mod 4 micro chronic resp disorders

when is the onset of COPD

middle adulthood

what is chronic bronchitis

cough and sputum production for at least 3 months in each of 2 consecutive years

what is COPD

slowly progressive respiratory disease of airflow obstruction

COPD patho

chronic inflammation causes damage to airways, pulmonary parenchyma or both; scar tissue causes narrowed airways, decreased elastic recoil and pulmonary HTN

what is emphysema

abnormal distention of air spaces beyond the terminal bronchioles with destruction of the walls of the alveoli

what does emphysema cause

increased dead space, impaired O2 diffusion and hypoxemia

what does hypoxemia from emphysema cause

pulmonary HTN, hypercapnia, and respiratory acidoisis

the types of emphysema

panlobular emphysema and centrilobular emphysema

what type of emphysema is common in smokers

centrilobular emphysema

what are the primary s/s of COPD

chronic cough

sputum production

dyspnea

s/s of COPD

chronic cough

sputum production

dyspnea

weight loss ( from dyspnea)

barrel chest (from hyperinflation)

accessory muscle use

retractions

systemic s/s of COPD

musculoskeletal wasting, metabolic syndrome, depression

dx for COPD

spirometry, ABGs, Chest xray, alpha 1 - antitrypsin

grade 1 (FEV1/FVC)

FEV1 greater than or equal to 80%

grade 2 (FEV1/FVC)

FEV1: 50 -79%

grade 3 (FEV1/FVC)

FEV1: 30-49%

grade 4 (FEV1/FVC)

FEV1: less than 30%

what confirms COPD

spirometry

what is alpha 1 antitrypsin

enzyme inhibitor that protects the lung parenchyma from injuries

when is screening for alpha 1- antitrypsin recommended

if under 45 years old

complications of COPD

respiratory insufficiency

respiratory failure

pneumonia

chronic atelectasis

pneumothorax

cor pulmonale

what is cor pulmonale

right ventricular dysfunction caused by pulmonary arterial HTN

cor pulmonale s/s

dependent edema

distended neck veins

pain in the liver

indications for long term oxygen therapy with COPD

evidence of tissue hypoxia, organ damage or PaO2 less than or equal to 55%

s/s of O2 toxicity

substernal discomfort

paresthesia

dyspnea

restlessness

fatigue

malaise

progressive respiratory difficulty

refractory hypoxemia

alveolar atelectasis

alveolar infiltrates on chest xray

when is supplemntal oxygen used in COPD

when goal is get baseline to PaO2: 60 mmHg

what is a bullectomy for

bullous emphsyema

what is lung volume reduction for

advanced or end stage COPD with primary emphysema (pallative)

meds for COPD

bronchodilators, corticosteroids, antibiotics, and mucolytics, and antitussives

what is the goal when treating COPD

promote lung emptying

widened airways

relieve bronchospasms

types of beta-adrenergic agonists

albuterol

types of muscarinic antagonists/anticholinergics

ipratropium bromide

purpose of corticosteroids

decrease inflammation

what vaccines are highly recommended

influenza and pneumococcal

nursing interventions for ineffective airway clearance

postural changes

chest physiotherapy

diaphragmatic breathing

what is Roflumilast

selective phosphodieterase - 4 inhibitors

Roflumilast purpose

help prevent exacerbations

what is asthma

chronic inflammatory disease of the airway that causes hyperresponsiveness, mucosal edema, and mucosal production

asthma s/s

cough, chest tightness, wheezing, and dyspnea

what is the first sign of an asthma attack

coughing

when do s/s usually appear

at night or early in the morning

what are a complications of asthma

-Status asthmaticus

-Respiratory failure

-Pneumonia

-Atelectasis

medication goal for asthma

prevent impairment of lung function

minimize s/s

prevent exacerbations

meds for asthma

beta-adrenergic agonist

anticholinergics

corticosteroids

long acting beta-adrenegric agonists

leukotriene modifiers

what are the meds for quick relief

albuterol and ipratropium

albuterol SE

tachycardia

muscle tremor

hypokalemia

increased lactic acidosis

Headache

increased BGL

ipratropium SE

dryness of the mouth

when is ipratropium used

if SABAs are not tolerated

ipratropium limitation

it does not block exercise induced asthma

corticosteroids SE

blood glucose irregularities

weight gain

HTN

peptic ulcer

insomnia

systemic corticosteroids indication

prevention of severe asthma

purpose of long acting beta adrenergic agonists

prevention and exercised induced

action of leukotriene modifiers

potent bronchoconstrictors

step 1 meds (asthma)

SABA

step 2 (asthma)

low dose ICS

step 3 (asthma)

low dose ICS + LABA

step 4 (asthma)

medium dose ICS + LABA

step 5 (asthma)

high dose ICS + LABA

step 6 (asthma)

High dose ICS + LABA + oral corticosteroid

when can the patient step down (asthma)

if asthma is well controlled for at least 3 months

when does use of the SABA for more than 2 days a week indicate

inadequate control and a need to step up

what to do before stepping up (asthma)

check adherence, environmental control, and comorbid conditions

what may sputum and blood tests show (asthma)

eosinophils or increase serum IgE

ABG results for asthma

respiratory alkalosis and then respiratory acidosis

what is the priority assessment for asthma

listening to breath sounds

what is silent chest a sign of

impending respiratory failure

green zone for peak flow

80-100% of personal best

yellow zone for peak flow

60 -80% of personal best

actions for yellow zone (asthma)

recheck peak flow in 20 -30 minutes

call provider if not back to green zone

red zone for peak flow

below 60% of personal best

actions for red zone (asthma)

use quick relief medicine right away

call 911 or the provider now

what is cystic fibrosis

Alterations in chloride transport lead to thick viscous, secretions in the lungs, pancreas, liver, intestines, and reproductive tract

What are the leading causes of morbidity and mortality with cystic fibrosis?

Respiratory infections

Signs and symptoms of cystic fibrosis

Persistent cough, thick mucus, wheezing, exercise, intolerance, repeated lung infections, inflamed nasal passages, foul greasy, smelly stool, poor weight gain, intestinal blockage, chronic or severe constipation

what is bronchiectasis

Chronic irreversible dilation of the bronchi and bronchioles

where does bronchiectasis start

In the upper lobes

Cystic fibrosis treatment

Nebulizers, chest physiotherapy, pancreatic enzymes, CFTR modulators

What can be used in the nebulizers?

Pulmozyme, hypertonic saline, inhaled antibiotics

What is needed to get CFTR modulators

Genetic typing

What kind of precautions should someone with cystic fibrosis be on?

Contact precautions

Why might a person with cystic fibrosis need pain management?

Because of the lung scarring

Indications for a double lung transplant

Chronic respiratory failure with end stage lung disease