Lower Airway Disorders and Chloride Imbalances

Comprehensive vocabulary flashcards covering chloride electrolyte imbalances, lower airway disorders (asthma, COPD, cystic fibrosis), diagnostic testing, medication administration, and nursing interventions.

Normal Serum Chloride

The normal reference range for serum chloride is $97-107\,\text{mEq/L}$. Chloride is a salt that closely mimics sodium levels and functions in fluid and electrolyte balance.

Hypochloremia

A serum chloride level below $97\,\text{mEq/L}$, caused by vomiting, burns, chronic respiratory acidosis, nasogastric suctioning, metabolic alkalosis, Addison's disease (adrenal cortex insufficiency), hyponatremia, or IV fluids low in chloride (such as $D_5W$) or high in bicarbonate.

Hypochloremia Distinctive S/S

Clinical manifestations include irritability, hypotension, twitching, tetany, shallow respirations, hyperexcitability of muscles and nerves, decreased BP, seizures, coma, and fever (which differentiates it from hyponatremia).

Hyperchloremia

A serum chloride level above $107\,\text{mEq/L}$, caused by excessive chloride infusion relative to sodium, or bicarbonate loss through GI and renal systems combined with $0.9\%\,\text{NaCl}$, $0.45\%\,\text{NaCl}$, or Lactated Ringer's (LR) solution.

Kussmaul's Respirations

Deep, rapid, labored respirations that occur to blow off excess $\text{CO}_2$ to compensate for metabolic acidosis, observed in conditions such as severe hyperchloremia and diabetic ketoacidosis.

Hyperchloremia Management

Interventions include administering hypotonic IV solutions (such as $0.45\%\,\text{NaCl}$) to replace fluid losses, sodium bicarbonate infusions to promote urinary chloride excretion, fluid restriction of sodium/chloride, and diuretics.

Asthma

A chronic lower airway disorder with acute exacerbations characterized by airway inflammation and bronchoconstriction (tightening of smooth muscles) that affects the bronchial airways while sparing the alveoli.

Asthma Live Flu Vaccine Precaution

The live attenuated influenza vaccine is strictly contraindicated in patients diagnosed with asthma due to the risk of precipitating severe bronchospasm or exacerbations.

Inability to Speak in Full Sentences

The classic clinical sign indicating severe dyspnea, exhaustion, and critically compromised respiratory effort during an acute asthma exacerbation.

Inspiratory Wheezing

An adventitious lung sound heard on inspiration that indicates worsening airflow limitation and intensifying respiratory distress in an asthmatic patient, whereas expiratory wheezing is expected.

Absent Breath Sounds (Silent Chest)

A critical finding indicating that no air is moving through the airways; this constitutes a medical emergency signaling imminent respiratory failure and the potential need for mechanical ventilation.

Status Asthmaticus

A life-threatening medical emergency where a severe asthma attack is unresponsive to initial treatment; characterized by wheezing on both inhalation and exhalation, and excessive accessory muscle use that can lead to respiratory muscle fatigue and cardiac arrest.

Pursed Lip Breathing

A controlled breathing technique performed by inhaling slowly through the nose for $2\,\text{counts}$ and exhaling through pursed lips for $4\,\text{counts}$ to prolong exhalation and prevent airway collapse.

Short-Acting Beta2-Adrenergic Agonists (SABAs)

Rescue inhalers, such as Albuterol, that provide rapid bronchodilation during acute bronchospasm; expected side effects include tachycardia, nausea, headache, and feeling jittery.

Long-Acting Beta2-Adrenergic Agonists (LABAs)

Maintenance medications taken daily to sustain bronchodilation over time; they are never to be used as rescue inhalers during an acute asthma attack.

Inhaled Anticholinergics

Maintenance bronchodilators—such as Ipratropium bromide (Atrovent) and Tiotropium bromide (Spiriva)—that relax large airway smooth muscles to improve airflow over time.

AeroChamber Spacer

A chamber attachment for a metered-dose inhaler (MDI) that optimizes drug delivery into the lungs; patients should hold their breath for about $10\,\text{seconds}$ after inhaling, and a whistling sound indicates they are breathing in too quickly.

Forced Expiratory Volume in 1 Second ($\text{FEV}_1$)

A pulmonary function test measuring the volume of air forcefully exhaled in the first second of expiration; the value is compared against predicted values for a healthy individual based on age and gender.

Peak Expiratory Flow (PEF) Meter Routine

A home monitoring test where the patient takes a deep breath, forms a tight seal around the mouthpiece, blows a fast hard blast $3\,\text{times}$, and records the highest rating (never the average) to guide their asthma action plan.

Emphysema

A form of COPD characterized by destruction and loss of elasticity of the alveoli; manifestations ('Pink Puffer') include a reddish complexion, puffing respirations, a barrel chest, and a thin body habitus.

Chronic Bronchitis

A form of COPD characterized by a chronic hyper-inflammatory response, bronchial wall thickening, airway obstruction, and copious tenacious sputum; manifestations ('Blue Bloater') include obesity, hypoxemia, cyanosis, and a persistent productive cough.

Early Signs of Hypoxia

Clinical indications of initial oxygen deficit, including tachycardia, tachypnea, hypertension, accessory muscle use, restlessness, and pale skin.

Late Signs of Hypoxia

Clinical indications of prolonged, severe oxygen deprivation, including bradycardia, shallow respirations, confusion, cyanosis, hypotension, cardiac dysrhythmias, and digital clubbing.

Hypoxic Drive

The physiological mechanism in chronic COPD where breathing is stimulated by low arterial oxygen levels (hypoxemia) rather than high carbon dioxide levels (hypercapnia); administering excessive oxygen can blunt this drive and cause hypoventilation or respiratory arrest.

Venturi Mask

An oxygen mask designed to deliver precise, accurate concentrations of inspired oxygen up to $40\%$, making it optimal for COPD patients who are vulnerable to oxygen toxicity.

BiPAP (Bilevel Positive Airway Pressure)

A noninvasive ventilation modality providing two preset pressure levels: a higher positive pressure during inspiration and a lower pressure during expiration, promoting enhanced oxygenation and ventilation.

Tripod Positioning

A compensatory physical posture where a patient sits or stands leaning forward with hands resting on their knees or a table to maximize thoracic expansion and ease the work of breathing.

First-Line Smoking Cessation Pharmacotherapy

The primary pharmacological options recommended for smoking cessation, consisting of Nicotine patches, Bupropion, and Varenicline (with Clonidine utilized as a second-line agent).

Cystic Fibrosis

An inherited autosomal recessive genetic disease of exocrine glands causing disrupted transport of chloride ions, sodium ions, and water, leading to abnormally thick, viscous mucus that obstructs the lungs, pancreas, and gastrointestinal tract.

Steatorrhea

Foul-smelling, bulky, greasy stools resulting from pancreatic duct obstruction by thick mucus, which hinders the release of pancreatic digestive enzymes and impairs nutrient and fat absorption in cystic fibrosis.

Sweat Chloride Test

The definitive diagnostic test for cystic fibrosis that evaluates exocrine dysfunction by measuring the concentration of chloride excreted in the patient's sweat.

CFTR Modulators

Medications that target specific molecular defects caused by mutations in the CFTR gene to correct the malfunctioning CFTR protein, improving ion transport without altering the gene itself.

Chest Physiotherapy (CPT)

An airway clearance technique combining postural drainage, percussion (clapping), vibration, and huff coughing to loosen secretions; scheduled $1\,\text{hour}$ before meals or $3\,\text{hours}$ after meals, and never performed over buttons or zippers.

Lung Cancer Palliative Care Timing

Supportive and palliative care initiated immediately upon diagnosis of lung cancer to address pain, dyspnea, and disease management, reflecting the poor overall prognosis of the disease.