T2 - Asthma, Sarcoidosis, Lung Cancer (Josh) Flashcards Preview

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Flashcards in T2 - Asthma, Sarcoidosis, Lung Cancer (Josh) Deck (68):
1

What happens to bronchioles during asthma?

obstructed on expiration due to muscle spasm, edema of mucosa, and thick secretions

2

Statistics of Asthma:

What is the impact of Asthma on healthcare?

5000 ED visits daily ; 217,000 ED visits annually

1000 hospital admissions daily ; 500,000 annually

10.5 million PCP visits each year

***Increases odds of needing medical treatment by 33% for obese clients

3

Statistics of Asthma:

What is the prevalence of Asthma in U.S.?

20 million americans

300 million worldwide

more common in adult women than men

more common in AA than Whites

***Number continues to increase

4

Statistics of Asthma:

What is the cost of Asthma in U.S.?

$ 19.7 billion annually

$3,300 per person annually

5

Asthma:

What are the two steps of Asthma?

Inflammation

Airway hyperresponsiveness leading to bronchoconstriction

6

Asthma:

Pathophysiology

Intermittent and resversible airflow obstruction affecting airways only, not alveoli

***AIRWAYS ONLY, NOT ALVEOLI

7

Asthma:

How could ASA and other NSAIDS trigger asthma?

increased production of leukotriene while suppressing other inflammatory pathways

8

Asthma:

What are some triggers of the Inflammation process?

Cold air

Dry air

Specific Allergens

General Irritants

Microorganisms

ASA

9

Asthma:

What are some triggers of the Hyper-Responsiveness process?

Exercise

URI

GERD

unknown reasons

10

Asthma:

What are some clinical manifestations?

Audible wheeze

Increased RR and cough

Use of accessory muscles

Barrel chest

Long breathing cycle

Cyanosis

Hypoxemia

11

Asthma:

What may happen to CO2 during asthma attack?

arterial CO2 may decrease (alkalosis) early in attack and increase (acidosis) later

***indicating poor gas exchange

12

Asthma:

What would serum eosinophil levels and Immunoglobulin E levels look like?

elevated

13

Asthma:

What is most accurate way to assess Pulmonary Function?

Spirometry

14

What is Forced Vital Capacity (FVC)?

volume of exhaled air from full inhalation to full exhalation

15

What is Forced Expiratory Volume in First Second (FEV1)?

volume of air blown out as hard and fast as possible during the first second after a full inhalation

***decreases by 15-20% of expected value is common in asthma

16

What is Peak Expiratory Flow Rate (PEFR)?

fastest airflow rate reached during exhalation

17

Asthma Severity:

What is Mild Intermittent?

symptoms less than twice a week

18

Asthma Severity:

What is Mild Persistent?

symptoms more than twice a week, but not daily

19

Asthma Severity:

What is Moderate Persistent?

daily symptoms, with exacerbations twice a week

20

Asthma Severity:

What is Severe Persistent?

symptoms occur continually with frequent exacerbations

21

Asthma Meds:

Which bronchodilator would not be first choice due to narrow therapeutic range?

Theophyline

22

Asthma Meds:

What anti-cholinergic is often used as a bronchodilator?

ipratroprium

23

Asthma Meds:

What are the anti-inflammatory agents?

Corticosteroids

Cromones (cromolyn)

Leukotrien Modifiers (reduce inflammation)

24

Status Asthmaticus:

What is it?

severe, life-threatenine, acute episode of airway obstruction

25

Status Asthmaticus:

Does patient respond to normal asthma meds?

no

26

Status Asthmaticus:

What are some complications?

Pneumothorax

Cardiac / Respiratory arrest

27

Status Asthmaticus:

What is treatment regimen?

IV fluids

Potent Systemic bronchodilator

Steroids

Epi

O2

28

Emphysema and Chronic Bronchitis are examples of ---

COPD (Chronic Obstructive Pulmonary Disease)

29

COPD:

What is it characterized by?

bronchospasm and dyspnea

***tissue damage is NOT reversible

***only can treat the symptoms

30

COPD:

Chronic Bronchitis is an --- problem

Pulmonary Emphysema is an --- problem

Airway

Alveolar

*** both are examples of COPD

31

COPD:

--- is a loss of lung elasticity leading to hyperinflation of lungs.

Emphysema

32

COPD:

--- is air trapping caused by loss of elastic recoil in alveolar walls, overstretching and enlargement of alveoli into bullae, collapse of small airways (bronchioles).

Emphysema

33

COPD:

In Emphysema, the hyperinflated lung (due to loss of elasticity) does what to the diaphragm?

flattens it

34

COPD:

--- is inflammation of bronchi and bronchioles caused by chronic exposure to irritants, especially CIGARETTE SMOKE

Chronic Bronchitis

35

In Chronic Bronchities, what is the pathophysioligy?

Inflammation leads to

Vasodilation, which leads to

Congestions, which leads to

Mucosal Edema, which leads to

Bronchospasm

36

COPD:

Chronic Bronchitis affects the ---, not the ---

airways

alveoli

***produces a large amount of thick mucous

37

COPD:

Etiology

Cig smoke

Advanced Age

Alpha 1 - antitrypsan (AAT) Deficiency

Exposure to Air Pollution

38

COPD:

Complications

Hypoxemia / Tissue Anoxia

Acidosis

Resp. Infections

Cardiac failure, especially cor pulmonale

Cardiac dysrthymia (PVCs)

39

COPD:

What is Cor Pulmonale?

right sided HR caused by pulmonary problems

40

COPD:

In lab assessment, what would we see in CBC?

Increase in HCT and Hgb

Polycythemia

WBC increase (due to mucous increase)

41

COPD:

What are nursing interventions?

Improve oxygenation and reduce CO2 retention

Prevent weight loss

Minimize anxiety

Improve activity intolerance

Prevent resp. infection

42

COPD:

How do we manage dyspnea while providing nutrition?

rest before meals

4-6 small meals a day (high calorie / high nutrient)

43

COPD:

What breathing techniques should we teach?

Pursed lip breathing

Diaphragmatic breathing

44

-- -- is a genetic disease that is an error of chloride transport, producing thick mucus with low water content.

Cystic Fibrosis

***life expectancy is 37 yrs

**sweat chloride test (normal is 5-45) (positive is 60-100 mEq/L)

45

CF:

Clinical Manifestations

Smaller, thinner adults due to malnutrition

Abdominal distention

GERD, Rectal Prolapse, Fouls Smelling Stools, Steatorrhea

Vit deficiences

DM

Osteoporosis

46

CF:

Pulmonary Manifestations

Resp infections

Chest congestion

Limited exercise tolerance

Cough and Sputum production

Use of accessory moscles

Decreased pulmonary function

Changes in CXR

Barrel Chest

47

CF:

What can we do NUTRITIONALLY to manage CF?

Weight mgmt

Vit supplementation

Diabetes mgmt

Pancreatic enzyme replacement

48

CF:

What can we do for PREVENTIVE therapy?

Chest physiotherapy

Positive EXPIRATORY pressure

Active cycle breathing technique

Exercise

49

CF:

What can we do to manage EXCASERBATIONS?

Avoid mechanical ventilation

Supplemental O2

Heliox (50% O2 / 50% helium)

Airway clearance techniques

Drug therapy

Prevention

50

CF:

What types of drugs can we use?

Pancrealipase

Bronchodilators

Antiinflammatories

Mucolytics

51

CF:

What can we do surgically to manage CF?

Lung and/or Pancreatic transplant

***doesn't cure
***adds 10-20 yrs to life
***continued risk for lethal pulmonary infections

52

Interstitial Pulmonary Diseases:

Which area of lungs do these diseases affect?

alveoli,

blood vessels,

surrounding support lung tissue

53

Interstitial Pulmonary Diseases:

Slow of Fast onset?

Slow (not acute)

54

Interstitial Pulmonary Diseases:

What is the most common manifestation?

SOB (Dyspnea)

55

Interstitial Pulmonary Diseases:

What type of disease is this?

restrictive disease resulting in thickened lung tissue, reduced gas exchange, and STIFF LUNGS

56

Sarcoidosis:

What is it?

GRANULOMATOUS disorder of unknown cause

(Scar Tissue)

57

Which disease?

Autoimmune response where normally protective T-lymphocytes increase and damage lung tissue.

Sarcoidosis

***treat with corticosteroids

58

Sarcoidosis:

What drug class is used to treat?

Corticosteroids

59

Idiopathic Pulmonary Fibrosis:

Restrictive or Obstructive Disease?

Restrictive

60

Idiopathic Pulmonary Fibrosis:

What is the etiology?

Cigarette smoking

Chronic exposure to inhalant irritants

AMIODARONE (long term high doses)

61

Idiopathic Pulmonary Fibrosis:

Leads to extensive -- and treated with --

scarring

corticosteroids

62

What is the leading cause of cancer deaths worldwide?

Lung Cancer

***poor long-term survival due to late-stage dx

63

Lung Cancer:

What do the letters stand for in the TNM Classification System?

T = size of tumor

N = number of nodes involved

M = number of areas of metastatic involvement

64

Lung Cancer:

What is Stage 1?

T1 with or without metastasis to the lymph nodes

T2 with no nodal or metastatic involvement

65

Lung Cancer:

What is Stage 2?

T2 with metastasis to the ipsilateral hilar lymph nodes

66

Lung Cancer:

What is Stage 3?

all tumors more extensive than T2

Any tumor with metastasis to the lymph nodes in the mediastynum or with distant metastasis

67

Lung Cancer:

After a pneumectomy, what are two major nursing responsibilities?

Airway

Pain Control

68

What are the Chest Tube Chambers used for?

Chamber 1: collects fluid draining from patient

Chamber 2: water seal prevents air from re-entering patient's pleural space

Chamber 3: suction control of system