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116 Cards in this Set
- Front
- Back
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Asthma is airway obstruction that happens intermittently. Airway obstruction can occur in two ways |
1. Inflammation 2. Airway hyperresponsiveness that leads to bronchoconstriction |
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_________ of the mucous membranes lining the airways is a key event in triggering an asthma attack. |
Inflammation |
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Inflammation occurs in response to the presence of specific allergens such as |
General irritants such as Cold air Dry air fine airborne particles Microorganisms aspirin and other NSAIDS |
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INflammation of airway mucous membranes causes blood vessel dilation and capillary leak, leading to: |
tissue swelling with increased secretions and mucus production. |
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Inflammation can also occur through: |
General irritation rather than allergic responses |
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________ is a narrowing of the bronchial tubes through constriction of the smooth muscle around and within the bronchial walls. |
Bronchospasm |
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Bronchospasm can occur as a result of _________ airways when small amounts of pollutants or respiratory viruses stimulate nerve fibers, causing constriction of bronchial smooth muscle. |
Hyperresponsive |
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________ and other ______ can trigger asthma in some people, although this response is not a true allergy |
Aspirin NSAIDS |
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________ is now thought to be a major trigger for asthma in some people, especially in those who have more asthma manifestations at ______. |
GERD Night |
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The patient with Asthma usually has a pattern of intermittent episodes of: |
dyspnea (SOB) Chest tightness coughing wheezing Increased mucous production |
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The pateint with Atopic (allergic) asthma often has other allergic problems such as: |
Rhinitis Skin rash pruritus |
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What questions do you want to ask someone with asthma in regards to their health history?
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Family members that have asthma or respiratory problems Ask about current or previous smoking habits. |
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During an acute episode asthma attack, the most common manifestations are? |
Audible wheeze increased respiratory rate |
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When inflammation occurs with asthma, _______ may increase. |
coughing |
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The patient with long standing, severe asthma may have a ____ ____ |
Barrel chest |
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Along with an audible wheeze, the breathing cycle is longer with prolonged _______ and requires more effort. |
Exhalation |
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The patient may be unable to speak more than a few words between breaths. ______ occurs with severe attacks. |
Hypoxia |
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Examine the ________ _____ and ___ _____ for cyanosis. |
Oral mucosa Nail beds |
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Other indicators of hypoxemia include changes in _____ _____ ____ and tachycardia. |
Level of Consciousness (cognition) |
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Lab assessment for asthma? |
ABG The arterial oxygen level may decrease during an asthma attack. PaCO2 may be decreased as the pt increases respiratory effort, but later in asthma episode PaCo2 increases. Allergic asthma often occurs with an elevated serum eosinophil cough and immunoglobulin E levels. |
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The most accurated tests for asthma are the _______ _____ _____ measured using spirometry. Baseline ______ are obtained for all patients diagnosed with asthma. |
Pulmonary function tests (PFT) PFT |
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Volume of air exhaled from full inhalation to full exhalation. |
Forced vital capacity (FVC) |
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Volume of air blown out as hard and fast as possible during the first second of the most forceful exhalation after the greatest full inhalation. |
Forced expiratory volume in the first second. (FEV1) |
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Fastest airflow rate reached at any time during exhalation. |
Peak expiratory flow (PEF) |
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A decrease in either the _____ or the _____ of 15% to 20% below the expected value for age, gender and size is common for the patient with asthma. An increase of 12% in these values after treatment with bronchodilators is diagnostic for asthma |
FEV1 PEF |
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For asthma, priority nursing actions focus on ______ ______ about proper implementation of a personal asthma action plan, which includes drug therapy and lifestyle management strategies to assist the pt in understanding his or her disease and its treatment. |
patient education |
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Self care requires ______ _____ for the pt to be able to self assess respiratory status, self treat and know when to consult the health care provider. |
Extensive education |
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Teach the pt to assess symptom severity at least twice daily using a __________ and to adjust drugs according to his or her personal asthma action plan to manage inflammation and bronchospasms to prevent or relieve symptoms. |
flowmeter |
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Teach the pt to first establish a baseline or personal best _______ ______ ______ by measuring his _______ twice daily for 2-3 weeks when asthma is well controlled and recording the results. |
peak expiratory flow (PEF) PEF |
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These are drugs used to reduce airway responsiveness to prevent asthma attacks from occurring. |
Control therapy drugs *used everyday regardless of symptoms |
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These drugs are used to actually stop and attack once it has started. |
Reliever drugs |
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_______ increase bronchiolar smooth muscle relaxation. They have no effect on inflammatory processes. |
Bronchodilators |
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How to use an inhaler correctly with a spacer (preferred technique) |
1. Before each use, remove the caps from the inhaler and spacer. 2. Insert the mouthpiece of the inhaler into the non mouthpiece end of the spacer 3. Shake the whole unit vigorously 3-4 times 4. Place mouthpiece into your mouth, over your tongue, and seal your lips tightly around it. 5. Press down firmly on the canister of the inhaler to release one dose of medication into the spacer. 6. Breathe in slowly and deeply. If whistling occurs your are breathing too fast 7. Remove mouthpiece from mouth, keeping your lips closed, hold breath at least 10 sec. and then breathe out slowly. 8. Wait at least 1 min between puffs 9. Replace the caps on inhaler and spacer 10. Clean at least once a day |
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How to use inhaler correctly without a spacer |
1. Before each use, remove the cap and shake the inhaler according to the instructions in the package insert. 2. Tilt your head back slightly, and breathe out fully 3. Open your mouth, and place the mouthpiece 1-2 inches away. 4. As you begin to breathe in deeply through your mouth, press down firmly on the canister of the inhaler to release one dose of medication. 5. Continue to breathe in slowly and deeply 6. HOld your breath for at least 10 secs to allow medication to reach deep into lungs, then breathe out slowly. 7. Wait at lease 1 min between puffs. 8. Replace the cap on the inhaler. 9. Clean at least once a day. |
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How to use inhaler correctly without a spacer (alternative method) |
1. Before each use, remove the cap and shake the inhaler according to the instructions in the package insert. 2. Tilt your head back slightly, and breathe out fully 3. Place mouthpiece into your mouth, over your tongue and seal your lips tightly around it. 4. As you begin to breathe in deeply through your mouth, press down firmly on the canister of the inhaler to release one dose of medication. 5. Continue to breathe in slowly and deeply 6. HOld your breath for at least 10 secs to allow medication to reach deep into lungs, then breathe out slowly. 7. Wait at lease 1 min between puffs. 8. Replace the cap on the inhaler. 9. Clean at least once a day. |
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How to use a dry powder inhaler (DPI) *For inhalers requiring loading* |
First load the drug by: Turing the device to the next dose of drug or Inserting the capsule into the device, or Inserting the disk or compartment into the device. |
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How to use a Dry powder inhaler (DPI) after loading the drug and for inhalers that do not require drug loading. |
1. Read your drs instructions for how fast you should breathe for your particular inhaler. 2. Place your lips over the mouthpiece, and breathe in forcefully. 3. Remove the inhaler from your mouth as soon as you have breathed in. 4. Never exhale into your inhaler. Your breath will moisten the powder, causing it to clump and not be delivered accurately. 5. NEVER wash or place inhaler in water 6. NEVER shake your inhaler 8. Keep inhaler in a dry place at room temp. 9. If the inhaler is preloaded, discard the inhaler after it is empty. 10. Because the drug is a dry powder and there is no propellant, you may not feel, smell, or taste as you inhale. |
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Long acting beta (LABAs) are useful in preventing an asthma attack but have no value during an actue attack. Therefore teach pt not to use LABAs alone to relieve them during an _______ or when wheezing is getting worse but instead to use a _______. Relying on LABAs during an attack can lead to worsening of symptoms and death. |
attack SABA (Short acting beta) |
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_____ ________ agents decrease the inflammatory response in the airways. Those given systemically have more side effects. Other are used as inhalants and have fewer systemic side effects. |
Anti-inflammatory |
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_________ exercise assists in maintaining cardiac health, enhancing skeletal muscle strength, and promoting ventilation and perfusion. Recommended for pts with asthma.
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Aerobic |
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Teach pts with asthma to examine the conditions that trigger an attack and to _______ the exercise routine as needed. |
adjust |
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_____ ____ is often used during an actue asthma attack. |
Supplemental oxygen |
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Oxygen is delivered by |
Mask Nasal cannula Endotracheal tube |
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______ is a mixture of helium and oxygen (50/50), can help improve oxygen delivery to the alveoli. This gas mixture is lower in density than oxygen alone or room air and flows even when airway resistance is high. |
Heliox |
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_____ ______ is a severe, life threatening acute episode of airway obstruction that intensifies once it begins and often does not respond to usual therapy. |
Status asthmaticus |
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What do we do when a pt is experiencing status asthmaticus? |
IV fluids Potent systemic bronchodilators Steroids Epinephrine Oxygen Prepare for emergency intubation |
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________ includes emphysema and chronic bronchitis. Although these are separate disorders with different pathologic processes, many pts with emphysema also have chronic bronchitis at the same time. |
COPD |
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The two major changes that occur with emphysema are |
Loss of lung elasticity and hyperinflation of the lung. |
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The pt with emphysema needs to use additional muscles such as: to inhale and exhale. |
in the neck chest wall abdomen |
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This increased effort increases the need for oxygen making the pt work harder and have an ______ _________ sensation. Often, inhalation starts before exhalation is completed, resulting an in uncoordinated pattern of breathing. |
air hunger |
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_______ is an inflammation of the bronchi and bronchioles caused by exposure to irritants, especially cigarette smoke. |
Bronchitis |
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The irritant triggers: |
Inflammation Vasodilation mucosal edema congestion bronchospasm |
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Chronic inflammation increases the number and size of _____ _____, which produce lrg amounts of thick mucus. The bronchial walls thicken and impair airflow. This thickening, along with excessive mucus, blocks some of the smaller airways and narrows larger ones. |
Mucous glands |
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The increased mucus provides what hazard to the pt? |
Breeding ground for microorganisms Leads to chronic low grade infection |
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What risks put the pt at risk for COPD |
Cigarette smoking Alpha antitrypsin deficiency |
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COPD affects oxygenation of all tissues. Complications can result in tissue _____ and _____ |
Anoxia death |
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Major problems r/t poor oxygenation of tissues. |
Hypoxemia acidosis respiratory infection cardiac failure dysrhythmias |
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_____ and ______ occur because the pt with COPD has reduced gas exchange, leading to decreased oxygenation and increased carbon dioxide levels. |
Hypoxemia Acidosis |
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_______ ______ risk increases because of the increased mucus and poor oxygenation. |
Respiratory infection. |
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_______ _______ occurs with bronchitis or emphysema. |
Cardiac failure cor pulmonale (right heart failure caused by pulmonary disease.) |
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What causes cor pulmonale? |
Air trapping, airway collapse, and stiff alveolar walls increase the lung tissue pressure, making blood flow through lung vessels more difficult. The increased pressure creates a heavy workload on the R side of the heart, which pumps blood into the lungs. |
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______ _____ are common in pts with COPD. They result from hypoxemia, other cardiac disease, drug effects, or acidosis. |
Cardiac dysrhythmias |
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What do you want to assess a pt with COPD for? Questions to ask? |
Packs smoked per day? Difficulty breathing while talking Wheezing, coughing, SOB Sputum production Cough in morning? Ability to perform ADLs? Worse laying down? Weight loss? (when heart failure is present with COPD, general edema with weight gain may occur) |
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Physical manifestations of COPD |
Thin, loss of muscle mass (neck muscles may be enlarged) Slow moving, slightly stooped, Tripod position Activity intolerance, can affect bathing, grooming Breathless with rapid, shallow respirations Abnormal breathing pattern (40-50 bpm) Jerky respiration movement Wheezes Reduced breath sounds Barrel chest Cyanotic Excessive sputum production Swelling of feel and ankles pallor |
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What would cause a COPD pt to not participate in social gatherings? |
Annoying coughs, excessive sputum or dyspnea. This can be embarrassing to the pt. Anxiety and fear r/t dyspnea and feeling of breathlessness may reduce the pts ability to participate in a full life. |
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Labs to do for a COPD pt? |
ABG Pulse oximetry (once ABG baseline determined) Sputum samples H&H |
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Imaging assessment for the pt with COPD? |
Chest xray |
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Other diagnositc assessments? |
Pulmonary function test Flowmeters |
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Interventions for the COPD patient experiencing hypoxemia. |
Airway maintenance monitoring breathing techniques oxygen therapy exercise conditioning suctioning hydration vibratory positive pressure device. |
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Before any intervention for COPD what do you want to do? |
Assess the pt to determine breathing pattern, especially the rate, rhythm, depth, and use of accessory muscles.
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_____ ______ is the most important focus of interventions to improve gas exchange. |
airway maintenance |
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How often do you want to monitor the Pt with COPD in the hospital. |
At least q2hrs Even when the purpose of the hospitalization is not COPD management |
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What type of breathing do you want to encourage for a pt with COPD? |
Diaphramatic or Abdominal breathing OR Pursed Lip breathing Smell the flowers blow the candles |
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What interventions in regards to positioning can you do for the COPD pt. |
Upright position Assist the pt who can tolerate sitting in a chair out of bed for 1hr periods 2-3 times a day. |
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We want to make sure a COPD pt is coughing and expelling secretions. What interventions can you do in regards to coughing? |
Cough on arising in the morning Cough before bedtime *coughing before meals can decrease appetite* Observe color, consistency, odor and amount of secretions. |
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How can you determine when O2 therapy is needed for the COPD patient? |
The need of oxygen therapy and its effectiveness can be determined by ABG values and oxygen saturation by pulse ox. |
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At what flow rate do you want to set a nasal canula and venturi mask at for a pt with COPD/ |
2-4 L/min for nasal canula 40% via venturi mask |
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When helping a pt with drug therapy for COPD we want to make sure that we? |
Teach!!!! Teach pts and family members the correct techniques for using inhalers and to care for them properly. |
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What can we suggest to a COPD pt for exercise conditioning? |
Have the pt walk indoors or outdoors daily as a self paced rate until symptoms limit furtner walking, followed by a rest period, and then continue walking until 20 mins of actual walking has been accomplished. Only beneficial if done 2-3 times a week |
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TRUE or FALSE We want to do suctioning on a routine schedule to prevent the buildup of secretions for a pt with COPD. |
FALSE Perform suctioning only when needed, for the pt with a weak cough, weak pulmonary muscles, and inability to expectorate effectively, the nurse or respiratory therapist performs nasotracheal suctioning. |
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Why do we want to hydrate a pt with COPD? How much water should they try to drink daily? Contraindications |
Maintaining hydration may thin the thick, tenacious secretions, making them easier to remove by coughing. 2-3L/day if recommended. We want to make sure that the pt is not experiencing HF r/t pulmonary issues, that would cause Fluid overload/ |
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A COPD pt is more at risk for weight loss, what is a way to monitor nutrition for the pt. |
Monitor weight skin condition Serum prealbumin |
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SOB interferes with eating for the COPD pt, what can you do to help with this. |
Four to six small meals a day may be preferred to three larger ones. Pursed lip breathing Bronchodilator 30 mins prior to meals |
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Dietary supplements, such as __________, provide nutrition with reduced carbon dioxide production. If early satiety is a problem advise him or her to avoid _______ ______ before and during the meal. |
Pulmocare Drinking fluids |
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A pt with COPD is likely to have anxiety, what can you do to help reduce anxiety. |
Together with the pt, develop a written plan that states exactly what he or she should do if symptoms flare. Stress the use of pursed lip and diaphragmatic breathing techniques during periods of anxiety or panic. |
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A pt with COPD is more prone to chronic fatigue. What can you do for the pt so they can better accomplish their ADLS |
Pace activities Do not rush through activities Supplement o2 during periods of high energy Avoid working with arms raised Try not to talk when engaged in activities that require energy. |
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A pt with COPD is more prone to getting a respiratory infection. What can you do to prevent infection? |
Avoid large crowds Get the pneumonia vaccination Influenza Vaccine |
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What puts you at risk for lung cancer? |
Cigarette smoking Secondhand smoke Chronic exposure to asbestos, beryllium, chromium, coal distillates, cobalt, iron oxide, mustard gas, pertroleum distillates, radiation, tar, nickle, uranium Air pollution with benzopyrenes and hydrocarbons |
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The incidence of lung cancer decreases when smoking stops.... |
although it remains higher than among people who have never smoked
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Prevention for lung cancer? |
Reducing tobacco smoking Teach workers in industrial settings about safety precautions such as wearing specialized masks and protective clothing to reduce exposure Encourage those at high risk to have frequent health examinations. |
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When doing a pts history who may have lung cancer, what questions do you want to ask regarding their medical history? |
How many packs per day? Any recent changes in symptoms or if position affects symptoms Chest pain or discomfort? One sided? Localized? Any sensation of fullness, tightness, or pressure in the chest? Pain radiating to the arm results from tumor invasion of nerve plexuses in advanced disease. |
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Clinical manifestations of lung cancer r/t pneumonitis or bronchitis that occurs with obstruction |
Chills, fever, and cough
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Clinical manifestations of lung cancer (pulmonary) |
blood tinged sputum
Hemoptysis Labored or painful breathing Rapid shallow breathing with pain Reduced inspiratory efforts: in advanced disease Accessory muscles, flared nares, stridor, asymmetric diaphragmatic movement on inspiration. Dyspnea and wheezing: w/ airway obstruction Increased fremitus |
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Clinical manifestations of lung cancer on nonpulmonary areas. |
Heart sounds may be muffled by tumor or fluid Dysrhythmias cyanosis clubbing fingers Loss of bone density Fatigue Weight loss anorexia dysphagia Nausea and vomiting Personality changes Bowel and bladder tone or function may be affected. |
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What diagnostic tests are done for someone suspected of lung cancer? |
Cytologic testing of early morning sputum specimens may identify tumor cells. Xrays CT Fiberoptic bronchoscopy Needle biopsy during bronchoscopy Thoracoscopy Needle biopsy of lymph nodes Direct surgical biopsy Thoracentesis with pleural biopsy MRI PFT ABG |
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___________ for the pt with lung cancer can have the purposes of curing the disease, increasing survival time, and enhancing quality of life through palliation. |
Interventions |
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What are some non surgical management options for the pt with lung cancer? |
Chemotherapy Targeted therapy Radiation therapy Photodynamic Therapy |
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What are some interventions that can be done for the pt going through chemo? |
Reassure pts that hair loss is temporary. Antiemetic drugs for Nausea before and after chemo. Good, frequent oral hygiene, including tooth cleaning and mouth rinsing. Use soft bristle toothbrush or disposable mouth sponges and to avoid using dental floss and water pressure gum cleaners. |
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What are some interventions/teaching that you can do for a pt going through radiation for lung cancer. |
Skin irritation and peeling, fatigue, Nausea and taste changes are likely to happen and are immediate. Protect skin from sun 1 yr, anti emetics for nausea Eat food that are soft, bland, and high in calories. Drink liquid nutrition supplements. |
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What are some interventions or things you want to teach about photodynamic therapy for the pt who has lung cancer? |
Pt usually stays in ICU for airway management At risk for bronchial hemorrhage, fistula formation and hemoptysis Supersensitive to light and will remain so for 30-90 days. Pt will say in the hospital for about 3 months. |
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What are the surgical procedures that can be done for lung cancer. |
Lobectomy Pneumonectomy Wedge Resection |
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Removal of a lobe |
lobectomy |
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removal of entire lung |
penumonectomy |
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Removal of the peripheral portion of small, localized areas of disease. |
Wedge resection. |
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What are some things you want to do post op for the pt who has lung cancer. |
Pts who have undergone thoracotomy requires closed chest drainage to drain air and blood that accumulate in the pleural space. |
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With a stationary chest tube there are 3 chambers. Chamber one collects the fluid draining from the pt. What are some special considerations with this chamber? |
The fluid in chamber one must never fill to the point that it comes into direct contact with either the tube draining from the pt or the tube connecting this chamber to chamber two. If the tubing from the pt enters the fluid, drainage stops and can lead to a tension pneumothorax. |
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Chamber two for the chest tube does what? What does bubbling mean? |
Is the water seal that prevents air from re-entering the pts pleural space. Should always contain at least 2 cm of H2O. As trapped air from the pts pleural space passes through the water seal, which serves as a one way valve, the water will bubble. Once all the air has been evacuated from the pleural space, bubbling of the water seal stops |
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What else causes bubbling to stop in chamber 2 for the chest tube drainage system? |
A blocked or kinked chest tube can cause bubbling to stop. Excessive bubbling in the water seal chamber may indicate an air leak. |
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There are different types of suction, most commonly ____ or ____. For either type of suction, the amount of suction in the system is determined not by the wall suction unit but by the chest tube drainage device. |
Wet or dry |
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What do you want to check the pt with a chest tube for? Precautions? |
Ensure dressing around tube is tight and intact, reinforce and change loose dressing depending on policy. Assess difficulty breathing Assess breathing effectiveness by pulse ox Listen to breath sounds for each lung Check alignment of trachea Check tube insertion site for condition of skin. Palpate area for puffiness or crackling that may indicate subcutaneous emphysema Observe site for signs of infection or excess bleeding Check to see if tube eyelets are visible Assess for pain and its location and intensity and administer drugs for pain as prescribed Assist pt to deep breath, cough, perform maximal sustained inhalations, incentive spirometer Reposition the pt who reports burning pain in chest. |
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Management of chest tube drainage system. |
Do not strip the chest tube Keep drainage system lower than pts chest. Keep chest tube straight as possible, avoid kinks and dependent loops. Ensure chest tube is securely taped to the connector and that the connector is taped to the tubing going into the collection chamber. Assess bubbling in the water seal chamber; should be gentle bubbling on pts exhalation, forceful cough, position changes. Assess for tidaling Check water level in the water chamber, keep at the level recommended by manufacture Check water level in suction control chamber, keep at level prescribed by surgeon. Clamp chest tube only for brief periods to change the drainage system or when checking for air leaks. Check and document amount, color, characteristics of fluid in collection chamber, as often as neede according to the pts condition and agency policy. Empty collection chamber or change the system before teh drainage makes contact with the bottom of the tube. When sample of drainage is needed for culture, obtain from the chest tube after cleansing, use a 20 gauge needle and dray up specimen into syringe. |
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When to notify the physician or rapid response team in regards to management of chest tube drainage systems. |
Tracheal deviation Sudden onset or increased intensity of dyspnea Oxygen sat less than 90% Drainage greater than 70ml/hr Visible eyelets on chest tube Chest tube falls out of pts chest (1st cover with sterile gauze, dry) Chest tube disconnects from the drainage system (1st put end of tube in a container of sterile water and keep below level of the pts chest.) Drainage in tube stops (in 1st 24 hrs) |
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Pain management for after surgery for the pt with lung caner. |
Assess pain level Pain meds, assess pts response to med Monitor VS before and after meds |
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Respiratory managment after surgery for the pt with lung cancer |
Pt is mechanically ventilated. Once pt is breahing on their own, priorities are to maintain a patent airway, ensure adequate ventilation and prevent complications. Assess pt q2hr Check alignment of the trachea Assess oxygen sats listen to breath sounds in all lobes on nonoperative side. Assess oral mucous membranes for cyanosis and nail beds for rate of cap refill. Suctioning as necessary O2 by mask or nasal cannula for the first 2 days after surgery. Warm and humidify the oxygen. Semi fowlers position or in a chair ASAP Incentive spirometer qhr Help with coughing by splinting any incision |
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Complications from a pneumonectomy? |
Empyema (purulent material in the pleural space)
Development of a bronchopleural fistual. |
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Interventions for palliation care for the pt with lung cancer. |
Humidified O2 to relieve dyspnea and anxiety Thoracentesis to temporarily relieve hypoxia, maybe a continuous draining catheter if reoccuring. Semi fowlers position May have bone pain, pain med around the clock and PRN for breakthrough pain. |
