Exam 4 content 3

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ssoucie
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214450
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Exam 4 content 3
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2013-04-20 17:02:15
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Gas Exchange Disorders
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  1. A severe prolonged asthma that does not respond to routine treatment. Without agressive therapy this can lead to respiratory failure with hypoxemia, hypercapnia, and acidosis?
    Status Asthmaticus
  2. What is chronic bronchitis?
    A disorder of excessive bronchial mucous secretions, characterized by a productive cough lasting more than 3 or months in 2 consecutive years
  3. A disorder of excessive bronchial mucous secretions, characterized by a productive cough lasting more than 3 or months in 2 consecutive years is known as what?
    Chronic Bronchitis
  4. A distruction of the walls of the aveoli, resulting in enlargment of abnormal air spaces. what is this?
    Emphysema
  5. what is emphysema?
    A distruction of the walls of the aveoli, resulting in enlargment of abnormal air spaces. what is this?
  6. what are these adverse reactions associated with?
    Increased blood sugar
    MoonFace & Buffalo Hump (abnormal fat deposits in face & truck)
    Glaucoma
    Growth retardation
    Long term use can cause adrenalatrophy
    Glucocorticoids
  7. Theophylline levels can become toxic at what level, so assessmentas of this should be monitored while on bronchodilators?
    20 mcg/ml
  8. How long should you wait to take a second dose, if it is required, of a bronchodilator?
    2 minutes
  9. If you are taking a bronchodilator and a steroid inhaler together, which should you administer first?
    Bronchodilator should be used first- then wait 5 minutes before using the steroid
  10. How long should you wait during the use of a bronchodilator and steroid?
    You should administer the bronchodilator first, then wait 5 min to use the steroid
  11. When taking a bronchodilator, what can happens to blood pressure and heart rate?
    They can increase greatly
  12. You should NOT adminster this for an acute asthma attack?
    singulair (montelukast)
  13. What over the counter medication decreases the montelukast concentration?
    St Johns Wart
  14. If perscribed an oral granule dose of montelukast, how soon after opening the packet should the dose be administered?
    Within 15 min
  15. What type of drug is prednisone?
    Glucocorticoid
  16. When perscribed prednisone, you should report a weight gain of ____ in several days, to your doctor?
    5 pounds
  17. What happens to serum potassium levels while taking glucocorticoids?
    They usually decrease
  18. What happens to blood pressure and blood sugar levels while taking prednisone (glucocorticoids)?
    They can increase while on steroids
  19. When should your dose of glucocorticoids be taken? with or without food?
    With food
  20. What are some foods rich in potassium?
    Fresh or dried fruits, veggies, meats & nuts
  21. What types of food should be increased while on glucocorticoids?
    And what are some examples?
    • -Potassium rich foods
    • - Fruits, veggies, meats & nuts
  22. What is caused by chronic airflow obstruction due to emphysema and/ or chronic bronchitis?
    • COPD
    • Chronic Obstructive Pulmonary Disease
  23. COPD is the ____ leading cause of death in US?
    3rd
  24. COPD is the ____ leading cause of disability?
    2nd
  25. What is the primary cause of COPD?
    Smoking
  26. This is a disorder of excessive bronchial mucous secretions and narrowed airways?
    Chronic Bronchitis
  27. This is characterized by a productive cough lasting 3 or more months for 2 consectutive years?
    Chronic Bronchitis
  28. Recurrent respiratory infections are common with someone with _____ ?
    Chronic Bronchitis
  29. This type of gas exchange disorder is known as Blue Bloaters?
    Chronic Bronchitis
  30. This gas exchange disorder is associated with right sided heart failure, cyanosis, and thick sputum?
    Chronic Bronchitis
  31. How does chronic bronchitis affect the heart?
    Can cause right sided heart failure
  32. Why does COPD cause Right Sided Heart Failure?
    Because the lungs become stiff, causing pressure in the lungs to rise, causing the right side of the heart to work harder to pump blood though lungs and to left atrium
  33. Because the lungs become stiff, causing pressure in the lungs to rise, causing the right side of the heart to work harder to pump blood though lungs and to left atrium, is a reaction from what?
    COPD - Right sided heart failure
  34. What are some signs/ symptoms associated with right sided heart failure due to COPD?
    • Ascites (mid section swelling)
    • Lower extremity swelling
    • JVD -
  35. What can be caused by the excessive breathing pattern of a COPD'er?
    Hypoxia
  36. If patient has COPD, oxygen should be started at ___L, why?
    2 liters, because too much oxygen can cause hypoxia and possibly kill them
  37. Blue Bloaters have an increased level of ____
    Increase level of C02 - Carbon dioxide
  38. They are known as the pink puffers?
    Emphysema patients
  39. Destruction of the walls of the aveoli with resulting enlargment of abnormal air spaces and loss of elastic recoil are due to what respiratory disorder?
    Emphysema
  40. To these respiratory patients, its easy to get air into the lungs, but not out of the lungs?
    Emphysema patients
  41. Why is it easier for emphysema patients to get air into the lungs, but not easy to get air out?
    Not as much room for air exchange because of tissue swelling
  42. What is the initial symptom of emphysema?
    Dyspnea - (Shortness of Breath)
  43. An emphysema patient is described as having what look to them?
    Barrel chested, thin and malnourished, uses accessory muscles for breathing, long expiratory phase
  44. If a patient has more fluid in the lunds, you will notice it at what location of the lungs first?
    The base, which is located pn the patients back
  45. Assessment for fluid volume overload should be monitored how in a patient with COPD?
    • - Daily weights (report anything over 2lbs per day or 5 in a week
    • - Monitor I & O
    • - Edema
  46. This is a chronic airway obstruction disorder, a constriction of the bronchial airways, increased mucous production, and airway remodeling
    Asthma
  47. Manifestions of acute asthma include?
    chest tightness, dyspnea (Shortness of breath), wheezing, tachypnea (rapid breathing) & tachycardia, and anxiety
  48. What are some common asthma triggers?
    dust, pollen, cig smoke, resp infections, emotional stress, ASA (asprin), NSAIDS, sulfites (used in beer preservatives, fresh fruits, & salad) Beta blockers, extreme hot/ cold temps
  49. What are some food choices & medicines that can trigger asthma?
    • -Beer, fresh fruits, salads
    • - ASA, NSAIDS, Beta Blockers
  50. Exercise induced asthma, affects ___ to ___ % of people with asthma?
    40-90%
  51. This should be used on a daily basis for monitoring & measuring asthma
    Peak Flow Meater
  52. What color on a peak flow rate is...
    - using rescue inhaler less than 2 X a week
    - able to do normal activities
    - no problems sleeping
    - under control
    • Green (well)
    • 80-100% of personal best
  53. What color on a peak flow rate is...
    - frequent coughing
    - wheezing, tight chest, SOB
    - unable to do normal activities
    - cold symptoms
    - give rescue medication
    • Yellow (caution)
    • 50-80% of personal best
  54. What color on a peak flow rate is...
    - very hard time breathing
    - constant coughing (5 min continuously)
    - trouble talking, walking
    - may or may not wheeze
    - give rescue medication
    • Red (Danger)
    • < 50% of personal best
  55. What type of inhaler is used as a rescue inhaler?
    Short Acting Beta Agonist
  56. What type of agents are used to promote bronchodilation?
    Adrenergic agents
  57. How much fluids should be encouraged during nursing intervention for asthma attack patients?
    2500-3000 ml unless otherwise contradicted
  58. What is severe prolonged asthma that does not respond to routine treatment?
    Status Asthmaticus
  59. A patient with asthma in an emergency room, should be assessed how often?
    Every 15 minutes
  60. What is the first line of defense medication for acute asthma attack?
    Sympathomimetics
  61. This can be used in an emergency for airway patency?
    Epinephrine
  62. What metered dose inhaler medication that is a short acting beta 2 agonist, is used for an acute asthma attach?
    Albuterol
  63. What is albuterol generally used for?
    to treat an acute asthma attack
  64. This is a nebulizer treatment often given in the emergency room for asthma attacks
    Albuterol- short acting beta 2 agonist
  65. Using a short acting beta agonist, like Albuterol, can do what to the heart rate?
    Increase heart rate
  66. These are the most potent natural anti-inflammatory substance known?
    Corticosteroids
  67. These can help restore the activity of sympathomimetics when they lose thier effects in hypoxia?
    Corticosteroids
  68. Wat route of corticosteroids have the fewest systemic effects?
    Inhaled, but teach patient to rinse mouth after use to prevent Candida infection
  69. While on corticosteroids, blood sugar levels should be monitored, Why?
    Because it causes hyperglycemia, and patient may require insulin
  70. Excess use of glucocoriticoids can cause this?
    Cushings Syndrome (moon face, wt gain in abdomen, buffalo humps)
  71. Cushings syndrome can be caused by this?
    Excess amount of glucocoriticoids
  72. Moon face and buffalo humps are associated with what syndrome?
    Cushings Syndrome
  73. If taking a glucocoriticoid what anticoagulants effect could be decreased?
    Coumadin
  74. What anticoagulant should be questioned while on a glucocoriticoid?
    Coumadin
  75. What are preventative drugs for asthma?
    • (Long acting beta agonist)
    • * Anticholinergics (Atrovent)
    • * Leukotriene (Singular)
    • * Xanthines
  76. What do Antocholinergics do?
    Dilates bronchioles, inhibits bronchospamsm
  77. Wat is the prototype drug for Leukotriene Receptor Agonist?
    Montelukast Sodium (Singular)
  78. If a patient is an alcoholic or has liver dysfunction, then we know not to give him what type of preventive therapy for asthma?
    Leukotriene - Singular
  79. A patient who is allergic t dogs experiences a sudden "asthma attack". Which assessment finding does the nurse expect to find for this patient?
    A- Slow deep, pursed lip respirations
    B- Breathlessness & difficulty completing sentences
    C- Clubbing of the fingers & cyanosis of the nailbed
    D- Bradycardia & irregular pulse
    B- Breathlessness & difficulty completing sentences
  80. A patient is admitted with asthma. Which assessment findings are most likely to indicate that the patients asthma condition is deteriorating & progressing towards reiratory failure?
    A- Rales, rhoncho, & productive cough wih yellow sputum
    B- Tachypnea, Tachycardia, thick tenacious sputum, & hemoptysis
    C- Decreased wheezing, inaudible breath sounds, & use of accessory muscles
    D- Respiratory alkalosis, tachycardia, slow & shallow respirations
    C- Decreased wheezing, inaudible breath sounds, & use of accessory muscles
  81. The patient taking oral parental glucocorticoids is at risk for experiencing ______?
    Hyperglycemia
  82. An active infection is usually a contradiction for glucocorticoid therapy, why??
    Because it supresses the immune response
  83. Patiens on glucocorticoid therapy are at higher risk for experincing fractures due to _____ ?
    Osteoporosis
  84. Long term use of glucocorticosteroids can cause ______?
    Cushings syndrome
  85. All of the following are appropriate nursing diagnosis for a patient with acute asthma attack, which is th highest priority?
    A- Anxiety related to difficulty breathing
    B- Ineffective airway clearance related to bronchoconstriction & increased mucous production
    C- Ineffective breathing pattern related to anxiety
    D- Ineffective health maintenance related to lack of knowledge about attack triggers & appropriate use of medications
    B- Ineffective airway clearance related to bronchoconstriction & increased mucous production
  86. The nurse caring for a patient with asthma notices that the patient's respirations have slowed and no longer coughing. Breathsounds are diminished thoughout his lung fields & absent in bases. The nurse should do which of the following?
    A- Notify healthcare provider
    B- Allow patient to rest undisturbed
    C- Obtain chest x-ray
    D- Askfamily members to leave
    A- Notify healthcare provider
  87. When teaching use of a metered dose inhaler (MDI), the RN instructs the patient to do which of the following?
    A- Take quick shallow breaths while holding canister down
    B- Use the inhaler of the anti-inflammatory drug first, then bronchodiolator
    C- Use anti-inflammatory inhaler as needed to treat acute episodes of wheezing
    D- Rinse mouth after using inhaler to reduce systemic absorption of the drug
    C- Use anti-inflammatory inhaler as needed to treat acute episodes of wheezing
  88. Which of the following would be an expected assessment finding in a patient with chronic obstructive airway disease?
    A- AP chest diameter equal to or greater than lateral chest diameter
    B- Mental confusion and lethargy
    C- Three + pitting edema in ankels and lower legs
    D- Oxygen saturation readings of 85% or less
    A- AP chest diameter equal to or greater than lateral chest diameter
  89. An appropriate goal for a patient admitted with acute exacerbation of COPD would be which of the following?
    A- Will verbalize self care measure to regain lost lung function
    B- Arterial blood gases will be within normal limits by time of discharge
    C- Will maintain SaO2 of 90% or higher
    D- Will identify strategies to help reduce number of cigarettes smoked per day
    C- Will maintain SaO2 of 90% or higher
  90. Which of the following best represents the RN understanding the use of supplemental O2 in patients with COPD?
    A- Patient should not smoke, b/c O2 is flammable
    B- O2 is only used at night for COPD patient
    C- O2 is never used for COPD patient, as they may become dependent on it
    D- Patients needs to be closely monitored for signs of respiratory destress
    D- Patients needs to be closely monitored for signs of respiratory destress
  91. The nurse working with a patient with Cystic Fibrosis specifically directs the home care aid to report which of the following? (select all that apply)
    A- Thick, tenacious, milky, white sputum
    B- Fever
    C- Bulky fatty stools
    D- Difficulty clearing mucous secretions
    E- Increased shortness of breath & fatigue
    • A- Thick, tenacious, milky, white sputum
    • B- Fever
    • D- Difficulty clearing mucous secretions
    • E- Increased shortness of breath & fatigue
  92. A patient in skeletal traction suddenly develops right sided chestpain & shortness of breath, what should the RN do?
    A- Check for Homan's sign
    B- Start oxygen per nasal cannula
    C- Administer perscribed analgesic
    D- Elevate HOB to 45 degrees
    B- Start oxygen per nasal cannula
  93. The RN caring for a patient with COPD recognizes which of the following as an early sign of possible respiratory failure?
    A- Restlessness & tachypnea
    B- Deep Coma
    C- Hypotension & tachycardia
    D- Decreased urine output
    A- Restlessness & tachypnea
  94. The RN caring for a patient undergoing mechanical ventilation for acute respiratory failure plans & implements which of the following to help maintain effective alveolar ventilation?
    A- Keep patient in supine position
    B- Increase tidal volume on ventilator
    C- Maintains ordered O2 concentration
    D- Performs endotracheal suctioning as needed
    D- Performs endotracheal suctioning as needed
  95. A patient is diagnosed with a pulmonary disorder that causes COPD. Lung tissue changes are normally reversable with this condition. The nurse understands that which is the clinets most likely diagnosis?
    A- Asthma
    B- Emphysema
    C- Bronchiectasis
    D- Chronic Bronchitis
    A- Asthma
  96. A patient with COPD has an acute bronchospsm. The nurse knows that which medication is best for this emergency situation?
    A- zafirlukast (Accolate)
    B- epinephrine (Adrenalin)
    C- dexamethasone (Decadron)
    D- oxtriphylline- theophyllinate (Choledyl)
    B- epinephrine (Adrenalin)
  97. A patient is taking aminophylline- theophylline ethylenediamine (Somophyllin). What should the nurse monitor?
    A- Drowsiness
    B- Hypoglycemia
    C- Increased heart rate
    D- Decreased white blood cell count
    C- Increased heart rate
  98. A patient is perscribed theophylline to relax the smooth muscles of the bronchi. The nurse monitors the patients theophylline serum levels to maintain which therapeutic range?
    A- 1-10 mcg/mL
    B- 10-20 mcg/mL
    C- 20-30 mcg/mL
    D- 30-40 mcg/mL
    B- 10-20 mcg/mL
  99. A patient with COPD is taking a leukotriene antagonist, montelukast (Singular). The RN is aware that this medication is for which purpose?
    A- Maintenance treatment for asthma
    B- Treatment of an acute asthma attack
    C- Reversing bronchospasm associate with COPD
    D- Treatment of inflammation in chronic bronchitis
    A- Maintenance treatment for asthma

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