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Asthma

answer

Chronic inflammatory disorder of the airways that results in recurrent episodes of airflow obstruction that is usually reversible Primary pathophysiologic process is persistent but variable inflammation of the airways

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Why is airflow limited in asthma?

answer

Inflammation results in bronchoconstriction, airway hyperresponsiveness (hyperreactivity), and edema of the airways

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What often initiates the inflammatory cascade of asthma?

answer

Exposure to a trigger such as an allergen or irritant (air pollutants, cigarette or wood smoke, vehicle exhaust, elevated ozone levels, sulfur dioxide, and nitrogen dioxide), a respiratory infection, or certain drugs

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What may influence asthma development?

answer

Genetics and one's immune responses

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Common allergens

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Tree or weed pollen, dust mites, molds, furry animals, and cockroaches

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What do you call asthma that is induced or exacerbated by physical exertion?

answer

Exercise-induced asthma

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Occupational asthma

answer

Occurs after exposure to agents in the workplace, such as wood dusts, laundry detergents, metal salts, chemicals, paints, solvents, and plastics

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What is a common history for patients with asthma?

answer

Allergic rhinitis GERD is also more common in patients with asthma

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Clinical manifestations of asthma

answer

Wheezing, coughing, dyspnea, and chest tightness, particularly at night or early in the morning. Expiration may be prolonged. Examination of the patient during an attack usually shows signs of hypoxemia.

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Classifications of asthma

answer

Intermittent, mild persistent, moderate persistent, and severe persistent

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What can be a result of severe acute asthma?

answer

Severe hypoxia, "silent chest," peak flow less than 25% of personal best

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Diagnosis of asthma

answer

Usually based upon clinical manifestations, health history, pulmonary function test, and peak flow variability

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What is the goal of asthma treatment?

answer

Achieving and maintaining control of the disease. Established guidelines provide direction on classification and help determine which type of meds are best suited to control symptoms

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What type of therapy is used for asthma?

answer

A stepwise approach to drug therapy based on asthma severity and level of control. Persistent asthma requires daily long-term (controller) therapy in addition to appropriate medications to manage acute symptoms (rescue). Persons with intermittent asthma should still carry rescue meds.

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Long-term control medications

answer

Used to achieve and maintain control of persistent asthma

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Quick relief (rescue) medications

answer

Used to treat symptoms and exacerbations

question

What are the most effective meds for improving asthma control?

answer

Corticosteroids, since chronic inflammation is a primary component of asthma

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What is first-line therapy for patients with persistent asthma?

answer

Inhaled agents (ICS) such as fluticasone and budenoside

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What meds are used for acute exacerbations of asthma?

answer

Orally administered corticosteroids Maintenance doses may be necessary to control asthma in a minority of patients with severe chronic asthma

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What are the most effective meds for relieving acute bronchospasm?

answer

Short-actings B2-adrenergic agonists such as albuterol Also used for acute exacerbations of asthma

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What meds are never used as monotherapy?

answer

Long-acting B2-adrenergic agonists such as salmeterol and formoterol, because of increased risk of death

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When are long-acting B2-adrenergic agonists safe?

answer

When used in combination with ICS

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Leukotriene modifiers

answer

Used in milder asthma as add-on therapy to reduce the use of inhaled corticosteroids

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What is omalizumab used for?

answer

Difficult to treat moderate to severe asthma unable to be controlled by inhaled corticosteroids

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Methylxanthine preparations

answer

Less effective long-term control bronchodilators as compared with B2-adrenergic agonists and carry a high incidence of side effects

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Ipratropium

answer

The only anticholinergic agent used in asthma treatment Used in the ED for acute attacks

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What are the goals for a patient with asthma?

answer

The patient with asthma will have asthma control as evidenced by minimal symptoms during the day and night, acceptable activity levels (including exercise and other physical activity), maintenance greater than 80% of personal best peak expiratory flow rate (PEFR) or forced expiratory volume in 1 second (FEV 1), few or no adverse effects of therapy, no recurrent exacerbations of asthma, and adequate knowledge to participate in and carry out management.

question

What is the nurse's primary role in preventing asthma attacks and decreasing the severity of asthma?

answer

Educating the patient and caregiver Teaching should include information about medications, including the name, purpose, dosage, method of administration, schedule, side effects, appropriate action if side effects occur, how to properly use and clean devices, and consequences for breathing if not taking medications as prescribed. Warn the patient about the dangers associated with nonprescription combination drugs

question

What is a nurse's goal during an acute attack?

answer

Decrease the patient's sense of panic Develop written asthma action plans with the patient and family, especially those with moderate/severe persistent asthma or a history of severe exacerbations

question

COPD

answer

A preventable and treatable disease state characterized by airflow limitation that is not fully reversible. It is usually progressive and associated with an abnormal inflammatory response of the lungs to noxious particles or gases, primarily caused by cigarette smoking. Includes chronic bronchitis and emphysema. Characterized by chronic inflammation found in the airways, lung parenchyma (respiratory bronchioles and alveoli), and pulmonary blood vessels. Anxiety and depression often occur Weight loss and malnutrition are commonly seen in the patient with severe emphysematous COPD

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Risk factors for COPD

answer

Cigarette smoke, occupational chemicals, air pollution, severe recurring respiratory infections, and A1-antitrypsin deficiency

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Chronic bronchitis

answer

The presence of chronic productive cough for 3 months in each of 2 consecutive years in a patient in whom other causes of chronic cough have been excluded

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Emphysema

answer

An abnormal permanent enlargement of the airspaces distal to the terminal bronchioles, accompanied by destruction of their walls and without obvious fibrosis

question

Defining features of COPD

answer

Not fully reversible airflow limitation during forced exhalation that is caused by loss of elastic recoil and airflow obstruction secondary to mucus hypersecretion, mucosal edema, and bronchospasm. Gas exchange abnormalities result in hypoxemia and hypercapnia

question

When should a diagnosis of COPD be considered?

answer

In any patient over the age of 40 who has symptoms of cough, sputum production, or dyspnea, and/or a history of exposure to risk factors for the disease. Chronic intermittent cough is the earliest symptom. The cough is present every day as the disease progresses. Sputum may or may not be present. Symptoms are progressive. Confirmed by pulmonary function tests. Diagnosis is made when the FEV1/FVC ratio is less than 70% and related symptoms are present.

question

Cor pulmonale

answer

Hypertrophy of the right side of the heart, with or without heart failure, resulting from pulmonary hypertension and is a late manifestation of chronic pulmonary heart disease.

question

Exacerbations of COPD

answer

Signaled by a change in the patient's usual dyspnea, cough, and/or sputum that is different than the usual daily patterns. These flares require changes in management and can have significant mortality if not appropriately treated. Patients who have severe COPD with exacerbations are at risk for development of respiratory failure.

question

Goals of diagnostic workup for COPD

answer

Confirming the diagnosis via spirometry and determining the impact of the disease on the patient's quality of life

question

Goals for care of the COPD patient

answer

Prevent disease progression, relieve symptoms and improve exercise tolerance, prevent and treat complications, promote patient participation in care, prevent and treat exacerbations, and improve quality of life and reduce mortality .

question

What intervention has the biggest impact in reducing the risk of COPD and influencing the natural progression of the disease?

answer

Smoking cessation

question

What can be used to reduce dyspnea and increase FEV1?

answer

Bronchodilator therapy

question

What drug modifies the decline of lung function in patients with COPD?

answer

None

question

What can be used for monotherapy in COPD?

answer

Inhaled anticholinergics or long-acting B2-adrenergic agonists They can also be combined with inhaled corticosteroids

question

Pursed-lip breathing

answer

Technique that is used to prolong exhalation and thereby prevent bronchiolar collapse and air trapping

question

Airway clearance techniques

answer

Effective coughing techniques, chest physiotherapy, and airway clearance devices. No one is better than the other, but it depends on patient preference.

question

Effective coughing

answer

Conserves energy, reduces fatigue, and facilitates removal of secretions

question

Chest physiotherapy

answer

Consists of percussion, vibration, and postural drainage

question

What are interventions with the COPD patient with weight loss needs?

answer

Extra protein and calories and tips on energy conservation while eating and preparing food

question

What is the overall goal of pulmonary rehabilitation?

answer

Increasing the quality of life and improving exercise capacity Should be considered for all patients with symptomatic COPD or those having functional limitations

question

What are two important, inexpensive interventions for COPD patients?

answer

Walking and adequate sleep

question

Long-term O2 therapy

answer

Improves survival, exercise capacity, cognitive performance, and sleep in hypoxemic patients. Goals are to reduce the work of breathing, maintain the PaO2 , and/or reduce the workload on the heart, keeping the SaO 2 more than 90% during rest, sleep, and exertion, or PaO 2 more than 60 mm Hg. Delivery systems are classified as low or high flow systems. Most are low flow that deliver O2 in concentrations that vary with the respiratory pattern

question

What is important with O2 therapy?

answer

Dry O2 has an irritating effect on mucus membranes and dries secretions. O2 should be humidified or nebulized when administered.

question

Medical complications with O2 therapy

answer

CO2 narcosis, oxygen toxicity, infection, and absorption atelectasis. The risk of combustion related injury is also a possibility requiring specific precautions for patient safety.

question

The nurse teaches a 33-year-old male patient with asthma how to administer fluticasone (Flovent HFA) by metered-dose inhaler (MDI). Which statement by the patient to the nurse indicates correct understanding of the instructions?

answer

"I will rinse my mouth each time after I use this inhaler."

question

The nurse supervises a team including another registered nurse (RN), a licensed practical/vocational nurse (LPN/LVN), and unlicensed assistive personnel (UAP) on a medical unit. The team is caring for many patients with respiratory problems. In what situation should the nurse intervene with teaching for a team member?

answer

LPN/LVN changed the type of oxygen device based on arterial blood gas results.

question

The nurse is caring for a 48-year-old male patient admitted for exacerbation of chronic obstructive pulmonary disease. The patient develops severe dyspnea at rest, with a change in respiratory rate from 26 breaths/minute to 44 breaths/minute. Which action by the nurse would be the most appropriate?

answer

Teach the patient to use pursed lip breathing

question

Although a diagnosis of cystic fibrosis is most often made before age 2, an 18-year-old patient at the student health center with a history of frequent lung and sinus infections has clinical manifestations consistent with undiagnosed cystic fibrosis (CF). Which information would be accurate for the nurse to include when teaching the patient about a scheduled sweat chloride test?

answer

"Sweat chloride greater than 60 mmol/L is consistent with a diagnosis of CF."

question

A 68-year-old patient with bronchiectasis has copious thick respiratory secretions. Which intervention should the nurse add to the plan of care for this patient?

answer

Increase intake to at least 12 eight-ounce glasses of fluid every 24 hours.

question

During an assessment of a 45-year-old patient with asthma, the nurse notes wheezing and dyspnea. The nurse interprets that these symptoms are related to what pathophysiologic change?

answer

Narrowing of the airway

question

A 45-year-old man with asthma is brought to the emergency department by automobile. He is short of breath and appears frightened. During the initial nursing assessment, which clinical manifestation might be present as an early manifestation during an exacerbation of asthma?

answer

Anxiety

question

The nurse is assigned to care for a patient who has anxiety and an exacerbation of asthma. What is the primary reason for the nurse to carefully inspect the chest wall of this patient?

answer

Evaluate the use of intercostal muscles

question

Which position is most appropriate for the nurse to place a patient experiencing an asthma exacerbation?

answer

High Fowler's

question

The nurse is caring for a patient with an acute exacerbation of asthma. Following initial treatment, what finding indicates to the nurse that the patient's respiratory status is improving?

answer

Wheezing becomes louder

question

The nurse identifies the nursing diagnosis of activity intolerance for a patient with asthma. In patients with asthma, the nurse assesses for which etiologic factor for this nursing diagnosis?

answer

Work of breathing

question

The nurse is assigned to care for a patient in the emergency department admitted with an exacerbation of asthma. The patient has received a β-adrenergic bronchodilator and supplemental oxygen. If the patient's condition does not improve, the nurse should anticipate what as the most likely next step in treatment?

answer

Systemic corticosteroids

question

A patient with an acute exacerbation of chronic obstructive pulmonary disease (COPD) needs to receive precise amounts of oxygen. Which equipment should the nurse prepare to use?

answer

Venturi mask

question

While teaching a patient with asthma about the appropriate use of a peak flow meter, what should the nurse instruct the patient to do?

answer

Keep a record of the peak flow meter numbers if symptoms of asthma are getting worse

question

The physician has prescribed salmeterol (Serevent) for a patient with asthma. In reviewing the use of dry powder inhalers (DPIs) with the patient, what instructions should the nurse provide?

answer

"Close lips tightly around the mouthpiece and breathe in deeply and quickly."

question

The nurse determines that a patient is experiencing common adverse effects from the inhaled corticosteroid beclomethasone (Beclovent) after what occurs?

answer

Oropharyngeal candidiasis and hoarseness

question

The nurse determines that the patient understood medication instructions about the use of a spacer device when taking inhaled medications after hearing the patient state what as the primary benefit?

answer

"More of the medication will get down into my lungs to help my breathing."

question

Which test result identifies that a patient with asthma is responding to treatment?

answer

A decreased exhaled nitric oxide

question

The nurse determines that the patient is not experiencing adverse effects of albuterol (Proventil) after noting which patient vital sign?

answer

Pulse rate of 72/minute

question

The patient has an order for each of the following inhalers. Which one should the nurse offer to the patient at the onset of an asthma attack?

answer

Albuterol (Proventil)

question

The nurse, who has administered a first dose of oral prednisone to a patient with asthma, writes on the care plan to begin monitoring for which patient parameters?

answer

Daily weight

question

When admitting a patient with a diagnosis of asthma exacerbation, the nurse will assess for what potential triggers?

answer

Exercise, allergies, emotional stress, and upper respiratory infections

question

The nurse is assisting a patient to learn self-administration of beclomethasone, two puffs inhaled every 6 hours. What should the nurse explain as the best way to prevent oral infection while taking this medication?

answer

Rinse the mouth with water after the second puff of medication

question

The nurse is evaluating if a patient understands how to safely determine whether a metered dose inhaler (MDI) is empty. The nurse interprets that the patient understands this important information to prevent medication underdosing when the patient describes which method to check the inhaler?

answer

Keep track of the number of inhalations used

question

When planning teaching for the patient with chronic obstructive pulmonary disease (COPD), the nurse understands that what causes the manifestations of the disease?

answer

Hyperinflation of alveoli and destruction of alveolar walls

question

A male patient with COPD becomes dyspneic at rest. His baseline blood gas results are PaO2 70 mm Hg, PaCO2 52 mm Hg, and pH 7.34. What updated patient assessment requires the nurse's priority intervention?

answer

Arterial pH 7.26

question

The nurse evaluates that nursing interventions to promote airway clearance in a patient admitted with COPD are successful based on which finding?

answer

Effective and productive coughing

question

When caring for a patient with chronic obstructive pulmonary disease (COPD), the nurse identifies a nursing diagnosis of imbalanced nutrition: less than body requirements after noting a weight loss of 30 lb. Which intervention should the nurse add to the plan of care for this patient?

answer

Order a high-calorie, high-protein diet with six small meals a day.

question

The nurse teaches pursed lip breathing to a patient who is newly diagnosed with chronic obstructive pulmonary disease (COPD). The nurse reinforces that this technique will assist respiration by which mechanism?

answer

Preventing bronchial collapse and air trapping in the lungs during exhalation

question

Nursing assessment findings of jugular venous distention and pedal edema would be indicative of what complication of chronic obstructive pulmonary disease (COPD)?

answer

Fluid volume excess resulting from cor pulmonale

question

A patient has been receiving oxygen per nasal cannula while hospitalized for COPD. The patient asks the nurse whether oxygen use will be needed at home. What is the most appropriate response by the nurse?

answer

"You will not need oxygen until your oxygen saturation drops to 88% and you have symptoms of hypoxia."

question

Before discharge, the nurse discusses activity levels with a 61-year-old patient with chronic obstructive pulmonary disease (COPD) and pneumonia. Which exercise goal is most appropriate once the patient is fully recovered from this episode of illness?

answer

Walk for 20 min/day, keeping the pulse rate less than 130 beats/min.

question

The nurse evaluates that a patient is experiencing the expected beneficial effects of ipratropium (Atrovent) after noting which assessment finding?

answer

Increased peak flow readings

question

The nurse is teaching a patient how to self-administer ipratropium (Atrovent) via a metered dose inhaler (MDI). Which instruction given by the nurse is most appropriate to help the patient learn the proper inhalation technique?

answer

"Breathe out slowly before positioning the inhaler."

question

Which statement made by the patient with chronic obstructive pulmonary disease (COPD) indicates a need for further teaching regarding the use of an ipratropium inhaler?

answer

"If my breathing gets worse, I should keep taking extra puffs of the inhaler until I can breathe more easily."

question

When teaching the patient with chronic obstructive pulmonary disease (COPD) about smoking cessation, what information should be included related to the effects of smoking on the lungs and the increased incidence of pulmonary infections?

answer

Decreased alveolar macrophage function

question

When teaching the patient with cystic fibrosis about the diet and medications, what is the priority information to be included in the discussion?

answer

Pancreatic enzymes and adequate fat, calories, protein, and vitamins are needed.

question

When teaching the patient with bronchiectasis about manifestations to report to the health care provider, which manifestation should be included?

answer

Increasing dyspnea

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