T2 - Asthma, Sarcoidosis, Lung Cancer (Josh) Flashcards by Faiza Dang

What happens to bronchioles during asthma?

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

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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

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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

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Statistics of Asthma:

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

$ 19.7 billion annually

$3,300 per person annually

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Asthma:

What are the two steps of Asthma?

Inflammation

Airway hyperresponsiveness leading to bronchoconstriction

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Asthma:

Pathophysiology

Intermittent and resversible airflow obstruction affecting airways only, not alveoli

***AIRWAYS ONLY, NOT ALVEOLI

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Asthma:

How could ASA and other NSAIDS trigger asthma?

increased production of leukotriene while suppressing other inflammatory pathways

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Asthma:

What are some triggers of the Inflammation process?

Cold air

Dry air

Specific Allergens

General Irritants

Microorganisms

ASA

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Asthma:

What are some triggers of the Hyper-Responsiveness process?

Exercise

URI

GERD

unknown reasons

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Asthma:

What are some clinical manifestations?

Audible wheeze

Increased RR and cough

Use of accessory muscles

Barrel chest

Long breathing cycle

Cyanosis

Hypoxemia

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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

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Asthma:

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

elevated

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Asthma:

What is most accurate way to assess Pulmonary Function?

Spirometry

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What is Forced Vital Capacity (FVC)?

volume of exhaled air from full inhalation to full exhalation

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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

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What is Peak Expiratory Flow Rate (PEFR)?

fastest airflow rate reached during exhalation

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Asthma Severity:

What is Mild Intermittent?

symptoms less than twice a week

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Asthma Severity:

What is Mild Persistent?

symptoms more than twice a week, but not daily

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Asthma Severity:

What is Moderate Persistent?

daily symptoms, with exacerbations twice a week

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Asthma Severity:

What is Severe Persistent?

symptoms occur continually with frequent exacerbations

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Asthma Meds:

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

Theophyline

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Asthma Meds:

What anti-cholinergic is often used as a bronchodilator?

ipratroprium

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Asthma Meds:

What are the anti-inflammatory agents?

Corticosteroids

Cromones (cromolyn)

Leukotrien Modifiers (reduce inflammation)

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Status Asthmaticus:

What is it?

severe, life-threatenine, acute episode of airway obstruction

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Status Asthmaticus: Does patient respond to normal asthma meds?

Status Asthmaticus: What are some complications?

Pneumothorax Cardiac / Respiratory arrest

Status Asthmaticus: What is treatment regimen?

IV fluids Potent Systemic bronchodilator Steroids Epi O2

Emphysema and Chronic Bronchitis are examples of ---

COPD (Chronic Obstructive Pulmonary Disease)

COPD: What is it characterized by?

bronchospasm and dyspnea ***tissue damage is NOT reversible ***only can treat the symptoms

COPD: Chronic Bronchitis is an --- problem Pulmonary Emphysema is an --- problem

Airway Alveolar *** both are examples of COPD

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

Emphysema

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

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

flattens it

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

Chronic Bronchitis

In Chronic Bronchities, what is the pathophysioligy?

Inflammation leads to Vasodilation, which leads to Congestions, which leads to Mucosal Edema, which leads to Bronchospasm

COPD: Chronic Bronchitis affects the ---, not the ---

airways alveoli ***produces a large amount of thick mucous

COPD: Etiology

Cig smoke Advanced Age Alpha 1 - antitrypsan (AAT) Deficiency Exposure to Air Pollution

COPD: Complications

Hypoxemia / Tissue Anoxia Acidosis Resp. Infections Cardiac failure, especially cor pulmonale Cardiac dysrthymia (PVCs)

COPD: What is Cor Pulmonale?

right sided HR caused by pulmonary problems

COPD: In lab assessment, what would we see in CBC?

Increase in HCT and Hgb Polycythemia WBC increase (due to mucous increase)

COPD: What are nursing interventions?

Improve oxygenation and reduce CO2 retention Prevent weight loss Minimize anxiety Improve activity intolerance Prevent resp. infection

COPD: How do we manage dyspnea while providing nutrition?

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

COPD: What breathing techniques should we teach?

Pursed lip breathing Diaphragmatic breathing

-- -- 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)

CF: Clinical Manifestations

Smaller, thinner adults due to malnutrition Abdominal distention GERD, Rectal Prolapse, Fouls Smelling Stools, Steatorrhea Vit deficiences DM Osteoporosis

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

CF: What can we do NUTRITIONALLY to manage CF?

Weight mgmt Vit supplementation Diabetes mgmt Pancreatic enzyme replacement

CF: What can we do for PREVENTIVE therapy?

Chest physiotherapy Positive EXPIRATORY pressure Active cycle breathing technique Exercise

CF: What can we do to manage EXCASERBATIONS?

Avoid mechanical ventilation Supplemental O2 Heliox (50% O2 / 50% helium) Airway clearance techniques Drug therapy Prevention

CF: What types of drugs can we use?

Pancrealipase Bronchodilators Antiinflammatories Mucolytics

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

Interstitial Pulmonary Diseases: Which area of lungs do these diseases affect?

alveoli, blood vessels, surrounding support lung tissue

Interstitial Pulmonary Diseases: Slow of Fast onset?

Slow (not acute)

Interstitial Pulmonary Diseases: What is the most common manifestation?

SOB (Dyspnea)

Interstitial Pulmonary Diseases: What type of disease is this?

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

Sarcoidosis: What is it?

GRANULOMATOUS disorder of unknown cause | Scar Tissue

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

Sarcoidosis ***treat with corticosteroids

Sarcoidosis: What drug class is used to treat?

Corticosteroids

Idiopathic Pulmonary Fibrosis: Restrictive or Obstructive Disease?

Restrictive

Idiopathic Pulmonary Fibrosis: What is the etiology?

Cigarette smoking Chronic exposure to inhalant irritants AMIODARONE (long term high doses)

Idiopathic Pulmonary Fibrosis: Leads to extensive -- and treated with --

scarring corticosteroids

What is the leading cause of cancer deaths worldwide?

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

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

Lung Cancer: What is Stage 1?

T1 with or without metastasis to the lymph nodes T2 with no nodal or metastatic involvement

Lung Cancer: What is Stage 2?

T2 with metastasis to the ipsilateral hilar lymph nodes

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

Lung Cancer: After a pneumectomy, what are two major nursing responsibilities?

Airway Pain Control

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

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

(68 cards)