Med Surg: Patients with COPD and Asthma

What is the best type of breathing to increase lung expansion?

Diaphragmatic breathing (NOT Chest breathing)

What is lung parenchyma?

Lung tissue; portion of the lung involved in gas transfer

Cromolyn sodium and Nedocromil are examples of which type of medication?

Mast cell stabilizers

Stage 1 is ______ COPD

Mild

Stage 2 is _______ COPD

Moderate

A nurse has just completed teaching with a client who has been prescribed a meter-dosed inhaler for the first time. Which statement if made by the client would indicate to the nurse that further teaching and follow-up care is necessary? "I will make sure to take a slow, deep breath as I push on my inhaler." "After I breathe in, I will hold my breath for 10 seconds." "I do not need to rinse my mouth with this type of inhaler." "If I use the spacer, I know I am only supposed to push on the inhaler once."

"I do not need to rinse my mouth with this type of inhaler." Mouth-washing and spitting are effective in reducing the amount of drug swallowed and absorbed systemically. Actuation during a slow (30 L/min or 3 to 5 seconds) and deep inhalation should be followed by 10 seconds of holding the breath. The client should actuate only once. Simple tubes do not obviate the spacer/VHC per inhalation.

Obstructive lung disease is a FEV1/FVC ratio less than ___%

70%.

Albuterol, levalbuterol HFA, and Ipratropium are used to relieve what type of asthma symptoms?

Acute

What is Spirometry used to evaluate?

Airflow Obstruction; determined by the ratio of forced expiration volume in 1 second to forced vital capacity

A client with asthma is prescribed a short acting beta-adrenergic (SABA) for quick relief. Which of the following is the most likely drug to be prescribed? Ipratropium bromide Fluticasone propionate Ipratropium bromide and albuterol sulfate Albuterol

Albuterol Albuterol (Proventil), a SABA, is given to asthmatic patients for quick relief of symptoms. Ipratropium bromide (Atrovent) is an anticholinergic. Ipratropium bromide and albuterol sulfate (Combivent) is a combination SABA/anticholinergic, and Fluticasone propionate (Flonase) is a corticosteroid.

What enzyme inhibitor protects the lung parenchyma from injury?

Alpha1-Antitrypsin

The nurse is caring for an asthmatic patient hospitalized with an acute asthma exacerbation. What drugs would the nurse anticipate being ordered for this patient to gain underlying control of persistent asthma? -Rescue inhalers -Anti-inflammatory drugs -Antibiotics -Antitussives

Anti-inflammatory drugs Because the underlying pathology of asthma is inflammation, control of persistent asthma is accomplished primarily with regular use of anti-inflammatory medications. Rescue inhalers, antibiotics, and antitussives do not aid in the control of persistent asthma.

A client with chronic obstructive pulmonary disease (COPD) is recovering from a myocardial infarction. Because the client is extremely weak and can't produce an effective cough, the nurse should monitor closely for: -Pleural effusion. -Pulmonary edema. -Atelectasis. -Oxygen toxicity.

Atelectasis In a client with COPD, an ineffective cough impedes secretion removal. This, in turn, causes mucus plugging, which leads to localized airway obstruction — a known cause of atelectasis. An ineffective cough doesn't cause pleural effusion (fluid accumulation in the pleural space). Pulmonary edema usually results from left-sided heart failure, not an ineffective cough. Although many noncardiac conditions may cause pulmonary edema, an ineffective cough isn't one of them. Oxygen toxicity results from prolonged administration of high oxygen concentrations, not an ineffective cough.

Stage 4 is _______ COPD

Very severe

What is the therapeutic range of Theophylline?

Between 5 and 15 μg/mL

Which statement is true about both lung transplant and bullectomy? -Both procedures cure COPD. -Both procedures treat end-stage emphysema. -Both procedures treat patients with bullous emphysema. -Both procedures improve the overall quality of life of a client with COPD.

Both procedures improve the overall quality of life of a client with COPD. Treatments for COPD are aimed more at treating the symptoms and preventing complications, thereby improving the overall quality of life of a client with COPD. In fact, there is no cure for COPD. Lung transplant is aimed at treating end-stage emphysema and bullectomy is used to treat clients with bullous emphysema.

Theophylline, albuterol, and atropine are examples of which type of medication?

Bronchodilators

Which of the following occupy space in the thorax, but do not contribute to ventilation? Bullae Alveoli Lung parenchyma Mast cells

Bullae Bullae are enlarged airspaces that do not contribute to ventilation but occupy space in the thorax. Bullae may compress areas of healthier lung and impair gas exchange. Alveoli are the functional units of the lungs. Lung parenchyma is lung tissue. Mast cells, when activated, release several chemicals called mediators that include histamine, bradykinin, prostaglandins, and leukotrienes.

Patients with advanced COPD experience progressive inactivity, exercise intolerance, and disability. The nurse must carefully monitor the exercise tolerance of patients taking: -Antihistamines -Short acting beta-adrenergics -Anticholinergics -Corticosteroids

Corticosteroids Corticosteroids are associated with myopathy, especially in leg muscles.

Dexamethasone and Prednisone are examples of which type of medication?

Corticostreoids

A client is being admitted to the medical-surgical unit for the treatment of an exacerbation of acute asthma. Which medication is contraindicated in the treatment of asthma exacerbations? -Albuterol -Cromolyn sodium -Levalbuterol HFA -Ipratropium

Cromolyn sodium Cromolyn sodium is contraindicated in clients with acute asthma exacerbation. Indications for cromolyn sodium are long-term prevention of symptoms in mild, persistent asthma; it may modify inflammation. Cromolyn sodium is also a preventive treatment before exposure to exercise or a known allergen. Albuterol, levalbuterol HFA, and ipratropium can be used to relieve acute symptoms.

What are Bullae?

Enlarged airspaces that do not contribute to ventilation, but occupy space in the thorax. BUllae may compress areas of healthier lung and impar gas exchange.

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

Exhales hard and fast with a single blow To use a peak flow meter, the client stands. Then the client takes a deep breath and exhales hard and fast with a single blow. The client repeats this twice and records a "personal best" in an asthma diary.

What is Pleural Effusion?

Fluid accumulation in the pleural space

A nurse has established a nursing diagnosis of ineffective airway clearance. The datum that best supports this diagnosis is that the client -Has wheezes in the right lung lobes -Has a respiratory rate of 28 breaths/minute -Reports shortness of breath -Cannot perform activities of daily living

Has wheezes in the right lung lobes Of the data listed, wheezing, an adventitious lung sound, is the best datum that supports the diagnosis of ineffective airway clearance. An increased respiratory rate and a report of dyspnea are also defining characteristics of this nursing diagnosis. They could support other nursing diagnoses, as would inability to perform activities of daily living.

What chemical mediators to Mast Cells release?

Histamine, Bradykinin, Prostaglandins, and Leukotrienes

Which measure may increase complications for a client with COPD? Administration of antibiotics Increased oxygen supply Administration of antitussive agents Decreased oxygen supply

Increased oxygen supply Administering too much oxygen can result in the retention of carbon dioxide. Clients with alveolar hypoventilation cannot increase ventilation to adjust for this increased load, and hypercapnia occurs. All the other measures aim to prevent complications.

What does Pulmonary Edema usually result from?

Left-sided heart failure

Montelukast, Zafirlukast, and Zileuton are examples of which type of medication?

Leukotriene modifiers (Inhibitors) [Aka: Antileukotrienes]

How is Cromolyn Sodium used to treat asthma?

Long-term prevention of symptoms in mild, persistent asthma; it may modify inflammation. Prophylactic treatment prior to exposure to exercise or a known allergen.

A ____________________ is a small hand-held device that measures the fastest flow the patient can generate after taking a deep breath in and blowing out as hard and fast as possible.

Peak flow meter

What is the best way to help slow expiration, prevent collapse of small airways, and control the rate and depth of respiration?

Pursed-lip breathing

The classification of Stage III of COPD is defined as At risk for COPD. Mild COPD. Severe COPD. Very severe COPD. Moderate COPD.

Sever COPD Stage III is severe COPD. Stage 0 is at risk for COPD. Stage I is mild COPD. Stage II is moderate COPD. Stage IV is very severe COPD.

Stage 3 is ___________ COPD

Severe

A client is receiving theophylline for long-term control and prevention of asthma symptoms. Client education related to this medication will include -The importance of blood tests to monitor serum concentrations. -Taking the medication at least 1 hour prior to meals. -Monitoring liver function studies as prescribed. -Development of hyperkalemia.

The importance of blood tests to monitor serum concentrations. The nurse should inform clients about the importance of blood tests to monitor serum concentration. The therapeutic range of theophylline is between 5 and 15 μg/mL. The client is at risk of developing hypokalemia.

Amoxicillin, ciprofloxacin, and cotrimoxazole are examples of which type of medication?

Antibiotics

Stage 0 is what? (COPD)

At risk for

What is the most common chronic disease of childhood?

Asthma

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

Inflamed airways obstruct airflow. Mucus secretions block airways. Overinflated alveoli impair gas exchange. Because of the chronic inflammation and the body's attempts to repair it, changes and narrowing occur in the airways. In the peripheral airways, inflammation causes thickening of the airway wall, peribronchial fibrosis, exudate in the airway, and overall airway narrowing (obstructive bronchiolitis). The airways are actually moist, not dry. In the proximal airways, changes include increased goblet cells and enlarged submucosal glands, both of which lead to hypersecretion of mucus.

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? Lung sounds Skin color Heart rate Respiratory rate

Lung Sounds A client with COPD is at risk for developing pneumothorax. The description given is consistent with possible pneumothorax. Though the nurse will assess all the data, auscultating the lung sounds will provide the nurse with the information if the client has a pneumothorax.

A nurse is preparing a discharge teaching plan for a client diagnosed with asthma and prescribed a leukotriene modifier. Which medication would the nurse most likely include when teaching the client about this group of medications? -Montelukast -Cromolyn sodium -Nedocromil -Albuterol

Montelukast Leukotriene modifiers (inhibitors), or antileukotrienes, are a class of medications that include montelukast, zafirlukast, and zileuton. Cromolyn and nedocromil are mast cell stabilizers. Albuterol is a short-acting bronchodilator.

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? -Providing sufficient oxygen to improve oxygenation -Avoiding the use of oxygen to decrease the hypoxic drive -Monitoring the pulse oximetry to assess need for early intervention when PCO2 levels rise I-ncreasing pH

Providing sufficient oxygen to improve oxygenation The main objective in treating patients with hypoxemia and hypercapnia is to give sufficient oxygen to improve oxygenation. (However you must also fix the issue of ventilation, otherwise this will only be a short-term fix)