MedSurg-Chapter 24- Chronic Pulmonary Disease

To establish the diagnosis of asthma, the doctor must determine:

that episodic symptoms of airflow obstruction are present, airflow is at least partially reversible, and other causes have been excluded

what test is used to determine whether a person has been infected with the TB bacillus?

the Mantoux test

health care providers should promote smoking cessation by:

-explaining risks of smoking and personalizing at-risk message to patient -work with patient to set a "quit date" -referral to smoking cessation program -follow up 3-5 days after the quit date to review progress This should be repeated as needed

how long after the exposure to TB will you have symptoms?

2-10 weeks

people that have TB are considered noninfectious after taking medications for how long?

2-3 weeks

how long does the coninuous phase for TB drugs last?

4-7 months

how long does the initial phase for TB drugs last?

8 weeks

True or false: the airlow limitation or obstruction in COPD is fully reversible

False; not fully reversible

what diagnostic test diagnoses bronchiectasis?

CT scan

what medications does the continuous phase consist of?

INH and rifampin or INH and rifanpentine

what are the four first-line anti-TB drugs?

INH, rifampin, pyrazinamide (PZA), and ethambutol (Myambuterol)

what type of medication is the most potent and effective anti-inflammatory medication currently available?

corticosteroids

what is a metered-dose inhaler?

a pressurized device that contains aerosolized powder medication

what are the three most common symptoms of asthma?

cough, dyspnea, wheezing

what is the strongest predisposing factor for asthma?

allergy (exposure to airway irritants or allergens)

how is emphysema defined?

an abnormal distention of the airspaces beyond the terminal bronchioles and destruction of the walls of the alveoli

what is the cornerstone therapy for bronchiectasis management?

antibiotics

for people with asthma, what type of medications are used in patients who do not tolerate short-acting beta2 adrenergic agonists?

anticholinergics

what is the parenchyma made up of? (other parts)

any form of lung tissue including bronchioles, bronchi, blood vessels, interstitium, and alveoli

goal PaO2 during oxygen therapy:

at least 60 mm Hg

goal SaO2 during oxygen therapy:

at least 90%

is TB caused by bacteria or virus?

bacteria

what are the main classes of bronchodilators that are used?

beta-adrenergic agonists, anticholinergic agents, methylxanthines, and combination agents

rifampin can alter the metabolism of what other types of medications?

beta-blockers, oral anticoagulants

what are the two types of short acting medications?

beta2 adrenergic agonists, anticholinergics

clubbing of the fingers is common in what condition?

bronchiectasis

what is the main pharmacological therapy in COPD?

bronchodilators

what are the three primary symptoms of COPD?

chronic cough, sputum production, and dyspnea

what is asthma?

chronic infammatory disease of the airways that causes airway hyperresponsiveness, mucosal edema, and mucus production

why can weight loss occur in patients with COPD?

dyspnea interferes with eating and the increased work of breathing is energy depleting

describe how you would distinguish between emphysema and chronic bronchitis?

emphysema is characterized by alveolar wall destruction (loss of elasticity) and chronic bronchitis is characterized by sputum production; emphysema is not about less o2 getting in and more about the problem with exhaling

COPD may include diseases that cause airflow obstruction such as

emphysema, chronic bronchitis

what is bullae and what condition can they be found in?

enlarged airspaces that do not contribute to ventilation but occupy space in the thorax. they compress areas of the lung and may impair gas exchange; seen in emphysema

what are the risk factors for COPD?

environmental exposures (smoking is #1) and host factors

clinical manifestations of SARS:

fever, coughing, and difficulty breathing

what are some examples of long-acting b2 agonists?

formoteraol, salmeterol, indacaterol

the nurse should encourage the patient to do what to prevent infection?

get immunizations against influenza and pneumococcal pneumonia

why would a nurse instruct a patient to avoid extreme heat and cold?

heat raises body temperature which raises oxygen requirements, and cold promotes bronchospasm

what is air trapping?

incomplete emptying of alveoli during expiration

in multidrug resistance in TB, which two agents is the patient resistant to?

isoniazid (INH) and rifampin

how does pursed-lip breathing help?

it helps slow expiration, prevent collapse of small airways, and control the rate and depth of respiration

how does diaphragmic breathing help?

it reduces respiratory rate, increases alveolar ventilation and sometimes helps expel as much air as possible during expiration

what type of bronchodilator is most convienent for a patient to use?

long acting B2-agonist

are cortiosteroids a short or long-acting medication?

long-acting

what are methylxanthines used for?

long-term control and prevention of symptoms in mild persistent asthma or in moderate or persistent asthma

what are some clinical manifestations of TB?

low-grade fever, cough, night sweats, fatigue, and weight loss

in grade 1 COPD, severity is:

mild

in grade 2 COPD, severity is:

moderate

when should patients with TB take their medications? why?

on an empty stomach or at least 1 hours before meals; food interferes with medication absorption

what are the two types of emphysema?

panlobular (panacinar) and centrilobular (centroacinar)

what type of oxygen mask is best used in a patient with status asthmaticus?

partial or nonrebreathing mask

how can asthma be prevented?

patients are instructed to avoid causative agents (dust, certain foods, mold, pollens, detergents, soaps)

other complications of COPD include:

pneumonia, chronic atelectasis, pneumothorax, and pulmonary arterial hypertension (cor pulmonale)

what diagnostic tests are used to diagnose TB?

positive skin test, blood test, sputum culture for acid-fast bacilli

what is the nursing management for a patient with TB?

promoting airway clearance, advocating adherence to the treatment regimen, promoting activity and nutrition, and preventing transmission

what type of breathing exercises are recommended with COPD patients?

pursed-lip and diaphragmatic breathing

what do anticholinergics specifically do?

reduce intrinsic vagal tone of the airway

for grade 3 or 4 COPD, what types of medications are normally prescribed?

regular treatment with one or more bronchodilators and/or inhaled corticosteroids for repeated exacerbations

in basic terms, what do bronchodilators do?

relieve bronchospasm and reduce airway obstruction

what is a bullectomy?

removal of bullae

most life-threatening complications with COPD:

respiratory insufficiency or failure

what is cor pulmonale and which disease is it seen in?

right-sided heart failure brought on by long-term high blood pressure in the pulmonary arteries; seen in emphysema

in grade 3 COPD, severity is:

severe

what does the breathing pattern look like in people with COPD?

shallow and rapid

is albuterol a short-acting or long-acting bronchodilator?

short

what medications are choice for relief of acute symptoms and prevention of exercise-induced asthma?

short-acting beta2 adrenergic agonists

for grade 1 COPD, what types of medications are normally prescribed?

short-acting bronchodilator

for grade 2 and 3 COPD, what types of medications are normally prescribed?

short-acting bronchodilator and regular treatment with one or more long-acting bronchodilator

complications of asthma include:

status asthmaticus, respiratory failure, pneumonia, and atelectasis

on the patient's arrival at the ED, the first line of treatment is:

supplemental oxygen therapy and rapid assessment to determine if the exacerbation is life threatening

COPD involves obstruction of what?

the airways or pulmonary parenchyma, or both

what is bronchiectasis?

the chronic, irreversible dilation of the bronchi and bronchioles that results from destruction of muscles and elastic connective tissue

TB primarily affects what?

the lung parenchyma

how is chronic bronchitis defined?

the presence of cough and sputum production for at least 3 months in each of 2 consecutive years

what is the treatment for SARS?

there is no treatment except supportive care

what do beta2 adrenergic agonists specifically do?

they are used to relax smooth muscle

what do bronchodilators do? (and how)

they relieve bronchospasm by altering smooth muscle tone and reduce airway obstruction by allowing increased oxygen distribution throughout the lungs and improving alveolar ventilation

why should patients rinse their mouth after administration of inhaled corticosteroids?

to prevent thrush

primary causes of acute exacerbation of COPD:

tracheobronchial infection and air pollution

True or false: hypoxemia is uncommon in asthma

true

patients taking INH should avoid foods that contain:

tyramine and histamine (tuna, aged cheese, red wine, soy sauce, yeast extracts); may cause headache, flushing, hypotension, palpitations, diaphesis

what is spirometry used for? (specifically)

used to evaluate airflow obstruction

in grade 4 COPD, severity is:

very severe