breathing patterns
No signs of hypoxia
Normal chest x-ray
Normal WBC count
Absence of complications related to pneumonia

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23
Q

pt teaching for home care of pneumonia

A

Emphasize need to take full course of medication(s)
Drug-drug and drug-food interactions
Adequate rest
Adequate hydration
Avoid alcohol and smoking
Cool mist humidifier
Chest x-ray, vaccinations

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24
Q

evaluation of pneumonia

A

Effective respiratory rate, rhythm, and depth of respirations
Lungs clear to auscultation
Reports pain control
SpO2 ≥ 95
Free of adventitious breath sounds
Clear sputum from airway

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25
other name for obstructive sleep apnea
obstructive sleep apnea-hypopnea syndrome (OSAHS)
26
what is obstructive sleep apnea
Partial or complete upper airway obstruction during sleep Apneic period may include hypoxemia and hypercapnia
27
clinical manifestations of obstructive sleep apnea
Frequent arousals during sleep Insomnia Excessive daytime sleepiness Witnessed apneic episodes Snoring Morning headache Irritability
28
complications of sleep apnea can results in what conditions:
Hypertension Cardiac changes Poor concentration/memory
29
how to diagnose obstructive sleep apnea
sleep study
30
Nursing and Interprofessional Mgmt of mild sleep apnea
Sleeping on one’s side Elevating head of bed Avoiding sedatives and alcohol 3 to 4 hours before sleep Weight loss Oral appliance
31
Nursing and Interprofessional Mgmt of severe Sleep Apnea (>15 apnea/hypopnea events/hr)
CPAP --Poor compliance BiPAP Surgery
32
Heterogenous disease characterized by a combination of clinical manifestations along with reversible expiratory airflow limitation or bronchial hyperresponsiveness
asthma
33
triggers for asthma
infection allergens exercise irritants Exercise Pollutants and Irritants Respiratory Infections Food and Drug Emotional Stress
34
early phase response of asthma triggered by allergen
allergens B lymphocyte plasma cells IgE antibodies mast cells allergens histamine and inflammatory mediators
35
clinical manifestations of asthma
Cough Shortness of breath (dyspnea) Wheezing Chest tightness Variable airflow obstruction
36
complications of asthma
Severe and life-threatening exacerbations Respiratory rate >30/min Dyspnea at rest, feeling of suffocation Pulse >120/min Too dyspneic to speak Drowsy/confused
37
diagnostic studies of asthma
Detailed history and physical exam Spirometry Peak expiratory flow rate (PEFR) Chest x-ray Oximetry Allergy testing Blood levels of eosinophils
38
interprofessional care for intermittent and persistent asthma
Avoid triggers of acute attacks Pre-medicate before exercising Short-term (rescue or reliever) medication Long-term or controller medication
39
drug therapy for asthma
Three types of antiinflammatory drugs -Corticosteroids -Leukotriene modifiers -Monoclonal antibody to IgE Three types of bronchodilators -β2-Adrenergic agonists -Methylxanthines -Anticholinergics
40
pt teaching for drug therapy of asthma
Correct administration of drugs is a major factor in success -Inhalation of drugs is preferable to avoid systemic side effects -MDIs, DPIs, and nebulizers are devices used to inhale medications Correct administration of drugs -Using an MDI with a spacer is easier and improves inhalation of the drug -DPI (dry powder inhaler) requires less manual dexterity and coordination
41
physical exam of asthma
Use of accessory muscles Diaphoresis Cyanosis Lung sounds
42
nursing diagnoses of asthma
Ineffective airway clearance Anxiety Deficient knowledge
43
planning and overall goals of asthma
Have minimal symptoms Maintain acceptable activity levels Maintain >80% of personal best PEFR Few or no adverse effects of therapy No acute exacerbations of asthma Adequate knowledge to participate in and carry out plan of care
44
nursing outcomes for asthma
Describe the disease process and treatment regimen Demonstrate correct administration of inhaled drugs Express confidence in ability for long-term management of asthma Maintain clear airway with removal of excessive secretions Experience normal breath sounds and respiratory rate Report decreased anxiety with increased control of respirations
45
Airflow limitation not fully reversible Usually progressive Abnormal inflammatory response of lungs, primarily caused by cigarette smoking and other noxious particles or gases
COPD
46
description of COPD
Definitions previously included chronic bronchitis and emphysema Chronic bronchitis is an independent disease Emphysema is a pathologic term that explains only one of several structural abnormalities in COPD
47
cally significant airway obstruction develops in __% of smokers
15
48
COPD should be considered in any person ___
over 40 with smoking history of 10 or more pack-years
49
Considerable pathologic and functional overlap between asthma and COPD
Older adults may have components of both diseases Asthma-COPD overlap syndrome
50
defining features of COPD
Not fully reversible airflow limitations during forced exhalation due to -Loss of elastic recoil -Airflow obstruction due to mucous hypersecretion, mucosal edema, and bronchospasm
51
primary process of inflammation in COPD
Inhalation of noxious particles and gases Mediators released cause damage to lung tissue Airways inflamed Parenchyma destroyed
52
supporting structures of lungs are destroyed how:
Air goes in easily, but remains in the lungs Bronchioles tend to collapse Causes barrel-shaped chest
53
clinical manifestations of COPD
polycythemia and cyanosis Prolonged expiratory phase Wheezes Decreased breath sounds ↑ Anterior-posterior diameter (barrel chest) Tripod position Pursed lip breathing
54
clinical manifestations of polycythemia and cyanosis
Hypoxemia Increased production of red blood cells Bluish-red color of skin Hemoglobin concentrations may reach 20 g/dL (200 g/L) or more
55
diagnostic studies of COPD
History and physical exam Diagnosis confirmed by spirometry -FEV1/FVC ratio <70% -Increased residual volume Chest x-ray 6-minute walk test COPD Assessment Test (CAT) Clinical COPD Questionnaire (CCQ) ABGs
56
mild classification of COPD
FEV1greater than 80%
57
moderate classification of COPD
FEV1 50-80%
58
severe classification of COPD
FEV1 30-50%
59
very severe classification of COPD
FEV1 less than 30%
60
complications of COPD
Cor pulmonale Exacerbations of COPD Acute respiratory failure Peptic ulcer disease Depression/anxiety
61
exacerbations of COPD signaled by change in usual:
dyspnea cough sputum
62
primary cause of COPD exacerbations
bacterial and viral infections
63
signs of severity for COPD exacerbations
use of accessory muscles central cyanosis
64
treatment for COPD exacerbations
Short-acting bronchodilators Oral systemic corticosteroids Antibiotics Supplemental oxygen therapy
65
interprofessional care for stable COPD
Treated as outpatients Hospitalized for complications -Acute exacerbations -Acute respiratory failure
66
interprofessional care of COPD
Evaluate for environmental or occupational irritants Influenza virus vaccine Pneumococcal vaccine Smoking cessation Biggest impact in reducing risk of developing COPD Accelerated decline in pulmonary function slows to almost nonsmoking levels
67
drug therapy for COPD
Commonly used bronchodilators -β2-Adrenergic agonists -Anticholinergics -Methylxanthines Anti-inflammatories -Corticosteroids
68
O2 therapy is used in COPD to:
Keep O2 saturation > 90% during rest, sleep, and exertion, or PaO2 > 60 mm Hg
69
COPD long-term O2 therapy improves:
Survival Exercise capacity Cognitive performance Sleep in hypoxemic patients
70
COPD chronic O2 therapy at home reduces:
Hematocrit Pulmonary hypertension Periodic reevaluations are necessary to determine duration of use
71
COPD O2 delivery systems are high or low flow
Low-flow is most common Low-flow is mixed with room air, and delivery is less precise than high-flow High-flow fixed concentration -Venturi mask
72
humidification in COPD treatment
Used because O2 has a drying effect on the mucosa Supplied by nebulizers, vapotherm, and bubble-through humidifiers
73
physical and respiratory therapy for COPD
Breathing retraining Effective coughing Chest physiotherapy -Percussion -Vibration -Postural drainage Airway clearance devices High-frequency chest wall oscillation -The Vest
74
breathing retraining for COPD
Decreases dyspnea, improves oxygenation, and slows respiratory rate -Pursed lip breathing (PLB) -Diaphragmatic (abdominal) breathing
75
pursed lip breathing for COPD
Prolongs exhalation and prevents bronchiolar collapse and air trapping Teach patients to use “just enough” positive pressure
76
chest physiotherapy is indicated in COPD for:
Excessive, difficult-to-clear bronchial secretions Retained secretions in artificial airway Lobular atelectasis from mucous plug
77
percussion for COPD
Hands in a cuplike position to create an air pocket Air-cushion impact facilitates movement of thick mucus If it is performed correctly, a hollow sound should be heard
78
vibration for COPD
Facilitates movement of secretions to larger airways Mild vibration tolerated better than percussion
79
flutter mucus clearance device for COPD
Provides positive expiratory pressure (PEP) treatment Produces vibration in lungs to loosen mucus for expectoration Handheld device
80
acapella device for COPD
Vibrates lungs to shake free mucous plugs Improves clearance of secretions Faster and more tolerable than CPT
81
high frequency chest wall oscillation for COPD
Inflatable vest that vibrates the chest Works on all lobes More effective than CPT
82
nutritional therapy for COPD
Malnutrition in COPD patients is multifactorial -Increased inflammatory mediators -Increased metabolic rate -Lack of appetite Decrease dyspnea and conserve energy High-calorie, high-protein diet is recommended Eat five to six small meals to avoid bloating and early satiety
83
subjective nursing assessment data
health history risk therapy
84
objective nursing assessment data
Integumentary Respiratory Cardiovascular Gastrointestinal Musculoskeletal
85
nursing diagnoses for COPD
Ineffective breathing pattern Ineffective airway clearance Impaired gas exchange Imbalanced nutrition: Less than body requirements Risk for infection
86
planning goals for COPD
Prevention of disease progression Ability to perform ADLs Relief from symptoms No complications related to COPD Knowledge and ability to implement long-term regimen Overall improved quality of life
87
health promotion for COPD
Abstain from or stop smoking. Avoid or control exposure to occupational and environmental pollutants and irritants. Early detection of small-airway disease Early diagnosis and treatment of respiratory tract infection
88
acute care of COPD
Required for acute exacerbations, pneumonia, cor pulmonale, or acute respiratory failure Degree and severity of underlying respiratory problem should be assessed
89
COPD implementation designed to reduce symptoms and improve quality of life
pulmonary rehab
90
factors of pulmonary rehab
exercise training smoking cessation nutrition counseling education
91
activity considerations for pulmonary rehab
Exercise training leads to energy conservation Modify ADLs to conserve energy Walk 15 to 20 minutes a day at least 3 times a week with gradual increases
92
COPD end-of-life considerations
Symptoms can be managed, but COPD cannot be cured End-of-life issues and advanced directives are important topics for discussion Palliative care, end-of-life and hospice care are important in advanced COPD
93
evaluation for COPD
Return to baseline respiratory function Demonstrate an effective rate, rhythm, and depth of respirations Experience clear breath sounds Maintain clear airway by effective coughing PaCO2 and PaO2 return to levels normal for patient Maintenance of normal body weight Normal serum protein levels Feeling of being rested Improvement in sleep patterAwareness of need to seek medical attention Behaviors minimizing risk of infection No infection

Medsurg Exam 2 (6 decks)

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