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90 Cards in this Set
- Front
- Back
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The right lung has how many lobes?
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-3 lobes
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The left lung has how many lobes?
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-2 lobes
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Crackles heard by the nurse on lung assessment are associated with what disease?
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-Congestive heart failure
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Crackles do or do not clear with coughing.
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-Do not
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The plan of care (POC) for a COPD patient would include which of the following?
--Exercise as tolerated such as walking. --Chronic oral corticosteroids --Increased flow of O2 --Breathing exercises to practice inhaling longer than exhaling |
--Exercise as tolerated such as walking
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The most common cause of emphysema is?
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-Cigarette smoking
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A diagnostic procedure to remove pleural fluid is called a?
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-Thoracentesis
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Asthma is best characterized as which of the following?
--Steady bronchoconstriction --Inflammatory process --Mucus production |
-Inflammatory process
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Excessive mucus production is associated with what condition?
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-Bronchitis
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What is most important for the nurse to teach a patient with COPD?
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-How to recognize the early s/sx of of COPD exacerbation
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Clubbing of the fingernails is a sign of?
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-Hypoxemia
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Clubbing of the fingernails is seen in patients with what disease?
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-COPD
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The acronym COPD stands for?
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-Chronic obstructive pulmonary disease
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The normal angle for the fingernails is?
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-160 degrees
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The angle of the fingernails with clubbing is?
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-180 degrees
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For COPD patients it is considered optimal to treat their condition in a hospital or to teach them how to manage their condition at home?
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-Respiratory rehab. Teaching patients how to manage their condition at home produces better outcomes. Hospitals expose these patients to pathogens that can cause complications in addition to COPD.
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Post bronchoscopy the patient c/o a sore throat and being thirsty. The nurse may give the patient fluids to drink when?
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-When the patient demonstrates an intact gag reflex
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A "barrel chest" is a sx of what disease?
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-Emphysema
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Prior to a radial arterial puncture the nurse must perform which test?
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-Allen's test
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Before treating a patient with bacterial pneumonia with an antibiotic, which diagnostic test must be performed?
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-Sputum culture
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In a patient with acute asthma, the nurse hears what adventitious breath sound on lung assessment?
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-Wheezing
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The nurse instructs a patient who has just used a steroid inhaler to do what?
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-Rinse their mouth immediately after use to avoid thrush
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The term obstructive lung disease includes which diseases?
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-Emphysema, bronchitis, asthma
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Which type of COPD is characterized by a patient who is coughing up mucus and feels short of breath 3 months or more each year for at least 2 years? The cilia are also damaged with this condition so that they are unable to remove excess mucus.
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-Chronic bronchitis
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Which type of COPD is characterized by a hypersensitivity of the airways to allergens and irritants which inflame the lining of the bronchioles, causing the lining to swell and the muscles in the bronchial walls to tighten and go into spasm?
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-Chronic asthma
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Which type of COPD is characterized by destruction of the alveoli, making it difficult for the lungs to absorb enough O2 or expel enough CO2. Walls of alveoli lose elasticity and enlarge, diaphragm flattens, making it difficult to move air in/out. Bronchioles become less elastic, narrow or collapse on exhalation. CO2 gets trapped in airways, preventing O2 from getting to the blood.
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-Emphysema
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Patients diagnosed with COPD should have no more than how much O2 therapy? Why?
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-2L
-Because these patients have elevated levels of CO2 their breathing drive will be suppressed if given too much O2 therapy. |
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"Pink Puffer" is a term used to describe patients diagnosed with what disease?
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-Pulmonary emphysema
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"Blue Bloater" is a term used to describe patients diagnosed with what disease?
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-Chronic bronchitis
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Characteristics of emphysema include?
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-Progressive destruction of alveoli R/T inflammation
-Decreased surface area of bronchioles, alveoli, and alveolar ducts available for gas exchange -Airway collapse due to loss of elasticity -Chronic form of COPD |
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Patients diagnosed with emphysema exhibit what characteristics?
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-Thin (*Expending much of caloric intake just to breathe)
-Sitting forward -Using accessory muscles to breathe |
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Etiologies of emphysema includes?
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-Cigarette smoking as the primary cause
-Secondhand smoke exposure -Occupational exposure -Also Alpha-1 antitrypsin deficiency (genetic) |
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Describe characteristics of "Pink Puffer" typical of emphysema assessment by the nurse.
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-*See list on "Pink Puffer" diagram
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Diagnostic tests performed/expected results for emphysema patients include?
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-ABG (Decreased PCO2, increased CO2)
-Chest x-ray (Hyperinflation of lungs, flattened diaphragm, wider lung field, enlarged heart in later stage) -PFTs (Cannot exhale, air gets trapped in alveoli) |
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Medications used for tx of emphysema patients includes?
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-Immunization against pneumonia and influenza (these infections can be life-threatening).
-Antibiotics as needed -Bronchodilators may be used to reduce dyspnea and attempt to increase FEV (forced expiratory volume) -Anticholinergics (atrovent) most effective for COPD |
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Characteristics of bronchitis include?
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-Chronic airway inflammation
-Chronic productive cough lasting at least 3 months a year for 2 successive years -Thick, gelatinous sputum |
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Etiologies of bronchitis include?
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-Cigarette smoking
-Chronic inflammation and infections |
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Characteristics exhibited by patients with chronic bronchitis include?
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*See "Blue Bloater" diagram.
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On assessment of the patient with chronic bronchitis the nurse would expect to observe?
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-Tendency for obesity
-Bluish-red skin color from cyanosis -Polycythemia (Elevated RBCs and Hct) |
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Diagnostic tests/expected results for the patient with chronic bronchitis include?
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-Blood tests (elevated RBC (polycythemia), elevated Hct due to hypoxia)
-Chest x-ray (congested lung field, inflammation/infection, enlarged heart) PFTs (Increased residual volume, decreased FEV) -ABG (decreased O2, increased CO2) (*More acetic so respiratory acidosis) |
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Medications used to tx patients with chronic bronchitis include?
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-bronchodilators, as with emphysema
-antibiotic -mucolytic to liquify mucus (*FYI: Liquid mucomyst used in Tylenol overdose) |
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Characteristics of asthma include:
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-Chronic inflammation of airways that leads to intermittent obstruction
-Severity/duration of sxs are unpredictable -Hypersensitivity reaction to inhaled allergens (ie. dust, mites, animal dander, pollen, mold) and also to food. |
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Etiologies of asthma include:
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-Physical/psychological stress, fatigue, hormonal changes (intrinsic)
-Allergic reactions to inhalants/food (extrinsic) -Widespread spasms of bronchiole smooth muscle with airway edema |
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Alternative therapies for tx of asthma may include?
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-Yoga
-Stress reduction -Smoking cessation |
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On asthma assessment the nurse would expect to see what s/sx?
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-Severe dyspnea
-wheezing with expiration (could have wheezing on inspiration also) -cough -chest tightness -restlessness -anxiety |
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Diagnostic tests performed/expected results for patients with asthma include?
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-Blood tests (elevated eosinophil count)
-PFTs (decreased forced expiratory volume and peak expiratory flow) |
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Medications used for the tx of acute exacerbation of asthma are know as?
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-Rescue drugs
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Asthma patients who use a peak flow meter at home for daily measurements understand what 3 zones/percentages used to categorize their breathing?
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-Green zone (80-100% of ideal)
-Yellow zone (50-80% of ideal) -Red zone (50% of ideal) |
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Asthma patients who perform peak flow meter readings at home understand that each particular level determines what?
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-The tx that will be used
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The objective of asthma patients learning to use/interpret peak flow meter readings at home is?
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-To help these patients take ownership of their disease and achieve a higher level of self-care (Orem's theory)
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The asthma patient understands that the goal of using a peak flow meter at home is?
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-To stay in the green zone (80-100% of ideal) and out of the red zone (50%) of ideal
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Ventolin (albuterol)
Class/Action: |
Class: Beta-2 agonist
Action: -Fast-acting bronchodilator -Rescue medication |
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Proventil (albuterol)
Class/Action: |
Class: Beta-2 agonist
Action: -Fast-acting bronchodilator -Rescue medication |
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Side effects of fast-acting bronchodilators (Beta-2 agonists) include?
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-Tremors
-Elevated heart rate -Elevated B/P -HA -Nausea |
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Nursing instructions for the patient using fast-acting bronchodilators (Beta-2 agonists) include?
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-Wait before taking the 2nd puff
-Do not exceed the rx'd dose |
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Fast-acting bronchodilators (Beta-2 agonists) are administered to the patient via what route/equipment?
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-Oral route via MDI or nebulizer
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Atrovent
Class/Action: |
Class: Anticholinergic
Action: -Slower-acting bronchodilator -Works with fast-acting bronchodilators (Beta-2 agonists) to maintain open airway |
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Side effects of slower-acting bronchodilators (anticholinergics) include?
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-HA
-Nervousness -Dry mouth |
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Nursing instructions for the patient using a slower-acting bronchodilator (anticholinergics) include?
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-Wait 2 to 5 minutes for 2nd puff
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Slower-acting medications used to tx asthma are known as?
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-Control medications
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Slower-acting bronchodilators (anticholinergics) are administered to the patient via what route/equipment?
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-Oral route via MDI or nebulizer
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Azmacort
Class/Action: |
Class: Steroid (inhaled)
Action: -Decreases inflammation to open airway |
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Steroids (oral or inhaled) are considered rescue or control medications in the tx of asthma?
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-Control medications
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Prednisone
Class/Action: |
Class: Steroid (p.o.)
Action: -Decreases inflammation to open airway |
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Solumedrol
Class/Action: |
Class: Steroid
Action: -Decreases inflammation to open airway -Would be given by IV route in an emergency situation |
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Side effects of steroid medications (inhaled/p.o./IV) would include?
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-Increased fluid retention
-Decreased BP -Decreased immune response |
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Nursing instructions for the patient using a steroid medication via MDI would include?
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-Rinse mouth with water immediately after use to avoid developing thrush
-Be sure to complete the entire amount of medication rx'd. -Do not DC the medication w/o consulting MD first |
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Cromylin
Class/Action: |
Class: Nonsteroidal antiinflammatory
Action: -Prevention of inflammation and wheezing. |
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Cromylin is a commonly used inhalation therapy for what patient demographic?
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-Children
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Side effects of Cromylin inhalation therapy include?
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-Dry mouth
-Bad taste -Nausea |
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Nursing instructions for a patient using Cromylin inhalation therapy include?
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-Rinse mouth with H2O immediately after use
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Nonsteroidal antiinflammatory inhalation therapy is medication used for rescue/control?
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-Control medication
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theophylline (Theo-Dur)
Class/Action: |
Class: Bronchodilator (p.o.)
Action: -Relaxes smooth muscle of respiratory system |
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aminophylline
Class/Action: |
Class: Broncholilator (IV drip/bolus)
Action: -Relaxes smooth muscle of respiratory system |
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Side effects associated with the use of bronchodilators such as theophylline and aminophylline include?
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-HA
-Nervousness |
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Theophylline and aminophylline are considered rescue/control medications?
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-Control medications (long-acting)
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Nursing instructions for patients receiving tx w/bronchodilators such as theophylline or aminophylline would include?
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-Important to regulate dose
-Important to monitor blood levels |
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epinephrine (Adrenalin, EpiPen)
Class/Action: |
Class: Bronchodilator (IV slow/SQ/IM such as EpiPen)
Action: -Relaxes bronchioles causing bronchodilation |
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Epinephrine is considered a rescue/control medication when used for COPD?
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-Rescue medication
-Used in acute attacks |
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Side effects associated with the use of epinephrine include?
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-Fight-or-flight response
-Increased heart rate -Decreased BP -Anxiety -Arrhythmias |
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Nursing instructions for the patient receiving epinephrine would include?
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-Monitor patient closely
-? pre-existing cardiac disease |
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montelukast (Singulair)
Class/Action: |
Class: Bronchodilator (p.o.)
Action: -Leukotriene modifier -Blocks allergic reaction |
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Side effects associated with the use of montelukast (Singulair) include?
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-HA
-Dizziness |
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Nursing instructions for the patient receiving montelukast (Singulair) would include?
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-Take medication p.o. daily in the evening to decrease the incidence of dizziness
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A combination of which respiratory medications may be used for fast relief of an acute exacerbation of COPD?
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First:
-Beta-2 agonists (albuterol) -Epinephrine (Adrenaline) *For fast relief Followed by: -Steroids IV (Solumedrol) -And possibly a bronchodilator (Theo-Dur/aminophylline) |
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Medications whose action is bronchodilation would include?
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-Beta-2 agonists (Ventolin,Proventil)
-Anticholinergics (Atrovent) -Theo-Dur, aminophylline -Epinephrine |
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Medications used to prevent an attack of COPD would include?
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-Anticholinergics (Atrovent)
-Steroids (Solumedrol, prednisone) -Nonsteroidal antiinflammatory (Cromylin) -Bronchodilator (Theo-Dur, aminophylline) -Montelukast (Singulair) |
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Steroids may be administered via which routes?
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-Inhalation (Azmacort)
-p.o. (prednisone) -IV (Solumedrol) |
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Control medications are ordered, whereas rescue medications are used?
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p.r.n.
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A combination medication used for management of COPD that acts both as a bronchodilator and a steroid, which is administered through 1 MDI rather than 2 is?
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-Combivent (albuterol + Atrovent)
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