W3, Respiratory System and Diseases

Where does gas exchange occur?

At alveoli

What are structures that allow air to travel through?

Nose, nasal cavity, pharynx, larynx, trachea, bronchi, bronchioles, and alveoli is where gas exchange occurs

What are risk factors for asthma?

Genetics, environment, pollen, air irritants, exercise, stress, smoke/environmental, respiratory infections, GERD, nose and sinus issues, eczema, allergic rhinitis, drugs and food additives (NSAIDs, Ace inhibitors)

What is asthma?

Diverse disease characterized by bronchial hyperreactivity with reversible airflow limitation

Does asthma affect lower or upper respiratory system?

Lower, so bronchi, bronchioles and alveoli

What are symptoms of minor asthma?

Mild SOB and chest tightness

What are symptoms of major asthma (attack)?

Severe SOB, accessory muscle use, stridor, severe hypoxemia leading to respiratory and/or cardiac arrest if untreated

True/False: Clinical course of asthma is unpredictable

True

What are common phenotypes (types) of asthma?

Allergic asthma, non-allergic asthma, aspirin-sensitive asthma, exercise-induced asthma

What is pathophysiology of asthma (5 steps)?

1. Lymphocytes produce interleukins that aid in communication with other cells and makes airway more inflamed

2. Eosinophils go to lungs to try to fix inflammation

3. Cytokines enter airway with eosinophils. Eosinophils release leukotrienes, which releases more inflammation

4. Increased inflammation from leukotrienes make it very difficult to breathe, O2 levels are lowered in blood

5. RR increases to try to increase O2 levels and decrease CO2 levels

How soon after exposure to an allergen or irritant does cell response (with leukotrienes, eosinophils, cytokines) occur in asthma?

Within minutes, and then symptoms can occur 4 to 6 hours later due to influx of inflammatory cells

Why do symptoms of asthma occur 4 to 6 hours after initial allergen or irritant exposure?

Due to influx of inflammatory cells (leukotrienes, eosinophils, cytokines)

What type of cell releases inflammatory mediators (leukotrienes, eosinophils, cytokines) when an allergen cross-links IgE receptors in asthma?

Mast cells

What are all mediators that mast cells release when allergen cross-links IgE receptors in asthma?

Leukotrienes, histamine, cytokines, prostaglandins, nitric oxide

What are manifestations (9) of asthma?

Wheezing, coughing, chest tightness, dyspnea, accessory muscle use, neuro symptoms like poor judgment, memory loss, inattentiveness, decrease in coordination of muscles (due to hypoxia neuro symptoms occur)

When does coughing typically occur with asthma?

In morning or night, and cough could be productive or dry

What are 4 types of asthma?

Intermittent, mild, moderate, severe asthma

What is intermittent asthma?

Manifestations occur less than 2 days/week and client gets woken up from coughing at night

What is mild asthma?

Episodes occur more than 2 days/week, and nighttime coughs/awakenings occur 3 to 4 times/month

What is moderate asthma?

Getting awoken more than 3 to 4 times/month

What is severe asthma?

Episodes occur every day and greater than 7 times/week

What are laboratory testing and diagnostics for asthma?

Peak flow meters, spirometry, ABGs, chest x-ray

What is function of peak flow meters, spirometry, ABGs, and chest x-ray with asthma?

Devices help measure severity of asthma and are used in conjunction with medications

True/False: A falling pulse oximetry value is a late finding of asthma

True

What is a VQ scan, also known as lung ventilation/perfusion scan?

Uses safe radioactive substance to show how well oxygen and blood are flowing to all areas of lungs

What is goal for client with asthma?

To ensure client safety and asthma management

What are health promotions for client with asthma?

Teach patient to identify and avoid known triggers and irritants, wash bedclothes in hot water or cooler water with detergent and bleach, use scarves or masks for cold air, avoid aspirin and NSAIDs, read OTC labels, consider desensitization therapy

What are quick-relief medications/rescue medications for asthma?

Bronchodilators like SABAs (short-acting beta agonists) so albuterol or levalbuterol, other bronchodilators like anticholinergic (muscarinic antagonists) so ipratropium (Atrovent)

What are examples of SABAs (short-acting beta agonists) that work as rescue meds for patients with asthma?

Albuterol, levalbuterol

What is example of muscarinic antagonists (anticholinergic) that work as rescue meds for patients with asthma?

Ipratropium (Atrovent)

What is function of albuterol and ipratropium in airway for patient with asthma?

Albuterol (SABA) opens up airway, ipratropium (anticholinergic) removes inflammation

What are long-term control medications for asthma?

Inhaled corticosteroids, LABAs (long-acting beta agonists), long-acting anticholinergic agents

What are examples of inhaled corticosteroids that are used for long-term control of asthma?

Beclomethasone, budesonide, fluticasone, mometasone

What is example of LABAs (long-acting beta agonists) that are used for long-term control of asthma?

Formoterol (Symbicort)

What are examples of long-acting anticholinergic agents that are used for long-term control of asthma?

Ipratropium/albuterol, aclidinium, glycopyrrolate, umeclidinium, tiotropium

What are 3 ways to deliver medications for patients with asthma?

Metered dose inhaler (MDI), dry powder inhaler (DPI), nebulizers

True/False: All asthma attacks are life-threatening

False; asthma attacks range from minor to life-threatening, however we cannot predict which will happen for each patient

What is initial treatment, generally, of asthma attack?

2.5 mg of albuterol by nebulization (or inhaler) every 20 minutes for an hour followed by hourly treatments

What is status asthmaticus (acute severe asthma)?

Severe, life-threatening asthma attack that does not get better with standard treatments like rescue inhalers or nebulizers

What are steps to help someone with status asthmaticus?

1. Administer SABA

2. Administer oral/IV methylprednisolone (Medrol)

3. Give supplemental O2

Also could give magnesium sulfate, also could give IV fluids if dehydrated

True/False: First step to help someone with status asthmaticus is to give supplemental O2

False;

1. Administer SABA

2. Administer oral/IV methylprednisolone (Medrol)

3. Give supplemental O2

Then could give magnesium sulfate, also could give IV fluids if dehydrated

Why would magnesium sulfate be given to patient with status asthmaticus (after SABA, Medrol, and O2)?

Magnesium sulfate is sometimes used to inhibit calcium-mediated smooth muscle constriction, which aids in breathing (so medication relaxes smooth muscle in lungs)

What is COPD?

Progressive lung disease characterized by persistent airflow limitation (limited getting OUT)

True/False: COPD patients have trouble getting air in whereas asthma patients have trouble getting air out

False; COPD patients have trouble getting air OUT whereas asthma patients have trouble getting air IN

What is COPD associated with?

Enhanced chronic inflammatory response in airways and lungs

What are main causes of COPD?

Cigarette smoking, noxious particles and gases, air pollution

What are 2 types of COPD?

Chronic bronchitis, emphysema

What is clinical definition of chronic bronchitis?

Presence of cough with sputum for at least 3 months in each of last 2 consecutive years

What is clinical definition of emphysema?

Destruction of alveoli without fibrosis

What is pathophysiology of COPD?

Long-term illness characterized by chronic inflammation of airways, lung parenchyma, and pulmonary blood vessels, and airway limitation is not fully reversible due to loss of elastic recoil and airflow obstruction from mucous hypersecretion, mucosal edema, and bronchospasm

What is defining feature of COPD?

Airway limitation is not fully reversible due to loss of elastic recoil and airflow obstruction from mucous hypersecretion, mucosal edema, and bronchospasm

How does COPD progress?

By worsening inability to expire/get air out; causes abnormalities in airflow limitation, air trapping, and problems with gas exchange, leading to impaired or destroyed lung tissue alongside normal tissue

Which respiratory illness does this patient have?

COPD

What are manifestations (15) of COPD?

Prolonged expiratory phase, decreased breath sounds, wheezing, barrel chest and tripod position, pursed-lip breathing, peripheral edema (ankles) with right HF, chronic cough (may be intermittent), significant airflow limitation, dyspnea, chest heaviness, air hunger, gasping, orthopnea, reddish-blue skin hue

What manifestations of COPD lead to diagnosis?

Chronic cough (intermittent, may be productive), significant airflow limitation, dyspnea (occurs with exertion and progressive)

What are complications of COPD (other than person not being able to breathe)?

Thromboembolic disease, lung cancer, acute respiratory failure, congestive heart failure, pulmonary hypertension, Cor pulmonale, acute exacerbations