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100 Cards in this Set
- Front
- Back
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Another term for Asthma is:
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Chronic reactive airway disorder (RAD)
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Asthma, a ____ airway disease (RAD) is a chronic _____ lung disease that results in airway _____, but is _____ in the early stages of the disease.
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reactive
inflammatory obstruction reversible |
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Name 4 trigger sources of asthma:
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Allergen inhalation
Air pollutants Viral URI Sinusitis Exercise Medications Occupational Exposures Food Additives Hormones Stress GERD |
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Name the 3 HALLMARKS OF ASTHMA
______________ ______________ ______________ |
HALLMARKS OF ASTHMA
Airway Inflammation Nonspecific hyperirritability Hyper responsiveness |
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A severe, life threatening asthma attack that is refractory to usual treatment and places the patient at risk for development respiratory failure is called?
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Status Asthmaticus
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Exhalation through the mouth mouth w/lips pursed together to slow exhalation is known as?
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Pursed Lip-Breathing
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Breathing that focuses on using the diaphragm instead of the accessory muscles to achieve max inhalation and slow the respiratory rate is:
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Diaphrqgmatic Breathing
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Treatment that is for pt w/excessive bronchial secretions, have evidence or suggestion of retained secretions in the presence of an artificial airway, lobar atelectasis caused by mucus plug/consists of percussion, vibration, & postural drainage is:
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Chest physiotherapy(CPT)
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A handheld device that provides positive expiratory pressure treatment for pt w/ mucus-producing conditions:
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Flutter Mucus Clearance Device
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An obstruction of the intestine in a newborn due to obliteration of the bowel lumen by excessively thick meconium; first evidence of cystic fibrosis:
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Meconium Ileus
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Asthma is a chronic _____ disorder of the _____ in which inflammation causes varying degrees of _____ in the airways. This inflammation cases recurrent episodes of ____, ____, ____, & _____ that occur particularly at ____ & in the early morning.
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inflammatory
airways obstruction wheezing breathlessness chest tightness cough night |
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With asthma, the inflammation causing recurrent episodes of wheezing, breathlessness, chest tightness, & cough is associated w/an increase in existing _____ to a variety of _____.
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hyperresponsiveness
stimuli |
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The highest hospitalization rates for the treatment of asthma is ____:
a) whites b) hispanics c) asians d) african americans Of these, death rates are again the highest in which age group? a) 1-6 yrs b) 7-14 yrs c) 15-24 yrs d) 6-24 years |
african americans
15-24 yrs |
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Asthma affects an estimated 1 in every __ Americans & incidents have increased 60% since the ____'s.
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1
1980's |
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Whites have the highest rate of ____, while blacks have the highest rate of ____.
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cystic fibrosis
asthma |
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Asthma that is induced or exacerbated during physical exertion such as aerobics, walking briskly, & climbing stairs is called?
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Exercise Induced Asthma
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Infections cause inflammatory changes in the _____ system & alter mucociliary mechanisms, increasing hyperresponsiveness of the ____ system. Increased airway responsiveness can last up to ___ weeks after the infection in both normal & asthmatic persons.
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trachiobronchial
bronchial system 2 - 8 weeks |
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The Hallmarks of asthma are airway ____ & nonspecific ____ or hyperresponsiveness of the ____ tree.
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inflammation
hyperirritibility bronchial |
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The airway hyperresponsiveness seen in asthma is caused by _______ in response to physical, ____, & pharmacologic agents.
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bronchoconstriction
chemical |
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The "early-phase response" in asthma is characterized by _____ which induces the inflammatory sequelae of the "late-phase response."
The effects in the "early-phase response are bronchospasm, increased ____, ____ formation, & increased tenacious sputum. This response peaks within 30-60 minutes & subsides in ___ to ___minutes. Symptoms are wheezing, ____, ____, dyspnea, & ____. |
bronchospasm
mucus edema 60-90 minutes chest tightness cough |
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The "late-phase response" in asthma peaks in 5-6 hours after exposure & may last for several hours or ____ & characterized primarily by ______.
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days
inflammation |
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The prominent pathophysiologic features of asthma are a reduction in airway ____ & an increase in airway ____ related to mucosal inflammation, constriction of bronchial ____ muscle, & excess production of ______.
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diameter
resistance smooth mucus |
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Although asthma is a disease of the airways, eventually all aspects of ______ function are compromised during an attack & if airway inflammation is not treated & resolved it may cause progressive irriversible ____ damage called airway ____.
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pulmonary
lung remodeling |
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The early-pase response, in asthma, is characterized by bronchospasm causing wheezing, breathlessness, chest tightness, dyspnea, & cough, whereas the "late-phase response" is characterized by _____ that increase airway _____ which leads to air trapping in the ___ & hyperinflation of the lungs.
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inflammation
reactivity alveoli |
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Wheezing is an unreliable sign to gauge the severity of an asthma attack.
True? False? |
Whheezing is nopt a reliable sign. (p640-lewis)
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Though wheezing is not an reliable gauge to determine a sever attack, severly diminished breath sounds called ____ ____ indicates a severe obstruction & impending ____ ____
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"silent chest"
respiratory failure |
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Examination of the pt during an acute asthma attack usually reveals signs of ____, restlessness, _____, innapropriate behavior, increased pulse & ____ ____, & a drop in systolic pressure during inspiration called ___ ___.
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hypoxemia
anxiety blood pressure pulsa paradoxus |
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Name 4 classifications for asthma:
_______ _______ _______ _______ |
mild intermittant
mild persistant moderate persistant severe persistant |
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Status asthmaticus is a severe, life threatening asthma attack that is refractory to usual treatment & places the pt at risk for developing _______ failure.
"the longer it last the worse it gets & the worse it gets the longer it lasts" |
respiratory
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Cause of status asthmaticus include viral illnesses, ingestion of ______ or other NSAIDS, emotional ____, increases in ______ pollutants or other allergen exposure, abrubt discontinuation of ____ therapy, abuse of ____ medication & ingestion of b-adrenergic blockers. The patient usually reports a history of ___ ___ asthma progressing over days or weeks.
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aspirin
stress environmental drug aerosol poorly controlled |
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Clinical manifestations of status asthmaticus result from increased airway ____ as a consequence of edema, ____ ___, & bronchospasm w/ subsequent air trapping & _______. Manifestations are similar to those of astma but are more severe & more ____.
Name 4 manifestations a patient may present with status asthmaticus: _________ _________ _________ _________ |
resistance
mucous plugging hyperinflation prolonged extreme anxiety fear of suffocation increased work to breathe diaphoresis use of accessory muscles to breathe hypoxemia hypocapnia |
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with asthma, the abscence of a wheeze is a life-threatening situation that may require ____ ____. In this event the chest appears fixed in a ________ position & often descrbed as _____ which indicates severely decreased movement of air through the ______ airways.
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mechanical ventilation
hyperventilated tight bronchial |
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The severity of the clinical manifestations of asthma determines the appropriate diagnostic studies.
True or False |
True
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In diagnosing a patient with asthma it is important to know 2 things. What are they?
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Can the pt sleep through the night?
Can the pt participate in an aerobic exercise program? (helps identify some triggers) |
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Pulmonary function tests on an asmatic pt are usually ____ normal limits between attacks if pt has no other underlying ____ disease.
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within
pulmonary |
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With asthma, seasonal attacks may indicate ______ triggers & attacks at night may becaused by sleeping with a cat, sleep apnea, mattress dust mites, or ____.
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pollen
GERD |
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An essential objective measuremnt of airflow obstruction that is used to diagnopse & manage asthma is a?
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Pulmonary function test
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There are 6 diagnostic studies used for for asthma. What are they?
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Pulmonary function test
Sputum specimen IgE levels & esonophil count Chest X-Ray Arterial Blood gases Pulse Oximetry GERD |
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The Pt who has persistant airflow obstruction & frequent attacks of asthma should be taught to do what 2 things?
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avoid triggers of acute attacks
premedicate before exercising |
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The Pt w/ mild intermittant asthma should premedicate before ____ using these 3 inhaled medications:
1) b-adrenergic agonists 2) __________/Intal 3) nedocromil/______ |
exercising
cromylin Tilade |
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A patient with a Peak Flow of 70%;respiratory rate & effort, mild accessory muscle use, end-expiratory wheezing, & PaO2 greater than 95% would be classified w/what type of asthma:
a) mild b) moderate c) severe |
mild
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A patient with a less than 50% predicted Peak Flow, tachypnea w/severe dyspnea, severe intercostal retractions, tracheosternal retractions, nasal flarring, possibly cyanotic, inaudible breath sounds, PaO2 less than 90% would be classified w/what type of asthma?
a) mild b) moderate c) severe |
severe
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A patient with a 50-70% predicted Peak Flow, increased respiratory rate, dyspnea, moderate intercostal retractions; tracheosternal retractions; chest hyperinflation, wheeze during entire respiratory cycle, & a PaO2 90-95% would be classified w/what type of asthma?
a) mild b) moderate c) severe |
moderate
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Moderate persistant asthma requires regular or ______ use of inhaled _______ medication.
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maintenance
antiinflammatory |
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Moderate persistant asthma requires regular/maintenance use of these 3 inhaled medications.
1) inhaled _________ 2) cromolyn/________ 3) nedocromil/______ |
corticcccosteroids
Intal Tilade |
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For severe persistant asthma, patients should use inhaled or ____ corticosteriods & inhaled or ___ b-adrenergic agonists, & _______ may be used to allievate symptoms. Some Pt's require ________ oral corticosteriods which should be maintained at as low a dosage as possible & administered on _________ days to reduce systemic side effects.
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oral
oral theophylline continuous alternate |
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Management of a patient presenting w/an acute asthma attack is:
1) start ____ immediately 2) monitor 02 admin w/____ 3) monitor severe case w/____ 4) admin b-adrenergic agonists w/____ dose inhaler using spacer devices or ____. 5) if initial response is insufficient (no response w/in _-_)use ____ IF Pt has had several recent attacks OR if Pt is recieving oral corticosteroid therapy. The choice of oral or ___ admin depends on the ____ of attack. Therapy should continue until Pt is ______ comfortably & ___ has dissapeared. |
02
pulse Ox ABG's metered nebulizer 30-60min corticosteriods IV severity breathing wheezing |
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Management of a patient presenting w/Status asthmaticus focuses on correcting ____ & improving _____. Most therapeutic measures are the same as w/an acute attack but it may be neccessary to increase frquency & dose of inhaled ____. When an MDI is used the typical dose is 2-6 puffs every 5 - ___ minutes depending on medication used.
(see Lewis page 644 "Staus Asthmaticus for further therapeutic measures) |
hypoxemia
ventilation bronchodilators 20 |
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Asthma medications are categorized into 2 classifcations. What are they?
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Long-term control medications
Quick -releif medications |
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Therapeutic use of long-term asthma medications is to achieve & maintain control of ____ asthma & quick relief medications are to treat ____ & exacerbations.
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persistent
symptoms |
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Because inflammation is considered an _______ & persistant component of asthma, drug therapy must be directed toward ____ term suppression of inflammation.
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early
long |
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With asthma, the therapeutic use of Anti-inflammatory Agents, Anticholinergics, Methylxanthine Derivitives, Mucolytics, Leukotriene Modifiers, are for :
a) prevention b) rescue |
prevention
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With asthma, the therapeutic use of Beta-Adrenergic Agonists is:
a) prevention b) rescue |
rescue
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A Nursing Management NDX is:
____ airway clearance, anxiety, activity intolerance r/t work of breathing, ineffective therapeutic management r/t knowledge deficit |
Ineffective
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Nursing Management Goals for Pt's with asthma are:
Near or normal ____ function & activity level No recurrent _____ Adequate _____ to carry & participate in treatment plan |
pulmonary
exacerbation knowledge |
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Identify some teaching strategies for Patient's w/asthma:
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Triggers
Medication Asthma Action Plan Peak Flow Meter Relaxation Hydrate GERD |
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Non prescription OTC medications include epinephrine, found in Primatine spray. The concern with this use is it acts for a short time & _____ Pt's heart rate & Bp.
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increases
This OTC is not recommended. |
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Theophylline (OTC) taken w/ other xanthines including ___ has additional side effects which include central nervous system & _______ effects, N&V & ______.
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caffeine
cardiovascular anorexia |
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A combination of ephedrine, found in many OTC ___ & theophilline causes synergistic stimulation of the nervous & _____ systems. Side effects include nervousness, heart ___ & arryhthmias, tremors, insomnia, & increases ____.
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decongestants
cardiovascular palpatations Bp |
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It is important for the nurse to warn patients w/ asthma about?
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dangers associated w/nonprescription combination drugs.
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Cystic Fibrosis is an autosomal recessive, ____ disease characterized by altered function of the ____ glands involving primarily the lungs, pancreas, & ___ glands.
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multisystem
exocrine sweat |
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Cystic Fibrosis is progressive & ______. The average life span of Pt's with cystic fibrosis is:
a) 12 years b) 28 years c) 40 years d) manageable until >50 years |
incurable
28 years |
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Pathophysiology of Cystic Fibrosis is Obstruction of _____ glands, glands distal to duct undergo ____, destruction of ____ tissue, chronic airway ____, diabetes mellitus, gastrointestinal complications.
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exocrine
fibrosis lung infection |
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Clinical Manifestations of Cystic Fibrosis in a newborn is ____ ileus & in childhood failure to ____, protuberant ____, & emaciated _____.
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meconium
grow abdomen extremities |
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S&S of Cystic Fibrosis are cough, recurring lung ____ w/ exacerbations that are more frequent resulting in loss of lung ____, gastrointestinal
complication of Distal Intestinal ____, Pancreatic fibrosis resulting in imairment in digestion & absorption of _____. Reproductive complications include sterility in ____ & menstrual ____ in females that make getting pregnant difficult. Difficulty getting pregnant |
infections
function Obstruction nutrients males irregularities |
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Diagnostics used for Cystic Fibrosis include:
(name 4) |
Sweat Chloride Test
Chest X-ray Pulmonary Function Test Fecal Analysis Test |
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Objectives in th therapeutic management of Cystic Fibrosis
are to promote clearance of ____, control _____ in the lungs, & provide adequate ____ |
secretions
infection nutrition |
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Nursing Diagnosis for Cystic Fibrosis include:
1) _____ airway clearance 2) Risk for ____ 3) Imbalanced ______ 4) Parental role _____ |
Ineffective
infection nutrition conflict |
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What should you do with an inhaler that has not been used for 5-7 days?
a) throw it away b) no problem, use it c) prime before using |
prime before using
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How many puffs are in a nebulizer?
a) 10 b) 20 c) 100 d) 200 |
20
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Many patients with asthma are found in this position when sleeping:
a) head propped up on pillow b) arms crossed around chest c) covers pulled up over head d) arms resting above head |
arms resting above head
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Mucus from patients with asthma is characterized by:
a) Watery & clear b) Thick & clear c) Watery & white d) Thick & white |
Thick & white
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The greatest incidence of asthma occurs in:
a) United States b) Northern European c) South of the Equator d) North of the equator b) |
United States
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Asthma occurs in:
a) 1-20 Americans b) 1-60 Americans c) 1-20 males d) 1-20 females |
1-20 Americans
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The problem with asthma is getting air into the lungs, not getting air out.
true false |
false
The problem is getting air out! |
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To reduce an asthmatic reaction, Zolair ______ IgE levels.
a) increases b) decreases c) maintains |
decreases
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S&S of asthma are:
1-Hypoxemia 2-tachycardia 3-increased restlessness 4-difficulty getting air ___ 5-familial cough 6-____ mucus 7-shortness of breath 8-wheezing with ______ 9-increased C02 10-prolonged ______ |
out
increased exhalations exhalations |
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Peak Flow meters are an assessment method to check:
a) small airways b) large airways c) tidal volume d) P02 levels |
large airways
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Patients with asthma should be assessed every 1-2 years using:
a) sputum specimen b) pulmomary function test c) ABG's d) IgE levels |
pulmomary function test
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A pulmonary Function test tells how much air:
a) is perfusing into the blood b) how much C02 is retained in the lungs c) how much air is in the large airways d) how much air is in the small airways |
how much air is in the small airways
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The best exercise for asthmatic Pt's is:
a) stairstepping b) aerobics c) swimming d) bicycling |
swimming
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Peak Flow measurements are lowest in:
a) morning b) evening |
morning
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Most incidents of asthma are triggered by:
a) stress b) exercise c) inhalation abuse d) allergy |
allergy
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A "salty kiss" is indicative of?
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CF
Cystic Fibrosis |
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Progressive chronic inflammatory changes result in _____, an irreversible thickening of the basement membrane, airway ____ muscle hypertrophy & mucus gland hypertrophy.
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airway remodling
smooth |
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Recognizing & addressing ___ & ___ are essential for reestablishing normal respirations in a Pt's having an asthma attack.
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fear & panic
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Most children experience their 1st asthmatic symptoms before:
a) before leaving the hospital as a newborn b) 1st year of birth c) 5 years of age d) 7 years of age d) before the age of 5 b) |
5 years of age
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The ____ airway responses to stimuli are present before the ____ initiates an asthmatic episode.
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reative
trigger |
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With asthma, the late allergic response starts ___ to ___ later when ____ cells respond & another wave of mediator release occurs which in turn stimulates more airway ______ & bronchospasm.
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6-9hrs
inflammatory inflammation |
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In asthma, mucus clogs ___ airways, traps air & the airways swell, creating muscle ___ that may become uncontrolled in ___ airways. Decreased perfusion of alveolar cappillaries results in ______ of the alveoli & hypoxemia leads to an _____ respiratory rate but ___ air is breathed per minute because of airway resistance.
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small
spasms large hyperinflation increased less |
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The warning signal that a childs airway is very sensitive to stimuli & the only possible sign of "silent" asthma is:
a) sleeping with arms crossed over the chest b) relief of wheezing when laying down c) relief from wheezing when sitting down d) coughing especially at night |
coughing especially at night
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2 Common findings in children who have repeated acute exacerbations of asthma attacks are:
1-__________ 2-__________ |
barrel chest
use of accessory muscles of respirations |
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Albuterol, a beta- adrenergic agonists, for the treament of asthma is:
a) preventative b) rescue |
rescue
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Before administration of albuterol it is important for the RN to ?
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take the pulse before use & monitor thereafter
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Albuterol, a short acting beta adrenergic agonist, relaxes ____ muscle in the airway & _____ water content in mucus to promote clearance resulting in ___ within __-__ minutes. Albuterol is a rescue medication & is to be used before inhaling a _____. Use of Albuterol is to wait ___ to ___ minutes between puffs, wait ___ minutes to give inhaled _____ & child should hold breath ___ seconds after inspiring & then rinse mouth & avoid swallowing medication.
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smooth
increases bronchodilation 5-10 minutes steroid 1-2 minutes 15 minutes steroid 10 seconds |
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Corticosteroids (prednisones) diminish airway ____ & obstruction, & enhance bronchodilating effects of _____. Corticosteroids (prednisones) are used for moderate to severe exacerbations when single beta-agonists dose given in ED does not resolve symptoms. Onset of action is ____ & is a short term therapy for ___ until symptoms are resolved or 80% peak expiratory flow personal best. Long term therapy may result in adverse affects such as ___ ___, unstable blood ___, immunosuppression.
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inflammation
beta-agonists ( albuterol) 4-6hrs 3-10 days decreased growth sugar |
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A sweat chloride [] of 50 to 60mEq/L is suspicious in diagnostic testing for ___ ___. If the chloride concentration is greater than 60mEq/L it is diagnostic with other signs. 2 other test used to confirm th ediagnosis are?
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cytic fibrosis
spirometer sputum culture |
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Clinical therapy in the management of cystic fibrosis, focuses on maintaining _____ fxn, promoting optimal _____ & exercise, managing ______, & preventing GI ______.
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respiratory
nutrition infection obstruction |
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Nursing assessment of child with CF focuses on the adequacy of ____ fxn. When child enters HCS w/symptoms of respiratory infection obtain ______, asses respiratory status, ausculate chest for _____, ____, & ______, inquire about the frequency & character of the cough & _____, note any cyanosis or _______ of the extremities. Evaluate growth by plotting the weight & height on a ______ curve & determine if child is maintaining appropriate growth pattern or is ______. Inquire about appetite & ____ intake, how nutritional suppliments, enzymes & _____ are used. Assess _____ pattern, & whether child has problems w/_____ pain, bloating, & whether these problems can be related to ____, ______ or other activities. Palpate the abdomen for _____ size, fecal masses & evidence of _____.
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respiratory
vital signs breath sounds crackles wheezes sputum clubbing growth malnourished dietary vitamins stooling abdominal eating stooling liver pain |
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Because children w/CF have _____ clearance of most antibiotics they need ______ doses & long treatment courses.
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increased
higher |
