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What is emphysema?
An irreversible lung damage secondary to loss of elasticity and hyperinflation of the lung
What is chronic bronchitis?
Inflammation and scarring of the lining of the bronchial tubes
What is the cause of COPD?
Cigarettes, air pollution, occupational substances, AAT deficiency
What are the clinical manifestations of COPD?
Accessory muscles, underweight, exertional dyspnea, diminished breath sounds, wheezes or crackles, clubbing, productive cough, frequent respiratory infections, activity intolerance, barrel chest, cor pulmonale (rt sided heart failure)
What would an ABG for a COPD patient show?
Decreased PO2, Increased PCO2, Decreased O2 sat
What would a CXR for a COPD patient show?
Hyperinflated lungs, flattened diaphragm
What diagnostic tests may be done on a patient with COPD?
ABG, CXR, pulmonary function test, sputum culture, CBC, electrolytes
Nursing diagnoses for the COPD patient:
Impaired gas exchange, ineffective breathing pattern, ineffective airway clearance, imbalanced nutrition, anxiety, activity intolerance, RC: pneumonia
Interventions for the COPD patient:
Airway maintenance, monitoring, oxygen therapy, drug therapy, chest physiotherapy, postural drainage, controlled coughing, suctioning, positioning, hydration, nebulizer treatment
What education should be provided for the COPD patient?
Avoid smoking, pulmonary irritants, and cold weather. Adequate nutrition. Prevent lung infections. Breathing techniques. Bronchodilator therapy and MDIs. Importance of pneumonia and flu vaccine.
How is TB transmitted?
TB process of infection:
- 1. Granulomatous inflammation created by the bacillus in the lungs become surrounded by collagen, fibroblasts, and lymphocytes.
- 2. Necrosis occurs in the center of the lesion, Ghon tubercle (primary lesion).
- 3. Cavitation occurs, bacilli continue to grow, and spread via lymph channels into new area of lung.
Who is at risk for TB?
Those with immune dysfunction or HIV, live in crowded areas, older and homeless people, drug and alcohol abusers, low socioeconomic groups, healthcare workers.
Clinical manifestations of TB:
Frequent cough, SOB, hemoptysis (cough up blood), night sweats, nausea, anorexia, weight loss, fever, chills, fatigue, lethargy
TB diagnostic tools:
Sputum culture, tuberculin skin test, CXR
Nursing diagnoses for the TB patient:
- Impaired gas exchange r/t disease progression
- Ineffective airway clearance r/t increased secretions
- Knowledge deficit r/t lack of information
- Fatigue r/t poor tissue oxygenation
- Imbalanced nutrition: less than body requirements
- Social isolation r/t altered state of wellness or changed appearance
Interventions for the TB patient:
Droplet precautions, monitor respiratory status, monitor O2 sat, provide diet rich in protein, iron and vitamin C, obtain sputum culture every 2-4 weeks, administer prescribed medications
What is the most common medication used to treat TB?
- Isoniazid (INH)
- *Prolonged use can cause liver problems
Which drug used to treat TB turns secretions orange?
Which drug used to treat TB can impair the 8th cranial nerve (hearing)?
Which drug used to treat TB can lead to renal toxicity and ototoxicity?
What should you teach the TB patient?
Infection control, adequate air ventilation, take medication as prescribed for the full durance to prevent resistant organisms, maintain good nutrition, rest for healing and to prevent fatigue
Coccidioidmycosis is also know as:
Symptoms of coccidioidmycosis:
- Flu-like symptoms:
- Fever, aching, chills, sweats, fatigue, cough, headache, lower extremity nodular erythema
Severity of coccidiodmycosis depends on what?
- 1. How many spores inhaled
- 2. How susceptible the host is
What are some drugs used to treat coccidioidmycosis?
What is Buerger's disease?
Inflammatory occlusions of distal arteries and veins
Signs and symptoms of buerger's disease:
Claudication, tingling, numbness, persistent coolness, aching pain, reduced or absent arterial pulses, sensitivity to cold
Management of buerger's disease:
Stop smoking, vasodilator drugs, low dose ASA, keep warm, foot care, monitor peripheral pulses frequently, may need arterial bypass surgery/amputation
What is raynaud's disease?
Episodic vasospasms of the small cutaneous arteries, usually involving the fingers and toes
Signs and symptoms of raynaud's disease:
Cold, numb, pain, cyanosis, ulcers, may progress to gangrene
Raynaud's disease management:
Stop smoking, keep warm, protect hands from injury, vasodilator drugs
What is the most common cause of acute arterial occlusive disease?
- *Embolus or thrombus is the precipitating event
What is a thrombus?
Blood clot that forms inside a blood vessel or chambers of the heart
What is an embolus?
Blood clot that moves through the bloodstream until it lodges in a narrowed vessel and blocks circulation
Symptoms of acute arterial occlusive disease:
- "Six P's" of ischemia:
- Pain, pallor, pulselessness, paresthesia, paralysis, poikilothermia (coolness)
Complications of acute arterial occlusive disease:
Necrosis, gangrene, complete loss of limb
How is acute arterial occlusive disease diagnosed?
- Electrocardiography (EKG)
- Transesophageal echocardiography (TEE)
- *needs patient consent, NPO
- Thallium stress test
- *no caffine
- Coronary angiography
- *requires consent
- *requires concent
Nursing interventions for anticoagulant therapy:
Monitor for bleeding, VS for hypotension and tachycardia, have antidotes available, monitor lab work, prolonged pressure to venipuncture sites.
What is the antidote for heparin?
What is the antidote for coumadin?
Signs and symptoms of chronic venous insufficiency:
Ankle edema, skin changes, stasis ulcers
Who is part of the rapid response team (RRT)?
Critical care nurse, respiratory therapist, primary care nurse
What criteria must be met before calling RRT?
- Change in HR (<45, >125)
- Change in systolic BP (<90)
- Change in resp rate (<10, >30) or threatened airway
- Change in SaO2
- Significant bleed
- Change in mental status
- New, repeated, or prolonged seizures
- Failure to respond to treatment to an acute problem/symptom
- Staff member concerned or worried about patient
What is polycythemia?
An excess of red blood cells characterized by a hematocrit higher than 55%
What are the manifestations of polycythemia?
- Initially asymptomatic
- Increased blood volume and viscosity (HTN)
- Headache, dizziness, vision and hearing problems, plethora
- Weight loss, night sweats, splenomegally, gi bleeding, intermittent claudication (pain in muscles)
Secondary polycythemia is also known as:
What is relative polycythemia?
Total RBC count is normal - plasma level is decreased
Nursing diagnoses for the patient with polycythemia:
- Risk for ineffective tissue perfusion r/t sluggish blood flow and increased risk for thrombosis
- RC: Hypertension
- Pain r/t effects of altered blood flow in distal extremities
- Decisional conflict regarding smoking cessation r/t addictive effects
Nursing care for the patient with polycythemia:
- Education about smoking cessation
- Prevention of CV disease
- Maintaining adequate hydration to think out the blood
- Prevention of blood stasis (SCD, OOB O2)
- Instruct in s/s of thrombosis
- Assess for possible bleeding
- Monitor Hct and cell counts