Chronic Health Test 1

Which team members deal with health perception, stress/coping, self-concept, and sleep (3)

• Social worker

• psychologist

• clergy member

Which team members deal with pain? (2)

• Acute pain nurse

• palliative care physician

What team members deal with activity? (3)

• Physiotherapist

• Occupational therapist

• Recreational therapist

What does a physiotherapist deal with?

Injury recovery \ long term body stress

What does an occupational therapist deal with?

Full body movement, ADLs

What does a recreation therapist do?

Promote hobbies and leisure, social engagement

What team members deals with nutrition / elimination? (2)

• dietician

• Speech language pathologist

What team member deals with hearing?

Audiologist

What team member deals with oxygenation?

Respiratory therapist

What team member deals with medication concerns / polypharmacy?

Pharmacist

What is an acute condition?

Develops suddenly and lasts a short time.

What is a chronic condition?

Develops slowly and requires long term treatment.

What are the types of common risk factors related to chronic illness? (3)

• Non-modifiable risk factors

• Behavioural risk factors

• Cultural and environmental conditions

What are common intermediate conditions that lead to chronic conditions? (4)

• high blood pressure (hypertension)

• elevated blood lipids (hyperlipidemia)

• obesity

• pre-diabetes

What is mortality?

Rate of deaths

What is morbidity?

Rate of disease in a population

What is illness?

The human experience of symptoms and suffering

What is illness behaviour?

The diverse ways individuals respond to symptoms

How is a chronic disease defined? (3)

• Health conditions that persist over extended periods of time.

• Complex to manage for patients and families.

• Often require a coordinated plan of care from many health care team members.

What are the most prevalent chronic diseases? (10
)

• Hypertension

• Osteoarthritis

• Mood disorders

• Osteoporosis

• Diabetes

• Asthma

• COPD

• Ishemic heart disease

• Cancer

• Dementia

What are three types of nursing diagnoses?

• At risk

• Problem focused

• Health promotion

Oxygenation

the process of supplying oxygen to the body’s cells

How does gas exchange work?

Gas exchange takes place in the alveolis in the lungs

inhaled oxygen moves from the alveoli to the blood in the capillaries, and carbon dioxide moves from the blood in the capillaries to the air in the alveoli

What happens when gas exchange is impaired? What are the symptoms?

If gas exchange is impaired, you cannot effectively get enough oxygen, or rid your body of carbon dioxide.

• Dyspnea (shortness of breath)

• Coughing

• High heart rate

• Increased respirations

• Accessory muscle use

• Restlessness

• Lethargy

• Cyanosis

• Diaphoresis (sweating)

• Confusion

What does effective oxygenation require? (6)

• Clear airways.

• Effective lung expansion + contraction.

• Clear bronchi + bronchioles (for oxygen to reach alveoli).

• Healthy alveoli (for gas exchange to occur).

• Effective heart pump.

• Adequate amount of hemoglobin.

What is the most common chronic disease among children?

Asthma

What is asthma?

Spasm of the bronchi due to inflamed and narrowed airways (inflammatory reaction to triggers)

What are some common triggers of ashtma? (6)

• Allergens

• Exercise

• Drugs

• Food additives

• Air pollutants

• Emotional stress

What is the pathophysiology of ashtma? (3)

1. Airway inflammation

2. Increased mucus production

3. Contraction of smooth muscles (bronchospasm)

What are the clinical manifestations of asthma? (5)

• Wheezing

• Breathlessness

• Chest tightness

• Coughing

• Increased HR, RR, and decreased SPO2

Hypoxia

Low oxygen in tissues

Hypoxemia

Low oxygen in blood

Exacerbation

Flare up

What are nursing interventions for asthma? (4)

• Position of comfort

• Frequent assessment of respiratory status

• Medications (rescue, possibly oral / iv corticosteroid)

• Supplemental oxygen

What are the two medications used for asthma?

• Bronchodilator (rescue / reliever)

  • Short acting Beta-2 Adrenergic Agonists. eg. Salbutamol

• Corticosteroid (maintenence)

  • eg. Fluticasone, Prednisone

What are the expected outcomes for a patient with asthma during the evaluation stage? (6)

• Normal activity level

• Proper nutrition

• Demonstrates education

• Can manage triggers

• Normal vitals

• Clear lung sounds

Does asthma impact inhalation or exhalation?

Exhalation

Chronic Obstructive Pulmonary Disease is the umbrella term for which two chronic diseases?

• Chronic bronchitis

• Chronic emphysema

What is chronic bronchitis?

Long-term bronchial inflammation with overproduction + hypersecretion of mucous

Chronic emphysema

Damage to the air sacs in the lung.

Destruction of the alveolar wall, respiratory bronchioles, alveolar ducts, and alveolar sacs. This causes permanent dilatation, decreasing the surface area of the ventilatory units.

What is the cause of COPD? (2)

• Long term exposure to lung irritants

• Genetics

What is the difference of lung function between COPD and asthma?

• Asthma: maintain lung function between flares.

• COPD: progressive deterioration, decrease in lung function over time.

How is COPD diagnosed? (2)

• Comprehensive health history (including exposure to risk factors)

• Confirmed by spirometery

What are the clinical manfestations of COPD? (11)

Early signs:

• Intermittent productive cough.

• Dyspnea (SOB) on exertion.

Symptoms when disease has progressed:

• Barrel chest.

• Ribs fixed in inspiratory position.

• Weight loss, anorexia.

• Fatigue.

• Prolonged expiratory phase.

• Wheezes, decreased lung sounds.

• Tripod position.

• Cyanosis.

• Fingernail clubbing.

What are the risk factors for Pneumonia? (5)

• Chronic disease

• Surgery

• Hospitalization

• Impaired mobility

• Older age

What are diagnostic tests a physician would order to confirm COPD or asthma? (10)

• WBC count

• Hemoglobin

• SpO2

• ABG (arterial blood gasses)

• Sputum culture

• Alpha-1 antitryspin (genetic marker for COPD)

• Chest x-ray (hyperinflation)

• Peak flow

• Spirometry (how much oxygen lungs can hold)

• CT scan (more detailed than x-ray)

Cor pulmonale

Abnormal enlargement of right side of heart due to lung disease

What are nursing interventions for COPD? (6)

• Reposition

• Auscultate lungs

• Vitals

• Supplemental oxygen

• Medications

• Push fluids

What are medications for an acute phase of COPD? (exacerbation) (3)

Rescue medications taken at onset of exacerbation:

• Bronchodilator: eg. Salbutamol

• Corticosteroid: eg. Prednisone

• Supplemental oxygen

What is an example of a broncodilator?

Salbutamol / Ventolin / Albuterol

^ all same medication, just different brand names

What are examples of corticosteroids? (2)

• Prednisone

• Fluticasone

What are medications for the maintence phase of COPD? (4)

Maintenance: take once or twice everyday.

• Short acting Beta-2 Agonist (Salbutamol) OR short acting Muscanaric Antagonist.

  • Combo: Combivent

• Long acting Beta-2 Agonist OR long acting Muscanaric Antagonist

  • Combo: Ellipta

What kind of drug is Salbutamol, and what does it do? (3)

• Short acting Beta-2 Agonist

• Bronchodilator

• Decreases inflammation, relaxes lung muscles

What kind of drug is Prednisone, and what does it do? (2)

• Corticosteroid

• Decreases inflammation in airways

What do short acting Muscanaric Antagonists do? (2)

• Stops normal muscle action by blocking acetylcholine receptors (inhibits broncoconstriction)

• Increases airflow

What is Combivent medication?

A combination of a short acting Beta-2 Agonist and a short acting Muscanaric Antagonist

What is Ellipta medication?

A combination of a long acting Beta-2 Agonist and a long acting Muscanaric Antagonist

What is the medication name of a long acting Beta-2 Agonist?

Serevent

What is the medication name of a long acting Muscanaric Antagnoist? (2)

Tiotropium / Spiriva

What is always taken first: bronchodilators or corticosteroids?

Bronchodilators are always taken first

What would a nurse teach someone with COPD? (7)

• Help quitting smoking

• Physical activity

• Nutrition (4-6 small meals a day allows your diaphragm to move more easily and for you to breathe better)

• How to use a peak flow meter

• Lung exercises

• Maintenance medications + how to take meds

• Supplemental oxygen as disease progresses

What outcomes would a nurse be looking for in the evaluation phase for a patient with COPD? (9)

• Returns to baseline respiratory status.

• Demonstrates effective respirations.

• “Normal” breath sounds for the person.

• Demonstrates effective coughing.

• Reports decreased dyspnea (SOB
  ).

• Maintains clear airway

• Maintains “normal” SpO2 for the person.

• Reports improved mental status and sleep.

• Improved nutritional intake.

What would a nurse teach a patient who is short of breath? (4)

• Comfortable position (tripod).

• Inhale through mouth.

• Pursed-lips on exhalation.

• Belly breathing.

What are potential complications of poor oxygenation? (3)

• Can damage organs, brain + heart damage.

• Cognitive impairment.

• Low immunity.

What does mobility require? (5)

• Muscle strength.

• Energy.

• Skeletal stability.

• Joint function.

• Neuromuscular synchronization.

What are potential musculoskeletal complications of immobility? (5)

Musculoskeletal:

• Pain

• Falls

• Muscle atrophy

• Contractures

• Fatigue

What are potential GI/GU complications of immobility? (3)

• UTI

• Constipation

• Malnutrition

What are potential neurological / psychosocial complications of immobility? (3)

• Delirium

• Anxiety

• Depression

What are potential respiratory complications of immobility? (3)

• Aspiration

• Hypoxia

• Pneumonia

What are potential integumentary complications of immobility? (2)

• Skin breakdown

• Deep vein thrombosis

What is the pathophysiology of Osteoarthritis? (2)

• Disorder of the synovial joints.

• Cartilage that cushions the ends of bones in your joints gradually deteriorates

What is the pathophysiology of Rheumatoid arthritis? (3)

• Systemic autoimmune & inflammatory disease.

• Occurs when your immune system mistakenly attacks your own body's tissues (not just joints).

• Affects the lining of your joints, causing a painful swelling that can eventually result in bone erosion and joint deformity.

Is arthritis more common in women or men?

Arthritis is more common in women

What diagnostic tests would a physician order for Osteoarthritis? (5)

• History / physical

• X-ray

• CT scan

• MRI

• Bone scan

What diagnostic tests would a physician order for Rheumatoid arthritis? (8)

• History / physical

• X-ray

• Serology (antibodies in blood)

• CBC (Complete Blood Count)

• CRP (C Reactive protein)

• ESR (Erythrocyte Sedimentation Rate)

• RF (Rheumatic factor)

• Analysis of synovial fluid

What are the risk factors for Osteoarthritis? (8)

• Older age

• Sex (women more common)

• Obesity

• Joint injuries

• Repeated stress on joint

• Genetics

• Bone deformities

• Metabolic disease (ex. diabetes)

What are the risk factors for Rheumatoid arthritis? (7)

• Age

• Sex (common in women)

• Genetics

• Smoking

• Having children

• Obesity

• Early life exposures (ex. formula fed)

What are the goals of care for someone with Osteoarthritis? (4)

• Pain management

• Decrease inflammation

• Prevent disability

• Maintain joint function

What are the goals of care for someone with Rheumatoid arthritis? (5)

• Early treatment

• Promote / maintain joint function

• Effective pain management

• Stop / slow progression

• Education

What classificiations of medications would be given to someone with Osteoarthritis? (4)

• Salicylates

• Analgesic

• NSAIDS

• Topical analgesics

What are salicytes and what is an example of this medication?

• Analgesic (painkiller) and anti-inflammatory.

  • ex. Aspirin

What are analgesics and what is an example of this medication?

• Analgesic (painkiller) and antipyretic (reduce fever).

  • ex. Acetaminophen

What are NSAIDS and what is an example of this medication?

• Analgesic (painkiller) and anti-inflammatory

  • ex. Ibuprofen

What are topical analgesics and what is an example of this medication?

• Analgesic (painkiller) and anti-inflammatory that is applied to the skin.

  • ex. Voltaren Emulgel

For arthritis, when are NSAIDS given?

given early in the diagnosis phase to manage lower rated pain

For arthritis, when are corticosteroids given?

given during a flare up but should be short term

For arthritis, when are DMARDS given?

DMARDs are prescribed early in diagnosis phase but take 3-6 weeks to work, so NSAIDs and Corticosteroids will be given until the DMARDs take effect.

For patients with Rheumatoid arthritis, what symptoms may precede arthritic complaints? (4)

• Anorexia

• Fatigue

• Weight loss

• Generalized stiffness

For Rheumatoid arthritis, what can progression of the disease lead to? (2)

Deformity and disability

What classificiations of medications would be given to someone with Rheumatoid arthritis? (5)

• Salicylates

• NSAIDS

• Topical analgesics

• Corticosteriods

• DMARDS (Disease-Modifying Antirheumatic Drug)

What are DMARDS and what is an example of this medication?

• Antimetabolites (decreasing the activity of your immune system)

  • ex. Methodextrate

What are corticosteroids and what is an example of this medication? (for Rheumatoid arthritis)

• Analgesic (painkiller) and anti-inflammatory

  • ex. Hydrocortisone, Prednisone, Methylprednisolone

What are the differences between Osteoarthritis and Rheumatoid arthritis? (4)

Osteoarthritis:

• A condition of mechanical “wear and tear” on joints.

• Affects joints asymmetrically.

• Age of onset: > 40.

Rheumatoid arthritis:

• Systematic autoimmune disease with exacerbations, body attacks joints.

• Affects joints symmetrically.

• Age of onset: young - middle age.

What would a nurse teach someone who has been diagnosed with arthritis? (3)

• Use firm mattresses and seats.

• Alternate between periods of rest and activity.

• Protect joints from stress.