332 CH 24 | Exam 2

Describe the two main types of emphysema

1. Panlobular type of emphysema, there is destruction of the respiratory bronchiole, alveolar duct, and alveolus. All airspaces within the lobule are essentially enlarged, but there is little inflammatory disease. A hyperinflated (hyperextended) chest, marked dyspnea on exertion and weight loss typically occur. 2. In the centrilobular (centroacinar) form, pathologic changes take place mainly in the center of the secondary lobule, preserving the peripheral portions of the acinus (the terminal airway unit where gas exchange occurs). This leads to central cyanosis and respiratory failure. The patient also develops peripheral edema.

The median survival age for individuals diagnosed with cystic fibrosis is now ___________________ years

37

A patient is being treated for status asthmaticus. What danger sign does the nurse observe that can indicate impending respiratory failure? a. Respiratory acidosis b. Respiratory alkalosis c. Metabolic acidosis b. Metabolic alkalosis

A

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. Providing sufficient oxygen to improve oxygenation b. Avoiding the use of oxygen to decrease the hypoxic drive c. Monitoring the pulse oximetry to assess need for early intervention when PCO2 levels rise d. Increasing pH

A

The nurse should be alert for a complication of bronchiectasis that results from a combination of retained secretions and obstruction and that leads to the collapse of alveoli. What complication should the nurse monitor for? a. Atelectasis b. Emphysema c. Pleurisy d. Pneumonia

A

Lois, who had emphysema for 25 years, is admitted to the hospital with a diagnosis of bronchitis. 6) The health care provider prescribes oxygen therapy for Lois. What delivery system does the nurse know will be most affected?

A venturi mask that delivers a predictable oxygen flow at about 24%

Upon assessment, the nurse suspects that a patient with COPD may have bronchospasm. What manifestations validate the nurses concern. (select all that apply) a. Compromised gas exchange b. Decreased air flow c. Wheezes d. Jugular vein distension e. Ascites

A, B, C

The nurse is assigned to care for a patient in the intensive care unit 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 combat dehydration b. To assist with the effectiveness of the corticosteroids c. To loosen secretions d. To facilitate expectoration e. To relieve bronchospasm

A, C, D

Lois, who had emphysema for 25 years, is admitted to the hospital with a diagnosis of bronchitis. 1) The nurse observes that Lois has a "barrel chest." What is the cause of the alteration in the chest shape and size?

Air trapping in the lungs

Describe three ways that bronchodilators relieve bronchospasm

Alter smooth muscle tone, reduce airway obstruction, and improve alveolar ventilation

A nurse notes that the FEV1/FVC ratio is less than 70% for a patient with COPD. What stage should the nurse document the patient is in? a. 0 b. I c. II d. III

B

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. Chest pain during respiration b. Sputum and a productive cough c. Fever, chills, and diaphoresis d. Tachypnea and tachycardia

B

The physician prescribes a beta2 adrenergic agonist agent that is short-acting and administered only by inhaler. What medication does the nurse anticipate will be administered? a. Metaproterenol b. Terbutaline c. Formoterol d. Isoproterenol

B

A _____________ is a surgical option for select patients with bullous emphysema

Bullectomy

A patient is prescribed a mast cell stabilizer for the treatment of asthma. Which commonly used medication will the nurse educate the patient about? a. Albuterol b. Budesonide c. Cromolyn Sodium d. Theophylline

C

A patient with cystic fibrosis is admitted to the hospital with pneumonia. When should the nurse administer the pancreatic enzymes that the patient has been prescribed? a. After meals and at bedtime b. Before meals c. With meals d. Three times a day regardless of meal time

C

The nurse is educating a patient with asthma about preventative measures to avoid having an asthma attack. What does the nurse inform the patient is a priority intervention to prevent an asthma attack? a. Using a long-attacking steroid inhaler when an attack is coming b. Avoiding exercise and any strenuous activity c. Preparing a written action plan d. Staying in the house if it is too cold or too hot

C

The nurse is instructing a client with asthma in the use of a newly prescribed leukotriene receptor antagonist. What should the nurse be sure to include in the education? a. The patient should take the medication with meals since it may cause nausea b. The patient should take the medication separately without other medications c. The patient should take the medication an hour before meals or 2 hours after a meal d. The patient should take the medication with a small amount of liquid

C

The single most cost-effective intervention to reduce the risk of developing COPD or slow its progression is ________________

Cessation of Smoking

List three primary symptoms associated with the progressive stage of COPD

Chronic cough, sputum production, and dyspnea on exertion

Describe the results of chronic airway inflammation of COPD

Chronic inflammation results in the following: increased goblet cells and enlarged submucosal glands (proximal airways), inflammation and airway narrowing (peripheral airways), and narrowing of the airway lumen

_________, one of the complications of emphysema, is right-sided heart failure brought on by long-term high blood pressure in the pulmonary arteries

Cor pulmonale

A child is having an asthma attack and the parent can't remember which inhaler to use for quick relief. The nurse accesses the child's medication information and tells the parent to use which inhalant? a. Cromolyn sodium b. Theophylline c. Salmeterol d. Albuterol

D

A patient with end-stage COPD and heart failure asks the nurse about lung reduction surgery. What is the best response by the nurse? a. "You are not a candidate because you have heart failure" b. "You would have a difficult time recovering from the procedure" c. "At this point, do you really want to go through something like that" d. "You and your physician should discuss the options that are available for treatment"

D

The nurse is caring for a patient with status asthmaticus in the intensive care unit. 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

Lois, who had emphysema for 25 years, is admitted to the hospital with a diagnosis of bronchitis. 5) The nurse is educating Lois on diaphragmatic breathing. How will this type of breathing help Lois?

Decreased respiratory rate, increased alveolar ventilation and reduction of functional residual capacity

Name a genetic risk factor for COPD

Deficiency in alpha-1 antitrypsin, and enzyme inhibitor that protects the lungs

Lois, who had emphysema for 25 years, is admitted to the hospital with a diagnosis of bronchitis. 2) The nurse recognizes the need to be alert for what major presenting symptom of emphysema?

Dyspnea

Lois, who had emphysema for 25 years, is admitted to the hospital with a diagnosis of bronchitis. 4) Lois is being medicated with a bronchodilator to reduce airway obstruction. What side effects should the nurse observe for that could be caused by the bronchodilator?

Dysrhythmias, central nervous system excitement, and tachycardia

List five of the nine major factors that determine the clinical course and survival of patients with COPD

History of cigarette smoking, passive smoking exposure, age, hypoxemia, weight loss, rate of decline of FEV1, reversibility of airflow obstruction, pulmonary artery pressure, and resting heart rate

Lois, who had emphysema for 25 years, is admitted to the hospital with a diagnosis of bronchitis. 3) The nurse is assessing the results of Lois's arterial blood gas. Which blood gas analysis will correlate with the diagnosis of emphysema?

Respiratory acidosis

Patients with COPD are at risk for ___________________ and _______________, which in turn increase the risk of acute and chronic respiratory failure.

Respiratory insufficiency and chronic respiratory failure

__________, depresses the activity of scavenger cells and affects the respiratory tract's ciliary cleansing mechanism, which keeps breathing passages free of inhaled irritants, bacteria, and other foreign matter

Smoking

________________ is used to evaluate airflow obstruction, which is determined by the ratio of FEV1 to forced vital capacity

Spirometry

To help prevent infections in patients with COPD, the nurse should recommend vaccination against two bacterial organisms: _____________________ and ______________________

Streptococcus pneumonia and Haemophilus influenzae

Primary causes for an acute exacerbation of COPD are ____________________ and ______________________

Tracheobronchial Infection and Air Pollution

The strongest predisposing factor for asthma is ________________ ; the three most common symptoms are _______________, ______________ and __________________

allergy; cough, wheezing and dyspnea

Complications of asthma may include _____________________, _______________, ___________________, and ____________________

status asthmaticus, respiratory failure, pneumonia, and atelectasis

Match 1. Albuterol 2. Ipratropium Bromide 3. Combivent 4. Theophylline 5. Montelukast 6. Cromolyn a. Mast cell stabilizer b. Leukotriene Modifier c. Anticholinergic Agent d. Methylxanthine e. Combination Short-Acting Beta2 Adrenergic Agonist f. Beta2 Adrenergic Agonist Agent

1. f 2. c 3. e 4. d 5. b 6. a