Respiratory Disorders

Question 1

What are risk factors for COPD?

Answer 1

• Irritant exposure (smoking, pollutants)
• Recurrent/chronic respiratory infections
• Genetic factors (Alpha1 Atitrypsin deficiency)
• allergies

Question 2

What changes occur with COPD?

Answer 2

Airways become inflamed and thickened, excessive mucous production, cilia become impaired (poor mucous clearance), walls of alveoli are damaged (decreased surface area) and airways and alveoli become less elastic. Old air gets trapped in the alveoli d/t narrowing.

Question 3

Is inspiration or expiration more difficult with COPD?

Answer 3

Expiration

Question 4

Symptoms of COPD

Answer 4

• cough, sputum production
• expiratory wheezing
• barrel chest, accessory muscle use
• dyspnea, orthopnea

Question 5

Symptoms of COPD

Answer 5

• cough, sputum production
• expiratory wheezing, diminished breath sounds
• barrel chest (AP to transverse ratio, normally 1:2), accessory muscle use, clubbing
• dyspnea, orthopnea, cyanosis
• tripod positioning, sleeping in a recliner
• pursed lip breathing
• RHF, increased red cells, ruddy skin color
• fatigue, wt loss
• tachypnea

Question 6

Why can COPD lead to right sided HF (cor pulmonale)?

Answer 6

The changes in pulmonary function increase the pressure in the arteries of the lungs against which the right side of the heart has to pump.

Question 7

How does the breathing pattern differ in a COPD patient in terms of inspiration and expiration vs. normal

Answer 7

Expiratory phase is prolonged. Normally it is shorter than inspiration.

Question 8

Tests relevant to COPD

Answer 8

• PFT (FEV1)
• ABG
• CXR
• CBC
• Sputum culture
• ECG

Question 9

Nursing Actions for COPD

Answer 9

• Maintain airway patency
• Administer SABAs and LABAs, inhaled glucocorticoids, mucolytics, corticosteroids, anticholinergics, and atropine as ordered
• Administer O2 (start low)
• small frequent feedings
• encourage fluids
• monitor breath sounds and ABGs

Question 10

Client education for COPD

Answer 10

• exposure to pollutants
• smoking cessation
• when to call health care provider
• O2 therapy (risk of combustion and CO2 narcosis)
• breathing retraining (pursed lip, helps open up alveoli)
• coughing
• vaccinations, reduce exposure to infections

Question 11

When to contact the Dr. for COPD

Answer 11

Exacerbation: Increase in sputum, change in color of sputum, s&s of infection (ie fever)

Question 12

What does forced expiratory volume (FEV) measure?

Answer 12

The amount of air a person can exhale during a period of time (FEV1=1st second, FEV2=2nd second…)

Question 13

What does the forced vital capacity (FVC) measure?

Answer 13

the total amount of air exhaled in a forced expiration from a full inspiration

Question 14

What is the predicted/normal value for the FEV1?

Answer 14

4-6L, should be 80% or more of predicted to be considered normal

Question 15

Below 1.5L/second for forced expiration is symptomatic of

Answer 15

COPD

Question 16

Common adverse effects of SABAs and LABAs

Answer 16

Palpitations, tachycardia, insomnia, irritability, tremors, hypokalemia

Question 17

Common adverse effects of anticholingergics

Answer 17

xerostomia, metallic taste, HA, cough

Question 18

Common adverse effects of theophylline

Answer 18

atrial and ventricular arrhythmias, grand mal convulsions, HA, nausea

Question 19

Common adverse effects of inhaled corticosteroids

Answer 19

Oral candidiasis, skin bruising

Question 20

Common adverse effects of Phosphodiesterase-4 inhibitor (PDE4)

Answer 20

Nausea, wt loss, diarrhea, headache, abd pain

Question 21

What drug class is Roflumilast in?

Answer 21

PDE4

Question 22

Drug classes used in COPD tx

Answer 22

• bronchodilators (beta agonists), anticholinergics, steroids, PDE4 inhibitors, methylxanthines

Question 23

Discharge goals for COPD

Answer 23

• ventilation/oxygenation adequate to meet self care goals
• nutritional intake meeting caloric needs
• infection treated/prevented
• disease process/prognosis and therapeutic regimen understood
• plan in place to meet needs after discharge

Question 24

Asthma definition

Answer 24

Chronic inflammatory disease of the the airways. Tracheobronchial tree has increased responsiveness to various triggers.

Question 25

Signs and Symptoms of Asthma

Answer 25

- Expiratory wheezing, prolonged expiration - recurrent nonproductive cough - chest tightness - SOB with activity or at rest - diminished breath sounds - tachycardia, tachypnea - accessory muscle use

Question 26

Asthma treatment

Answer 26

- Avoid triggers - Airway maintenance and coughing techniques - O2 - Bronchodilators - Flu and pneumococcal vaccines - corticosteroids - luekotriene modifiers - Anti-IgE antibody - Allergen immunotherapy

Question 27

Asthma: Nursing Care

Answer 27

- Educate pt about avoiding triggers - administer O2 - increase fluids to thin secretions - teach cough enhancing techniques - teach about peak flow meter use - teach about use of metered dose or dry powder inhalers - anxiety reduction and rest during acute attacks - educate about exercise regimen

Question 28

Explain the pathophysiology of asthma

Answer 28

Hyperresponsiveness of the lower airways occurs as a result of an inflammatory response to a trigger. The inflammatory response causes the release of chemical mediators histamine, leukotrienes, and prostaglandins. It also leads to bronchoconstriction, vascular congestion, edema, and formation of thick mucous. This leads to airway obstruction. With long term inflammation airway remodeling occurs.

Question 29

Asthma: Diagnostic tests

Answer 29

ABGs, SpO2, Hgb, Hct, Chest radiography, sputum samples, PERF

Question 30

Asthma: Risk factors/Causes

Answer 30

- genetic - allergen exposure - pollution - tobacco smoke

Question 31

Asthma: potential complications

Answer 31

- respiratory acidosis - cardiac dysrhythmias - cardiopulmonary arrest - chronic obstruction to airflow