Adult 1 Quiz 2: Lower respiratory

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oliviawise
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96320
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Adult 1 Quiz 2: Lower respiratory
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2011-08-07 16:03:57
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lower respiratory disorders
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lower respiratory disorders
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  1. Asthma: Nursing Management
    • Assessment (especially respiratory/cardiac status) - auscultate the lungs, look for use of accessory muscles, coughing. Signs of a diminishing condition: drop in pulse ox, diminished lung sounds, agitation/restlessness. Ask yourself: are these things normal for the pt's condition? (e.g., someone on continuous albuteral will have a higher HR considered normal for their condition)
    • Bedrest: High Fowler's or a recliner
    • C & DB
    • Chest PT
    • Pursed lip breathing
    • Balance activity & rest - conserves O2 and lessens demand
    • Fluid 3L/day
    • Diet: small but frequent meals - large meals increase O2 needs
    • NO SEDATIVES
    • Relaxation education: preventative measures

    • * if pt is wheezing and then stops wheezing = pt is getting worse, airway is closing off and becoming tighter. Pt will displays signs of distress (mentioned above)
    • * NO chest PT for pts while they are in an acute asthma attack - cough will be nonproductive because mucus is located below. Give chest PT after airway has been opened
  2. Patient Education: Preventative Measures for Asthma Patients
    • Stay indoors when the weather is too hot or too cold
    • Avoid OTC drugs containing ASA & Beta Blockers
    • Prompt diagnosis and treatment of URI
  3. Complications of Asthma
    • Acute Respiratory Failure
    • Status Asthmaticus: condition where pt is severly affected by asthma; significant asthma complications; pt may require ICU
    • Ruptured Bled: pneumothorax
  4. COPD (Chronic Obstructive Pulmonary Disease): Disease state characterized by the presence of airflow obstruction
    • Chronic Bronchitis: presence of chronic productive cough for 3 months X 2 years
    • Emphysema: abnormal enlargement of air spaces accompanied by destruction of the lung walls * problem with the alveoli

    * Patient can have both
  5. COPD Signifigance & Etiology
    • Chronic bronchitis: 45 - 65 years of age
    • Emphysema: 65 - 75 years of age
    • Related primarily to smoking - 20 year lag before signs of disease are present

    • Etiology
    • 3 major irritants: cigarette smoking (* primary cause for both), infection, inhaled irritants
    • Hereditary (AAT found in genetic emphysema - displays symptoms at an earlier age)
    • Aging
  6. Chronic Bronchitis Pathophysiology
    • Syndrome of excessive mucus production in the bronchi accompanied by a recurrent daily cough that persists for at least 3 months of the year during at least 2 consecutive years
    • Hypertrophy and hyperplasia of bronchial glands
    • Incresed # of goblet cells = increased mucus
    • Decreased cilia
    • Chronic inflammation = narrowed airway
    • Altered function of alveoli macrophages
  7. Emphysema Pathophysiology
    • Condition of the lung characterized by abnormal, permanent enlargement of the air spaces distal to the terminal bronchioles, accompanied by destruction of their walls, and without obvious fibrosis
    • Destruction of alveolar walls 2o proteolytic enzymes = destroys elastin and collagen
    • Alveolar air trapping = hyperinflation = alveoli meld together = bleb/bullae
    • Loose normal elastic recoil
    • Stimulation of macrphages and neutrophils
    • Problem with the ALVEOLI (as compared to the airway with bronchitis)
    • Alveoli expand but do not recoil and eventually become distended
    • Problem is with CO2 but not O2 - because these patients cannot get the air out of their lungs (bronchitis is a problem with both)
  8. Cor Pulmonale
    • "right sided heart failure"
    • Alveolar hypoxia = pulmonary capillary vasoconstriction = increased pulmonary artery pressure (pulmonary HTN) = hypertrophy of right ventricle = RIGHT SIDED HEART FAILURE
    • Complication that occurs with COPD - it is expected in these pts and must be watched for
    • Pressure build up in the lungs from air circulation of the condition - right side of the heart has to work harder than the left to pump blood
    • DO NOT give extra fluids
  9. Polycythemia
    • Complication that occurs with COPD - it is expected in these pts and must be watched for
    • Physiologic compensation for hypoxemia
    • Increased RBC's but not able to carry increased O2 as oxygen is not available = cyanosis
    • Compensation mechanism that the body uses to deal with the hypoxia that has developed from the chronic condition
    • Erythropoietin - kidneys pump out more to produce more RBCs but there is not enough O2 available to compensate for the increased RBCs
  10. Clinical Manifestations of Chronic Bronchitis
    • Cough - frequent & productive
    • Frequent respiratory infections
    • Dyspnea on exertion (DOE)
    • Hypoxemia & Hypercapnia
    • Edematous
    • "Blue Bloaters" - person appears blue and pale from the lack of O2, bloated, barreled chest, overweight
    • Robust appearance
    • Finger clubbing
    • Coarse rhonchi & wheezing
  11. Clinical Manifestations of Emphysema
    • Dyspnea
    • Cough - minimal
    • Barrel chest
    • Chest breather
    • "Pink puffer" - puff to try and get out CO2
    • Thin & underweight - energy and O2 are used in an attempt to get out CO2
    • Finger clubbing
    • Pursed-lip breathing
    • Diminished breath sounds
  12. COPD Diagnostic Studies
    • History & physical exam
    • Chest X-ray
    • Pulmonary function studies
    • ABG studies
    • Electrocardiogram
    • Sputum specimen for gram stain & culture
    • Serum a1 - antitrypsin levels
    • Exercise testing with Oximetry
    • Echocardiogram or Cardiac nuclear scans
  13. COPD Collaborative Care
    • Pharmacotherapy: Beta-adrenergic agents; Anticholinergic agents; Methylxanthines; Corticosteroids
    • Smoking cessation (will not fix damage done to alveoli but will help in cilia restoration)
    • Influenza & pneumococcal vaccinations
    • Avoid & immediately treat URIs
    • Oxygen: LOW flow, < 2L/min - safety
    • "O2 Drive"
    • O2 Toxicity: inactivates surfactant and can lead to ARDS
    • Nebulizer Treatment: devices - Bronkosol and Bronchosaline .. given before cup treatment
    • Encourage fluids - 3 L/day (not when patient have cor pulmonale)
    • Pursed lip breathing
    • Diaphragmatic breathing (abdomen protrudes on inhalation and contracts on exhalation)
    • Chest PT (done before meals and not when pt is wheezing)
    • Nutrition: small frequent meals, fluid between meals; high calorie/protein for emphysema; low carbohydrate
  14. COPD Nutrition
    • Rest 30 minutes before eating
    • Bronchodilator before eating
    • Frozen and microwave foods - conserve energy in food prep (be cautious of sodium content!)
    • Sodium restriction may be necessary
    • Avoid foods that cause bloating and gas (e.g. cabbage)
    • 5 - 6 small meals per day
    • Liquid commercials diets
    • Avoid food that requires significant chewing
    • Avoid exercising for 1 hour after eating
  15. COPD Home Care
    • Activity considerations: exercise training of upper extremities may reduce dyspnea. Pt may assume tripod position to conserve energy. Schedule periods of rest in between periods of activity. Walking 5 to 15 minutes a day, then slowly increase.
    • Pulmonary rehabilitation
    • Sexual Activity
    • Psychosocial considerations - location of bedrooms/bathrooms, number of steps
  16. COPD Complications
    • Cor pulmonale
    • Respiratory failure
    • Peptic Ulcer Disease and GERD
    • Pneumonia

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