NURS-332: Management of Care 2 (Exam 2)

What structures make up the upper respiratory tract?

The nasopharynx/nose, oropharynx/mouth, and larynx

What structures make up the lower respiratory tract?

The trachea, bronchi, bronchioles, and alveoli

Where does gas exchange primarily occur in the body?

In the alveoli of the lungs

What are common upper airway disorders?

Rhinitis, rhinosinusitis, pharyngitis, and laryngitis

Non-allergic rhinitis is commonly referred to as…

A cold

What is pharyngitis?

Inflammation of the pharynx or throat

What is laryngitis?

Inflammation of the larynx or voice box

What is the primary nursing focus for viral pharyngitis?

Symptom management

True or False: Fluid restriction and voice rest are necessary for viral pharyngitis.

False

What is the priority goal of care for upper airway infections?

Maintenance of a patent airway

What additional nursing goals are important in upper airway infections?

Pain relief, hydration, effective communication, prevention education, and absence of complications

True or False: Prophylactic antibiotics are the most important measure for preventing the spread of upper respiratory infections.

False

Why are prophylactic antibiotics not routinely used for upper respiratory infection prevention?

Most URIs are viral in origin

What pathophysiologic changes occur in asthma?

Airflow limitation, airway hyperresponsiveness, edema, and mucus hypersecretion

Which inflammatory cells are involved in asthma?

Mast cells, neutrophils, eosinophils, and lymphocytes

What major risk factor is linked to asthma?

Tobacco smoke exposure

Where is asthma more prevalent?

Developed countries

What are common manifestations of asthma?

Cough, dyspnea, and wheezing

How is asthma diagnosed?

Through history, physical examination, and spirometry

What are nursing care goals for asthma?

Symptom control, pulmonary function maintenance, prevention of exacerbations, optimal pharmacotherapy, and patient education

What medications are used for immediate asthma symptom relief?

Quick-relief medications

What medications maintain long-term asthma control?

Long-acting medications

What complications can occur with asthma exacerbations?

Status asthmaticus and respiratory failure

What is the nursing focus during an asthma exacerbation?

Maintaining airway/breathing and preventing complications

What devices are commonly used for breathing treatments?

Nebulizers and inhalers with spacers

Why are spacers used with inhalers?

To improve medication delivery into the lungs

What should asthma education include?

Trigger avoidance, medication compliance, inhaler technique, and symptom monitoring

What assessment findings are expected in asthma exacerbation?

Wheezing, dyspnea, chest tightness, tachypnea, and accessory muscle use

What is status asthmaticus?

A life-threatening episode of severe acute asthma

Why is status asthmaticus considered an emergency?

It can lead to ventilatory failure or death

What manifestations occur in status asthmaticus?

Extreme shortness of breath, chest tightness, confusion, and cyanosis

How can status asthmaticus affect psychosocial health?

It can cause stress and depression

Why may asthma be overlooked in older adults?

Dyspnea is often attributed to aging or other comorbidities

What medications are commonly administered for status asthmaticus?

Albuterol and corticosteroids

What indicates improvement after initial treatment of status asthmaticus?

Visible improvement in respiratory status

What may be required if status asthmaticus treatment fails?

Hospitalization and possible ventilator support

What causes airway obstruction in obstructive sleep apnea?

Nasopharyngeal tissue contraction

What is the greatest risk factor for obstructive sleep apnea?

Obesity

Which sex is obstructive sleep apnea more common in?

Males

What cardiovascular complications are associated with obstructive sleep apnea?

Hypertension, arrhythmias, heart failure, and stroke

Why are motor vehicle accidents common in patients with obstructive sleep apnea?

Daytime drowsiness

Why may obstructive sleep apnea be missed in older adults?

Sleepiness in often mistaken for normal aging

What are common manifestations of obstructive sleep apnea?

Snoring, apnea lasting 10 seconds or longer, and daytime sleepiness

What diagnostic test confirms obstructive sleep apnea?

Polysomnography (sleep study)

What patient education is important for obstructive sleep apnea?

CPAP compliance and avoidance of smoking, alcohol, and sedatives

What medications require caution in patients with obstructive sleep apnea?

Medications that cause sleepiness

What conditions commonly use positive airway pressure (PAP) therapy?

OSA, pneumonia, COPD, and atelectasis prevention

How is positive airway pressure (PAP) therapy delivered?

Through a mask or nasal pillows

What should nurses monitor with positive airway pressure (PAP) therapy?

Respiratory status, tolerance, oxygenation, and skin integrity

What is the difference between CPAP and BiPAP?

CPAP delivers one continuous pressure; BiPAP delivers different pressures during inhalation and exhalation

Which NIPPV is more commonly used at home?

CPAP

Which NIPPV is commonly used in hospitals?

BiPAP

What is AVAPS?

An NIPPV mode that uses pressure and volume settings to achieve a target tidal volume

An obese patient with daytime sleepiness and loud snoring likely has what disorder?

Obstructive sleep apnea

Why is obesity strongly linked to obstructive sleep apnea?

Excess tissue contributes to airway obstruction during sleep

What is the normal pH range on ABGs?

7.35-7.45

What is the normal PaCO₂ range?

35-45 mmHg

What is the normal HCO₃ range?

22-26 mEq/L

What is the normal PaO₂ range?

80-100 mmHg

What is the normal oxygen saturation range?

95-100%

What causes respiratory alkalosis?

Excessive loss of CO₂ from hyperventilation

What are common causes of respiratory alkalosis?

Anxiety, pain, rapid breathing, and hyperventilation

What causes respiratory acidosis?

Inability to remove enough carbon dioxide

What conditions can lead to respiratory acidosis?

COPD, asthma, scoliosis, obesity, OSA, and narcotic use

In respiratory disorders, how do pH and CO₂ relate?

Opposite directions

In metabolic disorders, how do pH and HCO₃ relate?

Same direction

What does ROME stand for in ABG interpretation?

Respiratory Opposite, Metabolic Equal

What imbalance is present with the following lab values: pH 7.21, CO₂ 67, HCO₃ 22?

Respiratory acidosis

What imbalance is present with the following lab values: pH 7.49, CO₂ 18, HCO₃ 24?

Respiratory alkalosis

What diseases are included in COPD?

Chronic bronchitis and emphysema

What is the leading cause of COPD?

Cigarette smoke exposure

What occupational risk can contribute to COPD?

Chronic irritant exposure

What characterizes chronic bronchitis?

Productive cough for at least 3 months over 2 consecutive years

What characterizes emphysema?

Destruction and enlargement of alveoli

What complications are common in COPD?

Pneumonia and respiratory failure

What assessment findings in a COPD patient indicate possible respiratory failure?

Somnolence, shallow breathing, decreased responsiveness, and low respiratory rate

How does COPD affect activity levels?

It decreases physical activity and health status

What are common COPD manifestations?

Dyspnea, chronic productive cough, wheezing, chest tightness, barrel chest, and weight loss

What diagnostic test is used for COPD?

Spirometry

What spirometry findings indicate COPD?

FEV1 less than 80% and FEV1/FVC ratio less than 70%

What patient education topics are important in COPD?

Energy conservation, medications, breathing techniques, and self-management

Why are corticosteroids prescribed for COPD?

For long-term symptom control and reducing exacerbations

True or False: Corticosteroids are not normally used as emergency bronchodilators.

True

Why is bronchoscopy performed?

To obtain biopsies, remove foreign bodies/secretions, and diagnose lung disease

What pre-op care is required before bronchoscopy?

Informed consent and NPO for at least 8 hours

What post-op priority is essential after bronchoscopy?

Keep patient NPO until cough reflex returns

What is atelectasis?

Collapse of alveoli causing decreased gas exchange

What are risk factors for atelectasis?

Post-op status, pain, opioids, and lung disease

What are manifestations of atelectasis?

Decreased breath sounds, fever, increased WBC count, and sputum

How is atelectasis managed?

Incentive spirometry, nebulizers, and chest physiotherapy

What causes pneumonia?

Bacterial or viral lung infection

What populations are at increased risk for pneumonia?

Older adults and patients with chronic lung disease

What are the major types of pneumonia?

Community-acquired, hospital-acquired, and healthcare-associated pneumonia

What diagnostics are used for pneumonia?

Chest x-ray, sputum culture, urine specimen, and blood cultures

What supportive care is provided for pneumonia?

Oxygen, hydration, nutrition, and anxiety reduction

What prevention measures reduce pneumonia risk?

Immunizations and smoking cessation

Why are older adults at greater risk for pneumonia complications?

Increased hospitalization risk and incidence

What findings indicate pneumonia is resolving?

Improved breath sounds, decreased fever, improved oxygenation, less sputum, and improved chest x-ray findings

What are advantages of a nasal cannula?

It is safe, simple, inexpensive, comfortable, allows eating/drinking, decreases claustrophobia, and avoids CO₂ rebreathing

What oxygen concentration can a nasal cannula deliver?

Approximately 24-44% oxygen