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156 Cards in this Set
- Front
- Back
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Top 10 Causes of Death in Women
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Heart Disease
Cancer Cerebrovascular Disease Chronic Obstructive Pulmonary Disease Pneumonia Influenzae Diabetes Accidents and adverse drug effects Alzheimer’s Disease Nephritis and septicemia |
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What does COPD consist of?
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Emphysema and Chronic Bronchitis
(One often goes with the other) |
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Is tissue damage from COPD reversible?
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No
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Does tissue damage with COPD become ore or less severe as time goes on?>
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More severe, eventually leading to respiratory failure
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What is COPD characterized by?
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Characterized by bronchospasm and dyspnea
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What can trigger bronchospasm?
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allergies, irritants, activities
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What happens during bronchospasm?
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airway constriction --> coughing a lot, productive/nonproductive
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CO2 retention looks like...
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fatigue/ tired/ sleepy
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What is Pulmonary Emphysema ?
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Loss of elasticity in alveoli (not fully expelling CO2) and hyperinflation (CO2 trapped in alveoli, sacks get bigger and bigger)
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What is the first sign of Pulmonary Emphysema ?
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retention of CO2
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What does emphysmatic respiration look like?
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dyspnea and increased respiratory rate
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With emphysema, excessive ________ cause alveoli to collapse
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proteases
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protease
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Made in liver and goes to lungs to eat bacteria
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What do we hear when alveoli collapse?
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crackles and rails
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With emphysema, d/t the loss of elastic recoil in alveolar walls, ___ ____ occurs
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air trapping
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Air trapping in the alveolar walls causes
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overstretching and enlargement of the alveoli into bullae, and collapse of small airways (bronchioles)
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What is a bullae?
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The alveolar walls collapse and form 1 big alveoli... "blebs"
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What happens to the diaphragm with emphysema?
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Diaphragm flattens, need for accessory muscles
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Air Hunger
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At its worst, emphysema can cause "air hunger." This is the constant feeling of being unable to catch one's breath.
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What do the CO2 and O2 levels look like with an emphysmatic patient?
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Co2 retention- may have low O2 level in late stage
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What is emphysema associated with?
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Associated with smoking or inhalation irritants
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What is a normal CO2 level?
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35-45
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What is a normal O2 level?
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80-100%
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What is Chronic Bronchitis
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Inflammation of bronchi and bronchioles
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What is the cause of Chronic Bronchitis
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Cause: Chronic exposure to irritants (smoke)
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Chronic Bronchitis come with large amounts of ___ ____
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thick mucous- can be as much as 2x the normal amount
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What happens to the bronchial walls with chronic bronchitis?
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Bronchial walls thicken and impair airflow due to chronic (>6mos) irritation
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Characteristics of Bronchitis?
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Inflammation, vasodilation, congestion, mucosal edema, and bronchospasm
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Does bronchitis affect the alveoli?
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No, it only affects the airway
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What happens to gas exchange with bronchitis?
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it is hindered
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What happens when PaO2 decreases?
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hypoxemia
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What happens when PaO2 increases?
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respiratory acidosis
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COPD: Etiology and Genetic Risk
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Cigarette smoking
Alpha1-antitrypsin (AAT) deficiency Air pollution |
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When do we start seeing changes in lungs with smokers?
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Changes start at 8 pack year hx
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When do we see early stage COPD with smokers?
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Around 20 Pack year hx
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Alpha1-antitrypsin (AAT) deficiency
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A special enzyme made by liver, normally present in the lungs- regulates proteases- people who have a deficiency in this enzyme have too much protease action, and the proteases start eating away at the lung tissue. GENETIC RISK
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Which populations are more at risk for COPD?
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Blue Collar workers
Northern Plane Indians African Americans Alaskan Natives Low SocioEconomic, Low educated classes |
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Is hypoxemia a complication of COPD?
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Yes
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Is acidosis a complication of COPD?
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Yes
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Are COPD pts more apt to get respiratory infections?
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Yes
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What do we teach COPD pts about preventing infection?
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Coughing --> pulmonary cleaning/hygiene
Oral hygiene Hand washing Avoid Crowds Getting vaccinations (pneumonia, flu) |
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What labs do we look at for hypoxemia?
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H & H, RBC/CBC
ABGs, E-, BUN, Creatinine, Prealbumin |
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How do we treat hypoxemia?
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Give O2 (1-2L)
Reposition to breathe Deep Breathing techniques Light exercise |
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What is important to remember about giving O2 to COPD patients?
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Their chronic increased CO2 levels is their drive to breathe, if we give them too much O2, they will lose this drive and will need to be put on a ventilator
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How do we reposition pts to make it easier to breathe?
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Sittin gup in bed, leaning/bending over a table from a sitting position
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What type of deep breathing do we teach COPD pts?
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Pursed lip breathing
abdominal breathing |
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What do we teach COPD pts about exercise?
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Light exercise, start out easy and build up
Space activity out over time and give frequent rest breaks ie: eat, rest, bathe, rest, ambulate, rest |
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What type of cardiac complications do COPD pts have?
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Cardiac failure, especially cor pulmonale
Cardiac dysrhythmias |
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cor pulmonale- s/s?
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Right sided heart failure- will show dependent edema, Legs and below
Enlarged liver, distended abdomen, enlarged neck veins |
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Cardiac dysrhythmias
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skipped beats, some of the dysrhythmias can be life threatening
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Why are COPD pts more at risk for septicemia?
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Damage to their cells leads to less irritant clearance, this leads to greater resp infection-since the alveoli are near capillaries they can carry infection into the blood stream
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Why are COPD pts more at risk for decreased nutritional status?
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Continuous coughing leads to less of an appetite, also swallowing sputum can case nausea
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What to teach COPD pts about increasing nutrition?
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Increase fluids (to thin secretions)
Take meds after meals eat sitting up Cough/clear secretions before eating |
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What are foods that COPD pts should avoid?
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No milk, chocolate, caffeine (makes secretions thicker)
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What should COPD pts do every morning upon waking up?
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Cough/clear secretions
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Hx assessment COPD pts
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Risk factors, increased age, male, race Hx of smoking, environment
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COPD- General appreaance
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clubbing fingers
barrel chested SOB Cyanotic Fatigue |
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Cardiac Changes with COPD
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enlarged heart?
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Lab assessment COPD
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ABG values
sputum samples CBC H & H serum E levels AAT levels |
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Tests/diagnostic for COPD
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Chest X-Ray
Pulmonary function test (how much CO2 remaining? |
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Residual volume in alveoli will increase or decrease with COPD?
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Increase
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High priority Nsg Diagnosis for COPD
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Impaired gas exchange
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Nonsurgical interventions for chronic obstructive pulmonary disease:
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Airway management
Monitoring patient at least every 2 hours Cough enhancement Oxygen therapy Drug therapy Pulmonary rehabilitation |
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Beta-adrenergic agents work by?
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Work by relaxing smooth muscle, bronchodialation
Used for asthma |
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Example of short acting Beta-adrenergic agent
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Albuterol
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How is Albuterol used? Important to remember?
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As a rescue inhaler during an attack- carry with you at all times! Monitor HR (excessive use causes tachycardia)
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Example of Long acting Beta-adrenergic agent? Important information?
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Serevent (Salmeterol) - Inhalent- onset slow duration long- primary use to prevent an attack
Takes 12 hours to work increase fluids when taking Do not use as a rescue drug |
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Cholinergic antagonists work as...
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bronchodilator- inhibits PSNS, activates beta2 receptors
Rescues and prevents asthma |
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What is an example of a Cholinergic antagonist?
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Ipratropium (Atrovent)
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Methylxanthines work as...
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bronchodilator for asthma
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Example of a Methylxanthine?
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Theophylline
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What is important to remember about Methylxanthine (Theophylline)
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Need to do Theophylline levels- causes tachycardia
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How do Corticosteroids work for LRS?
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Disrupts inflammatory pathway (anti-inflammatory) preventing an asthma attack
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Example of Corticosteroids?
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Fluticasone (Flovent)
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What to remember when taking Corticosteriods (Fluticasone -Flovent)
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Take Q day
Do not use with onset of asthma symptoms Perform good oral care- drug reduces local immunity- easier to get candida |
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Corticosteriods makes face ____, called "___ ___."
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swell
Moon face |
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Why do Corticosteriods cause face to swell?
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makes pt retain fluids
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What is important to remember about all steroids?
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Always taper off!!!
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How do NSAIDs work for LRS?
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Prevents release of inflammatory mediators
Prevents asthma attack triggered by inflammation by allergins |
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Example of NSAID for LRS?
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Nedocromil (Tilade)
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How do Mucolytics work?
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Break down mucous
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Example of a Mucolytic?
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Mucomyst
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How do Expectorants work?
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thin secretions, facilitate expectoration
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Example of an Expectorant?
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Gualfensin
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What surgical procedure as last effort for End stage COPD?
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Lung transplantation
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What drugs do Lung transplantation pts need to be on for the rest of their lives?
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Anti-rejection drugs
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Nursing Diagnoses for COPD?
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Ineffective Breathing Pattern
Ineffective Airway Clearance Imbalanced Nutrition Anxiety Activity Intolerance Potential for Pneumonia or Other Respiratory Infections Risk for Pressure Ulcer |
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Patient for Home care of COPD
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Drugs
Avoid irritants Nutrition Activity breathing techniques coughing deep breathing relaxation and energy conservation |
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Pt w/ emphysema should get 1-3L/min of O2, if needed, or he may lose his hypoxic drive. Which statement is correct about hypoxic drive?
1. Pt doesn’t notice he needs to breathe 2. Pt breathes only when O2 levels climb above a certain point. 3. Pt breathes only when O2 level dips below a certain point. 4. The client breathes only when CO2 level dips below a certain point. |
3. Pt breathes only when O2 level dips below a certain point.
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What is Pneumonia?
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Excess of fluid in the lungs resulting from an inflammatory process
Inflammation triggered by infectious organisms and inhalation of irritants |
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7th leading cause of death
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pneumonia
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Highest cause of death among the elderly?
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pneumonia
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2 types of pneumonia
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Community-acquired infectious pneumonia
or Nosocomial or hospital-acquired(nosocomial) |
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What do you do if you see a pt is prescribed both prednisone and solumedrol?
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Call Dr. and tell to D/C one!
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What is the cause of 50-60% of nosocomial acquired pneumonia cases?
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ventilators
Perform hygiene care! Handwash when working with ventilators! |
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What Hx to assess with pneumonia pt?
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find the cause- cold? aspiration? auto immune compromised? GI-bleed- aspirate on blood?
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Physical Assessment for pneumonia pts?
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Headache, muscle weakness, fever, chills, tachycardia, chest pain, pain when breathing, crackles, wheezing, dehydrated, decreased appetite
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What is the first sign of pneumonia (infection) in the elderly?
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Altered mental status
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hemoptysis
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coughing up blood
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What do we need before giving pneumonia pts Abx?
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sputum culture
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How to get sputum culture?
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Cough or suction
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What if pt cannot cough up sputum for culture?
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Give them fluids, mucolytics
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Why do we need culture before Rx Abx?
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To see if it is viral or bacterial infection
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How does lab assess sputum culture?
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Gram stain, culture and sensitivity testing
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Labs to assess for pts with pneumonia?
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sputum culture
CBC ABG Serum BUN, creatinine E (how dehydrated are they) |
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Imaging assessments for pneumonia?
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Chest X-rays
MRI (What's going in the tissues?) |
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Interventions for pneumonia pts?
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O2 therapy
IS Liquify secretions Drugs |
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How to help pneumonia pts liquify secretions?
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increase fluids
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What drugs to give pneumonia pts?
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bronchodilators
anti-infectives (5-7 days or up to 21 days if immune compromised) May add steroids and NSAIDs for aspiration pneumonia |
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What to teach pts about treating pneumonia at home?
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deep breathe/ cough
Limit activity Clean air/environment Someone to help at home Med teaching/no smoking- nicotine patch smoking cessation |
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What happens when someone wears a nicotine patch and smokes?
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MI
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An elderly client with pneumonia may appear with which symptoms first?
1. Altered mental status and dehydration 2. Fever and chills 3. Hemoptysis and dyspnea 4. Pleuritic chest pain and cough |
1. Altered mental status and dehydration
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What is Pulmonary Tuberculosis?
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Highly communicable disease caused by Mycobacterium tuberculosis
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How is TB transmitted?
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via aerosolization (sneeze, cough, laugh, sing), Airborne & inhaled
PROLONGED EXPOSURE |
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What countries does TB come from most prevalently at the present moment?
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Mexico
Philippines Viet Nam |
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What vaccine can cause a positive TB skin test?
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BCG vaccine
exposure to TB though doesn't mean you have TB |
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Who is more at risk for TB upon exposure, more than the normal population?
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Immune compromised- HIV
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What living conditions increase ones risk for TB?
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Overcrowded low economic areas- prisons, long term health facilities
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Clinical Manifestations of TB
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Progressive fatigue
Lethargy Nausea Anorexia Weight loss Irregular menses Low-grade fever, night sweats Cough, mucopurulent sputum, blood streaks COUGHING UP PUS SPUTUM |
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What test is used only for TB precautions?
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AFB- acid-fast bacillus
Positive Result |
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What speciman to use for AFB?
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1st morning sputum
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If AFB test positive what test next to diagnose TB?
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sputum culture of M. tuberculosis
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How long to get results back from sputum culture of M. tuberculosis?
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1-4 weeks
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QuantiFERON-TB Gold (QFT-G) test
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Blood test, results within 24 hours
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What is the Tuberculin test (Mantoux test)?
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purified protein derivative given intradermally in the forearm
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Whne to read Tuberculin test results and what is a positive result?
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Read in 48-72 hour
Induration of 10 mm or greater diameter indicative of positive exposure (If HIV anything >5mm) |
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If positive for Tuberculin test, what next?
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Chest X-Ray (looking for healed lesions)
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What type of room are TB and smallpox pts in?
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Negative pressure rooms
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What type of mask do we wear in TB rooms?
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N95
(Do not need gown and gloves) |
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Drugs used for TB
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Isoniazid (INH)
Rifampin Pyrazinamide Ethambutol ALL ORAL DRUGS |
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Isoniazid (INH) , what does it do?
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Kills actively growing bacteria and inhibits growth of dormant bacteria inside macrophages
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Isoniazid (INH) Dosing
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200-300mg Daily or
600-900mg twice a week |
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Pt teaching for Isoniazid (INH)
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Take on empty stomach, avoid antacids
Take multivites w/ B complex Avoid alcohol (liver damage) Report dark urine, jaundice, increased bruising or bleeding (liver toxicity/failure) |
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Rifampin, what does it do?
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Kills slower-growing organisms, even those in macrophages
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Rifampin Dosing
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500-600mg daily or twice a week
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Pt teaching for Rifampin (RIF)
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Expect drug to stain skin and urine- expected and harmless (can permanently stain soft contacts)
Women- use back up Birth Control Avoid Alcohol (liver damage) report dark urine, jaundice, bruising/bleeding (liver damage) |
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Can you take lots of other drugs with Rifampin?
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No, it interacts with lots of other drugs
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Pyrazinamide (PZA), what does it do?
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Effectively kills organisms inside macrophages- is not inactivated by the acidic environment of macrophages
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Pyrazinamide Dosing
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1000-2000mg Daily or
3000-6000mg twice a week |
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Pt teaching for Pyrazinamide
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Increases uric acid formation (assess for hx of gout)
increase fluid intake- take with 8oz H2O (dilutes uric acid) Photosensitivity No alcohol S/S liver damage |
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Ethambutol (EMB), what does it do?
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Inhibits RNA synthesis (replication) - thus supressing bacterial growth
Slow acting, must be used in combination with other TB drugs |
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Ethambutol Dosing
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750-1500mg daily or
2500-5000mg twice a week |
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Pt teaching for Ethambutol
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Avoid alcohol (will react and cause N/V)
Can cause optic neuritis and can lead to blindness (need to detect early on to reverse) Increases uric acid (hx of gout?) Drink lots of H2O- helps prevent uric acid problems |
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What is the most important teaching for pt in regards to ALL TB medications?
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TAKE FOR ENTIRE LENGTH
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What will happen if pt does not comply with TB med sched?
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TB will come back and will have to take meds even longer.
Public Health will get involved and make you take meds, can put you in prison if you refuse |
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How long must you have continuous appts after TB infection?
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for 1 year
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What diet to maintain for TB pts?
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High in Iron, Vitamin C, Vitamin B
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What is important for TB pts to know about activity?
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There is a lot of lethargy, start activity slowly
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Who else must be tested when someone has TB?
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Everyone in their family/Home
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How do we determine someone is not contagious anymore?
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3 negative sputum tests
(tests every 2-4 weeks) |
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Can TB patients smoke?
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No, that is NOT OK
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How common is TB?
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It is the most common bacterial infection worldwide- it is a HIGHLY transferrable communicable disease
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What is the name of the organism responsible for Tb?
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Mycobacterium Tuburculosis
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Does TB stay in the lungs?
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No, that is where is first affects the body but it can travel around to bone marrow, brain, liver, kidneys, etc.
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After treatment, is TB gone entirely?
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No, usually still have a few bugs in system for rest of life- can come back when sick and elderly
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Who is more at risk for TB?
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Elderly
immigrants Low Soc Eco Highly populated living |
