Exam #3 - NRSG 2300 - Unit 5 & 6

Infectious agent, reservoirs, portal of exit, means of transmission, portal of entry, and susceptible host These are all part of what?

chain of infection

Specific defenses --- Anatomical and physiological barriers Intact skin Nasal passages Each body orifice has its own defenses What is this?

chain of infection

What is this? •A complete chain is necessary for infection to occur •Susceptible host •Causative organism •A reservoir of available organisms •A portal of exit from the reservoir •A mode of transmission from the reservoir to the host •Mode of entry into a susceptible host

chain of infection

drugs, including aspirin, ibuprofen, beta blockers, sulfite preservatives, foods and condiments, nuts, monosodium glutamate (MSG), shellfish, and dairy products. These are all _____ and ____ that can contribute to asthma?

chemicals and food

Asthma in _____ •Frightening for child, parents •Educate family on how, when, why to give children medication •Written asthma action plan for parents, caregivers, teachers •Educate family on dangers of secondhand smoke

children

Indications for admission to hospital : Infant or children? Oxygen stat below 92%, cyanosis RR greater 50 breaths/min, difficulty breathing, grunting, signs of dehydration, family not able to provide, appropriate observation or supervision

children

Mild pneumonia Infant of older children temp over 38.5 C, RR over 50 breaths / min, mild breathlessness, no vomiting

children

Pneumonia Age Considerations _____ : in severe illness and rapid changes, children often suffer acute heart failure, respiratory failure and even toxic encephalopathy at the same time. / The inflammatory response was proactively controlled, to prevent suffocation and reduce mortality.

children

Infant/children Signs : - tachypnea - lower chest wall indrawing - stridor in a calm child Treatment : - refer uregently to hopsital for injectable ABOs / oxygen if needed - Give first dose of ABO What is this classified as

severe pneumonia

inflammation stages : •______ ___: exudate production •Serous •Purulent •Hemorrhagic

stage two

These are elements of _____ _______ •Hand hygiene •Use of gloves and other barriers •Proper handling of patient care equipment and linen •Environmental control •Prevention of injury from sharp devices and needles •Patient placement

standard precautions

Color of ____ should be : cherry red, bright pink, like here in picture

stoma

emotional stress, anxiety, exercise in dry, cold climates. This is ____, and can contribute to asthma.

stress

How to reduce a susceptible host :

- no smoking - avoiding alcohol - pneumonia and flu vaccination (flu yearly, pneumococcal) - healthy diet - exercise - sleep - no aging

When creating a discharge plan to manage the care of a client with COPD, the nurse will anticipate that the client will do which of the following? 1.Develop respiratory infections easily 2.Maintain current status 3.Require less supplemental oxygen 4.Show permanent improvement

1.Develop respiratory infections easily ● •At high risk for respiratory infections, slowly progressive so difficult to maintain current status / goal of less oxygen is unrealistic / treatment may slow progression of the disease, but permanent improvement is highly unlikely

A client with chronic obstructive pulmonary disease ( COPD) is experiencing dyspnea and has low PaO2 levels. The nurse plans to administer oxygen as ordered. Which of the following statements is true concerning oxygen administration to a client with COPD? 1.High oxygen concentrations will cause coughing and dyspnea 2.High oxygen concentrations may inhibit the hypoxic stimulus to breathe 3.Increased oxygen use will cause the client to become dependent on the oxygen Administration of oxygen is contraindicated in clients who are using bronchodilators

2.High oxygen concentrations may inhibit the hypoxic stimulus to breathe Clients who have a long history of COPD may retain carbon dioxide (CO2) . Gradually the body adjusts to the higher CO2 concentration and the high levels of CO2 no longer stimulate the respiratory center. The major respiratory stimulant then becomes hypoxemia. Administration of high concentrations of oxygen eliminates this respiratory stimulus and leads to hypoventilation. Give: O2 at 2L/min per nasal cannula/ Question orders higher than this.

A client has a history of chronic obstructive pulmonary disease (COPD). Following a coughing episode, the client reports sudden and unrelieved shortness of breath. Which of the following is the most important for the nurse to assess? A - Lung sounds B - Heart Rate C - Respiratory Rate D - Skin color

A - Lung sounds

Which of the following factors contribute to the underlying pathophysiology of chronic obstructive pulmonary disease (COPD)? Select all that apply. A - Mucus secretions block airways B - Overinflated alveoli impair gas exchange C - Dry airways obstruct airflow D - Inflames airways obstruct airflow

A - Mucus secretions block airways B - Overinflated alveoli impair gas exchange D - Inflamed airways obstruct airflow

Asthma Assessment Findings Low pitched sound continuous throughout inspiration = _____ large airway passages/(Rhonchi) ______ is high pitched (narrow smaller airways)

blocked wheezing

A patient comes to the clinic for the third time in 2 months with chronic bronchitis. What clinical symptoms does the nurse anticipate assessing for this patient? A - Sputum and a productive cough B - Fever, chills, and diaphoresis C - Chest pain during respiration D - Tachypnea and tachycardia

A - Sputum and a productive cough

Respiratory syncytial virus, other respiratory ciruses (parainfluenza viruses, influenza viruses, adenovirus), S. Pneumoniae, H influenza (type b, nontypable); if patient is afebrile, consider chlamydia trachomatis What age group is at risk for this?

3 week to 3 month

Which of the following physical assessment finds would the nurse expect to find in a client with advanced chronic obstructive pulmonary disease (COPD) ? 1.Underdeveloped neck muscles 2.Collapsed neck veins 3.Increased anterior to posterior chest diameter 4.Increased chest excursions with respirations

3- Increased anterior to posterior chest diameter (barrel chest)

Respiratory synctial cirus, othe respiraotry viruses (parainfluenza viruses, influenza viruses, adenoviru), S. pneumoniae, h influenzae (type b, nontypable, mycoplasma pneumnoia, group A streptococcus What age group is at risk for this?

4 months-4 year

Infection •Some medical therapies may predispose an individual to ______ •Radiation treatments •Medications such as antineoplastic medications •Disease that lowers the body's defenses

Infection

Prevalence of infectious - Healthcare Workers Change of a healthcare worker becoming infected from exposure to pathogens varies widely •30% hepatitis ___ •1.8% for hepatitis ___ •0.3% for ___

B C HIV

______ : 60-70% will require surgery Surgical cure is not possible with ______ disease 50% who require surgical intervention will eventually require additional future surgery Intestinal transplant: children / young & middle-aged adults who have lost intestinal function from disease May require ________ to relieve strictures

Crohns surgery

Both ____ and _____ ____ can have abdominal pain, weight loss, periods of remission, faitgue, peaks age 15-30 years, and both be at risk for dehydration

Crohns and ulcerative colitis

- Genetic predisposition - Environmental triggers (luminal bacteria, infection, NSAIDs, smoking) - Dysregulated mucosal immune response to commensal gut flora These are all etiologic theories in ______.

IBD

Aminosalicylates, corticosteroids, immunomodulators, antibiotics, and biologics these are all medications for what disease?

IBD

What step of the nursing process is this for COPD? Promote family coping •Assess interactions between client, family •Assess effect of illness on family •Help client, family identify strengths for coping •Provide information, teaching about COPD •Encourage expression of feeling •Help family recognize hindering behaviors •Encourage family to participate in care •Initiate conference involving client, family •Advocate for client if family dysfunction interferes •Refer to support groups as available •Arrange social services consultation •Refer to community agencies

Implementation

Need to ask and know.......Because HCAP is often difficult to treat, initial antibiotic treatment must not be delayed. Initial antibiotic treatment of HCAP is often different from that for CAP due to the possibility of ____ bacteria ___ is associated with a high mortality rate, in part because of the virulence of the organisms, the resistance to antibiotics, and the patient's underlying disorder. It is the most common cause of death among all patients with hospital-acquired infections, with mortality rates up to 33% ___ is a complication in as many as 28% of patient who require mechanical ventilation (Amanullah, 2015).

MDR HAP VAP

•Imaging: CXR ( chest X-ray) / ultrasonography •Sputum & blood cultures •Pulse oximetry / ABG •Thoracentesis if pleural effusion present •Bronchoscopy •Routine lab testing - CBC, BMP, LFTs •Physical Exam These are diagnostic tests for what ?

Pnemonia

Daily medications for asthma SABA= ICS= LABA= LTRA=

SABA=inhaled short acting bets-agonist ICS= inhaled corticosteroid LABA= inhaled long-acting bets-agonist LTRA= Leukotriene receptor antagonist

Is there a link between gum disease, heart disease, and stroke. T or F

True

Asthma Enhance _______ pattern •Monitor vital signs and laboratory results •Assist with ADLs as needed •Provide rest periods •Administer medications •Frequently assess respiratory rate, pattern, and breath sounds

breathing

Asthma Lung Sounds: ____ is reduced & breath sounds inaudible/ or severely decreased/ ineffective cough = immediate help/ intervention is needed

Wheeze

- tobacco smoke, ozone, nitrous and sulfur oxides, fumes from cleaning fluids or solvents, burning leaves. These are all _____ pollutants that can contribute to asthma.

air

•Smoking cessation •Avoid exposure to other airway irritants, allergens •Pulmonary hygiene measures •Exercise •Hydration •Humidifiers _________ and _________ - Dietary measures - Acupuncture - Hypnotherapy These are all interventions for what disease?

complementary and alternative COPD

Infection ____ and _____ considerations •Several differences in anatomy, physiology influence effects of inflammation in adults versus children •Structural differences in airway •Fewer and smaller lung alveoli •Glomerular filtration not fully developed •Absolute volumes of fluid loss represents a larger proportion of total body fluid •Changes in the state of the heart reduce the sympathetic nervous system response to changes in blood volume and stress •Gastrointestinal inflammation •Immune response to insult differs significantly

genetic and lifespan

Inflammation means what

itis

Infection Localized or systemic Redness, swelling, painful or tender warm to touch

localized

Genetic and Lifespan Considerations - Infections _____ adults •Have reduced defenses •Physiological changes •Cardiovascular changes •Respiratory system changes •Genitourinary changes •Gastrointestinal changes •Skin, subcutaneous tissue changes •Immune changes Aging process •Thymus gland atrophies •Antibody responses decline •Reduced resistance to antigens •Classic signs of infection may be absent

older

Disease monitoring for Asthma PEFR What does this stand for?

peak expiratory flow reading

Inflammation stages : •______ ____: reparative phase •Regeneration •Fibrous tissue formation -----Granulation tissue

stage three

_____ _____ : 30-40% will require surgery: Proctocolectomy, which is removal of the rectum and colon, the surgery cures the disease

ulcerative colitis

_____ ______ 2x's more common •Diarrhea and bloody stools/ may have mucus •Colon ulceration and bleeding / perforation possible •Colon mainly progresses from rectum •Pain in lower left side

ulcerative colitis

______ _______ Higher incidence than CD •More commonly seen in North America and Europe

ulcerative colitis

________ - chronic inflammatory disease •Recurrent episodes ---Wheezing ---Breathlessness ---Chest tightness ---Coughing •Most _____ attacks require treatment •_____ in early life may lead to airway remodeling •Affects 25 million Americans

asthma

Symptoms of ______ infection •Fever •Increased pulse •Malaise and loss of energy •Loss of appetite and, in some situations, nausea and vomiting •Enlargement or tenderness of lymph nodes that drain area of infection

systemic

Pneumonia complications may include? Check all that apply A.Bacteria in your bloodstream B.Septic Shock C.Fluid Accumulation and infection around your lungs D.Lung abscess E.Acute Respiratory Distress Syndrome (ARDS)

A, B, C, D, E

Which of the following is the most common chronic disease of childhood? A - Obesity B - Asthma C - Cerebral palsy D - Autism

B - Asthma

When planning care for a patient with ulcerative colitis who is experiencing an exacerbation of symptoms, which client care activities can the nurse appropriately delegate to an unlicensed assistant? Select all that apply: A.Assessing the clients bowel movements B.Providing skin care following bowel movements C.Evaluating the clients response to antidiarrheal medications D.Maintaining intake and output records E.Obtaining the clients weight

B, D, E Assessing and evaluating can NOT be delegated WHY are each of these activities important in the care of this client?

- specific progressive disorder •Slowly alters structures of respiratory system over time •Irreversibly affects lung function •Periodic exacerbations with increased symptoms of dyspnea and sputum production •Not curable, but can be managed •Typically includes components of bronchitis and emphysema What is this?

COPD

Which of the following is used to diagnose pneumonia? A.MRI B.Chest X-ray C.Blood tests D.Brain CT scan

B.Chest X-ray

Which would be least likely to contribute to a case of hospital-acquired pneumonia? A - A highly virulent organism is present B - Inoculum or organisms reaches the lower respiratory tract and overwhelms the hosts defenses C - A nurse washes her hands before beginning client care D - Host defenses are impaired

C - A nurse washes her hands before beginning client care

What are precautions & teaching will you take with a person with pneumonia? A.Advise patient against smoking B.Advise patient against drinking water C.Droplet precaution D.Both A and C

D.Both A and C

•Acute bacterial infections and also some infections caused by viruses & fungi •Inflammation (IBD, RA, Burns, heart attack, kidney failure, burns, smoking, hereditary What is this? Neutrophilia or neutropenia

Neutrophilia - increased neutrophils

The prolonged nature of the disease has an impact on the patient and often strains their family life and financial resources. Family support is vital; however, some family members may be resentful or feel guilty, tired, or unable to cope with the emotional demands of the illness and the physical demands of providing care. Some patients with ___ do not socialize for fear of being embarrassed. Because they have lost control over elimination, they may fear losing control over other aspects of their lives. They need time to express their fears and frustrations. Individual and family counseling may be helpful.

IBD

These are all treatment goals of what disease? •Induce Clinical Remission /Induce "deep" remission •Maintain steroid-free remission/ Biologic remission •Mucosal healing •Suppressing inappropriate immune responses •Avoid short- and long-term toxicity of treatment •Reducing inflammation •Providing rest/diseased bowel-healing •Improving quality of life •Preventing or minimizing complications/ reduce cancer risk

IBD

These are nursing diagnosis for what disease? •Diarrhea •Acute pain •Deficient fluid volume •Imbalanced nutrition •Activity intolerance •Anxiety •Ineffective coping •Risk for impaired skin integrity •Deficient knowledge

IBD

This is a nursing assessment for what issue? •Family History •Stool frequency / consistency / type/ aggravated by •Abdominal pain/ location •History of GI infections / inflammation •Other auto-immune diseases •Smoking •Abdomen assessment

IBD

___ •Estimated:-1-1.3 million / prevalence •Physician Visits over 700,000 a year •Hospitalization 100,000 a year •Cost: 4 billion a year

IBD

•Attains optimal nutrition; tolerates small, frequent feedings without diarrhea •Avoids fatigue/ Rests periodically during the day •Adheres to activity restrictions •Is less anxious •Reports a decrease in the frequency of diarrheal stools •Adheres to dietary restrictions •Maintains bed rest •Takes medications as prescribed •Has reduced pain •Maintains fluid volume balance •Drinks 1 to 2 L of oral fluids daily •Has normal body temperature •Displays adequate skin turgor and moist mucous membranes These are Nursing : Planning/Evaluation for what disease?

IBD

•Fluids: Oral fluids / fluid & electrolyte imbalances from dehydration & diarrhea =IV therapy •Parental nutrition •Low-residue, high-protein, high-calorie diet -----Avoid foods that exacerbate diarrhea -----Avoid cold food & smoking ( increase intestinal motility ) •Supplemental vitamin therapy •Supplemental iron replacement • Control Pain These are treatment options for what?

IBD

Other risk factors for ___ include being Caucasian, of Ashkenazi Jewish background, living in a northern climate, and living in an urban area (CDC, 2015a). ____ are at a slightly higher risk for ulcerative colitis (NIDDK, 2014f); whereas, _____ are at greater risk for Crohn's disease

IBD men women

______ ____ ____ Most patients have long periods of well-being interspersed with short intervals of illness. Management depends on the disease location, severity, and complications (Harris & Jelemensky, 2014; Smith & Harris, 2014; Walfish, 2016). Treatment paradigms and therapeutic options for ___ have evolved rapidly over the past decade, with the availability of several new biologics, an increased emphasis on dual therapy to reduce immunogenicity, improve efficacy and preserve durability, emerging use of therapeutic drug monitoring to optimize response and guide management of loss of response, and increased emphasis on mucosal healing as an important treatment goal as it correlates with surgical-free outcomes with minimal intestinal damage and patient disability.

Irritable bowel disease

Group B streptococcu, escherichia coli, other gram negative bacilli, steptococcus pneumoniae, haemophilus influenzae (type b, nontypable) What age group is at risk for this?

Neonates <3 weeks

•viral infections •certain viral infections tend to reduce the neutrophil count (hepatitis (B), influenza, rubella, rubeola, and mumps •Severe, overwhelming infection (sepsis:-neutrophils are used up) / chronic infections •Reaction to drugs (e.g., penicillin, ibuprofen, phenytoin, etc.) •Autoimmune disorder •Chemotherapy = Aplastic anemia What is this?

Neutropenia - decreased neutrophils

individuals may have traits that affect their susceptibility and severity of disease Examples : immune deficiency, diabetes, burns, surgery, age This is what in the chain of infections?

Susceptible host

T or F Pneumonia disproportionately affects the young, the elderly, and the immunocompromised. It preys on weakness and vulnerability.

T

The incidence of ____ increases with the duration of mechanical ventilation. The estimated rates are _% per day for the first 5 days, _% per day for days 6 through 10, and _% per day thereafter (Amanullah, 2015). The crude mortality for VAP is 27% to 76%, with an estimated attributable mortality rate of 8% to 15% The etiologic bacteriologic agents associated with VAP typically differ based on the timing of the occurrence of the infection relative to the start of mechanical ventilation. VAP occurring within 96 hours of the onset of mechanical ventilation is usually due to antibiotic-sensitive bacteria that colonize the patient prior to hospital admission, whereas VAP developing after 96 hours of ventilatory support is more often associated with MDR bacteria.

VAP 3 2 1

COPD Promote _________ nutrition •Assess nutritional status •Observe, document food intake •Monitor lab values •Consult with dietitian •Provide frequent, small feedings, snacks •Client in seated or high-Fowler for meals •Assist to choose preferred foods •Snacks at the bedside •Mouth care before meals •Consult with physician if intake poor

balanced

Ulcerative colitis •_____ incidence pattern •Onset 15-30 years or older than 60 years of age / at greater risk •Genetic factors: Family history very important •5-15% in first degree relative •______ Jews have 3-5x higher risk

bimodal ashkenazi

IBD .MONITORING AND MANAGING POTENTIAL ______: Serum electrolyte levels are monitored daily, and electrolyte replacements are given as prescribed. Evidence of dysrhythmias or changes in level of consciousness must be reported immediately.The nurse closely monitors rectal bleeding and administers blood component therapy and volume expanders as prescribed to prevent hypovolemia. It is important to monitor the blood pressure for hypotension and to obtain coagulation profiles and hemoglobin and hematocrit levels frequently. Vitamin K may be prescribed to increase clotting factors.The nurse closely monitors the patient for indications of perforation (i.e., acute increase in abdominal pain, rigid abdomen, vomiting, or hypotension) and obstruction and toxic megacolon (i.e., abdominal distention, decreased or absent bowel sounds, change in mental status, fever, tachycardia, hypotension, dehydration, and electrolyte imbalances).

complications

________ precautions •Use for organisms spread by skin-to-skin contact, such as antibiotic-resistant organisms or Clostridium difficile •Use of barriers to prevent transmission •Emphasize cautious technique because organisms are easily transmitted by contact between the health care worker and the patient •Masks not needed

contact

______ : 11 yrs 2-3yrs for exercise

flossing

Asthma Assessment _____ wheezing and the use of accessory muscles when inhaling indicate a progression of the severity of the symptoms, but airflow is still occurring; therefore, they do not require the most urgent action.

diffuse

•______ precautions •Used for organisms transmitted by close contact with respiratory or pharyngeal secretions: influenza, meningococcus •Wear a face mask but door may remain open; transmission is limited to close contact

droplet

Asthma To help promote airway clearance place the client in _____ position to facilitate breathing and lung expansion,. Providing adequate rest periods prevents fatigue and reduces oxygen demands. Reducing excessive stimuli promotes rest. Assisting with activities of daily living conserves energy and reduces oxygen demands.

fowler

Infection can be : _______, _______, or _______

generalized, localized, systemic

What step of the nursing process is this for COPD? Encourage smoking cessation •Assess client's knowledge, understanding of choices •Acknowledge concerns, values, beliefs •Spend time with client •Encourage expression of feelings •Help plan course of action with client •Demonstrate respect for decisions •Provide referrals as needed

implementation

Blood work for Infection: •WBC (White Blood Count) •WBC with differential / low neutrophils = neutropenia(autoimmune, CA in bone marrow, severe infection/ high neutrophils = neutrophilia (inflammation, infection, physiological stress) more on next slide •_________ : elevated white blood cell count (WBC) above normal greater then (10,000mm) •In the presence of an infection, additional WBC's are released from the bone marrow and as WBC's move out of the bone marrow into the blood, the bone marrow increases its production of additional leukocytes leading to leukocytosis. •Differential: Can help identify specifics: immune issue, bone etc.

leukocytosis

IBD _______ FLUID INTAKE: o detect fluid volume deficit, the nurse keeps an accurate record of I&O. The nurse monitors daily weights for fluid gains or losses and assesses the patient for signs of fluid volume deficit (i.e., dry skin and mucous membranes, decreased skin turgor, oliguria, fatigue, decreased temperature, increased hematocrit, elevated urine specific gravity, and hypotension). It is important to encourage oral intake of fluids and to monitor the flow rate of any IV fluids. The nurse initiates measures to decrease diarrhea (e.g., dietary restrictions, stress reduction, antidiarrheal agents).

maintaining

Infection - direct contact, ingestion, fomites, airborne What are these

means of transmission

•Four categories of _________ Bacteria : Most commonly cause infection Viruses : Nucleic acid, must enter living cells Fungi : Yeasts, molds Parasites : Protozoa, helminths, arthropods

microorganisms

•________ invade human body and proliferate when they are undetected, uncontrolled, or not eliminated by the inflammatory and immune responses

microorganisms

Ways in which the infectious agent is spread from the reservoirs to the susceptible host Examples : physical, contact, droplets, airborne This is what in the chain of infection?

modes of transmission

Changes : Increase in residual lung volume; decrease in muscle strength, endurance, and vital capacity; decreased gas exchange and diffusing capacity; decreased cough efficiency Signs and symptoms : Fatigue and breathlessness with sustained activity; decreased respiratory excursion and chest/lung expansion with less effective exhalation; difficulty coughing up secretions Health promotion : Exercise regularly; avoid smoking; take adequate fluids to liquefy secretions; receive yearly influenza immunization and pneumonia vaccine at 65 years of age; avoid exposure to upper respiratory tract infections. These are ____ physiological changes in the elderly

normal

Infants / children : Tachypnea is the most sensitive and specific signs of _______ in children pneumonia

pneumonia

Infection - mucous membrane, gi tract, gu tract, respiratory tract, broken skin. What are these

portal of entry

IBD ______ PAIN; The character of the pain is described as dull, burning, or crampy. It is important to ask about its onset. Does it occur before or after meals, during the night, or before elimination? Is the pattern constant or intermittent? Is it relieved with medications? The nurse administers analgesic agents as prescribed for pain. Position changes, local application of heat (as prescribed), diversional activities, and prevention of fatigue also are helpful for reducing pain.

relieving

Infection people, equipment, water. What are these?

reservoirs

Place in which infectious agents live, grow and reproduce Example : people, water, food This is what in the chain of infection?

reservoirs

Bacterial, fungal, and viral. These are _______ infections that can cause asthma.

respiratory

__________-speaking client who smoke and are diagnosed with COPD requires information regarding smoking cessation. For clients who do not speak English, it is appropriate for the nurse to obtain written education material for the client in the client's native language, Spanish. Relatives should not be used as a medical interpreter due to the need for knowledge of medical terminology.

spanish

Asthma If using ______, it will require therapeutic blood levels to be drawn, severe side effects if to much. Avoid: Herbal preparations that include atropa belladonna (the natural form of atropine) or ephedra (also called ma huang), an herb that contains ephedrine, should not be used, as they can interact with prescribed medications,

theophylline

Prevention/Vaccination / CDC - Pneumonia •CDC recommends: •___ pneumococcal vaccines for adults 65 years or older. •Get a dose of the pneumococcal conjugate vaccine (PCV__) first. Then get a dose of the pneumococcal polysaccharide vaccine (PPSV__) at least 1 year later. •If you've already received PPSV23, get PCV13 at least 1 year after receipt of the most recent PPSV23 dose. •If you've already received a dose of PCV13 at a younger age, does not recommend another dose. •Infants and children younger than 2 years of age •series of four doses of Prevnar 13 given at 2 months, 4 months, 6 months, and sometime between 12 and 15 months of age.

two 13 23

Chrons or ulcerative colitis Course : exacerbations, remissions Bleeding : common-severe Perianal involvement : rare-mild Fistulas : rare diarrhea : severe What is this?

ulcerative colitis

•______ _____ patients at increased risk of colorectal cancer •___% after 10 years, ____% after 20 years and _____% after 30 years •Following initial _____, subsequent screening depends on extent of disease •Risk factors for colorectal cancer: •Duration and extent of disease •Endoscopic and histologic severity of inflammation Regular screen for active infection : tuberculosis, infections hepatitis, CMV, HIV and C. difficile

ulcerative colitis two eight eighteen colonoscopy

Ulcerative colitis or crohns Therapeutic management : corticosteroids, aminosalicylates, sulfasalazine useful in preventing proctocolectomy, with ileostomy rectum can be preserved in only a few patients cured by colectomy

ulcerative colitits

A type of HAP that develops greater than or equal to 48 hours after endotracheal tube intubation. What is this?

ventilator associate pneumonia (VAP)

Give PCV__ to infants as a series of 4 doses, one dose at each of these ages: 2 months, 4 months, 6 months, and 12 through 15 months. Age 65: PPSV23 Influenza : yearly

13

A mother brings her 4 month old infant to the walk in clinic and reports the infant has a bad cold and is having trouble breathing. And "she is not acting her self". Which of the following nursing actions should the nurse do first? 1.Check the infant's heart rate 2.Weigh the infant 3.Assess the infant's oxygen saturation 4.Obtain more information from the father

3.Assess the infant's oxygen saturation

Attack prolonged by late-phase response •_-__ hours after exposure to trigger •Inflammatory cells damage airway epithelium, produce mucosal edema, impair mucociliary clearance, and prolong bronchocontriction •Airway resistance increases •If untreated, hypoxemia develops •Hyperventilation can lead to respiratory alkalosis This is the pathophysiology and etiology of what disease?

4-12 asthma

When instructing clients on how to decrease the risk of chronic obstructive pulmonary disease (COPD). The nurse would emphasize which of the following behaviors? 1.Participate regularly in aerobic exercises 2.Maintain a high protein diet 3.Avoid exposure to people with known respiratory infections 4.Abstain from cigarette smoking

4.Abstain from cigarette smoking

Which of the following is the primary reason to teach pursed-lip breathing to clients with emphysema? 1.To promote oxygen intake 2.To strengthen the diaphragm 3.To strengthen the intercostal muscles 4.To promote carbon dioxide elimination

4.To promote carbon dioxide elimination

An 80 year old male patient is admitted to your medical floor with Bacterial pneumonia. During the health history you learn that the patient has osteoarthritis, is vegetarian, owns 5 cats & 4 chickens and is obsessed with cleanliness. Which of the following would most likely be a predisposing factor for the diagnosis of pneumonia? A - Age B - Osteoarthritis C - Vegetarian diet D - Daily bathing E - Animal bacteria

A - Age Client age is a predisposing factor for pneumonia: pneumonia is more common in elderly or debilitated clients. Other predisposing factors include smoking, suppression and the presence of a chronic illness.

Which of the following would be priority assessment data to gather from a client who has been diagnosed with pneumonia? Select all that apply A.Auscultation of breath sounds B.Auscultation of bowel sounds C.Presence of chest pain D.Presence of peripheral edema E.Color of nail beds Include ALL elements of a respiratory assessment-(oxygen SATs, positioning, accessory muscles, color & presence of sputum, breathing effort, respiratory rate, etc.)

A, C, E

A nurse is teaching a client to use a metered dose inhaler (MDI) to administer his bronchodilator medication. Indicate the correct order of the steps the client should take to use the MDI appropriately: A.Shake the inhaler immediately before use B.Hold breath for 5 to 10 seconds and then exhale C.Activate the MDI on inhalation D.Breathe out through the mouth

A,D,C,B

A patient who has had ulcerative colitis for the past 5 years is admitted to the hospital with exacerbation of the disease. Which of the following factors was most likely of greatest significance in causing an exacerbation of ulcerative colitis ? A.A demanding and stressful job B.Changing to a modified vegetarian diet C.Beginning a weight training program D.Walking 2 miles every day

A.A demanding and stressful job Stressful and emotional events have been clearly linked to exacerbation of ulcerative colitis, although their role in the etiology/ cause of the disease had been disproved, A modified vegetarian diet or and exercise program is an unlikely cause of the exacerbation

Which of the following, if described by the parents of a child with cystic fibrosis, indicates the parents understand the underlying problem of the disease? A.An abnormality in the body's mucus secreting glands B.Formation of fibrous cysts in various body organs C.Failure of the pancreatic ducts to develop properly D.Reaction to the formation of antibodies against streptococcus

A.An abnormality in the body's mucus secreting glands CF is characterized by a dysfunction in the body's mucus producing exocrine glands the mucus secretions are think and sticky rather than thin and slippery. The mucus obstructs the bronchi bronchioles and pancreatic ducts. Mucus plugs in the pancreatic ducts can prevent pancreatic digestive enzymes from reaching the small intestine resulting in poor digestion and poor absorption of various food nutrients.

Which of the following is the FIRST priority in preventing infections when providing care for a client? A.Handwashing B.Wearing gloves C.Using a barrier between clients furniture and nurses bag in the home care setting D.Wearing gowns and googles

A.Handwashing CDC: Hand hygiene is now regarded as one of the most important element of infection control activities. In the wake of the growing burden of health care associated infections (HCAIs), the increasing severity of illness and complexity of treatment, superimposed by multi-drug resistant (MDR) pathogen infections, health care practitioners (HCPs) are reversing back to the basics of infection preventions by simple measures like hand hygiene. This is because enough scientific evidence supports the observation that if properly implemented, hand hygiene alone can significantly reduce the risk of cross-transmission of infection in healthcare facilities (HCFs)1-5.

A client with chronic obstructive pulmonary disease (COPD) reports steady weight loss and being "too tired from just breathing to eat." Which of the following nursing diagnoses would be most appropriate when planning nutritional interventions for this client? A.Imbalanced nutrition: Less than body requirements related to fatigue B.Activity intolerance related to dyspnea C.Weight loss related to COPD Ineffective breathing pattern related to alveolar hypoventilation D.Ineffective breathing pattern related to alveolar hypoventilation

A.Imbalanced nutrition: Less than body requirements related to fatigue Ineffective breathing pattern may be a problem but this diagnosis does not specifically address the problem of weight loss described by the client.

Which of the following health promotion activates should the nurse include in the discharge teaching plan for a client with asthma? A.Incorporate physical exercise as tolerated into the daily routine B.Monitor peak flow numbers after meals and at bedtime C.Eliminate stressors in the work and home environment D.Use sedatives to ensure uninterrupted sleep at night

A.Incorporate physical exercise as tolerated into the daily routine Physical exercise is beneficial and should be incorporated as tolerated into the client's schedule. Peak flow numbers should be monitored daily usually in the morning before taking medication. Peak flow does not need to be monitored after each meal. Stressors in the client's life should be modified but cannot be eliminated. Although adequate sleep is important. It is not recommended that sedatives be routinely taken to induce sleep.

Which of the following blood gas abnormalities should the nurse anticipate in a client with advanced chronic obstructive pulmonary disease (COPD)? A.Increased PaCO2 B.Increased PaO2 C.Increased pH D.Increased oxygen saturation

A.Increased PaCO2 As COPD progresses, the client typically develops increased PaCO2 levels and decreased PaO2 levels. This results in decreased pH and decreased oxygen saturation - the result of air trapping and hypoventilation

A client is prescribed a metaproterenol (Alupent) via a metered dose inhaler, two puffs every 4 hours. The nurse instructs the client to report adverse effects. Which of the following are potential adverse effects of metaproterenol? A.Irregular heartbeat B.Constipation C.Pedal edema D.Decreased pulse rate

A.Irregular heartbeat Irregular heartbeats should be reported promptly to care provider. Metaproterenol (Alupent) may cause irregular heartbeat, tachycardia, or angina pain because of its adrenergic effect on beta-adrenergic receptors in the heart. It is not recommended for use in clients with known cardiac disorders.

Bedrest is prescribed for a client with pneumonia during the acute phase of the illness. Bedrest serves which of the following purposes? A.It reduces the cellular demand for oxygen B.It decreases the episodes of coughing C.It promotes safety D.It promotes clearance of secretions

A.It reduces the cellular demand for oxygen Exudate in the alveoli interferes with ventilation and the diffusion of gases in clients with pneumonia during the acute phase of the illness. It is essential to reduce the body's need for oxygen at the cellular level; bed rest is the most effective method for doing so. Bedrest does not reduce coughing or promote clearance of secretions

When developing a teaching plan for the mother of an asthmatic child concerning measures to reduce allergic triggers which of the following suggestions should the nurse expect to include? A.Keep the humidity in the home between 50% and 60% B.Have the child sleep in the bottom bunkbed C.Use a scented room deodorizer to keep the room fresh D.Vacuum the carpet once or twice a week

A.Keep the humidity in the home between 50% and 60% To help reduce allergic triggers in the home the nurse should recommend the humidity level be kept between 50 and 60% . Doing so keeps the air moist and comfortable for breathing. When air is dry the risk for respiratory infections increase. Too high a level of humidity increases the risk for mold growth. Typically, the child with asthma should sleep on the top bunkbed to minimize the risk of exposure to dust mites. Scented sprays should be avoided because they may trigger an asthmatic episode. Ideally carpeting should be avoided in the home if the child has asthma.

Which of the following is a priority goal for the client with chronic obstructive pulmonary disease (COPD)? A.Maintaining functional ability B.Minimizing chest pain C.Increasing carbon dioxide levels in the blood D.Treating infectious agents

A.Maintaining functional ability Priority for the client with COPD is to manage the signs and symptoms of the disease process to maintain the clients functional ability (to perform ADL's etc. & keep O2 levels up). Chest pain is NOT typical symptom. The carbon dioxide concentration in the blood is increased to an abnormal level in client with COPD. It would not be a goal to increase the level further. Preventing infection would be a goal of care for the client with COPD.

Then nurse is planning to teach a client with chronic obstructive pulmonary diseases how to cough effectively. Which of the following instructions should be included? A.Take a deep abdominal breath or sniff, bend forward and cough three or four times on exhalation B.Lie flat on the back, splint the thorax, take two deep breaths and cough C.Take several rapid shallow breaths and then cough forcefully D. Assume a side-lying positon, extend the arm over the head and alternate deep breathing with coughing

A.Take a deep abdominal breath, or sniff bend forward and cough three or four times on exhalation Goal of effective coughing is to conserve energy and facilitate removal of secretions and minimize airway collapse. They should assume a sitting position with feet on the floor, if possible (Tri-pod). Bend forward slightly and use pursed lip breathing to exhale. After resuming an upright positon, client should use abdominal breathing to slowly and deeply inhale. After repeating this process three or four times, client should take a deep abdominal breath bend forward and cough three or four times upon exhalation ("huff" cough).

• _____ ________ •characterized by the local vascular and exudative changes •usually lasts less than 2 weeks •immediate & serves a protective function •after the causative agent is removed: the inflammation subsides & and healing takes place with the return of normal or near-normal structure and function.

Acute inflammation

For a client with chronic obstructive pulmonary disease, which nursing intervention helps maintain a patent airway? A - Restricting fluid intake to 1,000 ml/day B - Teaching the client how to perform controlled coughing C - Administering ordered sedatives regularly and in large amounts D - Enforcing absolute bed rest

B - Teaching the client how to perform controlled coughing

A 9 month old child with cystic fibrosis does not like taking pancreatic enzyme supplement with meals and snacks. The mother does not like to force the child to take the supplement. The most important reason for the child to take the pancreatic enzyme supplement with meals and snacks is: A.The child will become dehydrated if the supplement is not taken with meals and snacks B.The child needs these pancreatic enzymes to help the digestive system absorb fats, carbohydrates and proteins C.The child needs the pancreatic enzymes to aid in liquefying mucus to keep the lungs clear D.The child will experience severe diarrhea if the supplement is not taken as prescribed

B. The child needs these pancreatic enzymes to help the digestive system absorb fats, carbohydrates and proteins They must take the pancreatic enzyme supplement with meals and snacks to help absorb nutrients so he can grow and develop normally. In cystic fibrosis, the normally liquid mucus is tenacious and blocks three digestive enzymes from entering the duodenum and digesting essential nutrients. Without the supplemental pancreatic enzyme, the child will have voluminous, foul fatty stools. Due to the undigested nutrients, they may experience developmental delays due to malnutrition. The pancreatic enzymes have no effect on the viscosity of the tenacious mucus. Diarrhea is not caused by failing to take the pancreatic enzyme supplement.

A newly diagnosed patient with ulcerative colitis has been placed on steroids. They state they have heard that taking steroids can be dangerous and ask the nurse why steroids are prescribed. Which of the following statements by the nurse provides the client with accurate information about the use of steroid therapy in the treatment of ulcerative colitis? A."Ulcerative colitis can be cured by the use of steroids." B."Steroids are used in severe flare-ups because they can decrease the incidences of bleeding." C."Long-term use of steroids will prolong periods of remission." D."The side effects of steroids outweigh their benefits to clients with ulcerative colitis."

B."Steroids are used in severe flare-ups because they can decrease the incidences of bleeding." Steroids are effective in management of the acute symptoms of ulcerative colitis. They do NOT cure it. Long term use is not effective in prolonging the remission; assess carefully for side effects but the benefits of short term steroid therapy usually outweigh the potential adverse effects

When developing the plan of care for a child with cystic fibrosis who is scheduled to receive postural drainage. The nurse would anticipate performing postural drainage at which of the following times? A.After meals B.Before meals C.After rest periods D.Before inhalation treatments

B.Before meals Perform before meals to avoid the possibility of vomiting or regurgitating food. Although the child with CF needs frequent rest periods, this is not an important factor in scheduling postural drainage. However the nurse would not want to interrupt the child's rest period to perform the treatment. Inhalation treatments are usually given before postural drainage to help loosen secretions.

When performing postural drainage, which of the following factors promotes the movement of secretions from the lower to the upper respiratory tract? A.Friction between the cilia B.Force of gravity C.Sweeping motion of cilia D.Involuntary muscle contractions

B.Force of gravity The principle behind using postural drainage is gravity will help move secretions from smaller to larger airways. Postural drainage is best used after percussion has loosened secretions. Coughing or suctioning is then used to remove secretions. Movement of cilia is not sufficient to move secretions. Muscle contractions do not move secretions within the lungs

At a follow up appointment after being hospitalized an adolescent with history of cystic fibrosis describes his stools to the nurse. Which of the following descriptions should the nurse interpret as indicative of continued problems with malabsorption? A.Soft with little odor B.Large and foul smelling C.Loose with bits of food D.Hard with streaks of blood

B.Large and foul smelling Poor digestion and absorption of foods, especially fats results in frequents bowel movements that are bulky large and foul smelling. The stools also contain abnormally large quantities of fat which is called steatorrhea. An adolescent experiencing good control of the disease would describe soft stools with little odor. Stool describes as loose with bits of food indicates diarrhea. Stool describes as hard with streaks of blood may indicate constipation.

Which goal for the clients care should take priority during the first days of hospitalization for an exacerbation of ulcerative colitis? A.Promoting self-care and independence B.Managing diarrhea C.Maintaining adequate nutrition D.Promoting rest and comfort

B.Managing diarrhea Diarrhea (bloody many times) is the primary symptom in an exacerbation of ulcerative colitis and decreasing the frequency of stools is the first goal of treatment. The other goals are ongoing and will be best achieved by halting the exacerbation. The client may receive antidiarrheal agents, antispasmodic agents, bulk hydrophilic agents, or anti-inflammatory drugs

Which of the following should be a priority focus of care for a client experiencing exacerbation of Crohn's disease? A.Encouraging regular ambulation B.Promoting bowel rest C.Maintaining current weight D.Decreasing episodes of rectal bleeding

B.Promoting bowel rest Priority goal of care during an acute exacerbation of Crohn's disease is to promote bowel rest. This is accomplished through decreasing activity encouraging rest, and initially placing client on nothing by mouth status while maintain nutritional needs parenterally. Regular ambulation is important, but the priority is bowel rest. The client will probably lose some weight during the acute phase of the illness. Diarrhea is nonbloody in Chrohn's disease and episodes or rectal bleeding are not expected

Which assessment findings should lead the nurse to suspect a toddler is experiencing respiratory distress. (Select all that apply): A.Coughing B.Respiratory rate of 35 breaths minute C.Heart rate of 95 bpm D.Restlessness E.Malaise F.Diaphoresis

B.Respiratory rate of 35 breaths minute D.Restlessness F.Diaphoresis Early signs of respiratory distress include restlessness, tachypnea, tachycardia and diaphoresis. Coughing and malaise typically do not indicate respiratory distress. A heart rate of 95 is normal for a toddler. Other signs and symptoms include hypertension, nasal flaring, expiratory grunting, wheezing, and intercostal retractions.

A client with bacteria pneumonia is to be started on I.V. antibiotics . Which of the following diagnostic tests must be completed before antibiotic therapy begins? A.Urinalysis B.Sputum culture C.Chest radiograph D.Red blood cell count

B.Sputum culture A sputum culture is obtained for culture to determine the causative organism. After the organism is identified an appropriate antibiotic can be prescribed . Beginning antibiotic therapy before obtaining the sputum specimen may alter the results of the test.

A 12 year old with asthma wants to exercise. Which of the following activities should the nurse suggest to improve her breathing? A.Soccer B.Swimming C.Track D.Gymnastics

B.Swimming Swimming is appropriate for this child because it requires controlled breathing, assists in maintaining cardiac health enhances skeletal muscle strength and promotes ventilation and perfusion. Stop and start activities such as soccer, track and gymnastics commonly trigger symptoms in asthmatic clients.

Which of the following would be an appropriate expected outcome for an elderly client recovering from bacterial pneumonia? Pick the BEST one! A.A respiratory rate of 25 to 30 breaths / minute B.The ability to perform activities of daily living without dyspnea C.A maximum loss of 5 to 10 lb. of body weight D.Chest pain that is minimized by splinting the rib cage

B.The ability to perform activities of daily living without dyspnea Should be no pain, no tachypnea, and no weight loss if they are recovering

The client with asthma should be taught which of the following is one of the most common precipitating factors of an acute asthma attack? A.Occupational exposure to toxins B.Viral respiratory infections C.Exposure to cigarette smoke D.Exercising in cold temperatures

B.Viral respiratory infections The most common precipitator of asthma attacks is viral respiratory infection. Clients with asthma should avoid people who have the flu or cold and should get yearly flu vaccinations. Environmental exposure to toxins or heavy particles matter can trigger asthma attacks however, far fewer asthmatics are exposed to such toxins than are exposed to viruses. Cigarette smoke can also trigger asthma attacks but to lesser extent than viral respiratory infections. Some asthmatic attacks are triggered by exercising in cold weather.

The client with asthma should be taught which of the following is the most common precipitating factors of an acute asthma attack? A.Occupational exposure to toxins B.Viral respiratory infections C.Exposure to cigarette smoke D.Exercising in cold temperatures

B.Viral respiratory infections The most common precipitator of asthma attacks is viral respiratory infection. Clients with asthma should avoid people who have the flu or cold and should get yearly flu vaccinations. Environmental exposure to allergic triggers for the client i.e.( animals, dust, grass, dust mites etc.) or heavy particulates matter can trigger asthma attacks . Cigarette smoke can also trigger asthma attacks, but to lesser extent than viral respiratory infections. Some asthmatic attacks are triggered by exercising in cold weather.

When teaching a client with chronic obstructive pulmonary disease to conserve energy the nurse should teach the client to lift objects: A.While inhaling through an open mouth B.While exhaling through pursed lips C.After exhaling but before inhaling D.While takin a deep breath and holding it

B.While exhaling through pursed lips Exhaling requires less energy than inhaling. Therefore, lifting while exhaling saves energy and reduces perceived dyspnea. Pursing the lips prolongs exhalation and provides the client with more control over breathing. Lifting after exhaling but before inhaling is similar to lifting with the breath held. This should not be recommended because it is similar to the Valsalva maneuver, which can stimulate cardiac arrhythmias.

Pharmacologic therapy for COPD _________ will keep the alveoli open and increase exchange of oxygen and carbon dioxide more effectively/ improve airflow and reduce air trapping and especially may be used when asthma is a major component of COPD. It improves symptoms and exercise tolerance and may reduce the severity of exacerbations

Bronchodilators

Which measure may increase complications for a client with COPD? A - Decrease oxygen supply B - Administration of antibiotics C - Increased oxygen supply D - Administration of antitussive agents

C - Increased oxygen supply

A client's diagnosis of cystic fibrosis was made 13 years ago and he has since been hospitalized several times. On the latest admission the client has labored respirations fatigue, malnutrition and failure to thrive. Which nursing actions are most important initially? A.Placing the client on bed rest and ordering a blood gas analysis B.Ordering a high calorie, high protein low fat vitamin enriched diet and pancreatic granules C.Applying an oximeter and initiating respiratory therapy D.Inserting an IV line and initiating antibiotic therapy

C. Applying an oximeter and initiating respiratory therapy Clients commonly die from respiratory problems. The mucus in the lungs is tenacious and difficult to expel leading to lung infections and interference with oxygen and carbon dioxide exchange. The client will likely need supplemental oxygen and respiratory treatments to maintain adequate gas exchange, as identified by oximeter reading. The child will be on bed rest due to respiratory distress. However although blood gases will probably be ordered the oximeter readings will be used to determine oxygen deficit and are therefore more of a priority. Diet high in calories, proteins and vitamins with pancreatic granules added to all foods ingested will increase nutrient absorptions and help the malnutrition. Inserting an IV to administer antibiotic is important and can be done after ensuring adequate respiratory function.

An adolescent complains of chest pain and goes to the school nurse. The nurse determines the teenager has a history of asthma but has had no problems for years. Which of the following should the nurse do next? A.Call the adolescent's parent B.Have the adolescent lie down for 30 minutes; obtain a peak flow reading C.Obtain a peak flow reading D.Give two puffs of a short acting bronchodilator

C. Obtain a peak flow reading Complaint of chest pain in children and adolescents as are rarely cardiac. With a history of asthma the most likely cause of the chest pain is related to the asthma. So the nurse should check the adolescents peak flow reading( blow out) to evaluate the status of the air flow. Calling the parents would be appropriate, but this would be done after the nurse obtains the peak flow reading and additional assessment data. Having the adolescent lie down may be an option. But more data need to be collected to help establish a possible cause. Because the adolescent has not experienced any asthma problems for a long time it would be inappropriate for the nurse to administer a short acting bronchodilator at this time

A client with acute asthma is prescribed short term corticosteroid therapy. Which is the rationale for the use of steroids in clients with asthma? A.Corticosteroids promote bronchodilation B.Corticosteroids act as an expectorant C.Corticosteroids have an anti-inflammatory effect. D.Corticosteroids prevent development of respiratory infections

C.Corticosteroids have an anti-inflammatory effect. Corticosteroids have an anti-inflammatory effect and act to decrease edema in the bronchial airways and decrease mucus secretion. Corticosteroids DO NOT have a bronchodilator effect

A nurse notes that a client has kyphosis and generalized muscle atrophy. Which of the following problems is a priority when the nurse develops a nursing plan of care? A.Infection B.Confusion C.Ineffective coughing and deep breathing D.Difficulty chewing solid foods

C.Ineffective coughing and deep breathing In kyphosis of the thoracic spine bends forward with convexity of the curve in a posterior direction, making effective coughing and deep breathing difficult. Although the client may develop other problems because respiratory status deteriorates when pulmonary secretions are not adequately cleared from airway and can lead to pneumonia. Ineffective coughing and deep breathing should receive priority attention.

Which of the following mental status changes may occur when a client with pneumonia is first experiencing hypoxia? A.Coma B.Apathy C.Irritability D.Depression

C.Irritability Hypoxia: irritability , restlessness, or anxiety as INITIAL mental status changes; as the hypoxia becomes more severe patient may become confused and combative. Coma is a LATE manifestation

The nurse teaches a client with chronic obstructive pulmonary disease (COPD) to assess for signs and symptoms of right sided heart failure. Which of the following signs and symptoms should be included in the teaching plan? A.Clubbing of nail beds B.Hypertension C.Peripheral edema D.Increased appetite

C.Peripheral edema Right sided heart failure (Cor Pulmonale) = complication of COPD that occurs because of pulmonary hypertension. Signs and symptoms of right sided heart failure include peripheral edema, jugular venous distention, hepatomegaly and weight gain due to increased fluid volume (more in perfusion unit) Clubbing of nail beds is associated with conditions of chronic hypoxemia. Hypertension is associated with left sided heart failure. Clients with heart failure have decreased appetites.

The nurse administers theophylline (Theo-Dur) to a client. To evaluate the effectiveness of this medication, which of the following drug actions should the nurse anticipate? A.Suppression of the clients respiratory infection B.Decrease in bronchial secretions C.Relaxation of bronchial smooth muscle D.Thinning of tenacious purulent sputum

C.Relaxation of bronchial smooth muscle Theophylline (Theo-dur) is a bronchodilator administered to relax airways and decrease dyspnea. Theophylline is not used to treat infections and does not decrease or thin secretions.

When preparing the teaching plan for the mother of a child with asthma, which of the following should the nurse include as signs to alert the mother that her child is having an asthma attack? A.A Secretion of thin, copious mucus. B.Tight , productive cough C.Wheezing an expiration D.Temperature of 99.4 F.

C.Wheezing an expiration Asthma attack typically demonstrates wheezing on expiration initially. This results from air moving through narrowed airways secondary to broncho- constriction. The child's expiratory phase is normally longer than the inspiratory phase. Expiratory is passive as the diaphragm relaxes. During as asthma attack, secretion are thick and are not usually expelled until the bronchioles are more relaxed. At the beginning of the asthma attack the cough will be tight but not productive. Fever is not always present unless there is an infection that may have triggered the attack.

•All patients with ___ should be counseled to quit smoking •Unlike in ___, surgery is not curative in ___ •Meds for symptom relief: •Antidiarrheal agents •Anticholinergic antispasmodic agents •Fecal transplant ( future?)

CD UC CD

Sticky buildup of mucus: lungs, pancreas, other organs. Mucus clogs airways/ traps bacteria=infections, extensive lung damage, eventually, respiratory failure. Pancreas: mucus prevents release of digestive enzymes= body unable to break down food/ absorb vital nutrients. What is this?

CF

A client who is diagnosed with ______ may have alterations in both oxygenation and perfusion. Clinical manifestations associated with a decrease in perfusion include acrocyanosis and confusion,a weak pulse and blue nailbeds would also indicate poor perfusion. _______ is an abnormal breath sound and may be heard, but it is not an indication of poor perfusion.

COPD wheezing

The inflammatory process in _______ ______ begins with crypt inflammation and abscesses, which develop into small, focal ulcers. These initial lesions then deepen into longitudinal and transverse ulcers, separated by edematous patches, creating a characteristic cobblestone appearance to the affected bowel. Fistulas, fissures, and abscesses form as the inflammation extends into the peritoneum. Granulomas can occur in lymph nodes, the peritoneum, and through the layers of the bowel in about half of patients. Diseased bowel segments are sharply demarcated by adjoining areas of normal bowel tissue. These are called skip lesions, from which the label regional enteritis is derived. As the disease advances, the bowel wall thickens and becomes fibrotic, and the intestinal lumen narrows. Diseased bowel loops sometimes adhere to other loops surrounding them (Smith & Harris, 2014; Walfish, 2016).

Chrons disease

- fatigue - chronic cough - recurrent URI - Thick, sticky mucus - chronic hypoxia - clubbing, barrel chest - decreased absorption of vitamins and enzymes - abdominal distention - decreased digestive enzymes - rectal prolapse - fatty, stinky stool (Steatorrhea) These are symptoms of what?

Cystic fibrosis

Maintaining respiratory function •Exercise, airway clearance (CPT, oscillating chest vests) Managing infection •Frequent courses of antibiotics, immunizations Promoting optimal nutrition and exercise •Well-balanced diet; supplement fat-soluble vitamins •Pancreatic enzymes supplements (decrease fat) •Given at each meal (can be taken orally or put on food) Preventing gastrointestinal blockage •Hyperosmolar enemas •Isotonic fluid lavage of intestines (oral or NG tube) This is all medical management of what disease?

Cystic fibrosis

Which of the following diets would be most appropriate for a client with COPD? A.Low fat low cholesterol diet B.Bland soft diet C.Low sodium diet D.High calorie high protein diet

D. High calorie/ high protein diet High calorie, high protein meals to maintain nutritional status and prevent weight loss that results from the increased work of breathing. The client should be encouraged to eat small frequent meals. A low fat, low cholesterol diet is indicated for clients with coronary artery disease. The client with COPD does not necessarily need to follow a sodium restricted diet unless otherwise medically indicated.

A 34 year old female with a history of asthma is admitted to the emergency department. The nurse notes the client is dyspneic with a respiratory rate of 35 breaths minute, nasal flaring and use of accessory muscles. Auscultation of the lung fields reveals greatly diminished breath sounds. Based on these findings, which action should the nurse take to initiate care of the client? A.Initiate oxygen therapy reassess the client in 10 minutes B.Draw blood for an arterial blood gas analysis and send the client for a chest X-ray C.Encourage the client to relax and breathe slowly through the mouth D.Administer bronchodilators

D.Administer bronchodilators In an acute asthma attack - diminished or absent breath sounds/ reduced wheeze (no air movement heard) can be an ominous sign indicating lack of air movement in the lungs and impending respiratory failure. The client requires immediate intervention with inhaled bronchodilators, IV corticosteroids and possibly IV theophylline. Administering oxygen and reassessing the client 10 minutes later would delay needed medical attention as would drawing blood and obtaining a chest x-ray. It would be futile to encourage the client to relax and breathe slowly without providing the necessary pharmacologic intervention

Which of the following would be an appropriate expected outcome for an adult client with well controlled asthma? A.Chest X-ray demonstrates minimal hyperinflation B.Temperature remains lower than 100 F C.Arterial blood gas analysis demonstrates a decrease in PaO2 D.Breath sounds are clear

D.Breath sounds are clear Between attacks, breath sounds should be clear on auscultation with good air flow present throughout lung fields. Chest x-rays should be normal. The client should remain afebrile. Arterial blood gases should be normal. What would the pH be if there are problems? (Remember last week!)

The nurse assesses the respiratory status of a client who is experiencing an exacerbation of chronic obstructive pulmonary disease (COPD) secondary to an upper respiratory tract infection. Which of the following findings would be expected? A.Normal breath sounds B.Prolonged inspiration C.Normal chest movement D.Coarse crackles and rhonchi

D.Coarse crackles and rhonchi Exacerbations of COPD are commonly caused by respiratory infections. Coarse crackles and rhonchi (low pitched, large airways on inspiration/blocked) would be auscultated as air moves through airways obstructed with secretions. In COPD, breath sounds are diminished because of an enlarged anteroposterior diameter of the chest. Expirations, not inspiration, becomes prolonged. Chest movement is decreased as lungs become over distended.

When teaching the parents of an older infant with cystic fibrosis about the type of diet the child should consume, which of the following would be most appropriate? A.Low protein diet B.High fat diet C.Low carbohydrate diet D.High calorie diet

D.High calorie diet CF affects the exocrine glands. Mucus is thick and tenacious, sticking to the walls of the pancreatic and bile ducts and eventually causing obstruction. Because the difficulty with digestion and absorption a high calorie high protein high carbohydrate moderate fat diet is indicated.

A patient who has ulcerative colitis says to the nurse, "I can't take this anymore! I'm constantly in pain, and I can't leave my room because I need to stay by the toilet. I don't know how to deal with this. "Based on these comments , an appropriate nursing diagnosis for this client would be: A.Impaired physical mobility related to fatigue B.Disturbed thought processes related to pain C.Social Isolation related to chronic fatigue D.Ineffective coping related to chronic abdominal pain

D.Ineffective coping related to chronic abdominal pain These patients may become apprehensive and upset about the frequency of stools and the abdominal cramping. During these exacerbations they need emotional support and encouragement to verbalize their feelings about their chronic health concerns and assistance in developing effective coping methods. The client has not expressed feeling of fatigue or isolation or demonstrated disturbed thought processes.

You are more likely to acquire pneumonia for all the following reasons, EXCEPT: A.Smoking B.History of chronic lung disease C.Antibiotic use within the past 3 months D.Living in cold environment

D.Living in cold environment

Which of the following measures would most likely be successful in reducing pleuritic chest pain. Which of the following describes pleuritic chest pain? A.Encourage the client to breathe shallowly B.Have the client practice abdominal breathing C.Offer the client incentive spirometry D.Teach the client to splint the rib cage when coughing

D.Teach the client to splint the rib cage when coughing Pleuritic pain is triggered by chest movement and is particularly severe during coughing. Splinting the chest wall will help reduce the discomfort of coughing; deep breathing is essential to prevent further atelectasis . Abdominal breathing is not effective in decreasing pleuritic pain. Incentive spirometry facilitates effective deep breathing but does not decrease pleuritic chest pain.

Which of the following outcomes would be appropriate for a client with chronic obstructive pulmonary disease (COPD) who has been discharged to home? A.The client promises to do pursed - lip breathing at home B.The client states actions to reduce pain C.The client states that he will use oxygen via a nasal cannula at 5 L. minute D.The client agrees to call the physician if dyspnea on exertion increases

D.The client agrees to call the physician if dyspnea on exertion increases Dyspnea on exertions indicates that the client may be experiencing complications of COPD Pain is not a common symptom of COPD. Clients with COPD use low flow oxygen supplementation 1 to 2 L min to avoid suppressing the respiratory drive which for these clients is stimulated by hypoxia

This is Nursing : Planning/______ for IBD •Seeks emotional support as appropriate •Verbalizes fewer feelings of anxiety and concern •Copes successfully with diagnosis •Verbalizes feelings freely •Uses appropriate stress reduction behaviors •Maintains skin integrity •Cleans perianal skin after defecation •Uses appropriate skin barrier •Acquires an understanding of the disease process •Modifies diet appropriately to decrease diarrhea •Recovers without complications • Electrolytes within normal ranges/ Normal sinus or baseline cardiac rhythm • Maintains fluid balance • Experiences no perforation or rectal bleeding

Evaluation

Organisms of HAI Infection Potential •C. difficile : Most common cause of ____s •Methicillin-resistant S. aureus (MRSA) •Healthcare-associated MRSA •Community-associated MRSA •Vancomycin-resistant enterococcus (VRE) •Multidrug-resistant organisms (MDROs)

HAI

•Prevention of _____s •Effective hand washing •Invasive equipment, procedures minimally •Meticulous medical, surgical asepsis •Critical thinking, agency policy •Hand hygiene for client, nurse •Use of alcohol-based antiseptic hand scrubs before and after direct client contact

HAI

____: Hospitalization for ≥2 days in an acute care facility within 90 days of infection/ Hospital-acquired pneumonia has a higher mortality rate than any other hospital-acquired infection. ____ : Residence in a nursing home or long-term care facility/Antibiotic therapy, chemotherapy, or wound care within 30 days of current infection/Hemodialysis treatment at a hospital or clinic/Home infusion therapy or home wound care/Family member with infection due to multidrug-resistant bacteria

HAP HCAP

Age considerations and psychosocial issues for what? •Diagnosis at critical developmental times / self image •Self-management is critical to patient improvement •Shared decision making •Individual patient characteristics should be discussed •Entails clear goals, understanding of the disease, plan of action to reduce symptoms or prevent disease activity

IBD

Long term complications of _____ - Malabsorption and malnutrition - anemia - perforated bowel - fistula, strictures, and abscesses - eye soreness / redness - swelling / pain in joints - osteoporosis - increased risk of colon cancer - conjunctivitis arthritis

IBD

Symptoms of ____ Sufferers - **Abdominal pain - **Cramps - Mouth/stomach ulcers more in crohn's - **Diarrhea - urgency to move bowels - Rectal bleeding more in UC - loss/change in appetite - fever - **weight loss - **fatigue - change/loss of menstrual cycle constipation can lead to bowel obstruction - sensation of incomplete evacuation Long term complications - malnutrition and malabsorption - anemia - perforated bowel - fistulas, strictures, and abscesses - eye soreness/redness - swelling/pain in joints - osteoporosis - increased risk of colon cancer

IBD

Symptoms of ______ sufferers - abdominal pain - cramps - mouth/stomach ulcers more in crohns - diarrhea - urgency to move bowels - rectal bleeding more in UC - loss/change in appetite - fever - weight loss - fatigue - change/loss of menstrual cycle - constpiation / can lead to bowel obstruction

IBD

These are collaborative/complications of what issue? •Electrolyte imbalance •Cardiac dysrhythmias related to electrolyte imbalances •GI bleeding with fluid volume loss •Perforation of the bowel

IBD

Ulcerative colitis and crohns disease are two main forms of ______

IBD

Acute infection of the lung parenchyma by carious pathogens - milk to severe illness in people of all ages. What is this?

Pneumonia

Age considerations : Infant/children What is this about? •Does the child look sick? •Neonates: may have fever only with subtle or no physical findings /______ is unreliable/ look for chest wall indrawing & grunting •Inflammatory response needs to be proactively controlled= prevent suffocation & reduce mortality. •Children: Look for Apprehension : because of difficulty breathing or SOB •Involve family / consider developmental age •Children as well as adults: need to do exercise, enhance nutrition, bask more in sunshine and engage in outdoor activities, ensure adequate sleep, pay attention to personal health, and get vaccinated for the prevention of pneumonia and influenza if necessary. •Most cases of pneumonia in healthy children can be managed on an outpatient basis.

Pneumonia auscultation

Pharmacologic therapy : stepwise approach ASTHMA Prevent and control symptoms •Inhaled ____ for quick relief •Meds administered by MDI, DPI, or nebulizer •________ •Relax smooth muscles of airway •Adrenergic stimulants ( beta 2 agonist) •Anticholinergic agents ( ipratropium/ atrovent) usually used with another med ) •Methylxanthines (theophylline and aminophylline) •_______ and NSAIDs •Cromolyn sodium, nedocromil •_______ modifiers •Oral medications •Montelukast ( Singulair) •Zafirlukast •Zileuton

SABA bronchodilators corticosteroids Leukotriene

How can we support or enhance the bodies natural defenses as nurses. How can we enhance the healing process with nutrition and other.

Sleep, exercise, probiotics, reduce stress Diet - High protein, high carb, vitamin C, zinc

Prevention remains the key to reducing the burden of ____ (Amanullah, 2015). See Chart 21-11 in Chapter 21 for overview of bundled interventions aimed at preventing VAP. ______: localized 1 or more lobes ( completely consolidated ______________: inflammatin in lung centered in bronchioles -mucopurlulent exudate obstructs small airways ,causes patchy consolidation of the adjacent lobules ______ _______ : inflammation of the interstitum walls of the alveoli, alveolar sacs & ducts / bronchioles. ( characteristic of acute viral infectins / may be a chronic process / Interstitial : characterized by progressive scarring of both lungs / diffuse/ bilateral usually viral

VAP lobar bronchopneumonia interstitial pneumonia

bronchitis, bronchiolitis may be hard to distinguish between specific microbial aetiology remains unknown in more than a third of patients, although it is common in children for a blood culture to be the only test performed to provide a specific diagnosis, which may only be positive in 5-10 % of patients and up to 20 % in the most severely ill patients [12]. _____ shows elevated

WBC

COPD Promote ______ •Assess how client meeting ADLs •Discuss importance of spacing activity, rest •Design exercise plan to meet current level •Build stamina and strength •Interdisciplinary team

activity

Asthma The client admitted with an _____ exacerbation of asthma will require a rescue medication, such as an inhaled short-acting beta-agonist, Oral corticosteroids, inhaled long-acting beta agonists, Oral ________ are maintenance medications used to treat asthma.

acute anticholinergics

COPD - Implementation ______ fluid intake is needed to keep secretions thin: at least 2-2.5 quarts of fluid daily Dietary Measures: A diet high in protein and fats without excess ______ is recommended to minimize carbon dioxide production during metabolism. Frequent small meals help maintain intake and reduce fatigue associated with eating. Carbohydrate-rich foods may increase the client's carbon dioxide production and worsen the symptoms of the disease.. Eat frequent snacks.

adequate carbohydrates

Asthma Promote _______ to therapeutic regimen •Assess client's level of understanding •Discuss client's perceptions •Assist client, significant others to identify •Problems integrating treatment into lifestyle •Assess knowledge, understanding of medications •Provide verbal, written instructions

adherence

•_______ precautions •TB, varicella, other airborne pathogens •Hospitalized patient should be in a negative pressure room with the door closed; health care providers should wear an N-95 respirator (mask) at all times when in the room

airborne

pollen from trees, grassess, and weeds, animal dander, household dust, mold. These are all _______ that can contribute to asthma?

allergens

IBD Treatment Pharmacology ______ : - anti-inflammatory - ex mesalamine, balsalazide, olsalazine _____ : - anti-inflammatory, ex prednisione, hydrocortisone - side effect make not suitable for long term use ______ - suppresses the immune system. Ex azathioprine - patients have increased risk of infection while taking _______ - used to prevent and control infection in UC and CD patients _______ - moderate to severe cases. Ex adalimumab, infliximab - block proteins called tumor necrosis factor

aminosalicylates corticosteroids immunomodulators antibiotics biologics

Asthma Help relieve ______ •Assess level of anxiety •Assist to identify previous coping skills •Listen actively to concerns •Include client in care planning, decision making •Reduce excessive environmental stimuli •Supportive family members with client •Assist to use relaxation techniques

anixety

Lab tests to help diagnosis systemic and localized infection: •Urinalysis •Culture and Sensitivity from suspicious site : determine organism and __________ that are sensitive to it (blood, sputum, urine, stool, tissue, cerebrospinal fluid, mucus from nose..throat. genital)

antibiotics

Medical treatment for Pneumonia •______ for bacterial pneumonia •_____ medication for viral pneumonia •_______ medication for fungal pneumonia •Supportive: •Rest /Fluids / Antipyretics/ Decongestants , Antihistamines •Severe: Oxygen, IV antibiotics, Ventilator support

antibiotics antiviral antifungal

IBD REDUCING ______; Rapport can be established by being attentive and displaying a calm, confident manner. The nurse allows time for the patient to ask questions and express feelings. Careful listening and sensitivity to nonverbal indicators of anxiety (e.g., restlessness, tense facial expressions) are helpful. The patient may be emotionally labile because of the consequences of the disease and the uncertainty of exacerbations with complications. The nurse tailors information about possible impending surgery to the patient's level of understanding and desire for detail. If surgery is planned, pictures, illustrations, websites, and blogs help explain the surgical procedure and help the patient visualize what a stoma looks like.

anxiety

What step of the nursing process is this for pneumonia? •History •Secretions: amount, odor, color, temp •Cough: frequency and severity •Tachypnea, shortness of breath •Choking episode/ GERD •Recent ABO use •Vital signs/ O2 sats •Inspect and auscultate chest •History and assess: Changes in: •mental status •fatigue •edema •dehydration •heart failure (older adult patients) •Blood culture/ no ABO's 1st •Sputum collection: Oral hygiene first/ deep cough

assessment

Acute inflammatory response triggered Inflammatory mediators released •Causes activation of inflammatory cells •Bronchoconstriction, airway edema, impaired clearance of secretions •Increases work of breathing •Trapped air mixes with inhaled air •Impairs gas exchange This is the pathophysiology and etiology of what disease?

asthma

Allergies: Pollens, weeds, dust mites, animals Other triggers: exposure to aspirin, NSAIDs, exercise, exposure to hot or cold air, respiratory irritants in the workplace Stimuli result : hyper-responsiveness Status asthmaticus à severe, prolonged asthma that is difficult to treat These are the etiology of what disease?

asthma

Control of dust in the child's bedroom is an important aspect of environmental control for _____ management, and replacing the carpeting in the child's bedroom with tile flooring will reduce dust. When possible, pets and plants should not be kept in the home. Smoke from fireplaces should be eliminated.

asthma

During an ______ attack, tachycardia, tachypnea, and prolonged expirations are common. They are early symptoms of the disease process and can be addressed without urgency. An increased respiratory rate indicates respiratory compromise, but not exhaustion

asthma

Education for family and family friends: A client with _____ must not be exposed to items that can exacerbate their disease process. Specific allergens, chemicals, and foods must be avoided. Flowers, food, and items that may contain dust and much, such as a stuffed animal, should be avoided. Objects void of irritants, such as a book, would be an appropriate gift.

asthma

Goals may include that client will: •Experience decreased number and severity of exacerbations •Require fewer unscheduled visits to primary care provider or emergency department •Reduce exposure to irritants that aggravate asthma control •Experience improved quality of life what disease is this?

asthma

Health history •Current symptoms •History •Controller medications •Acute care Physical examination •Level of distress •Vital signs, color This is the assessment for what disease?

asthma

Respiratory status can change rapidly during an acute _______ attack. Slowed, shallow respirations with significantly diminished breath sounds and decreased wheezing may indicate exhaustion and impending respiratory failure. Immediate intervention is necessary.

asthma

These are all nursing diagnosis for what disease? Nursing diagnoses may include: - Ineffective Breathing Pattern - Ineffective Airway Clearance - Impaired Gas Exchange - Activity Intolerance - Anxiety - Ineffective Therapeutic Regimen Management (NANDA-I ©2012)

asthma

These are all risk factors what? •Genetic factors •Common causes of ____ •Air pollutants •Allergens •Chemicals, food •Stress •Respiratory infections

asthma

This is complementary and alternative therapy for what disease? - herbals - biofeedback, yoga, breathing techniques - acupuncture

asthma

This is prevention for what issue? •Avoiding allergies and environmental triggers •Controlling dust •Removing carpets •Covering mattresses and pillows •Pet removal

asthma

•#1: Respiratory infections i.e. colds, RSV flu. Sinus infections, •Tobacco Smoke (second hand and smoking /avoid areas with it) •Pets (avoid, bath pet) •Cockroach Allergen (inner city, area of country, treat area, no food left out) •Air Pollution (inner city, watch forecast and reports-stay inside) no wood burning stoves, fireplaces inside, watch cleaning products other industrial type pollutants) •Dust Mites (have hardwood floors, use mattress & pillow covers, no stuffed animals & down filled blankets, wash dry bedding super hot water) •Pollen i.e. grass, plants etc. (avoid, wash hair & bath before bed) •Mold (reduce humidity, treat) •Foods/ food additives/ medications •Physical exercise (usually very strenuous...but still need exercise) •Weather i.e.: thunderstorms or high humidity; breathing in cold, dry air •Fragrances/ aerosol sprays •Strong emotions These are all ____ triggers

asthma

•Coughing, wheezing, shortness of breath, chest tightness, tachypnea, tachycardia -----Abrupt or insidious -----Frequency, severity vary •Anxiety and apprehension •Frequency of severity of attacks vary widely These are all clinical manifestations of what issue?

asthma

•Maintain oxygenation, patent airway •Improve ability to function •Improve ability to participate in ADLs, exercise •Improve quality of life This is the nursing process for what disease?

asthma

•PEFR •Allergic asthma: scratch or patch testing, IgE testing •Other tests -CBC with diff, ABG -Pulmonary function study -Chest x-ray -Oxygen saturation monitoring -Transcutaneous oxygen and carbon dioxide This is diagnostic test for what disease?

asthma

Effective treatment of asthma includes long-term treatment to prevent ______ and decrease _______, as well as short-term treatment when an attack occurs. Long-term treatment of asthma continues indefinitely, not for just a year. Age-appropriate, evidence-based interventions for a young adolescent client diagnosed with asthmas include referral to a peer-lead support group, assessing peer-support of the client, and collaborating with teachers to ensure the client has the necessary support in the school setting. While it is appropriate to include the parents in the educational process, the client should be taught how to administer medications prior to teaching the parents.

attacks inflammation

Prevention of Infection •HAI ______ _______; CLABSI •Bundle approach: (1) Hand hygiene; (2) maximal barrier precaution; (3) chlorhexidine skin antisepsis; (4) optimal catheter site selection; (5) daily review of line necessity with prompt removal of unnecessary lines

bloodstream infections

Ulcerative colitis and crohn's disease are differentiated on basis of • genetic predisposition • risk factors •clinical, endoscopic and histologic features Result in inflammation or ulceration (or both) of the ____

bowel

COPD Enhance _______ patterns •Monitor vital signs, lab results •Assist with ADLs as needed •Provide rest periods between activities •Teach and assist with breathing patterns •Medications as ordered •Prepare for intubation and mechanical ventilation if respiratory status deteriorates

breathing

Asthma _______: Working on the sympathetic nervous system " fight or flight" to relax smooth muscle Teaching: client should be on a maintenance medication schedule to reduce inflammation-exacerbation at home/ i.e. •Inhaled corticosteroid •Long acting inhaled Beta agonist •Leukotriene receptor antagonist

bronchodilators

Pneumonia _____ may also occur in patients with reactive airway disease. Because of hypoventilation, a ventilation-perfusion Venous blood entering the pulmonary circulation passes through the underventilated area and travels to the left side of the heart poorly oxygenated. The mixing of oxygenated and unoxygenated or poorly oxygenated blood eventually results in arterial hypoxemia.

bronchospasm

Unlike in UC, ______ disease can affect any portion of the GI tract, from the oropharynx to rectum, often with patchy distribution of lesions. Due to this, symptoms tend to be less focal than in UC and patients often present later in disease Common presenting symptoms include abdominal pain, bloody or watery diarrhea, incontinence, fistulas and perianal symptoms. Extracolonic GI involvement associated with aphthous ulcers, dysphagia, upper abdominal pain and vomiting. Scar tissue and the formation of granulomas interfere with the ability of the intestine to transport products of upper intestinal digestion through the constricted lumen, resulting in crampy abdominal pain. There is abdominal tenderness and spasm. Because eating stimulates intestinal peristalsis, the crampy pains occur after meals. To avoid these bouts of crampy pain, the patient tends to limit food intake, reducing the amounts and types of food to such a degree that normal nutritional requirements are often not met. As a result, weight loss, malnutrition, and secondary anemia occur (NIDDK, 2016b).

chron's

•Unlike in UC, _____ disease can affect any portion of the GI tract •Common presenting symptoms •RLQ abdominal pain, chronic watery diarrhea, distention/ incontinence, fistulas and perianal symptoms(bleeding) •Fever •Weight Loss •Extracolonic GI involvement: aphthous ulcers, dysphagia, upper abdominal pain and vomiting. •Patients with ___ may have hx of other autoimmune disorders,

chron's

Inflammation and excess mucus : _______ ______ Alveolar membranes break down : _______

chronic bronchitis Emphysema

•______ _______ - injurious agent persists & acute response continues •Symptoms: months to years •May be insidious/ never have an acute phase •Does not serve a beneficial & protective function •Debilitating & produce long-lasting effects •Changes occur at the site of injury •exudate becomes proliferative •cycle of cellular infiltration, necrosis, and fibrosis begins, with repair and breakdown occurring simultaneously •considerable scarring may occur, resulting in permanent tissue damage. •Chronic disease is driven by inflammation

chronic inflammation

Chrons or ulcerative colitis Therapeutic management : corticosteroids, aminosalicylates, sulfasalazine (azulfidinel) ileostomy or anastomosis

chrons

Although its characteristic histopathologic changes can occur anywhere in the GI tract, it most commonly occurs in the distal ileum and the ascending colon. Approximately 35% of patients have only ileal involvement (ileitis), 45% of patients have diseased ileum and colon (ileocolitis), and 20% of patients have only colon involvement (granulomatous colitis) (Walfish, 2016). CD and UC _______ mouth to anus _______ _____= rectum / colon

chrons ulcerative colitis

Chrons or ulcerative colitis Course : Prolonged, variable Bleeding : Usually not, but if it occurs it tends to be mild Perianal involvement : mild Fistulas : common Diarrhea : Common What is this?

chrons disease

•Respiratory therapist •Other healthcare providers This is ______ in asthma?

collaboration

Types of infections •_______ •Infection occurs - microorganisms invade body part with ineffective defenses •Types of infections •Local infection •Systemic infection •Acute infection •Chronic infection

colonization

Alterations - Inflammation •Inflammation can occur in any tissue •________ disorders •Allergic rhinitis •Appendicitis •Crohn disease, IBD •Arthritis •Nephritis •Gallbladder disease •Peptic ulcers •__________ disorders •Rheumatoid arthritis •Systemic lupus erythematosus •Guillane-Barré syndrome

common autoimmune

Prevention of Infection •_____ ______ ______ •Collaborate effort of CDC, state, and local public health departments •Methods: sanitation techniques, regulated health practices, food preparation, immunization program

community acquired infections

Classifications of Pneumonia : •CAP: ____ ______ _____ •HCAP: _____ ____ _____ ______ •HAP: _____ _____ ______ •VAP: ______ ____ _______ •Overlap in how specific pneumonias are classified, because they may occur in differing settings. Risk factors associated for specific pathogens.

community acquired pneumonia health care associate pneumonia hospital acquired pneumonia ventilator acquired pneumonia

Pneumonia occurring in the community of less than or equal to 48 hours after hospital admission or institutionalization of patients who do not meet the criteria for health care-associate pneumonia. What is this?

community acquired pneumonia (CAP)

Infection ______ and prevention •World Health Organization (WHO) •Centers for Disease Control and Prevention (CDC) •CDC publications, guidelines, and website •Occupational safety and health administration (OSHA) •Mandatory regulations and guidelines •Local agencies •Hospital and facility infection control specialists and facility policies

control

IBD ENHANCING ______ MEASURES: Because the patient may feel isolated, helpless, and out of control, understanding and emotional support are essential. The patient may respond to stress in a variety of ways that may alienate others (e.g., anger, denial, social self-isolation).The nurse needs to recognize that the patient's behavior may be affected by a number of factors. Any patient suffering the discomforts of frequent bowel movements and rectal soreness is anxious, discouraged, and unhappy. It is important to develop a relationship with the patient that supports their attempts to cope with these stressors. It is also important to communicate that the patient's feelings are understood by encouraging the patient to talk and express their feelings and to discuss any concerns. Stress reduction measures that may be used include relaxation techniques, visualization, breathing exercises, and biofeedback. Professional counseling may be needed to help the patient and family manage issues associated with chronic illness and resulting disability.

coping

IBD treatment - pharmacology _______ are: cortisone, prednisone, prednisolone, hydrocortisone, methylprednisolone, beclometasone, and budesonide

corticosteroids

Approximately one-third of patients with ______ disease do not respond to conventional treatments, and some experience significant adverse effects, such as serious infections and lymphoma, and many patients require surgery due to complications. Increasing evidence suggests that specific changes in the composition of gut microbiota, termed as dysbiosis, are a common feature in patients with inflammatory bowel disease (IBD).

crohns

_______ Diarrhea Common, less than colitis: NO or little blood in them •Bowel Perforation possible/especially, if not compliant with treatment...disease goes unchecked •Entire GI tract: most common is transition between small& large intestine •Pain in lower right side

crohns

Defect in the cftr gene that makes a protein that controls the movement of salt and water in and out of your bodies cells, it does not work well which causes thick, stick, mucus and very salty sweat. CVTR proteins also affects the body in other ways. Every person also affects the body in other ways. Every person inherits two CFTR genes - one from each parent. Children who inherit a faulty CFTR gene from each parent will have CF. What is this?

cystic fibrosis

Medications - antibiotics - supplemental vitamins - aerosol - bronchodilators - mucolytics - pancreatic enzymes These are medications for what?

cystic fibrosis

Respiratory diseases that are obstructive (rather than infectious) •COPD (chronic obstructive pulmonary disease) •Chronic Bronchitis •Emphysema •Asthma - ________

cystic fibrosis

Treatment of _____ - Diet : increase calories, increase protein - pulmonary therapy - Chest physiotherapy ----- postural drainage - breathing exercises - aerosol therapy

cystic fibrosis

•Assessment •Physiologic - Adequacy of respiratory function - Evaluate child's growth and development - Assess child's stool patterns/GI function •Psychosocial - Emotional stress - Parent - Child - Sibling This is nursing management and assessment for what disease?

cystic fibrosis

•Bowel obstruction •Malnutrition •Increased sodium and chloride excretion •Respiratory infection(s) •Death These are complications of what disease?

cystic fibrosis

•Ineffective airway clearance related to thick mucus in lungs •Ineffective breathing pattern •Risk for infection •Altered nutrition •Fear/anxiety •Knowledge deficit This is nursing diagnosis for what disease?

cystic fibrosis

•Promote airway clearance •Administer medications •Meet nutritional needs •Provide psychosocial support •Discharge planning and home care teaching •Supportive home care These are nursing interventions for what disease?

cystic fibrosis

•Salty taste to the skin •Thick, sticky mucus production •Meconium ileus (bowel obstruction) in newborn •Constipation is common; intestinal obstruction possible •Chronic moist, productive cough= Frequent respiratory infections •Wheezing, retractions, tachypnea, fine crackles •Clubbing and barrel chest •Difficulty gaining and maintaining weight •Stool : Frothy (bulky, large quantity); Smell foul; Contain fat (steatorrhea); Float These are the clinical manifestations of what disease?

cystic fibrosis

•Stool Test (for fat) and/or Blood test •Sweat Test- done if blood test is positive •Classic Symptoms •Four Major Presentations •Newborn meconium ileus, malabsorption (failure to thrive), chronic recurrent respiratory infections, or intussusception •Positive Family History These are all diagnostic studies of what disease?

cystic fibrosis

•_____ _____ •A chronic inherited disorder of the exocrine glands characterized by abnormal thick secretions leading to multi-system effects •Respiratory- cilia in lungs cannot clear mucous •Gastrointestinal -obstructed pancreatic ducts, also lack of chloride and fluid secretion in intestines •Reproductive- most males sterile, females at high risk for pulmonary and nutritional complications •Pathophysiology •Altered function of exocrine glands

cystic fibrosis

•**WBC count •**WBC differential •Procalcitonin •Cultures of wound, blood, or other infected body fluids •Serological testing •Direct antigen detection methods •Antibiotic peak, trough levels •Radiological examination of the chest, abdomen, or urinary system •Lumbar puncture •Ultrasonic examination •Urinalysis These are _____ tests for what?

diagnostic tests for infection

IBD MAINTAINING NORMAL __________ PATTERNS: The nurse assists the patient in determining if there is a relationship between diarrhea and certain foods, activities, or emotional stressors. Identifying precipitating factors, the frequency of bowel movements, and the character, consistency, and amount of stool passed is important. The nurse provides ready access to a bathroom, commode, or bedpan and keeps the environment clean and odor free. It is important to administer antidiarrheal medications as prescribed. Loperamide may be prescribed 30 minutes before meals (see previous discussion on interventions for diarrhea). The nurse should record the frequency and consistency of stools after therapy is initiated.

elimination

Destruction of alveolar septa, airway instability. What is this?

emphysema

•Small airways undergo repeated cycles of inflammation and repair which increase collagen and scar tissue in the walls of the airways. These changes narrow the airway lumen and produce a fixed airway obstruction. •Elastic fibers in the alveolar walls are tethered to small airways and hold the airways open during expiration. Destruction of the alveolar membrane results in premature closure of the terminal airways and air trapping during expiration •Destruction of capillary bed This is the pathophysiology of what disease?

emphysema

Alterations and Manifestations •Healthcare-associated infections (HAIs) •Sources •______ ( own bacteria or microflora) •_______ ( from environment..... "a nurses gloves") •________ ( due to a treatment/ therapy)

endogenous exogenous latrogenic

Risk factors for infection with ____ gram-negative bacteria - residency in a long term care facility - underlying cardiopulmonary disease - multiple medical comorbidities - recent antibiotic therapy

enteric

- Expected outcomes may include: •Client consistently maintains O2 saturation > 90% •Client demonstrates appropriate modifications of ADLs •Client is able to maintain patent airway •Family is able to describe resources available What step of the nursing process is this for COPD?

evaluation

Asthma Promote effective gas ______ •Monitor skin color, temperature, LOC •Assess ABG results, pulse oximetry •Place in Fowler, high-Fowler, or orthopneic position •Administer oxygen as ordered •Administer nebulizer treatments, humidification as ordered •Increase fluid intake •Frequently assess respiratory status

exchange

Crohns Disease (CD) •Genetic factors •_____ _____ well established as one of the strongest risk factors for development for CD •Between age 20 and 29 are at greatest risk for Crohn's disease •Environmental factors •Lifestyle factors such as tobacco use, sedentary lifestyle, exposure to air pollution, and consumption of western diet •______ factors •CD often occurs after infectious gastroenteritis •Linked to other autoimmune diseases: asthma, MS,DM1, celiac

family history infectious

Infection changes : ______ : most common endogenous pyrogens (internal substances that cause fever) released from neutrophils /macrophages=reset the hypothalamic thermostat ______: Increase: synthesis & release of neutrophils from bone marrow

fever leukocytosis

Infection •Some microorganism are part of the normal _____ but have no beneficial role •Normally no harm unless the person is susceptible to infection due to suppression of the body's immune response

flora

Genetic considerations and non-modifiable risk factors •Native or Mexican Americans ---Increased risk for _________. •Female gender •African Americans •More likely than Caucasians to develop _____ as a result of lupus •Family history •Associated with _____ _____ ________

gallstones nephritis peptic ulcer disease

Client with COPD ______ may include that client will: •Adapt breathing patterns to meet demands •Experience ease of respirations •Maintain patent airway •Maintain O2 saturation levels above 90% •Tolerate activity levels, allowing for ADLs

goals

M. pneumoniae, S. pneumoniae, chlaydophilia pneumoniae, h influenzae type b, nontypable), influenza viruses, adenovirus, other respiratory viruses, legionella pneumophila What age group is at risk for this?

greater or equal to 5 years

Peak expiratory flow reading (PEFR) Traffic signal colors indicate •_____: 80 - 100% of personal best; asthma is under control •_____: 50 - 80%; caution, need treatment •_____: <50%; immediate need for bronchodilator/further medical treatment

green yellow red

Prevention of infection _____ ______ ______ •Effective hand washing is the single most important measure in infection control ( nurse and client) •Invasive procedures and equipment should only be used when absolutely necessary/ minimally •Medical and surgical asepsis is necessary •Critical thinking, agency policy

healthcare acquired infection

_____ ______ ________ Can develop: During client's stay in the facility Manifest after discharge Urinary tract infection is the most common type of _____s

healthcare aquired infections HAIs

pneumonia occurring in a non hospitalized patient with extensive health care contact with one of more of the following - hospitalization for greater than or equal to two in an acute care facility within 90 days of infection - residence in a nursing home or long term care facility - antibiotic therapy, chemotherapy, or wound care within 30 days of current infection - hemodialysis treatment at a hospital or clinic - home infusion therapy or home wound care - family member with infection due to multidrug-resistant bacteria What is this?

healthcare associate pneumonia (HCAP)

•_____ _____ 2020 goal: •Reduce •Pertussis •Hepatitis B •Varicella •Measles •Other vaccine-preventable diseases •Food-borne pathogens •HIV infection

healthy people

Pneumonia occuring greater than or equal to 48 hours after hospital admission that did not appear to be incubating at the time of admission What is this?

hospital acquired pneumonia

Infections •________ •Dramatically decrease incidence of infectious disease •Should begin shortly after birth •Completed throughout childhood

immunizations

________ have had a great impact on reducing the incidence of vaccine-preventable causes of pneumonia. _____ infections can be reduced in severity by use of palivizumab . • Reducing the length of mechanical ventilation and using antibiotic treatment only when necessary can reduce ventilator-associated pneumonias. • Hand washing before and after every patient contact and use of gloves for invasive procedures are important measures to prevent nosocomial transmission of infections. • Hospital staff with respiratory illnesses or who are carriers of certain organisms, such as methicillin-resistant S. aureus, should use masks or be reassigned to non-patient care duties.

immunizations RSV

Pharmacology of IBD _____________: TNF inhibitor i.e humira ( Anti-TNF-a therapy)(biologic therapy ) NF inhibitors are antibodies -made in a lab from human or animal tissue. Once they're put into your blood, they cause a reaction in your immune system that blocks inflammation. Your immune system makes a substance called tumor necrosis factor (TNF). Usually, your body keeps your TNF levels steady. But if you have an autoimmune disease like IBD, something goes wrong. You start making too much TNF, and that leads to inflammation. / Given in an injection most times.

immunomodulators

Techniques used to instruct a client to control the breathing pattern include pursed-lip breathing, abdominal breathing, and relaxation such as visualization and meditation. The following activities may enhance breathing pattern for the COPD client: Providing adequate rest periods prevents fatigue and reduces oxygen demands. Assisting with ADLs conserves energy and reduces oxygen demands. Relaxation techniques reduce anxiety and its effect on the respiratory rate. Pursed-lip breathing helps keep airways open by maintaining positive pressure. These is what step of the nursing process for COPD?

implementation

This is what step of the nursing process for a patient with COPD? Promote airway clearance •Assess respiratory status every 1-2 hours •Monitor ABG results •Daily weights, I & O, hydration assessment •Encourage fluid intake unless contraindicated •Place in Fowler, high-Fowler, orthopneic •Assist with coughing, deep breathing every 2 hours •Provide tissue, paper bag for disposal •Refer to respiratory therapist for PVD •Administer expectorant, bronchodilators •Provide supplemental oxygen as ordered •Promptly report changes in oxygen saturation, skin color, mental status

implementation

Asthma ______ breath sounds, reduced wheezing, and ineffective cough are some indicators that little or no air movement into and out of the lungs is taking place and immediate intervention is needed

inaudible

COPD Indications for a diagnoses of ______ ______ pattern may include: an elevated respiratory rate it is an indication of an ineffective breathing pattern.

ineffective breathing

Indications for admission to hospital : Infant or children? Oxygen stat below 92%, cyanosis RR greater 70 breaths/min, difficulty breathing intermittent apnea, grunting not feeding, family not able to provide appropriate observation or supervision

infant

Mild Pneumonia Infant or older children Temp over 38.5 C, RR over 50 breaths / min , taking full feeding

infant

Severe pneumonia Infant or older children Temp over 35.8 C , RR over 70 breaths / min, moderation to severe retractions, cyanosis, intermittent apnea, grunting respirations, not feeding

infants

Body Responses : Local : - redness, warmth, swelling, pain, loss of function Systemic : fever, leukocytosis, malaise, anorexia, sepsis, loss of appetite What is this?

infection

Risk factors for _____ with pseduomonas aeruginosa - structural lung disease ex bronchiectasis - corticosteroid therapy - broad spectrum therapy (>7 days in the past month) - malnutrition

infection

Vascular changes : - Vasodilation - Increased capillary permeability - increased blood flow - local tissue congestion These are changes that occur in what?

infection

We would recommend this diet to who? Diet - High protein, high carb, vitamin C, zinc

infection

•Assessing clients for ______ is vital to: •Treating clients •Preventing spread of infection •Look at history to assess degree of client risk Especially important for clients at risk of ______ such as those with •IV lines •Indwelling catheters •Surgical wounds

infection infection

Role of the _____ ______ _____ •Specially trained •Knowledgeable about: •Prevention •Detection •Treatment •All infections reported to IC nurse •Employee education

infection control nurse

Cellular changes : - phagocytosis - increased leukocytosis (granulocytes and monocytes) - release of chemical mediators (mast cells and macrophages) These are changes that occur in what?

infections

Stages of the _______ Process •Stages of the ______ process 1.Incubation period 2.Prodromal stage 3.Illness stage 4.Convalescent stage •Carrier state --Host defenses eliminate infectious disease --Organism continues to multiply

infectious infectious

Microorganism capable of causing diseases of illness Example : Bacteria, fungi, parasite, prions This is what in the chain of infection?

infectious agents

Infection - bacteria, fungi, viruses, rickettsiae, protozoa. What are these?

infectous agents

Cells/ tissues of the body may be injured or killed •Physical •Chemical •Microorganisms What is this?

inflammation

•Treat underlying condition/ disease •Treat Symptoms •Anti-inflammatory Medications •Diet - For healing process: ----- High Carbohydrate ----- High protein ----- Foods with anti-inflammatory properties What is this for?

inflammation

•_____ response : naturally occurs in the healthy tissues adjacent to the site of injury.

inflammatory

Nursing Process : _________ for pneumonia •Incentive spirometry •Nutrition •Hydration •Rest •Activity as tolerated •Patient teaching •Self-care •Oxygen with humidification to loosen secretions •Face mask or nasal cannula •Coughing techniques •Chest physiotherapy •Position changes

interventions

Asthma Provide education regarding activity ________ •Teach client to monitor cardiopulmonary response to activity •Teach client how to monitor, record PFR •Help assess capacity to sustain activities •Assess need for short-acting bronchodilators before activity, exercise •Space periods of rest, activity •Assist with ADLs as needed

intolerance

Asthma Appropriate teaching for a client prescribed ______ bromide (Atrovent) (anticholinergic bronchodilator) includes only taking the prescribed number of doses each day to prevent a drug overdose and the use of hard candy or extra fluids to decrease dry mouth. Bronchodilator therapy acts to stimulate the ____-or-_____ response, beta2-adrenergic receptors of the sympathetic nervous system are stimulated, the bronchiolar smooth muscle relaxes, and bronchodilation occurs..

ipratropium fight-or-flight

_____ Precautions •Guidelines to prevent the transmission of microorganisms in hospitals •Two tiers: •Standard precautions used for all patients •The primary strategy for preventing HAIs •Transmission-based precautions are for patients with known infectious diseases spread by airborne, droplet, or contact routes

isolation

In children Application of nasal continuous positive airway pressure (NCPAP) Since the application of ______ _______ is prone to cause ventilator-related complications, to improve the successful rescue rate of children with severe pneumonia and shorten the course of treatment, the use of NCPAP may be considered a priority. children as well as adults: need to do exercise, enhance nutrition, bask more in sunshine and engage in outdoor activities, ensure adequate sleep, pay attention to personal health, and get vaccinated for the prevention of _______ and ______ if necessary. _____ may have fever only with subtle or no physical findings of pneumonia. • The typical clinical patterns of viral and bacterial pneumonias usually differ between older infants and children, although the distinction is not always clear for a particular patient. • Fever, chills, • tachypnea, • cough, • malaise, • pleuritic chest pain, • retractions, and • apprehension, because of difficulty breathing or shortness of breath. Auscultation is unreliable when examining infants. / Lower chest wall indrawing •Stridor in a calm child= Severe Pneumonia

mechanical ventilation pneumonia and influenza neonates

_______ risk factors for infection •Hygiene •Nutrition •Fluid •Sleep •Stress

modifiable

New Meds for CF: "BIG Game changers" : _______ Orkamb Kayydcco/Ivacaftor Elexacafter Helps with defective CFTR protein; puts its place on the cell surface and increases the proteins activity once it is in place

modulators

Pneumonia - spreading _____ cases: person to person by coughing / tiny droplets •Some pathogens can live in nose and throat without causing disease - But when inhaled into lungs, they can cause pneumonia. While many people are exposed to pneumococcus, usually only those with underlying health issues develop pneumonia.

most

_____ Screening in CF: law in some states: •Check pancreatic levels of: immunoreactive trypsinogent, or IRT- F/U with a sweat test if elevated to confirm CF •If a Meconium ileus is present: suggestive of CF (present in up to 10% with CF)

newborn

Genetic and Lifepsan Considerations •________ •Immature immune systems •Protected by immunoglobulins received from mother •Infants begin to synthesize immune system at 1-3 months of age _______ : Fecal-oral and respiratory routes are most common modes of transmission in children for infectious disease

newborns children

Infants and children Signs : - tachypnea Treatment - Prescribe appropriate ABOs - advise caregiver of other supportive measure and when to return for a follow up visit What is this classified as?

non- sever pneumonia

IBD MAINTAINING OPTIMAL ______; Parenteral nutrition is indicated in patients who have Crohn's disease with severe malnutrition and intolerance to enteral nutrition and who are expected to likely remain intolerant to enteral nutrition for more than 1 to 2 weeks (Smith & Harris, 2014). With parenteral nutrition, the nurse maintains an accurate record of fluid I&O as well as the daily weight. The patient should gain 0.5 kg (1.1 lb) daily during parenteral nutrition therapy. Because parenteral nutrition is very high in glucose and can cause hyperglycemia, blood glucose levels are monitored every 6 hours. Once the symptoms of any exacerbation have diminished and the patient has gained or stabilized weight, parenteral nutrition is stopped and the patient is advanced on oral elemental feedings. Elemental feedings are high in protein and low in fat and residue. They are digested primarily in the jejunum, do not stimulate intestinal secretions, and allow the bowel to continue to rest. The nurse notes intolerance if the patient exhibits nausea, vomiting, diarrhea, or abdominal distention. See Chapter 44 for further discussion of enteral and parenteral nutrition.If oral foods are tolerated, small, frequent, low-residue feedings are given to avoid overdistending the stomach and stimulating peristalsis. The patient must restrict activity to conserve energy, reduce peristalsis, and reduce caloric requirements.p. 1334p. 133

nutrition

severe pneumonia Infant or older children Tempt over 35.8 C, RR over 50 breaths / min, severe difficulty in breathing, nasal flaring, cyanosis, grunting respirations, signs of dehydrations

older children

Pneumonia ______ :lots of different types of microbes, and no single one is responsible for as many as 10% of pneumonia cases. •_____= Antibiotics can be effective for many types/ resistance is growing •______ = viral pneumonia leading cause of hospitalization of infants) •Few treatments for most viral pneumonias •Fungi •For most pneumonia patients, the microbe causing the infection is never identified

organisms bacteria Viruses

Infant and children Signs : - normal respiratory rate Treatment : - advise caregiver of other supportive measure and when to return if symptoms persist or worsen What is this classified as?

other respiratory illness

Asthma Expected ________ may include that client •Maintains oxygen saturation greater than 90% •Demonstrates proper use of inhalers •Lists common triggers, strategies to avoid •Lists symptoms requiring immediate notification of primary provider •Responds appropriately to asthma flare-up •Maintains optimal nutrition to promote health •Describes appropriate follow-up care

outcomes

_______ (outside of the circulation system that is involved with gas exchange and includes the alveoli and respiratory bronchioles.) Lower lung: may be difficult to distinguish clinically. /encompass bronchitis, bronchiolitis _______ is a general term for lung inflammation that may or may not be associated with consolidation

parenchyma pneumonitis

______ differences •Narrower airway •Edema and swelling •Ribs flexible •Oxygen consumption higher •More rapid muscle fatigue What Affects 10% of children in U.S.?

pediatric asthma

Risk factors for infection with _____ resistant and _____ resistant pneumococci - age > 65 years - alcoholism - beta-lactam therapy (ex cephalosporins) in past 3 months - immunosuppressive disorders - multiple medical conditions - exposure to a child in a day care facility

penicillin drug

Age Considerations : Elderly For what disease process? •A primary diagnosis or complication of a chronic disease •More difficult to treat- higher mortality rate •Chest x-rays/ differentiate chronic heart failure from pneumonia •TX: watch fluid overload in this population. •Preventative: Vaccinations / manage chronic illnesses •Classic symptoms (cough, chest pain, sputum production, and fever) may differ: •General deterioration, weakness, abdominal symptoms, anorexia, confusion, tachycardia, and tachypnea. •Abnormal breath sounds: Crackles ( fine & coarse) and reduced breath sounds function changes.

pneumonia

Aspiration •Inhalation of foreign material into the lungs •Serious complication of ______ •Clinical picture: tachycardia, dyspnea, central cyanosis, hypertension, hypotension, and potential death •Nursing interventions: •Keep HOB elevated >30 degrees/ and after eating •Avoid stimulation of gag reflex with suctioning or other procedures •Check for placement before tube feedings •Thickened fluids for swallowing problems

pneumonia

Clinical manifestations / signs and symptoms •Varies depending on type, causal organism, and presence of underlying disease •Cough •Fever and chills •Tachypnea / SOB / orthopnea / crackles/ increased tactile fremitus •Chest pain/ pleuritic •Confusion •Headache /Muscle,joint pain /Fatigue •Rash •Pharyngitis •Symptoms of low oxygenation These are manifestations of what?

pneumonia

Risk Factors and Prevention for ________ •Adults 65 years or older •Depressed cough & glottic reflexes / nutrition depletion / immune / dry mouth/ oral hygiene •Effective cough & breathing exercises & ambulation / vaccination/ nutrition / oral care •Smoking cigarettes: Smoking cessation program •Children younger than 5 years old / vaccinations •Conditions that interfere with normal lung drainage ( COPD, cancer etc): Promote coughing/expectorations •Respiratory depression (general anesthetic, sedative, opioid)=pooling of bronchial secretions: monitor for •Depressed cough reflex= leads to aspiration of foreign material - supine position = unable to protect airway •Elevate head of bead, small bites & chew well , no distractions,

pneumonia

Risk factor : advanced age, because of possible depressed cough and glottic reflexes and nutritional depletion Preventative : Promote frequent turning, early ambulation and mobilization, effective coughing, breathing exercises, and nutritious diet What is this a risk factor for what?

pneumonia

Signs and symptoms of _______ may also depend on a patient's underlying condition. Different signs occur in patients with conditions such as cancer, and in those who are undergoing treatment with immunosuppressant medications, which decrease the resistance to infection. Such patients have fever, crackles, and physical findings that indicate consolidation of lung tissue, including increased tactile fremitus (vocal vibration detected on palpation), percussion dullness, bronchial breath sounds, egophony (when auscultated, the spoken "E" becomes a loud, nasal-sounding "A"), and whispered pectoriloquy (whispered sounds are easily auscultated through the chest wall). These changes occur because sound is transmitted better through solid or dense tissue (consolidation) than through normal air-filled tissue; these sounds are described in Chapter 20. Purulent sputum or slight changes in respiratory symptoms may be the only sign of pneumonia in patients with COPD. Determining whether an increase in symptoms is an exacerbation of the underlying disease process or an additional infectious process may be difficult.

pneumonia

Some patients exhibit an upper respiratory tract infection (nasal congestion, sore throat), and the onset of symptoms of __________ is gradual and nonspecific. The predominant symptoms may be headache, low-grade fever, pleuritic pain, myalgia, rash, and pharyngitis. After a few days, mucoid or mucopurulent sputum is expectorated. In severe pneumonia, the cheeks are flushed and the lips and nail beds demonstrate central cyanosis (a late sign of poor oxygenation [hypoxemia]). The patient may exhibit orthopnea (shortness of breath when reclining or in the supine position), preferring to be propped up or sitting in bed leaning forward (orthopneic position) in an effort to achieve adequate gas exchange without coughing or breathing deeply. Appetite is poor, and the patient is diaphoretic and tires easily. Sputum is often purulent; however, this is not a reliable indicator of the etiologic agent. Rusty, blood-tinged sputum may be expectorated with streptococcal (pneumococcal), staphylococcal, and Klebsiella pneumonia.

pneumonia

Systemic : - high fever - may be low in elderly - chills Skin : - Clamminess - Blueness Lungs : - cough with sputum or phlegm - SHOB - pleurtic chest pain - hemoptysis - tachypnea Muscular - fatigue - aches Central - headaches - loss of appetite - mood swings - cognition issues Vascular - low blood pressure Heart - High heart rate Gastric - Nausea - vomiting Joints - pain These are all signs of what?

pneumonia

These are collaborative problems for what issue? •Continuing symptoms after initiation of therapy •Sepsis and septic shock •Respiratory failure •Atelectasis •Pleural effusion •Delirium

pneumonia

These are diagnosis for what condition? •Ineffective Airway Clearance •Fatigue and Activity Intolerance •Risk for Fluid Volume Deficit •Imbalanced Nutrition •Knowledge Deficit

pneumonia

These are expected outcomes for what issue? •Demonstrates improved airway patency •Rests and conserves energy and then slowly increasing activities •Maintains adequate hydration; adequate dietary intake •Verbalizes increased knowledge about management strategies •Complies with management strategies •Exhibits no complications

pneumonia

These are possible complications of what disease? •Septic Shock •Respiratory Failure •Abscess •Empyema •Scarring •Pleural Effusion •Pneumothorax

pneumonia

This is nursing process : planning for what? •Improved airway patency •Increased activity •Maintenance of proper fluid volume •Maintenance of adequate nutrition •Understanding of the treatment protocol and preventive measures •Absence of complications

pneumonia

______ is the #1 most common reason for US children to be hospitalized. Less % die than adults For US adults, _______ is the most common cause of hospital admissions other than women giving birth.While young healthy adults have less risk of _______ than the age extremes, it is always a threat. Half of all non-immunocompromised adults hospitalized for severe ______ in the US are younger adults (18-57 years of age). Half the deaths from bacteremic pneumococcal _______ occur in people ages 18-64. seniors, hospitalization for pneumonia has a greater risk of death compared to any of the other top 10 reasons for hospitalization. Interesting fact: The death rate from ______in the US has had little or no improvement since antibiotics became widespread more than half a century ago. We are not yet winning the battle against pneumonia _____ was first described by Hippocrates [5] (460-370 BC). The first descriptions of its clinical and pathological features were made 22 centuries later in 1819 by Laennec [6] while Rokitansky [7] in 1842 was the first to differentiate lobar and bronchopneumonia. During the next 47 years at least 28 terms were used to identify _______ [8], and by 1929 the total number of terms listed in the Manual of the International List of Causes of Death had grown to 94, with 12 sub-terms [9]..

pneumonia

_______ •1 million : seek care in a hospital due to ______ • 3 million cases •1/3 over age 65 •50,000 people die / U.S. •4/100 children US develop pneumonia every year •Leading infectious cause of death in children younger than 5 years old worldwide. •In top ten most expensive conditions seen during inpatient hospitalizations. •$10.6 billion / 1.1 million hospital stays (2011)

pneumonia

_______ varies in its signs and symptoms depending on the type, causal organism, and presence of underlying disease. However, it is not possible to diagnose a specific form or classification of pneumonia by clinical manifestations alone. The patient with streptococcal (pneumococcal) pneumonia usually has a sudden onset of chills, rapidly rising fever (38.5° to 40.5°C [101° to 105°F]), and pleuritic chest pain that is aggravated by deep breathing and coughing. The patient is severely ill, with marked tachypnea (25 to 45 breaths/min), accompanied by other signs of respiratory distress (e.g., shortness of breath and the use of accessory muscles in respiration) (Weinberger, Cockrill & Mandel, 2014). A relative bradycardia (a pulse-temperature deficit in which the pulse is slower than that expected for a given temperature) may suggest viral infection, mycoplasma infection, or infection with a Legionella organism.

pneumonia

risk factors and prevention for _______ •Immunosuppressed patients / low neutrophil count: Special precautions/(reverse isolation) •Prolonged immobility=shallow breathing: TCDB, promote lung expansion / suction/ chest physical therapy •NPO / NG/ Endotracheal tube : oral hygiene, protocols, check placement •Antibiotic therapy( very ill people the oropharynx is likely to be colonized by gram-negative bacteria) •Monitor patients receiving / no overuse of ABO •Ongoing medical conditions ( diabetes, ht, disease, asthma) : mange disease, monitor, vaccination Frequent Hand Washing / Clean surfaces that are touched a lot/ Cough & sneeze into elbow & stay away from sick people

pneumonia

•Viruses: most common type in children & infants •Bacteria/ micro bacteria •Fungi •Non-effective: Toxins/Chemicals/Aspiration •Inflammatory process: alveolar area= edema & exudation •Difficulty with diffusion ( oxygen & carbon dioxide) •Partial occlusion of the bronchioles or alveoli •Alveolar walls thickened by edema This is the pathophysiology of what disease?

pneumonia

_______ = most common cause of sepsis and septic shock, causing 50% of all episodes. when a comorbid disease complicates the pneumonia, or when the patient is immunocompromised. While successful pneumonia treatment often leads to full recovery, it can have longer term consequences. Children who survive pneumonia have ______ risk for chronic lung diseases. Adults who survive pneumonia may have worsened exercise ability, cardiovascular disease, cognitive decline, and quality of life for months or years. Pneumococcus in blood = _____ Pneumococcus in spinal fluid = ______

pneumonia increased bacteremia menigitis

Infection excretions, secretions, skin, droplets What are these?

portal of exit

Ways in which the infectious agent enters the susceptible host Examples - mucous membrane - respiratory system - digestive system - broken skin This is what in the chain of infection?

portals of entry

Ways in which infectious agent leaves the reservoir Example : blood, secretions, excretions, skin. This is what in the chain of infection?

portals of exit

Asthma and ______ •Most common respiratory disease in pregnancy •Improves in 1/3, maintains in 1/3, worsens 1/3 •Prematurity •Low birth weight •Multidisciplinary care

pregnancy

IBD _______ SKIN BREAKDOWN; The nurse examines the patient's skin frequently, especially the perianal skin. Perianal care, including the use of a skin barrier (e.g., petroleum ointment [Vaseline]), is important after each bowel movement. The nurse gives immediate attention to reddened or irritated areas over bony prominences and uses pressure-relieving devices to prevent skin breakdown. Consultation with a wound-ostomy-continence (WOC) nurse (or WOCN; a nurse specially educated in the management of a variety of fecal and urinary diversions) is often helpful

preventing

IBD ________ REST: The nurse recommends intermittent rest periods during the day and schedules or restricts activities to conserve energy and reduce the metabolic rate. It is important to encourage activity within the limits of the patient's capacity. The nurse suggests naps and periods of bed rest for a patient who is febrile, has frequent diarrheal stools, or is bleeding. However, the patient should perform active exercises to maintain muscle tone and prevent venous thromboembolic complications. If the patient cannot perform these active exercises, the nurse performs passive exercises and joint range of motion. Activity restrictions are modified as needed on a day-to-day basis

promoting

Ulcerative Colitis •Environmental factors •_______ associated with paradoxically lower risk, milder disease •_____ of prior GI infections, e.g. Shigella, Salmonella, Campylobacter, during adulthood double risk of developing UC: possible changes in gut flora triggering chronic inflammatory process •Weak associations between NSAIDs, Oral contraceptives and increased risk of UC

smoking history

Inflammation stages •______ ____: vascular and cellular responses •Blood vessels at site constrict •Injured tissue releases histamines, kinins, and prostaglandins •Chemical mediators cause hyperemia •Vascular permeability increases •Fluid, proteins, and leukocytes leak into interstitial spaces causing edema and pain •Leukocytes à margination, emigration •Leukocytosis

stage one

Asthma Rinse mouth after using inhalers/ leaving _____ in the mouth can cause thrush & and to reduce the amount of drug swallowed that may contribute to systemic side effects of steroids (not so much with the newer inhalers) _______ modifiers like (Singulair) works by blocking substances in your lungs called _____ that cause narrowing and swelling of airways. Blocking _______ improves asthma symptoms and helps prevent asthma attacks. ________ also cause allergic rhinitis symptoms. By blocking ______, SINGULAIR improves seasonal allergic rhinitis symptoms. Take Singulair at least 1 hour before eating

steroids leuotrienes

Evidence that care provided to a client with COPD was _________ may include: the client conducting morning care and ambulating in the room while maintaining an oxygen saturation of 92%. This outcome identifies the client's ability to maintain adequate oxygenation and perform activities of daily living.

successful

infection - immunosupression, diabetes, surgery, burns, elderly. What are these?

susceptible host

Infection Localized or systemic Headaches, fever, fatigue, vomiting, diarrhea, increased pulse and respiration.

systemic

Common indications for surgery in patients with _____ ____ include the presence of colon cancer or colonic dysplasia/polyps (see later discussion); megacolon; severe, intractable bleeding; or perforation (NIDDK, 2014f; Walfish, 2016).

ulcerative colitis

Notes: ______ ______ •Patients with _____ _____ predominantly complain of increasing rectal bleeding with frequent stools and mucus discharge. In severe cases, purulent rectal discharge can result in lower abdominal pain and severe dehydration, especially in the elderly. urgency •Symptomatically, it presents with a loosening of the stool, progressing to bloody stool, severe urgency of bowel movements and possibly cramping abdominal pain. As the disease progresses, diarrhea may begin, and can be accompanied by loss of appetite and weight loss along with fatigue. As the disease moves from moderate to severe, skin lesions, joint pain, eye inflammation and liver disorders may occur. •Biopsy of the mucosa is recommended to identify the extent of the disease with respect to the thickness of the bowel wall. Histology may reveal crypt abscesses and mucosal inflammation. •Routine blood tests that should be performed include assays for C-reactive protein, anti-prothrombin, and serum albumin. •Plain abdominal radiographs are in the diagnosis of ulcerative colitis. The images may show colonic dilatation, suggesting toxic megacolon, evidence of perforation, obstruction, or ileus. Patients with tenesmus should be queried for symptoms of rectal prolapse. Rectal prolapse may result in distal rectal inflammation suggestive of ulcerative proctitis.

ulcerative colitis

_____ ______: Clinical Manifestations : Signs and Symptoms Altered bowel movements •Increased stool frequency (diarrhea) with urgency •Decreased stool consistency •Abdominal pain •Rectum- colon usually affected: LLQ cramping, relieved with defecation •Blood in stool •More rarely can see fistulas, weight loss, more common in CD •In severe or advanced cases, patients may present with fever •Extraintestinal manifestations are more commonly seen in UC than CD: include aphthous oral ulcers, iritis/uveitis/episcleritis, seronegative arthritis, ankylosing spondylitis, sacroiliitis, erythema nodosum, pyoderma gangreosum, autoimmune hemolytic anemias and primary sclerosing cholangitis •Characterized by alternating periods of remission and relapse

ulcerative colitis

Surgical intervention •_______ _____ : 30-40% will require surgery •Proctocolectomy, which is removal of the rectum and colon, the surgery cures the disease •______: 60-70% will require surgery •Surgical cure is not possible with ______ disease •50% who require surgical intervention will eventually require additional future surgery •Intestinal transplant •children / young & middle-aged adults who have lost intestinal function from disease •May require surgery to relieve strictures

ulcerative colitis chrons

When nonsurgical measures fail to relieve severe symptoms of IBD, surgery may be necessary. Nearly one third of patients with severe _____ _____and between 60% and 70% of patients with ____ disease require surgery (NIDDK, 2016b; Walfish, 2016).

ulcerative colitis Crohns

Some types of pneumonia, such as those caused by ______ infections, occur in previously healthy people, often after a viral illness. The World WHO has set a high priority on developing new vaccines and new therapeutic drugs to tackle these viral pneumonias that largely have no currently available vaccines or treatments ______ infections can lead to epidemics or pandemics, such as from avian influenza viruses (bird flu), severe acute respiratory system (SARS) coronavirus, Middle East Respiratory Syndrome (MERS) virus, and more. Environmental reservoirs or sources can cause lusters of infection, such as Legionella pneumonia. Bioweapons can cause pneumonia such as from anthrax.

viral emerging

Atypical bacteris= Mycoplasma pneumoniae commonly causes mild infections of the respiratory system. In fact, pneumonia caused by M. pneumoniae is sometimes referred to as "_____ _____" since symptoms tend to be milder than pneumonia caused by other germs. A common cause of bacterial pneumonia is Streptococcus pneumoniae (pneumococcus). However, clinicians are not always able to find out which germ caused someone to get sick with pneumonia.

walking pneumonia

Which is the most important risk factor for development of chronic obstructive pulmonary disease (COPD)? A - Cigarette smoking B - Genetic abnormalities C - Air pollution D - Occupational exposure

A - Cigarette smoking

A nurse is caring for a group of clients on a medical-surgical floor. Which client is at greatest risk for developing pneumonia? A - A client with a nasogastric tube B - A client who is receiving acetaminophen (tylenol) for pain C - A client with a history of smoking two packs of cigarettes per day until quitting 2 years ago D - A client who ambulated in the hallways every 4 hours

A - A client with a nasogastric tube

The nurse at a long-term care facility is assessing each of the residents. Which resident most likely faces the greatest risk for aspiration? A - A resident who suffered a severe stroke several weeks ago B - A resident with mid-stage alzheimer disease C - A 92 year old resident who needs extensive help with ADLs D - A resident with severe and deforming rheumatoid arthritis

A - A resident who suffered a severe stroke several weeks ago

A client with a pulmonary embolus has the following arterial blood gas (ABG) values: pH, 7.49; partial pressure of arterial oxygen (PaO2), 60 mm Hg; partial pressure of arterial carbon dioxide (PaCO2), 30 mm Hg; bicarbonate (HCO3-) 25 mEq/L. What should the nurse do first? A - Administer oxygen by nasal cannula as ordered B - Auscultate breath sounds bilaterally every 4 hours C - Encourage the client to deep-breath and cough every 2 hours D - Instruct the client to breath into a paper bag

A - Administer oxygen by nasal cannula as ordered

During discharge teaching, a nurse is instructing a client about pneumonia. The client demonstrates his understanding of relapse when he states that he must: A - Continue to take antibiotics for the entire 10 days B - Follow up with the physician in 2 weeks C - Maintain fluid intake of 40 ox (1,200 ml) per day D - Turn and reposition himself every 2 hours

A - Continue to take antibiotics for the entire 10 days

A client has a 10-year history of Crohn's disease and is seeing the physician due to increased diarrhea and fatigue. What is the recommended dietary approach to treat Crohn's disease? A - Dietary approach varies B - Lactose-rich foods C - High-fiber diet D - Low-fiber diet

A - Dietary approach varies

The nurse is assessing a client who had an ileostomy created three days ago for the treatment of irritable bowel disease. The nurse observes that the client's stoma is bright red and there are scant amounts of blood on the stoma. What is the nurse's best action? A - Document these expected assessment findings B - Contact the care provider to have the clients hemoglobin and hematocrits measured C - Apply barrier ointment to the stoma as prescribed D - Cleans the stoma with alcohol or chlorhexidine

A - Document these expected assessment findings

A nurse is assessing a client who comes to the clinic for care. Which findings in this client suggest bacterial pneumonia? A - Dyspnea and wheezing B - Sore throat and abdominal pain C - Nonproductive cough and normal temperature D - Hemoptysis and dysuria

A - Dyspnea and wheezing

The nurse is providing care for a client who has recently been diagnosed with chronic obstructive pulmonary disease. When educating the client about exacerbations, the nurse should prioritize which topic? A - Identifying specific causes of exacberations B - Prompt administration of corticosteroids during exacberations C - The relationship between activity levels and exacberations D - The importance of prone positioning during exacberation

A - Identifying specific causes of exacberations

A client is admitted to a health care facility for treatment of chronic obstructive pulmonary disease. Which nursing diagnosis is most important for this client? A - Impaired gas exchange related to airflow obstruction B - Risk for infection related to retained secretions C - Anxiety related to actual threat to health status D - Activity intolerance related to fatigue

A - Impaired gas exchange related to airflow obstruction

A nurse is caring for a client who was admitted with pneumonia, has a history of falls, and has skin lesions resulting from scratching. The priority nursing diagnosis for this client should be: A - Ineffective airway clearance B - Impaired tissue integrity C - Ineffective breathing pattern D - Risk for falls

A - Ineffective airway clearance

Crohn's disease is a condition of malabsorption caused by which pathophysiological process? A - Inflammation of all layers of intestinal mucosa B - Gastric resection C - Infectious disease D - Disaccharidase deficiency

A - Inflammation of all layers of intestinal mucosa

A gerontologic nurse is teaching a group of medical nurses about the high incidence and mortality of pneumonia in older adults. What is a contributing factor to this that the nurse should describe? A - Older adults often lack the classic signs and symptoms of pneumonia B - Older adults are not normally candidates for pneumococcal vaccination C - Older adults have les compliant lung tissue than younger adults D - Older adults often cannot tolerate the most common antibiotics used to treat pneumonia

A - Older adults often lack the classic signs and symptoms of pneumonia

A client is admitted to the facility with a productive cough, night sweats, and a fever. Which action is most important in the initial care plan? A - Placing the client in respiratory isolation B - Wearing gloves during all client contact C - Monitoring the clients fluid intake and output D - Assessing the clients temperature every 8 hours

A - Placing the client in respiratory isolation

A client has been hospitalized for treatment of acute bacterial pneumonia. Which outcome indicates an improvement in the client's condition? A - The client has a partial pressure of arterial oxygen PaO2 value of 90 mm Hg or higher B - The client exhibits restlessness and confusion C - The client exhibits bronchial breath sounds over the affected area D - The client has a partial pressure of arterial carbon dioxide (paCO2) value of 65 mmHg or higher

A - The client has a partial pressure of arterial oxygen PaO2 value of 90 mm Hg or higher

A nurse is teaching the client about use of the pictured item with a metered-dose inhaler (MDI). What instructions should the nurse include in the teaching? Select all that apply. A - The device may increase delivery of the MDI medications B - It is not necessary to hold your breath after using C - Activate the MDI once D - Take a slow, deep inhalation from the device E - Use normal inhalations with the device

A - The device may increase delivery of the MDI medications C - Activate the MDI once D - Take a slow, deep inhalation from the device

A client presents to the emergency department with complaints of acute GI distress, bloody diarrhea, weight loss, and fever. Which condition in the family history is most pertinent to the client's current health problem? A - Ulcerative colitis B - Appendicitis C - Gastoesophageal reflux disease D - Hypertension

A - Ulcerative colitis

A nurse is providing care for a client who has a diagnosis of irritable bowel syndrome (IBS). When planning this client's care, the nurse should collaborate with the client and prioritize what goal? A - Client will demonstrate appropriate care of his ileostomy B - Client will accurately identify foods that trigger symptoms C - Client will adhere to recommended guidelines for mobility and activity D - Client will demonstrate appropriate use of standard infection control precautions

B - Client will accurately identify foods that trigger symptoms

An asthma nurse educator is working with a group of adolescent asthma clients. What intervention is most likely to prevent asthma exacerbations among these clients? A - Encouraging clients to carry a corticosteroid rescue inhaler at all times B - Educating clients about recognizing and avoiding asthma triggers C - Ensuring that clients keep their immunizations up to date D - Teaching clients to utilize alternative therapies in asthma management

B - Educating clients about recognizing and avoiding asthma triggers

A client has chronic obstructive pulmonary disease (COPD) and is exhibiting shallow respirations of 32 breaths per minute and a pulse oximetry of 93% despite receiving nasal oxygen at 2 L/minute. What action should the nurse take? A - Encourage the client to take deep breaths B - Encourage the client to exhale slowly against pursed lips C - Increase the flow of oxygen D - Teach the client to perform upper chest breaths

B - Encourage the client to exhale slowly against pursed lips

A nurse consulting with a nutrition specialist knows it's important to consider a special diet for a client with chronic obstructive pulmonary disease (COPD). Which diet is appropriate for this client? A - Full liquid B - High Protein C - Low-Fat D - 1,800-calorie ADA

B - High Protein

A client with acquired immunodeficiency syndrome (AIDS) develops Pneumocystis carinii pneumonia. Which nursing diagnosis has the highest priority? A - Impaired oral mucous membranes B - Impaired gas exchange C - Activity intolerance D - Imbalanced nutrition : Less than body requirements

B - Impaired gas exchange

A nurse is teaching a client with emphysema how to perform pursed-lip breathing. The client asks the nurse to explain the purpose of this breathing technique. Which explanation should the nurse provide? A - It decreases use of accessory breathing muscles B - It helps prevent early airway collapse C - It prolongs the inspiratory phase of respiration D - It increases inspiratory muscle strength

B - It helps prevent early airway collapse

•Pulmonary function testing •V-Q scanning •Serum α1-antitrypsin levels •Arterial blood gas •Pulse oximetry •Exhaled carbon dioxide •CBC with WBC differential •Chest x-ray These are all ______ tests for what disease?

diagnostic COPD

A client is diagnosed with a chronic respiratory disorder. After assessing the client's knowledge of the disorder, the nurse prepares a teaching plan. This teaching plan is most likely to include which nursing diagnosis? A - Impaired swallowing B - Anxiety C - Imbalanced nutrition : More than body requirements D - Unilateral neglect

B - Anxiety

A client arrives in the emergency room with emphysema and has developed an exacerbation of COPD with respiratory acidosis from airway obstruction. What is the highest priority for the nurse? A - Assess vital signs every 2 hours, including O2 saturations and ABG results B - Apply supplemental oxygen as ordered C - Educate the client about the importance of pursed lip breathing D - Refer the client to respiratory therapy if breathing becomes labored

B - Apply supplemental oxygen as ordered

A nurse is discussing asthma complications with a client and family. What complications should the nurse include in the teaching? Select all that apply. A - Pertussis B - Atelectasis C - Thoracentesis D - Status asthmaticus E - Respiratory Failure

B - Atelectasis D - Status asthmaticus E - Respiratory Failure

A nurse is developing the teaching portion of a care plan for a client with COPD. What would be the most important component for the nurse to emphasize? A - Smoking up to three cigarettes weekly is generally allowable B - Chronic inhalation of indoor toxins can cause lung damage C - Minor respiratory infections are considered to be self limiting and are not treated with medication D - Activities of daily living (ADLs) should be clustered in the early morning hours

B - Chronic inhalation of indoor toxins can cause lung damage

A nurse is reviewing lab results for a client with an intestinal obstruction, and infection is suspected. What would be an expected finding? A - Leukopenia, metabolic acidosis, elevated sodium, potassium and chloride B - Leukocytosis, elevated hematocrit, low sodium, potassium, and chloride C - Leukopenia, decreased hematocrits, low sodium, potassium, and chloride D - Leukocytosis, metabolic alkalosis, elevated sodium, potassium, and chloride

B - Leukocytosis, elevated hematocrit, low sodium, potassium, and chloride

What is histamine, a mediator that supports the inflammatory process in asthma, secreted by? A - Eosinophils B - Mast Cells C - Neutrophils D - Lymphocytes

B - Mast Cells

A client is being seen in the emergency department for exacerbation of chronic obstructive pulmonary disease (COPD). The first action of the nurse is to administer which of the following prescribed treatments? A - Ipratropium bromide (alupent) by metered dose inhaler B - Oxygen through nasal cannula at 2 L/Minute C - Vancomycin 1 gram intravenously over 1 hour D - Intravenous methylprednisolone (Solu-Medrol) 120 mg

B - Oxygen through nasal cannula at 2 L/Minute

A nurse is caring for a 6-year-old client with cystic fibrosis.To enhance the child's nutritional status, which priority intervention should be included in the plan of care? A - Total parenteral nutrition (TPN) B - Pancreatic enzyme supplementation with meals C - Provision of five to six small meals per day rather than three larger meals D - Magnesium, thiamine, and iron supplementation

B - Pancreatic enzyme supplementation with meals

The nurse is assigned the care of a 30-year-old client diagnosed with cystic fibrosis (CF). Which nursing intervention will be included in the client's care plan? A - Providing the client a low-sodium diet B - Performing chest physiotherapy as ordered C - Restricting oral intake of 1,000 ml/day D - Discussing palliative care and end of life issues with the client

B - Performing chest physiotherapy as ordered

In chronic obstructive pulmonary disease (COPD), decreased carbon dioxide elimination results in increased carbon dioxide tension in arterial blood, leading to which of the following acid-base imbalances? A - Metabolic acidosis B - Respiratory acidosis C - Metabolic alkalosis D - Respiratory alkalosis

B - Respiratory acidosis

In the prevention of occupational lung diseases, the nurse would direct preventive teaching to which high-risk occupations? Select all that apply. A - Banker B - Rock quarry worker C - Mechanic D- Nurse E - Stone cutter F - Miner

B - Rock quarry worker E - Stone cutter F - Miner

A client has a newly created colostomy. After participating in counseling with the nurse and receiving support from the spouse, the client decides to change the colostomy pouch unaided. Which behavior suggests that the client is beginning to accept the change in body image? A - The client avoids talking about the recent surgery B - The client touches the altered body part C - The client asks the spouse to leave the room D - The client closes his or her eyes when the abdomen is exposed

B - The client touches the altered body part

The nurse is assigned to care for a patient in the ICU who is diagnosed with status asthmaticus. Why does the nurse include fluid intake as being an important aspect of the plan of care? (Select all that apply.) A - To relieve bronchospasm B - To combat dehydration C - To assist with the effectiveness of the corticosteroids D - To loosen secretions E - To facilitate expectoration

B - To combat dehydration D - To loosen secretions E - To facilitate expectoration

Which technique does the nurse suggest to a client with pleurisy while teaching about splinting the chest wall? A - Use a heat or cold application B - Turn onto the affected side C - Avoid using a pillow while splinting D - Use a prescribed analgesic

B - Turn onto the affected side

A client newly diagnosed with emphysema asks the nurse to explain all about the disease. The nurse would include the following response when defining emphysema: A - Inflammation of the bronchioles with a normal distention of the air spaces B - Decreased sputum production with dilation of bronchioles C - An abnormal distention of the air spaces with destruction of the alveolar walls D - Increased oxygen diffusion with inflammation of the bronchioles

C - An abnormal distention of the air spaces with destruction of the alveolar walls

The nurse is assessing a client whose respiratory disease is characterized by chronic hyperinflation of the lungs. Which physical characteristic would the nurse most likely observe in this client? A - A moon face B - Long, thing fingers C - Barrel chest D - Signs of oxygen toxicity

C - Barrel chest

A client with chronic obstructive pulmonary disease (COPD) reports increased shortness of breath and fatigue for 1 hour after awakening in the morning. Which of the following statements by the nurse would best help with the client's shortness of breath and fatigue? A - Sit in a chair whenever doing an activity B - Drink fluids upon arising from bed C - Delay self care activities for 1 hour D - Raise your arms over your head

C - Delay self care activities for 1 hour `

An admitting nurse is assessing a client with COPD. The nurse auscultates diminished breath sounds, which signify changes in the airway. These findings indicate to the nurse to monitor the client for what? A - Bradypnea and pursed lip breathing B - Sepsis and pneumothorax C - Dyspnea and hypoxemia D - Kyphosis and clubbing of the fingers

C - Dyspnea and hypoxemia

A nurse is evaluating the diagnostic study data of a client with suspected cystic fibrosis (CF). Which of the following test results is associated with a diagnosis of cystic fibrosis? A - Presences of protein in the urine B - Positive phenylketonuria C - Elevated sweat chloride concentration D - Decreased tidal volume

C - Elevated sweat chloride concentration

You are caring for a client who has been diagnosed with viral pneumonia. You are making a plan of care for this client. What nursing interventions would you put into the plan of care for a client with pneumonia? A - Offer nutritious snacks 2 times a day B - Give antibiotics as ordered C - Encourage increased fluid intake D - Place client on bed rest

C - Encourage increased fluid intake

An asthma educator is teaching a client newly diagnosed with asthma and the family about the use of a peak flow meter. The educator should teach the client that a peak flow meter measures highest airflow during which type of breath? A - Forced inspiration B - Normal inspirations C - Forced expiration D - Normal expirations

C - Forced expiration

Which of the following is the key underlying feature of asthma? A - Chest tightness B - Productive cough C - Inflammation D - Shortness of breath

C - Inflammation

Which vaccine should a nurse encourage a client with chronic obstructive pulmonary disease (COPD) to receive? A - Human Papilloma Virus (HPV) B - Hepatitis B C - Influenza D - Varicella

C - Influenza

A client newly diagnosed with COPD tells the nurse, "I can't believe I have COPD; I only had a cough. Are there other symptoms I should know about"? Which is the best response by the nurse? A - There are no other symptoms, however, your cough may get worse as the disease progresses B - You can also expect to experience a progressive weight gain C - Other symptoms you may develop are shortness of breath upon execration and sputum production D - As your COPD worsens, you will frequently develop respiratory infections

C - Other symptoms you may develop are shortness of breath upon execration and sputum production

Which should a nurse encourage in clients who are at the risk of pneumococcal and influenza infections? A - Using incentrive spirometry B - Using prescribed opioids C - Receiving vaccinations D - Mobilizing early

C - Receiving vaccinations

A nurse is developing a teaching plan for a client with asthma. Which teaching point has the highest priority? A - Avoid contact with fur-bearing animals B - Avoid goose down pillows C - Take ordered medications as scheduled D - Change filters on heating and air conditioning units frequently

C - Take ordered medications as scheduled

A nurse is admitting a new client who has been admitted with a diagnosis of COPD exacerbation. How can the nurse best help the client achieve the goal of maintaining effective oxygenation? A - Assist the client in developing an appropriate exercise program B - Administer supplementary oxygen by simple face mask C - Teach the client strategies for promoting diaphragmatic breathing D - Teach the client to perform airway suctioning

C - Teach the client strategies for promoting diaphragmatic breathing

A nurse is caring for a client experiencing an acute asthma attack. The client stops wheezing and breath sounds aren't audible. This change occurred because: A - The swelling has decreased B - The attack is over C - The airways are so swollen that no air can get through D - Crackles have replaced wheezes

C - The airways are so swollen that no air can get through

A client is admitted to the emergency department with reports right lower quadrant pain. Blood specimens are drawn and sent to the laboratory. Which laboratory finding should be reported to the health care provider immediately? A - Serum potassium 4.2 mEq/L B - Hematocrit 42% C - White blood cell (WBC) count 22.8/mm3 D - Serum sodium 135 mEq/L

C - White blood cell (WBC) count 22.8/mm3

Nursing diagnoses may include: - Ineffective Breathing Pattern - Ineffective Airway Clearance - Activity Intolerance - Imbalanced Nutrition: Less Than Body Requirements - Compromised Family Coping - Decisional Conflict: Smoking (NANDA-I ©2012) These are all nursing diagnosis for what disease?

COPD

Pathophysiology and Etiology •Results from repeated exposure to respiratory irritants - Begin to damage structure of respiratory system •Chronic bronchitis - Excessive bronchial mucus secretion •Emphysema - Destruction of walls of alveoli •Asthma often comorbid with _____ What is this?

COPD

Risk factors - Smoking - Short-term exposure to high levels of irritating substances Prevention - Not engaging in behaviors linked with etiology of the disease Risk factors associated with the development of ______ include working in an industrial environment, a history of asthma, and cigarette smoking. What is this?

COPD

The earliest-presenting symptom of _____ is coughing in the morning with clear sputum unless the client develops an infection, in which case the sputum would become yellow or green in color.

COPD

_____ typically includes components of both chronic bronchitis and emphysema, two distinctly different processes. Although the _____ complex can also include asthma, small airways disease, and narrowing of small bronchioles, it is more commonly known to include bronchitis and emphysema.

COPD

•A leading cause of death, illness, disability •Not curable •Preventable à 80% of cases smokers •Environmental exposures What is this?

COPD

•Presentation varies •Simple bronchitis without disability •Chronic respiratory failure, severe disability •Manifestations typically absent or mild early •Forced expiratory volume in 1 second (FEV1) + symptoms = level of severity •Initially dyspnea only on exertion •Signs/symptoms: dyspnea, barrel chest, tripod position, pursed-lip breathing, chest pain, hypertension •Prolonged impairment of gas exchange results in cardiac dysfunction •Caloric demand increases as effort to breathe increases •Anxiety These are clinical manifestations of what?

COPD

With the progression of ____, the body compensates by producing extra red blood cells. These extra blood cells clog the small blood vessels of the fingers, leading to the development of cyanotic nail beds and clubbing of the fingertips. Enlargement and thickening of the right ventricle of the heart often results in ______. _____ chest occurs because the lungs are chronically overinflated with air, so the rib cage stays partially expanded.

COPD dysrhythmias barrel

Which is the strongest predisposing factor for asthma? A - Male Gender B - Air pollution C - Congenital malformations D - Allergy

D - Allergy

Which type of chest configuration is typical of a client with COPD? A - Pigeon chest B - Flail Chest C - Funnell Chest D - Barrel Chest

D - Barrel Chest

A nurse is completing a focused respiratory assessment of a child with asthma. What assessment finding is most closely associated with the characteristic signs and symptoms of asthma? A - Increase anterior-posterior (AP) diameter B - Shallow respirations C - Bradypnea D - Bilateral wheezes

D - Bilateral wheezes

A client hospitalized with pneumonia has thick, tenacious secretions. Which intervention should the nurse include when planning this client's care? A - Turning the client every 2 hours B - Maintaining a cool room temperature C - Elevating the head of the bed 30 degrees D - Encouraging increased fluid intake

D - Encouraging increased fluid intake

The nurse has instructed the client to use a peak flow meter. The nurse evaluates client learning as satisfactory when the client A - Records in a diary the number achieved after one breath B - Inhales deeply and holds the breath C - Sits in a straight back chair and leans forward D - Exhales hard and fast with a single blow

D - Exhales hard and fast with a single blow

Crohn's disease is a condition of malabsorption caused by which pathophysiological process? A - Gastic resection B - Infectious disease C - Disaccharidase deficiency D - Inflammation of all layers of intestinal mucosa

D - Inflammation of all layers of intestinal mucosa

A client with chronic obstructive pulmonary disease (COPD) is admitted to the medical-surgical unit. To help this client maintain a patent airway and achieve maximal gas exchange, the nurse should: A - Administer pain medication as ordered B - Administer anxiolytics, as ordered, to control anxiety C - Maintain the client on bed rest D - Instruct the client to drink at least 2 L of fluid daily

D - Instruct the client to drink at least 2 L of fluid daily

In COPD, the body attempts to improve oxygen-carrying capacity by increasing the amount of red blood cells. Which term refers to this process? A - Asthma B - Emphysema C - Bronchitis D - Polcythemia

D - Polcythemia

It is important for the nurse to monitor serum electrolytes in a patient with acute diarrhea. Select the electrolyte result that should be immediately reported. A - Calcium of 9 mg/dl B - Chloride of 100 mEq/L C - Sodium of 136 mEq/L D - Potassium of 2.8 mEq/L

D - Potassium of 2.8 mEq/L

The nurse is assigned to care for a patient with COPD with hypoxemia and hypercapnia. When planning care for this patient, what does the nurse understand is the main goal of treatment? A - Monitoring the pulse oximetry to assess need for early intervention when PCO2 levels rise B - Increase pH C - Avoiding the use of oxygen to decrease the hypoxic drive D - Proving sufficient oxygen to improve oxygenation

D - Proving sufficient oxygen to improve oxygenation

During a community health fair, a nurse is teaching a group of seniors about promoting health and preventing infection. Which intervention would best promote infection prevention for senior citizens who are at risk of pneumococcal and influenza infections? A - Exercise daily B - Take all prescribed medications C - Drink six glasses of water daily D - Receive vaccinations

D - Receive vaccinations

As status asthmaticus worsens, the nurse would expect which acid-base imbalance? A - Metabolic alkalosis B - Metabolic acidosis C - Respiratory alkalosis D - Respiratory acidosis

D - Respiratory acidosis

The nurse is caring for a patient with status asthmaticus in the intensive care unit (ICU). What does the nurse anticipate observing for the blood gas results related to hyperventilation for this patient? A - Metabolic acidosis B - Metabolic alkalosis C - Respiratory acidosis D - Respiratory alkalosis

D - Respiratory alkalosis

A nurse is caring for a client who is at high risk for developing pneumonia. Which intervention should the nurse include on the client's care plan? A - Turning the client every 4 hours to prevent fatigue B - Providing oral hygiene daily C - Keeping the head of the bed at 15 degrees or less D - Using strict hand hygiene

D - Using strict hand hygiene

-Improves •Exercise tolerance •Mental functioning •Reduces rate of hospitalization •Intermittent, at night, continuous •Home therapy •With caution in client with chronic elevated CO2 This is all ______ therapy in patients with COPD

Oxygen

Bronchial edema, hyper secretion of mucus, chronic cough, bronchospasm. What is this?

chronic bronchitis

•Be aware of who is caring for client with COPD living at home •Discuss need for sufficient caregiver information These are all _____ efforts for COPD

collaboration

Pharmacologic Therapy for COPD A _____ suppressant is not an appropriate medication for a client with COPD as it is important for the client to expel mucous to maintain adequate oxygenation. An ______ vaccine may be ordered to reduce the risk of respiratory infections. A broad-spectrum ______ may be prescribed if infection is suspected

cough influenza antibiotic

________: Loss of alveolar surface reduces gas exchange/ Elastic recoil is lost reducing volume of air that is passively expired ( air trapping)/ bronchioles or alveoli may be involved _______ : excessive bronchial mucous secretions / productive cough lasting 3 or more months in 2 consecutive years / lose ability to clear mucus / airway edema/ recurrent infection is common These above processes: Result in increased work of breathing, impaired expiration with air trapping and impaired gas exchange

ehmphysema Bronchitis

Assessment for COPD _______ history •Current symptoms •Frequency of respiratory infections •Chronic bronchitis •Smoking history ________ examination •General appearance •Weight for height •Vital signs

health physical

______ Drive: A client with COPD may have their breaths stimulated by a ______ drive/ this disease process causes the body to retain carbon dioxide. Providing too much oxygen(like i.e. 4-6 L. of oxygen per nasal cannula) this much oxygen can result in an increase in carbon dioxide levels, leading to respiratory failure. Oxygen should be at a lower rate, such as 1-2 liters/minute per nasal cannula.

hypoxic

Pharmacologic Therapy for COPD Steroidal/ Corticosteroid therapy and Nonsteroidal anti-inflammatory agents are commonly ordered to decrease the ________ and swelling of lung tissues to maximize oxygen and carbon dioxide exchange and to improve symptoms.

inflammation

•Positioning, percussion, vibration (PVD) - Dependent nursing function •_____ - forceful striking of skin with cupped hands •______ - series of vigorous quiverings produced by hands on client's chest wall •_______ drainage - drainage by gravity of secretions from lung segments These can all assist in improving what?

percussion vibration postural COPD

•Immunizations •Antibiotics if infection suspected •Bronchodilators •Corticosteroid therapy •Research indicating statins may be useful These are all _______ therapy for what disease?

pharmacologic COPD

•Promote health •Reduce risk of infection •Maintain client safety •Teach client how to maximize self-care •Teach client to know when to notify healthcare team This is a part of the nursing _____ for what disease?

process COPD

Dietary Measures: A diet high in _____ and ____ without excess carbohydrates is recommended to minimize carbon dioxide production during metabolism. Frequent small meals help maintain intake and reduce fatigue associated with eating. Carbohydrate-rich foods may increase the client's carbon dioxide production and worsen the symptoms of the disease.. Eat frequent snacks. This is a diet recommendation for what disease?

proteins and fats COPD

•Lung transplantation -Single -Bilateral •Lung reduction -Diffuse emphysema -Lung hyperinflation These are all _____ options for what disease?

surgery COPD