Week 4 Flashcards

Question

Clinical Manifestations- Decreased oxygen saturation (02 Sats)

Answer 1

When gas exchange is impaired, less oxygen travels across the alveoli-capillary membrane into the circulation.

Answer 2

This is a late sign where a bluish colour of the skin is seen usually in the lips, nail beds or conjunctiva.

Answer 3

This may be related to inflammation of the pleura resulting in pleurisy.

Answer 4

The body's response to infection as the immune system is working the body hard and requires rest to support the restorative process.

Answer 5

Resulting from invasion of the body by micro-organisms which reset the bodies thermo-regulatory system in order to optimise the immune response

Answer 6

This should include the following subjective data: · Previous hospitalisations including any ICU admissions · Do they have an asthma management plan? · Have they been taking prescribed medications? · Are they normally well? · Any co-morbidities. · Exposure to triggers and objective data: · General – is the person restless? · Integumentary – any diaphoresis or cyanosis? · Respiratory – any nasal discharge, polyps, increased WOB, positioning. · Cardiovascular – tachycardia · Diagnostic findings – chest x-ray, arterial blood gases

Answer 7

This should include the following subjective data: Apart from the asthma plan, the information collected here will be the same. Some patients may have a sick time plan as well. And objective data: Again, the information you are looking for here is the same as for asthma. Use all your senses here as this becomes part of your primary and secondary assessment.

Answer 8

This should include the subjective and objective data identified for asthma and COPD. Most people presenting with pneumonia, will not have previous hospitalisations for pneumonia or a management plan. However, you will still need to complete a brief health history and document all of your clinical findings. It is important to review all of their medical notes regarding their clinical presentation and their treatment plan.

Answer 9

If not already performed = airway, breathing, circulation, disability (mental status assessment), exposure

Answer 10

If not already performed = airway, breathing, circulation, disability (mental status assessment), exposure

Answer 11

If not already performed = airway, breathing, circulation, disability (mental status assessment), exposure

Answer 12

Comprehensive, systematic body systems assessment (or head-to-toe assessment) General appearance → looks well / unwell, discomfort, skin colour → pallor or flushed face Full set of vital signs Pain assessment: PQRST, OLDCARTS, is the patient experiencing chest pain?

Answer 13

Comprehensive, systematic body systems assessment (or head-to-toe assessment) General appearance → looks well / unwell, discomfort, skin colour → pallor or flushed face Full set of vital signs Pain assessment: PQRST, OLDCARTS, is the patient experiencing chest pain?

Answer 14

Comprehensive, systematic body systems assessment (or head-to-toe assessment) General appearance → looks well / unwell, discomfort, skin colour → pallor or flushed face Full set of vital signs Pain assessment: PQRST, OLDCARTS, is the patient experiencing chest pain?

Answer 15

Inspect * Observe the overall appearance (does the patient appear well/unwell?) * Observe the patients colour both centrally and peripherally * Observe the patient's respiratory rate, rhythm and depth & respiratory effort (are they using accessory muscles?) * Inspect the symmetry and shape of chest * Inspect the tracheal position * Can you hear any audible sounds? Auscultation * Listen for breath sounds * Auscultate the lung fields Percussion * Percuss the thorax Palpation * Bilateral symmetry of chest expansion * Palpate the skin feeling for skin temperature, turgor and moisture * Assess capillary refill both centrally and peripherally

Answer 16

Inspect * Observe the overall appearance (does the patient appear well/unwell?) * Observe the patients colour both centrally and peripherally * Observe the patient's respiratory rate, rhythm and depth & respiratory effort (are they using accessory muscles?) * Inspect the symmetry and shape of chest * Inspect the tracheal position * Can you hear any audible sounds? Auscultation * Listen for breath sounds * Auscultate the lung fields Percussion * Percuss the thorax Palpation * Bilateral symmetry of chest expansion * Palpate the skin feeling for skin temperature, turgor and moisture * Assess capillary refill both centrally and peripherally

Answer 17

Inspect * Observe the overall appearance (does the patient appear well/unwell?) * Observe the patients colour both centrally and peripherally * Observe the patient's respiratory rate, rhythm and depth & respiratory effort (are they using accessory muscles?) * Inspect the symmetry and shape of chest * Inspect the tracheal position * Can you hear any audible sounds? Auscultation * Listen for breath sounds * Auscultate the lung fields Percussion * Percuss the thorax Palpation * Bilateral symmetry of chest expansion * Palpate the skin feeling for skin temperature, turgor and moisture * Assess capillary refill both centrally and peripherally

Answer 18

The mainstay of asthma diagnosis is a comprehensive health history and physical examination. · Peak expiratory flow rate (PEFR) – important for monitoring of condition · Chest X-ray · Pulmonary function tests/studies (PFT/S) – aid in diagnosis and monitoring of severity. · Allergy skin testing (if indicated) · Blood level of eosinophils and IgE (if indicated)

Answer 19

As with asthma, a comprehensive health history and physical assessment are vital in the diagnosis of COPD. · PFT – spirometry, is required to confirm presence of airflow obstruction and determines severity. · Chest X-ray · Serum α1-antitrypsin levels · ABGs · Six-minute walk test

Answer 20

Once again, the history and physical examination, along with a chest X-ray are the main stays of pneumonia diagnosis. Other tests include: · Sputum culture · Pulse oximetry* or ABGs (if indicated) · Pathology including: Blood cultures (if indicated) and FBC - WCC and inflammatory markers

Answer 21

* The nature of asthma as a chronic inflammatory disease * Definition of inflammation and bronchoconstriction * Identification of triggers and reduce exposure to them * Reduce risk of airway infections * Knowledge of early signs and symptoms of acute asthma * Purpose and action for each medication * Importance of the adherence to medication regime (even when symptom free) * Proper inhalation technique * Monitor peak flow (See below for video on how to perform a peak flow reading) * How to implement an action management plan (see below for video on asthma action plans) * When and how to seek assistance * Consult with general practitioner or respiratory physician to regularly update asthma action plans.

Answer 22

* Case finding and confirm diagnosis * Optimise function * Prevent deterioration * Develop a plan of care * Manage eXacerbations

Answer 23

Non-pharmacological strategies are recommended for managing COPD, including smoking cessation. Smoking is a significant risk factor for COPD development, and cessation can slow lung function decline, delay disability onset, and preserve remaining function. Nurses play a crucial role in patient education on smoking cessation and Quitline details.

Answer 24

There are two core aims of pharmacological treatment according to the Lung Foundation Australia. These are: 1. treatment of symptoms 2. reduction of risk of severe exacerbations or deterioration. Whilst as nurses we do not prescribe medications, we need to be aware of what the patient is or should be taking so that we can provide appropriate education for them.

Answer 25

It is important that individuals with COPD adhere to the management strategies and to do this, they must be provided with the knowledge to do so. This knowledge should include: * Non-pharmacological therapies * Pharmacological therapies * Correct inhaler technique for all potential types of inhalers used * Health literacy * Cost of medications along with the ability to pay for these AND * Treatment for any co-morbidities

Answer 26

Deterioration of an individual's COPD can occur by the following: * The most important factor in deterioration prevention is smoking cessation. See the information provided on this in the previous section. * Control of exacerbations requires optimisation of pharmacotherapy and referral to pulmonary rehabilitation services. Early identification and treatment of exacerbation symptoms according to the individual's management plan should also occur which may include antibiotics if infection is evident and oral corticosteroid therapy for moderate to severe exacerbations. * Vaccination against influenza and pneumococcal infections should be encouraged. Practice nurses would ensure that individuals are provided with reminders to ensure these vaccinations are up to date

Answer 27

COPD care can improve exercise capacity and health-related quality of life through the incorporation of interprofessional care that covers elements such as: * exercise * self management education * use of a COPD action plan for exacerbation management.

Answer 28

* Nurses, in close collaboration with the GP or respiratory physician, will assist in completion of an asthma action/management plan, sick day planning and rehabilitation planning for patients with COPD, as well as provision of focused education, including inhaler techniques and reviews. * Nurses can make recommendations to other healthcare professionals including physiotherapists and dieticians as required.

Answer 29

* As the main therapy for patients with respiratory disorders are medication based, a pharmacist is vital in the provision of education on medications and their administration.

Answer 30

* Patients with chronic respiratory conditions often use a lot of energy in the act of just breathing. They also, as their condition progresses, struggle to eat large volumes of food at one sitting so find it difficult to ingest sufficient calories/kilojoules to support their respiratory effort, let alone any additional activities. * These patients will benefit from dietician input to optimise their caloric intake. Dieticians can provide education on higher energy foods as well as supplements to help the individual to obtain sufficient calories/kilojoules.

Answer 31

* As respiratory diseases/disorders progress, the individual may struggle to continue to work and provide an income for themselves and their families. Social workers can talk with patients and their families to identify their concerns, assist with applying for financial support if appropriate as well as connect with any community supports and groups our patients' might need on discharge: such as meal services, at-home physiotherapy, and more * Social workers are important to the whole family when a patient has been admitted to hospital, holistically they can gauge where support systems already exist for the patient and support other members of their family in providing the best care possible

Answer 32

* Physiotherapists play a vital role in the support and management of individuals with chronic respiratory conditions. For patients that retain secretions (COPD, pneumonia, and other disorders) they can provide education on airway clearance techniques. They provide chest physiotherapy in the inpatient setting which may include postural drainage, percussion and vibration as well as provision of airway clearance or insentive devices. * In the community, physiotherapists will often run pulmonary rehabilitation programs along with other health professionals. Their input can ensure that disease progression is halted or at least slowed down.

Answer 33

* As the respiratory condition progresses, an individual's ability to undertake ADLs may be severely impacted and they may require the input from an Occupational Therapist to provide education on how to optimise their energy throughout the day as well as the provision of equipment to support them in their ADLs.

Answer 34

* Whilst much of the management of COPD and Asthma is coordinated by the GP, if there is difficulties around diagnosis, progression of the condition, particularly COPD requiring home oxygen or admission to hospital for any of the disorders discussed this week, a respiratory physician or specialist will need to be involved. * Respiratory specialists assist with difficult diagnosis, optimise management and provide educational support for the individual and their family/carer.

Answer 35

- Β2 adrenoreceptor stimulation resulting in bronchodilation. - Onset of action 5-15 minutes, duration 3-6 hours - This is a symptom reliever - Caution with pregnancy unless benefits outweigh risks. Crosses placental barrier causing foetal tachycardia. - Fine skeletal muscle tremor - Palpitations - Tachycardia - Nervousness - Check inhaler technique - Monitor vital signs as an ^HR may be a side effect - Monitor and escalate any arrhythmias -Educate patients on possible side effects

Answer 36

- Inhalation (accuhaler - DPI) - Aerolizer – DPI - Breezhaler - DPI - Β2-adrenoreceptor stimulation resulting in bronchodilation. - Onset of action 10-30 minutes, duration 12 hours. - Used for maintenance, not relief of symptoms - Caution with pregnancy unless benefits outweigh risks. Crosses placental barrier causing foetal tachycardia. - Fine skeletal muscle tremor - Palpitations - Tachycardia - Nervousness - Check inhaler technique - Monitor vital signs - Monitor and escalate any arrhythmias - Educate patients that these are not to be used as a reliever. - Once commenced they should be used regularly to control asthma or COPD symptoms

Answer 37

* For individuals with asthma or COPD the GP will manage their condition from home. They will develop asthma management plans and COPD action plans in consultation with the individual and their family/carers. * For those with pneumonia they can establish a diagnosis, recommend investigations (chest x-ray, sputum samples, blood tests), commence antibiotic therapy if appropriate and refer for further input from other health professionals such as physiotherapists and respiratory physicians. * GPs are a vital team member for all elements of a patient's ongoing management both pre and post hospital admission and should always be kept in the loop.

Answer 38

Nebuliser, MDI - Block vagal tone and those reflexes that induce bronchoconstriction. May also reduce secretions - Onset of action 3-5 minutes, duration 4-6 hours - Symptom reliever in those unable to tolerate SABAs, chronic asthma, but less effective than SABA - Caution in those with unstable angina, AMI or arrhythmias - Caution in those with urinary outlet constriction, acute /narrow angle glaucoma - Contraindicated in those with sensitivity/allergy to atropine - Local irritation, dry mouth, dysphagia, thirst, constipation, nausea, vomiting - headache, nervousness, insomnia, - urinary urgency, retention - impotence - tachycardia, palpitations, arrhythmias - maintenance of good dental/oral health due to persistent dry mouth potentiating dental caries. - Ensure appropriate MDI technique including avoiding mist entering eyes - Inform patient to seek medical advice if – difficulty passing urine, painful urination, eye pain/discomfort.

Answer 39

Dry powder inhalation - This is not a first-line treatment for asthma management - Block vagal tone and those reflexes that induce bronchoconstriction. May also reduce secretions - Onset of action 3-5 minutes, duration 4-6 hours - Symptom reliever in those unable to tolerate SABAs, chronic asthma, but less effective than SABA - Caution in those with unstable angina, AMI or arrhythmias - Caution in those with urinary outlet constriction, acute /narrow angle glaucoma - Contraindicated in those with sensitivity/allergy to atropine - Local irritation, dry mouth, dysphagia, thirst, constipation, nausea, vomiting - headache, nervousness, insomnia, - urinary urgency, retention - impotence - tachycardia, palpitations, arrhythmias - maintenance of good dental/oral health due to persistent dry mouth potentiating dental caries. - Ensure appropriate MDI technique including avoiding mist entering eyes - Inform patient to seek medical advice if – difficulty passing urine, painful urination, eye pain/discomfort.

Answer 40

IV Oral - Bronchial smooth muscle relaxation - Stimulation of myocardium, CNS and respiration - Relaxation of smooth muscle in blood vessels decreasing peripheral resistance - Inhibits release of inflammatory mediators and histamine - Promotes diuresis - Maintenance therapy for severe asthma and COPD. - Pregnancy unless benefits outweigh risks - Breastfeeding – dosage to mother should be minised as excreted in breastmilk - Anxiety - Headache - Nausea and vomiting - Bradycardia - Xanthines, diuretics and hypoxia may increase the risk of hypokalaemia if administered with β2 adrenoreceptor agonists - Warn patient not to take excessive amounts of caffeine related beverages

Answer 41

MDI, DPI Tablet/liquid - anti-inflammatory blocking bronchial hyper-responsiveness - reduces prostaglandin and histamine generation - reduces production of substances leading to bronchospasm - reduces production of immunoglobulins IgE, IgG and mast cells - reduces mucus production - Used in chronic asthma and COPD - Not to be used as a nasal spray as resulting severe nasal infection, septic ulceration and recurrent nasal bleeding can result. - Impaired wound healing - Abdominal pain, diarrhoea - Hoarseness, sore throat, dry mouth - Instruct patient to take bronchodilator first to enable opening of airway - Caution if on both oral and inhaled steroid therapy - Teach patient to rinse mouth after using inhalation therapies

Answer 42

IV Oral - Suppress inflammatory response including inhibiting inflammatory mediators - Increase gluconeogenesis and decrease peripheral glucose utilisation - Inhibit protein synthesis - Affect mood and behaviour, neuronal excitability - May be used for a short period to assist with control of acute respiratory conditions - Pregnancy and breastfeeding - Sodium and fluid retention, potassium and calcium depletion - Hypertension, congestive cardiac failure, arrhythmias - Muscle wasting, weakness, osteoporosis - Nausea, vomiting, abdominal distension - Headache, depression, mood swings, insomnia - Delayed wound healing, easy bruising - Acute adrenal insufficiency if ceased abruptly - Monitor electrolytes, ensure salt restricted diet, consider potassium supplements. - Patient should be monitored for changes in mood - Monitor BGL – especially in patients with diabetes mellitus. - Fluid balance chart/daily weigh - Monitor adrenal functioning in long term use.

Answer 43

Nebuliser solution, MDI, DPI - Anti-inflammatory medications that inhibit the release of histamine, leukotriene, and other mediators of inflammation from mast cells. - Used for mild to moderate asthma prophylaxis and prevention of bronchospasm. - Caution when used as a nasal spray as it may result in severe nasal infection, septal ulceration and recurrent nasal bleeding - Headache - Nausea, vomiting and abdominal pain - Cough, pharyngitis, bronchospasm - Inform the patient to use a spacer with the inhaler - Ensure medication is not stopped abruptly as asthma may deteriorate.

Answer 44

Oral tablets - Block leukotriene receptors to reduce inflammation, mucous secretion and bronchoconstriction - Used for prophylaxis and treatment of chronic asthma - Caution in pregnancy - Fever - Headache, dizziness, fatigue - Sleep disturbance - Depression - Not to be used as a reliever during acute asthma - Inform patient to avoid use of heavy machinery if symptomatic with dizziness and/or fatigue.

Answer 45

Elixir, Inhalation, tablet - Mucolytics alter the structure of mucous, breaking down the mucous chains to decrease viscosity and aid in removal. - This thins the secretions allowing them to be removed through ciliary action. - breastfeeding - nausea, vomiting, diarrhoea - headache, dizziness - may contain fructose so avoid for those with fructose intolerance - caution in those with gastric ulcer or severe kidney/liver disease.

Answer 46

Oral – tablets and suspension IM, IV - Inhibit formation of bacterial wall - Bactericidal against gram-positive bacteria. - Wide usage across multiple body systems - breastfeeding - nausea, vomiting, diarrhoea - headache, dizziness - may contain fructose so avoid for those with fructose intolerance - caution in those with gastric ulcer or severe kidney/liver disease.

Answer 47

Oral – tablets and suspension IM, IV - Inhibit formation of bacterial wall - Bactericidal but broad spectrum. - Wide usage across multiple body systems - Pregnancy and breastfeeding (apart from cefalexin and cefazolin which are considered safe for use during pregnancy and breastfeeding) - Nausea, vomiting, dyspepsia, bad taste, abdominal pain/cramps, diarrhoea - Hypersensitivity reaction - Dizziness, headache, insomnia, somnolence, malaise - Superinfection - Granulocytopenia, leukopenia, neutropenia, eosinophilia Instruct patient to seek medical advice immediately if any of the following occurs: - signs of frequent infection including fever, sore throat, swollen glands or mouth ulcers - unusual bleeding or bruising under the skin - tiredness, headache, dizziness, paleness, shortness of breath - yellowing of skin or eyes.

Answer 48

Oral – tablets Ointment IV - Interfere with bacterial protein synthesis by blocking 30S ribosomal subunit - Bacteriostatic - Broad spectrum - Used for infections due to E. coli, Enterobacter, H. influenzae, Klebsiella, Proteus, Streptococcus pyogenes, S. faecalis - Absorption may be reduced by milk, food, sodium bicarbonate and other oral compounds. - Should not be given in combination with penicillins - Close monitoring of prothrombin time for those on oral anticoagulant therapy - Anorexia, dysphagia, nausea, vomiting, diarrhoea, abdominal pain, glossitis - Oesophagitis, oesophageal ulceration - Dizziness, headache, tinnitus, vertigo, light headedness - Increase in serum urea so not recommended for those with renal impairment - For patients on prolonged therapy, blood counts, renal and liver function should be monitored regularly - Warn patients to avoid exposure to direct sunlight and sunlamps or beds. Cover up all skin if unavoidable - Patients to take oral preparations whilst sitting up and with at least 100ml of fluid. To remain sitting up for at least 30 minutes. - Avoid taking within 2 hours of any antacid or iron supplement.

Answer 49

The patient should be advised or instructed to: · Obtain a MedicAlert bracelet or pendant if they have an allergy to any antibacterial agent · Inform any medical or nursing personnel of an allergy · Complete the entire course of the prescribed antibiotic even if they are feeling better. · Immediately seek medical advice if any they experience any diarrhoea, severe stomach cramps and/or fever during therapy, skin rashes or hives, blistering or peeling of skin, facial swelling including lips, mouth or throat making it difficult to breathe or swallow. · Take medication in appropriate association with food. Some antibiotics must be taken on an empty stomach whilst others should be taken with food. · Seek medical advice (not an emergency) if vaginal itching or discharge occurs (thrush) · Check with their prescriber if also on oral contraceptive medication as many antibiotics may reduce the effectiveness of oral contraceptives. · Seek medical advice if a female patient becomes pregnant or plans to breastfeed during therapy.

Week 4 Flashcards

(73 cards)