Chapter 26: Coordinating Care for Patients with Lower Airway Disorders

What is the definition of asthma?

Asthma is a chronic inflammatory disorder of the airways characterized by reversible airflow obstruction and hyper-responsiveness.

What triggers an asthma attack?

Common triggers include allergens, exercise, cold air, smoke, and stress.

What is bronchoconstriction in asthma?

Bronchoconstriction is the tightening of smooth muscles around the bronchi, narrowing the airway and reducing airflow during an attack.

How do asthma symptoms differ from COPD symptoms?

Asthma symptoms are usually reversible with treatment, unlike COPD symptoms, which are persistent and progressive.

List three common symptoms of asthma.

Wheezing, dyspnea (shortness of breath), and coughing.

What is status asthmaticus?

A life-threatening, prolonged asthma attack that is unresponsive to usual treatments.

What is the importance of trigger avoidance in asthma management?

Avoiding triggers is crucial to help prevent asthma attacks and manage the condition effectively.

What role does anxiety play in asthma exacerbations?

Anxiety can worsen bronchospasm and make it harder for the patient to breathe during an asthma attack.

Name one bronchodilator used in asthma management.

Albuterol is a commonly used short-acting beta₂ agonist.

What is the purpose of systemic corticosteroids in asthma management?

They reduce airway inflammation and prevent prolonged symptoms after an acute attack.

What does a peak flow meter measure?

A peak flow meter measures how fast air can be expelled from the lungs, helping monitor asthma control.

What are inhaled corticosteroids and their purpose in asthma?

Inhaled corticosteroids are long-term controller medications that reduce airway inflammation and mucus.

What is the typical first-line treatment for acute asthma exacerbation?

The first-line treatment is the administration of a rapid-acting bronchodilator.

How does position affect a patient experiencing an asthma attack?

Positioning the patient upright can maximize lung expansion and ease breathing.

What dietary recommendations may benefit an asthmatic patient?

A well-balanced diet and maintaining hydration can help respiratory function.

What are the main signs of chronic obstructive pulmonary disease (COPD)?

Chronic cough, dyspnea, sputum production, and wheezing.

What is chronic bronchitis associated with in terms of symptoms?

Chronic bronchitis is characterized by inflammation of the bronchi with a productive cough for at least three months in two consecutive years.

What significant risk factor is primarily associated with COPD?

Cigarette smoking is the leading risk factor for COPD.

What is significant about emphysema in COPD patients?

Emphysema results in the destruction of alveolar walls and loss of elastic recoil, causing air trapping.

What is cor pulmonale in relation to COPD?

Cor pulmonale is right-sided heart failure due to pulmonary hypertension resulting from chronic hypoxia.

How can nutrition impact individuals with COPD?

Patients should consume small, frequent, high-calorie meals to meet energy needs without causing excessive dyspnea.

What is pneumonia?

Pneumonia is an acute infection of the lung parenchyma leading to inflammation and consolidation of lung tissue.

What is the common etiology of community-acquired pneumonia?

Streptococcus pneumoniae is the most typical bacterial cause of community-acquired pneumonia.

What is a classic symptom of pneumonia?

Fever, productive cough, dyspnea, and crackles upon auscultation.

What is the recommended treatment for pneumonia?

Antibiotics are the cornerstone of treatment for bacterial pneumonia.

What role do cough and deep breathing exercises play in pneumonia management?

They help prevent atelectasis and promote airway clearance.

What is the risk of untreated tuberculosis (TB)?

If not treated, latent TB can progress to active TB, leading to severe health complications.

How is TB transmitted?

TB is primarily an airborne disease that spreads when an infected person coughs or sneezes.

What are the signs of active pulmonary tuberculosis?

Persistent cough, night sweats, fever, fatigue, and weight loss.

What is cystic fibrosis (CF)?

CF is a genetic disorder causing thick mucus production that impacts the lungs and digestive system.

What are the hallmark respiratory symptoms of cystic fibrosis?

Chronic cough and lung infections due to thick mucus.

What is a significant complication of CF related to nutrition?

Pancreatic insufficiency leads to malabsorption, necessitating pancreatic enzyme replacement.

What is a key nursing intervention for a patient with lung cancer experiencing dyspnea?

Administer oxygen therapy to manage oxygen saturation and provide comfort.

What should a nurse monitor for patients receiving chemotherapy for lung cancer?

Monitor for side effects such as nausea, infection, and anemia.

What are the recommendations for monitoring a patient on long-term inhaled corticosteroids for asthma?

Regularly assess for oral thrush due to the immunosuppressive effects, monitor growth in children, and ensure proper inhaler technique to prevent systemic side effects.

What patient education should be provided regarding the use of a peak flow meter?

Patients should be instructed to measure their peak flow daily at the same time, identify their personal best, and recognize warning signs of exacerbation to take preventive action.

Upon assessing a patient with an asthma exacerbation, what findings would indicate the need for immediate intervention?

Signs of severe distress, such as use of accessory muscles, cyanosis, inability to speak full sentences, and peak flow measurements significantly below the patient's personal best. Immediate bronchodilator treatment and possibly oxygen therapy would be necessary.

Which medications are commonly used for quick relief of asthma symptoms, and how do they work?

Short-acting beta₂ agonists like albuterol provide rapid bronchodilation by relaxing bronchial smooth muscle. They are often referred to as 'rescue' inhalers.

What is a nursing priority when caring for a patient with COPD exhibiting signs of acute exacerbation?

Administer prescribed bronchodilators and corticosteroids, assess respiratory status continually, and monitor for hypoxemia. Education on breathing techniques, like pursed-lip breathing, can also assist in managing dyspnea.

A patient with pneumonia presents with high fever and productive cough. What nursing interventions should be prioritized?

Administer antibiotics as prescribed, provide antipyretics for fever, encourage fluid intake to thin secretions, and perform frequent respiratory assessments to monitor for changes or complications.

What dietary modifications should be recommended for patients with cystic fibrosis?

High-calorie diets rich in fat and protein should be emphasized. Patients often require pancreatic enzymes with meals to aid digestion due to pancreatic insufficiency.

What is the nursing intervention for managing a patient with pulmonary tuberculosis on medication therapy?

Ensure compliance by providing education about the importance of completing the full course of therapy, monitoring liver function tests due to potential hepatotoxicity from medications, and addressing the need for ongoing surveillance for drug resistance.

NCLEX-style scenario: A patient with a history of asthma presents to the ER with wheezing and shortness of breath after exposure to a pet. What is the first action the nurse should take?

The first action is to administer a rapid-acting bronchodilator, such as albuterol, as it will provide quick relief of bronchoconstriction.

What are the hallmark signs of cor pulmonale in a patient with COPD?

Signs include peripheral edema, distended neck veins, and chest pain, often leading to fluid overload symptoms. Reminder: look for JVD (Jugular Venous Distention) as a quick assessment cue.

How should a nurse educate a patient about proper inhaler technique to enhance medication delivery?

Instruct the patient to shake the inhaler well, breathe out fully, seal lips around the mouthpiece, and inhale slowly while pressing down on the inhaler to release the medication, followed by breath retention for 10 seconds.

What lifestyle modifications can help manage asthma symptoms?

Regular exercise, maintaining a healthy weight, and avoiding smoking can significantly improve asthma control.

What is the role of a spacer in asthma management?

A spacer helps increase medication delivery to the lungs when using an inhaler, especially in children or those who have difficulty coordinating inhalation and activation.

What is the significance of asthma action plans?

Asthma action plans provide patients with guidance on daily management and how to respond to worsening symptoms or attacks.

What are some common side effects of long-term systemic corticosteroids in asthma patients?

Potential side effects include weight gain, osteoporosis, diabetes, and increased risk of infections.

What is the importance of regular follow-up appointments for asthma patients?

Regular follow-up allows for monitoring of asthma control, medication adjustments, and education on managing triggers.

What is a key indicator for asthma control?

A key indicator is maintaining a peak expiratory flow rate (PEFR) of at least 80% of the patient's personal best.

Why is it important for asthma patients to recognize early signs of an attack?

Early recognition allows for prompt management, which can prevent a full-blown asthma attack and the need for emergency treatment.