ADH1 FINAL (Respiratory + DM)

Clinical Manifestations COPD: (9)

1. Chronic dyspnea (RR 40-50/min during exacerbations)

2. Barrel chest

3. Productive cough (worse in morning)

4. Crackles, Wheezing, Hypoxemia

5. Tripod

6. Accessory muscles

7. Pursed lip breathing

8. Cyanosis & Clubbing nails

9. Weight loss d/t dyspnea

Why can’t u over oxygenate pt w/ COPD?

Range for O2 admin?

They will lose drive to breath

• 88-92%

What kind of chest shape will COPD have?

barrel chest

COPD pt should perform what kind of breathing?

Pursed lip breathing

Diagnostic tools for COPD: (3)

1. Pulmonary Functions Test (PFTs)

   • FVC/FEV1

2. Chest Xray

3. ABGs

What acid base imbalance would COPD pt have?

• CO2 retention = Respiratory Acidosis (hypoventilating)

1. ratio of FEV1/FVC to confirm COPD:

2. Hypoxemia PaO2:

3. Hypercapnic PaCO2:

< 70% positive for COPD

• PaO2 <80 mmHg

• PaCO2 > 45mmHg

Complications of COPD: (3)

1. CO2 retention (Resp. Acidosis) —>

2. Respiratory failure

3. Cor pulmonale (R. sided HF)

Asthma is a chronic condition worsens based on what?

Triggers!!

What strongly triggers asthma?

ALLERGIES

Common asthma manifestations: (5)

1. Dyspnea

2. Chest tightness

3. Coughing

   • worse at night/ early mornings

4. Wheezing

5. Mucus production

Severe asthma attack signs: (3)

1. Accessory muscles

2. Prolonged expiration

3. Poor O2 saturation (low SaO2)

List meds for asthma:

• 2 main categories

• 5 classes

• drugs in those classes (6)

1. Bronchodilators

   a. SABA: albuterol

   b. LABA: salmeterol

   c. anticholinergics: ipratropium

2. Anti-inflammatory agents

   a. Corticosteroids: Fludrocortisone; Prednisone

   b. Leukotriene Blockers: Montelukast

Whats the most accurate diagnostic test for asthma?? *also for COPD as well

FEV1/FVC ratio

< 70%

Pneumonia manifestations: (8)

1. Fever

2. Sharp pleuritic CP

3. Dull chest percussion over consolidated areas

   • filled w/ exudate

4. SOB

5. Tachypnea

6. Productive cough

   • yellow, blood-tinged, purulent, rust colored

7. Crackles, Wheeze

8. Hypoxia

   • **similar to COPD!!

Lab/ Diagnostic tests for pneumonia: (7)

1. Sputum culture and sensitivity

   • bacteria

2. Blood culture

   • spread of infx—sepsis

3. CBCs

4. ABGs

5. BMP

6. CT

7. CXR

Community Acquired Pneumonia (CAP) diagnosed when?

dx in community/ early in hospital admission (< 48 hrs)

Which of the 4 pneumonias is most common and whats it caused by?

CAP

• influenza

Healthcare Associated Pneumonia (HCAP) diagnosed how?

Non-hospitalized pts have extensive contact w/ healthcare ppl

• chemo, dialysis

HCAP is often caused by what pathogen, and linked to what rates?

Multidrug resistant pathogen (MDR) so also more likely to be resistant to abx tx

• Linked to higher mortality rates

When does Hospital Acquire Pneumonia (HAP) develop? And what pathogen sources could pt be exposed to? (3)

> 48 hrs+ AFTER hospital admission

1. Medical equipment

2. Provider contact

3. Shared facilities

Ventilator Associated Pneumonia is sub-type of which other one? And HOW does it occur?

Hospital Acquired Pneumonia (HAP)

• when condition manifests > 48hrs+ AFTER pt is INTUBATED

Nursing care for pt w/ pneumonia and why: (9)

1. Assessment

   • get baseline/ abnormalities

2. Breathing tx/ meds

   • open airways

3. O2 therapy

   • > 95%

4. Position

   • High fowlers max efficiency

5. Mobility

   • prevent atelectasis

   • loosen secretions

6. Promote nutrition/ hydration

   • 2-3L to thin secretions!

7. Have rest periods

   • Conserve energy

8. Provide reassurance

   • bc they’re anxious

9. Monitor skin breakdown

   • around ears bc of mask

The 2 equipments to teach a pt w/ pneumonia how to use:

1. Incentive spirometer: encourage deep breathing

   • breath IN

2. PEP: opens alveoli and moves mucous from smaller airways larger airways and easier to expel

What members of interprofessional care would be consulted for pt w/ pneumonia? (3)

1. RT:

   • ABGs

   • breathing tx (inhalers)

   • O2 monitoring

2. Nutritionist:

   • high protein/calorie diet

3. Rehab (OT/PT)

   • Fine— OT

   • Gross— PT

   • get back to baseline functioning bc they’re weak

Nursing INTERVENTION to prevent Aspiration?? (6)

1. HOB > 30

2. Use few sedatives as possible

3. Confirm tube placement B4 enteral feedings

4. No stimulate gag reflex w/ suctioning

5. Have suction @ bedside tho

6. Thicken liquids for swallowing problems

DM1 & DM2 Fasting blood glucose and HA1c ranges:

• Fasting blood glucose: > 126 mg/dL

• HA1c: > 6.5%

What does HA1c measure?

> 6.5% measures avg blood glucose of past 2-3 months

Patho of DM1?

Absolute LACK of insulin d/t destruction of insulin producing beta-cells

Patho of DM2:

• Cell membrane no transport glucose INTO cell aka pancreas beta cells FAIL (F-)

3P’s of T1 and T2 DM?

1. Polydipsia: really thirsty/ dehydrated form peeing

2. Polyphagia: really hungry

3. Polyuria: excessive urination

DKA usually found in what DM?

T1DM

Patho of DKA? (2)

1. no insulin for cells to get enough glucose for normal metabolism

2. breakdown of fat leads to fatty acids then converted by liver into KETONES

Clinical manifestations DKA: (5)

1. Kussmauls respirations (fast rate)

2. Fruity acetone breath

3. Poly-uria

4. -dipsia

5. -phagia

Specific labs for DKA:

• Blood glucose level

• Ketones

• Anion gap

• Serum Bicarb

• pH

• Serum osmolarity

• Blood glucose level: > 250 mg/dL

• pH: < 7.30 (met. acidosis)

• Serum Bicarb: <18 mEq/L

• Ketones: +

• Anion gap: +

• Serum osmolarity: > 300 mOsm/kg

How would u treat DKA? (3 steps) and whats the most important electrolyte??

1. Fluid replacement IV NS

2. Correct electrolyte imbalances B4 Insulin!!!—-especially K+

3. IV regular Insulin admission

HHS is usually in what type DM?

T2DM and higher mortality rate than DKA!!

Common causes of HHS? (4)

1. Infection

2. Stress

3. Trauma

4. Surgery

Patho HHS: (3)

1. there’s enough insulin to prevent rapid fat breakdown/ ketone release

2. BUT not enough to prevent HYPERglycemia

3. Extreme hyperosmolality —> osmotic diuresis

*cells are fed, just not enough to prevent hyperglycemia**

Specific labs for HHS:

• Blood glucose level

• Ketones

• Anion gap

• Serum Bicarb

• pH

• Serum osmolarity

• Blood glucose level: > 600 mg/dL

• Ketones : -

• Anion gap: -

• Serum Bicarb: > 15 mEq/L

• pH: > 7.40

• Serum osmolarity: > 320 mOsm/kg

Specific clinical manifestations of HHS: (2)

1. Profound dehydration

2. Altered LOC

How to treat HHS?? (3)

1. Fluid IV NS replacement

2. Tx for Altered mental status —AIRWAY management********!!!

3. Admin IV Regular insulin