Chronic Pulmonary Disease and Hematologic Disorders

Vocabulary practice flashcards covering management of chronic obstructive pulmonary disease, asthma, oxygen therapy, and nonmalignant hematologic disorders (anemias) based on lecture material.

Chronic Obstructive Pulmonary Disease (COPD)

A slowly progressive respiratory disease of airflow obstruction that is preventable and treatable but not fully reversible.

Primary Anatomic Sites Involved in COPD

The airways, pulmonary parenchyma, or both.

COPD Mortality Ranking in the United States

The $4\text{th}$ leading cause of death in the United States for people of all ages.

Other Chronic Pulmonary Diseases

Bronchiectasis, asthma, and cystic fibrosis.

COPD Airflow Limitation Pathophysiology

Progressive airflow limitation associated with an abnormal inflammatory response to noxious particles or gases.

Effects of Airway Scar Tissue in COPD

Results in narrowing of the airways.

Effects of Parenchymal Scar Tissue in COPD

Decreases elastic recoil (compliance).

Effects of Pulmonary Vasculature Scar Tissue in COPD

Causes a thickened vessel lining and hypertrophy of smooth muscle, leading to pulmonary hypertension.

Chronic Bronchitis Clinical Diagnostic Criteria

Cough and sputum production for at least $3\text{ months}$ in each of $2\text{ consecutive years}$.

Airway Changes in Chronic Bronchitis

Ciliary function is reduced, bronchial walls thicken, bronchial airways narrow, and mucous may plug airways.

Alveolar Changes in Chronic Bronchitis

Alveoli become damaged and fibrosed, and alveolar macrophage function diminishes.

Pathophysiology of Chronic Bronchitis Structural Comparison

Comparison showing normal bronchus versus chronic bronchitis characterized by inflammation, an increased number of mucous glands, and excess mucus causing chronic cough.

Alveolar Macrophage Function in Chronic Bronchitis

Alveolar macrophage function is altered; without functional macrophages to destroy foreign materials like bacteria, patients become more susceptible to respiratory infections.

Seasonal Occurrence of Chronic Bronchitis Exacerbations

Exacerbations are most likely to occur during the winter when viral and bacterial infections are more prevalent.

Three Primary Symptoms of COPD

Chronic cough, sputum production, and dyspnea.

Cause of Weight Loss in COPD Patients

Weight loss occurs due to dyspnea.

Barrel Chest

A physical chest wall change seen in emphysema and COPD where the anteroposterior diameter increases.

Normal Adult Chest Wall Diameter Ratio

Anteroposterior (A-P) diameter to transverse diameter ratio equal to $\frac{1}{2}$.

Barrel Chest Diameter Ratio

Anteroposterior (A-P) diameter to transverse diameter ratio equal to $\frac{1}{1}$.

Typical Posture of a Person with COPD

Leaning forward in a sitting position with hands placed on knees or chair arms to brace accessory muscles for breathing.

Assessment and Diagnostic Methods for COPD

Health history (Chart 20-2), pulmonary function tests, spirometry, arterial blood gas, and chest x-ray.

Complications of COPD

Respiratory insufficiency and failure, pneumonia, chronic atelectasis, pneumothorax, and cor pulmonale.

Medical Management Strategies for COPD

Promoting smoking cessation, reducing risk factors, managing exacerbations, providing supplemental oxygen therapy, administering pneumococcal and influenza vaccines, and pulmonary rehabilitation.

Primary Bronchodilator Medication Classes for COPD

Beta-adrenergic agonists, muscarinic antagonists (anticholinergics), and combination agents.

Additional Pharmacological Agents for COPD Management

Corticosteroids, antibiotics, mucolytics, and antitussives.

Surgical Options for COPD

Bullectomy, lung volume reduction, and lung transplant.

Nursing Management Focus Areas for COPD

Assessing the patient, achieving airway clearance, improving breathing patterns, improving activity tolerance, and MDI patient education.

Asthma

A chronic inflammatory disease of the airways that causes hyperresponsiveness, mucosal edema, and mucus production.

Reversibility Feature of Asthma

Asthma is largely reversible, occurring either spontaneously or with treatment.

Strongest Predisposition Factor for Asthma

Allergy.

Primary Clinical Symptoms of Asthma

Cough, dyspnea, and wheezing.

Clinical Manifestations of Severe Asthma Exacerbations

Productive or non-productive cough, generalized wheezing, chest tightness, dyspnea, diaphoresis, tachycardia, hypoxemia, and central cyanosis.

Quick-Relief Asthma Medications

Beta-2 adrenergic agonists and anticholinergics.

Long-Acting Asthma Medications

Corticosteroids, long-acting beta-2 adrenergic agonists, and leukotriene modifiers.

Essential Patient Teaching Points for Asthma

How to identify and avoid triggers, proper inhalation techniques, how to perform peak flow monitoring, how to implement an action plan, and when/how to seek assistance.

Post-Inhalation Nursing Care for Corticosteroid MDI

Rinse mouth with water immediately after use to avoid development of thrush in the oral cavity.

Risk Factors for COPD

Exposure to tobacco smoke, older age, occupational exposure, pollution, and genetic abnormalities.

Nursing Interventions to Promote Oxygenation in COPD

Incentive spirometry, postural drainage, chest percussion and vibration, and breathing exercises.

Oxygen Therapy Definition and Purpose

Administration of oxygen at greater than $21\%$ to provide adequate transport of oxygen in the blood while decreasing the work of breathing and reducing stress on the myocardium.

Hypoxemia

A decrease in the arterial oxygen tension in the blood.

Hypoxia

A decrease in oxygen supply to the tissues and cells, which can be caused by problems outside the respiratory system.

Oxygen Toxicity Threshold

May occur when an oxygen concentration greater than $50\%$ is administered for an extended period.

Symptoms of Oxygen Toxicity

Substernal discomfort, paresthesias, dyspnea, restlessness, fatigue, malaise, progressive respiratory difficulty, refractory hypoxemia, alveolar atelectasis, and alveolar infiltrates on x-ray.

Prevention Strategies for Oxygen Toxicity

Use the lowest effective concentrations of oxygen, and use PEEP or CPAP to prevent or reverse atelectasis and allow lower oxygen percentages to be used.

Oxygen Delivery System Classifications

Classified as low flow or high flow.

Common Oxygen Administration Devices

Nasal cannula, oropharyngeal catheter, masks, and transtracheal catheter.

Venturi Mask Oxygen Delivery Characteristics

A high-flow system specifically designed to deliver precise but lower concentrations of oxygen (less than $30\%$ oxygen).

Non-Rebreathing Mask Oxygen Delivery Characteristics

A low-flow oxygen delivery system that may imprecisely deliver high concentrations of oxygen (up to $100\%$).

Patient Instructions for Home Oxygen Therapy

Instruct on safe administration methods in the home, forms available (gas, liquid, concentrated), portable devices, requirement for humidity, and community resources.

Status Asthmaticus

A rapid onset, severe, and persistent asthma that does not respond to conventional therapy, often requiring hospitalization.

PaCO2 Monitoring Significance in Status Asthmaticus

Increasing levels of $\text{PaCO}_2$ indicate a worsening condition with inadequate gas exchange, rather than improvement.

Anemia

A condition characterized by lower than normal hemoglobin and fewer than normal circulating erythrocytes; it serves as a sign of an underlying disorder.

Hypoproliferative Anemia

A category of anemia resulting from a defect in the production of erythrocytes (RBCs).

Etiologies of Hypoproliferative Anemia

Iron, vitamin B12, or folate deficiency, decreased erythropoietin production, cancer, and bone marrow damage.

Hemolytic Anemia

A category of anemia resulting from excess destruction of erythrocytes (RBCs).

Etiologies of Hemolytic Anemia

Altered erythropoiesis or direct injury to the erythrocyte.

Pathophysiological Cascade in Hemolytic Anemia

Premature destruction of erythrocytes releases hemoglobin into plasma, raising bilirubin concentration; increased erythrocyte destruction causes tissue hypoxia, stimulating erythropoietin production and elevating the reticulocyte count.

General Manifestations of Anemias

Fatigue, weakness, malaise, pallor or jaundice, cardiac, GI, neurologic, and respiratory symptoms, tongue changes, nail changes, angular cheilitis, and pica.

Diagnostic Testing Options for Anemia

Hemoglobin, hematocrit, reticulocyte count, RBC indices, iron studies, vitamin B12, folate, haptoglobin, erythropoietin levels, and bone marrow aspiration.

Medical Management Strategies for Anemia

Correcting or controlling the cause, packed RBC transfusion, dietary therapy, iron/vitamin supplementation (iron, folate, B12), and immunosuppressive therapy.

Examples of Hypoproliferative Anemias

Iron deficiency anemia, anemia in renal disease, anemia of inflammation, aplastic anemia, and megaloblastic anemia (folic acid or B12 deficiency).

Key Assessment Domains for Patients with Anemia

Health history, physical exam, lab data, symptom evaluation (fatigue, weakness, malaise, pain), nutritional assessment, medications, cardiac/GI status, blood loss (menses/GI), and neurologic assessment.

Collaborative Complications of Anemia

Heart failure, angina, paresthesias, confusion, injury related to falls, and depressed mood.

Major Nursing Planning Goals for Anemia

Decreased fatigue, attainment/maintenance of adequate nutrition, maintenance of adequate tissue perfusion, compliance with prescribed therapy, and absence of complications.

Core Nursing Interventions for Anemia

Balancing physical activity, exercise, and rest; maintaining adequate nutrition and perfusion; patient education for compliance; monitoring VS and pulse oximetry with supplemental oxygen as needed; monitoring for complications.

Prevalence of Iron Deficiency Anemia

It is the most common nutritional disorder.

Populations Most Susceptible to Iron Deficiency Anemia

The very young, women in reproductive years, and people on a poor diet.

Dietary Causes of Iron Deficiency

Normally dietary intake is sufficient, but increased requirements occur during menstruation and pregnancy.

Anatomic Site of Intestinal Iron Absorption

Iron absorption occurs in the duodenum.

Malabsorption Causes of Iron Deficiency Anemia

Diseases or surgery that alter, destroy, or remove the absorption surface of the duodenum.

Blood Loss as an Etiology of Adult Iron Deficiency Anemia

The major cause of iron deficiency in adults, most commonly through hidden or unapparent GI and GU system bleeding.

Additional Contributing Factors to Adult Iron Deficiency

Postmenopausal bleeding, chronic kidney disease, and dialysis.

Laboratory and Diagnostic Studies for Iron Deficiency Anemia

Hgb, Hct, MCV, MCH, MCHC, reticulocytes, serum iron, TIBC, bilirubin, platelets, stool occult blood test, endoscopy, colonoscopy, and bone marrow biopsy.

Most Common Clinical Manifestation of Iron Deficiency Anemia

Pallor.

Glossitis

Inflammation of the tongue, presenting as a clinical manifestation in anemias.

Cheilitis

Inflammation of the lips, presenting as a clinical manifestation in anemias.

Primary Goal of Iron Deficiency Anemia Management

Treat the underlying problem causing loss, reduced intake, or poor absorption of iron.

Replacement Modalities for Iron Deficiency Anemia

Nutritional therapy, oral iron supplements, and transfusion of packed RBCs.

Standard Daily Dosage for Oral Iron Supplementation

The daily dose is $150\text{ to }200\text{ mg}$.

Effectiveness of Enteric-Coated or Sustained-Release Oral Iron

Enteric-coated or sustained-release capsules are counterproductive for treating iron deficiency.

Optimal Absorption Environment for Oral Iron

Oral iron is best absorbed in an acidic environment.

Administration Precaution for Liquid Oral Iron

Undiluted liquid iron may stain teeth, so it should be diluted and drunk through a straw.

Common Side Effects of Oral Iron Supplements

Heartburn, constipation, and diarrhea.

Indications for Parenteral Iron Therapy

Malabsorption, oral iron intolerance, need for iron beyond normal limits, or poor patient compliance.

Routes and Skin Precaution for Parenteral Iron

Can be given IM or IV; IM administration may stain the skin.

Vitamin B12 (Cobalamin)

A vitamin that helps the body make RBCs; deficiency can lead to physical, neurological, and psychological problems.

Etiologies of Vitamin B12 Deficiency

Inadequate dietary intake, lack of hydrochloric acid (gastritis), lack of intrinsic factor (pernicious anemia), or digestive conditions (celiac or Crohn's disease).

Pernicious Anemia

A specific form of Vitamin B12 deficiency caused by a lack of intrinsic factor required for vitamin absorption.

Risk Factors for Vitamin B12 Deficiency

Being older than $75\text{ years}$ old, vegan or vegetarian diet, excessive alcohol use, digestive conditions, and certain medications.

Physical Manifestations of Vitamin B12 Deficiency

Fatigue or weakness, and sore mouth or tongue ulcers.

Neurological Manifestations of Vitamin B12 Deficiency

Numbness/tingling in hands and feet, memory loss, confusion, and mobility changes.

Psychological Manifestations of Vitamin B12 Deficiency

Feeling depressed or irritable.

Diagnostic Blood Tests for Vitamin B12 Deficiency

CBC, Vitamin B12 level, and Homocysteine level.

Treatment Modalities for Vitamin B12 Deficiency

Oral Vitamin B12 supplements, Vitamin B12 injection, or Vitamin B12 nasal spray/gel.

Folate (Vitamin B9)

A vitamin essential for DNA synthesis and RBC formation; important for pregnant women and necessary for fetal growth and development.

Etiologies of Folate Deficiency

Inadequate dietary intake, excessive alcohol use, overcooking fruits/vegetables, hemolytic anemia, digestive conditions, and anti-seizure medications.

Daily Folate Requirements

Adults need $400\,\mu\text{g}$ ($400\text{ mcg}$) of folate daily, with pregnant women needing additional supplementation.

Systemic Complications of Folate Deficiency

Decreased cognitive function (dementia), infertility, and cardiovascular disease due to development of abnormal, non-functioning RBCs.

Pregnancy-Related Complications of Folate Deficiency

Birth defects such as spina bifida, preterm birth, low birth weight, and increased risk of placental abruption.

Clinical Features Shared Between B12 and Folate Deficiencies

Both deficiencies manifest with fatigue, weakness, mouth sores/ulcers, red tongue, memory loss, confusion, and irritability.