Ex 2 Obstructive Pulmonary Diseases

Front 1

Any disease with an increase resistance to airflow d/t an obstruction or narrowing airways?

Back 1

Obstructive pulmonary disease

Front 2

Some examples of obstructive pulmonary disease are?

Back 2

Asthma, COPD, cystic fibrosis, brochiectasis

Front 3

A chronic inflammatory disorder of the airways that leads to intermittent obstruction?

Back 3

Asthma

Front 4

With asthma pts, we as nurses want to find out?

Back 4

What their triggers are
Effects more women then men, more African Americans

Front 5

In an asthma attack, a trigger initiates the inflammation cascade, causing?

Back 5

Edema, vascular congestion, producton of thick mucus, bronicole muscles spasm, thickened airway walls, increased bronichiole hyperresponsiveness.

Front 6

So what starts the asthma attack and what are the steps the body experiences?

Back 6

Trigger > bronichiole spasm >airways/muscle edema causing narrowing of airways > hypersecretion of mucous > hyperinflation of lungs > increased residual volume > ventillation/profusion prolems > increased airway resistance

Front 7

What s x s would we see in our asthma pts?

Back 7

Wheezing on expiration
Coughing
Dyspnea
Chest tightness
Prolonged expiration
Quick RR -tachypnea
Using accessory muscles to breathe
Diminished breath sounds
Increased HR, increased BP
Restlessness, anxiety

Front 8

What are the complications that can occur with asthma?

Back 8

Fractured ribs
Pneumonia
Status asthmaticus-severe asthma attack
Pneumothroax
Pneumomediastinum-bursting aveolia d/t increased pressure
Atelectasis

Front 9

What is the difference between status asthmaticus and asthma?

Back 9

pt with severe asthma attack that does not respond to medications, leading to respirtatory failure

Front 10

What is the most common symptom you see in a pt with status asthmaticus?

Back 10

Extreme anxiety,
Also,
fear of sufficating
diaphoresis
severely increased work of breathing

Front 11

Why would status asthmatus lead to respiratory failure?

Back 11

Hypoxemia, hypercapnia-increased CO2 in the blood, respiratory acidosis-cant breathe off the CO2.

Front 12

What would the pulmonary function test outcomes be from a pt with asthma?

Back 12

Increased residual volume
decreased vital capacity
decreased expiratory volume

Front 13

How would be the arterial blood gases PO2 with mild alkalosis?

Back 13

decreased PO2

Front 14

What type of medications are usually given to asthma pts?

Back 14

Corticosteroids- anti inflammatary.

Front 15

Leukotrine modifiers are used for what, and what is an example?

Back 15

Singulair, propholatic and maintience

Front 16

If pt is allergenic asthma, uncontrolled by inhaled corticosteroids, the pt can take?

Back 16

Monoclonal antibody to IgE

Front 17

The beta 2 adrenergenic agonist drugs, called broncodilaltors are?

Back 17

Proventil, onset is minutes.
DONT GIVE TO CARDIAC PROBLEM PTS

Front 18

Methylaxidines, another type of broncodilator, are given to asthma pts that?
What intensifies adverse effects?
What are the signs of toxicity?

Back 18

Bronchodilator- theophylline PO given to pt that dont respond to other agents.
Caffinee intensifies effects.
Toxicity- N/V, siezures, insomnia.

Front 19

What do we need to monitor in pt taking theophylline so pts dont get toxic?

Back 19

serum levels

Front 20

What do the bronchodilators , anticholerginic drugs, like Atrovent, are usually used in combo with what drugs, to block broncoconstriction?

Back 20

beta 2 adrenergic agonist

Front 21

What is the onset of action of the anticholernergic Atrovent in combo with beta 2 adrenergeic agonists?

Back 21

Onset of 30 minutes, duration of 6 hours

Front 22

What is the goal for the peak flow rate to be maintained for an asthma pt?

Back 22

Maintain more than 80% of personal best peak expiratory flow rate or forced expiratory volume

Front 23

The group of diseases that are characterized by abnormal inflammatory responses to particles/gases which lead to irreversible airflow limitations?

Back 23

COPD- emphysema, bronchitis

Front 24

The key to COPD is?

Back 24

Its preventable and treatable, but unforutenately progressive. MAJOR CAUSE IS SMOKING. We catch it in our late stages.

Front 25

What are the COPD triggers?

Back 25

Smoking, dust, air pollution, heridity, age, chemicals, infection

Front 26

The primary process and key to COPD start is?

Back 26

inflammation process

Front 27

After imflammation process in COPD, then ?

Back 27

Inhaled particals, noxious gases

Front 28

After inhaled particles, what comes next in COPD?

Back 28

Inflammation of central airways, pulmonary vasular changes

Front 29

Chronic bronchitis is characterized by?

Back 29

Chronic productive cough for about 3 months out of year for 2 years

Front 30

Why does bronchitis cause a pt to have a continuous productive cough?

Back 30

1. hyperplasia of mucous glands, causing excessive sputum production.
2. cillia that moves secretions disappear
3. goblet cells develop at terminal bronchioles, and increase mucous production

Front 31

What results from bronchitis?

Back 31

Frequent infections, with more frequent mucous, become hypoxic, and causes polycythemia as a compensatory mechnism.

Front 32

Why are ppl with bronchitis called blue bloaters?

Back 32

Because they start to have polycythemia from hypoxia (lots of RBC made to carry 02)-usually overweight, thick mucous

Front 33

What chest finding would you see in pt with bronchitis?

Back 33

Increases anterior to posterior measure

Front 34

What is the pt with polycythemia now at risk for?

Back 34

Developing a vein thromboisis due to the increase in hematocrit and hemoglobin

Front 35

What is emphysema?

Back 35

DESTRUTCTION of the aveoli related to chronic inflammation and mucous production

Front 36

What are the results in the lung tissue and alveoli from emphysema?

Back 36

Alveoli loose elasticity, air is trapped in alveoli, leading to airway collapse

Front 37

What are the results seen clinically from having emphysema?

Back 37

Increased infections from increased mucous production, barrel chest from air being trapped in alveoli

Front 38

What are ppl with emyphysema commonly called?
(signs similar to asthma)

Back 38

"Pink puffers"
Barrel chest
Pursed lip breathing (forced exhalation)
Hyperventillating to oxygenate
Central cyanosis-look at tounge
Finger clubbing
Exertional dyspnea
Continued tachycardia d/t inadequate oxygenation
Diminished breath sounds
(wheezes, crackles)

Front 39

What labs are elevated in later stages of chronic bronchitis?

Back 39

Elevated RBC, H and H

Front 40

How is the PO2 in empysema?

Back 40

slighly decreased PO2
PCO2 not elevated until later stages

Front 41

What would a chest x ray reveal about a pt with emphysema about her heart, lungs, and diaphragm?

Back 41

Normal size heart, flatten diaphragm, hyperinflated lungs

Front 42

What would a chest x ray reveal about a bronchitis pt about their heart, lungs, and diaphragm?

Back 42

Enlarged heart, CONGESTED lung field, normal-flattened diaphragm

Front 43

In emphysema, how would a pt vital capacity and forced expiratory volume be?

Back 43

Low vital capacity, low forced expiratory volume

Front 44

In chronic bronchitis, how would the residual volume and vital capacity and forced expiratory volume be afftected?

Back 44

Increased residual volume, decreased vital capacity, decreased forced expiratory volume.

Front 45

What is the goal for our COPD pts?

Back 45

To improve ventillation and maintain a patent airway by mobilizing secretions

Front 46

What would be considered adequate fluid status in a COPD pt?

Back 46

at least 2L to thin secretions

Front 47

A normal pt responds to what to trigger breathing?

Back 47

High CO2 in blood

Front 48

A pt with COPD responds to what to trigger breathing?

Back 48

Low O2 levels provide stimulus to breathe (its why if we raised supplemental O2, we would decrease their respiratory drive to breathe)

Front 49

What is cor pulmonale?

Back 49

Damage to right ventricle of the heart from high BP in the pulmonary artery, leads to right sided heart failure

Front 50

How do we treat pulmonary hypertension?

Back 50

Cant treat it, can only treat causes of HTN to stop it. Often goes unnoticed. Only thing we can do is a heart and lung transplant

Front 51

There is a high correlation between COPD and what GI problem?

Back 51

Peptic ulcer/Gerd disesase

Front 52

What is the hereditary disease affecting the exocrine (mucous)glands of lungs, liver, pancreas, and intestines causing progressive disability d/t mulitsystem failure?

Back 52

Cystic fibrosis (pts are now living longer into their 60's)

Front 53

What is the biggest complication r/t the lungs in pts with cystic fibrosis?

Back 53

Increased mucous production

Front 54

Increased mucous productions puts pt at risk for?

Back 54

Increased frequent lung infections

Front 55

A disease that causes localized irreversible dilation of the bronchial tree?

Back 55

Bronchiectasis

Front 56

What happens in bronchilectasis?

Back 56

Involed bronchi are inflammed, dilated, and easily collapsable, resulting in airflow obstruction and impaired clearance of secretions

Front 57

What other disorders are associated with bronchiectasis?

Back 57

Cystic fibrosis, necrotizing bacterial infections, like from staph, kleb, or bordella pertusis. (similar treatment of COPD pt, but little different disease process)

Front 58

What is the best predictor of survival for pts with cystic fibrosis?

Back 58

lung function

Front 59

Who is Don Berwick, the man in the bell curve article?

Back 59

A former pediatrician, working for the nonprofit called Institue for Healthcare Improvement,giving grants to hospitals who "go naked." Modern Healthcare calls him the 3rd most powerful person in healthcare

Front 60

What pediatrician working at LeRoy Matthews believed in the idea that with pts, you have to do whatever you can to keep your pt lungs as open as possbile?

Back 60

Warren Warwick- Janelle (17) was his pt. Invented a new stethescope, new cough, and new chest pounding vest