Gas Exchange
Drugs used to treat asthma and COPD include drugs to block inflammation and drugs to dilate bronchi
Drugs used to treat asthma and COPD include drugs to _______ inflammation and drugs to _________ bronchi
Because they have fewer alveoli
The upper and lower airways are smaller in children than adults, making them more susceptible to obstruction in the presence of mucus, debris, or edema. Why do children have a higher risk for hypoxemia than adults?
PH = 7.35 - 7.45 PaCO2 = 35 - 45 mmHg PO2 = 80 - 100 mmHg HCO3 = 22 - 26 mEq/L
What are the normal lab values for an arterial blood gas and PH analysis test?
Surfactant
A chemical produced in the lungs to maintain the surface tension of the alveoli and keep them from collapsing. This chemical is formed in the womb between 34-36 weeks. Therefore, if an infant is born before 34 weeks, he/she is at high risk for the alveoli to collapse.
Common in asthma
A common S & S of what may include cough mostly at night starts as hacking non-productive cough becomes productive with frothy sputum
Anemia
A condition in which the blood is deficient in red blood cells, in hemoglobin, or in total volume.
Hyperventilation
A condition in which there is more than the normal amount of air entering and leaving the lungs. This leads to low levels of arterial carbon dioxide. This condition is typically brought on by a psychologic factor or stress.
Asthma
A condition in which your airways narrow and swell and may produce extra mucus. This can make breathing difficult and trigger coughing, a whistling sound (wheezing) when you breathe out and shortness of breath. Can occur at any age. Allergy is the strongest predisposing factor for asthma. Chronic exposure to airway irritants or allergens also increases the risk of asthma.
Sickle Cell Disease
A hereditary hemoglobinopathy that replaces a normal hemoglobin with the abnormal hemoglobin S (Hgb S). Research shows this disease is more common in people of African descent.
Emphysema
A lung condition that affects the alveoli. Over time, the inner walls of the air sacs weaken and rupture — creating larger air spaces instead of many small ones. This reduces the surface area of the lungs and, in turn, the amount of oxygen that reaches your bloodstream. When you exhale, the damaged alveoli don't work properly and old air becomes trapped, leaving no room for fresh, oxygen-rich air to enter. impaired oxygen and carbon dioxide exchange results from destruction of the walls of overdistended alveoli.
C. Chest physiotherapy may help loosen and mobilize secretions, increasing mucus clearance. This is especially helpful for patients with large amounts of secretions or an ineffective cough, such as patients with cystic fibrosis
A nurse is assisting a respiratory therapist with chest physiotherapy for patients with ineffective cough. For which patient might this therapy be recommended? A) A postoperative adult B) An adult with COPD C) A teenager with cystic fibrosis D) A child with pneumonia
A Dyspnea If a problem exists in ventilation, respiration, or perfusion, hypoxia may occur. Hypoxia is a condition in which an inadequate amount of oxygen is available to cells. The most common symptoms of hypoxia are dyspnea (difficulty breathing), an elevated blood pressure with a small pulse pressure, increased respiratory and pulse rates, pallor, and cyanosis.
A nurse is caring for a patient with COPD. What would be an expected finding upon assessment of this patient? A) Dyspnea B) Hypotension C) Decreased respiratory rate D) Decreased pulse rate
c. The nurse should encourage the patient to breathe through the nose with the mouth closed. The nurse should assure that the oxygen is flowing out of the prongs prior to inserting them into the patient's nostrils. The nurse should adjust the fit of the cannula so it is snug but not tight against the skin. The nurse should adjust the flow rate as ordered.
A nurse is caring for a patient with chronic lung disease who is receiving oxygen through a nasal cannula. What nursing action is performed correctly? A) The nurse assures that the oxygen is flowing into the prongs. B) The nurse adjusts the fit of the cannula so it fits snug and tight against the skin. C) The nurse encourages the patient to breathe through the nose with the mouth closed. D) The nurse adjusts the flow rate to 6 L/min or more.
B, D, E. When caring for patients with COPD, it is important to create an environment that is likely to reduce anxiety and ensure that they eat a high-protein/high-calorie diet. People with dyspnea and orthopnea are most comfortable in a high-Fowler's position because accessory muscles can easily be used to promote respiration. Patients with COPD should pace physical activities and schedule frequent rest periods to conserve energy. Meals should be eaten 1 to 2 hours after breathing treatments and exercises, and drinking 2 to 3 quarts (1.9 to 2.9 L) of clear fluids daily is recommended.
A nurse working in a long-term care facility is providing teaching to patients with altered oxygenation due to conditions such as asthma and COPD. Which measures would the nurse recommend? Select all that apply. A) Refrain from exercise. B) Reduce anxiety. C) Eat meals 1 to 2 hours prior to breathing treatments. D) Eat a high-protein/high-calorie diet. E) Maintain a high-Fowler's position when possible. Drink 2 to 3 pints of clear fluids daily.
C trying a different antihistamine
A patient is not getting a response to the antihistamine that was prescribed. Appropriate action might include a. switching to a decongestant. b. stopping the drug and increasing fluids. c. trying a different antihistamine. d. switching to a corticosteroid.
D. For a patient who is too fatigued to complete daily hygiene on his or her own, the nurse should group personal care activities into smaller steps and allow rest periods between the activities. The nurse should assist with bathing and hygiene tasks as needed and only when the patient has difficulty. The nurse should encourage the patient to voice feelings and concerns about self-care deficits, and teach the patient to coordinate diaphragmatic breathing with the activity.
A patient with COPD is unable to perform personal hygiene without becoming exhausted. What nursing intervention would be appropriate for this patient? A) Assist with bathing and hygiene tasks even if the patient feels capable of performing them alone. B) Teach the patient not to talk about the procedure, just to perform it at the best of his or her ability. C) Teach the patient to take short shallow breaths when performing hygiene measures. D) Group personal care activities into smaller steps, allowing rest periods between activities.
C within 6-10 months
A patient with anemia who is given iron salts could expect to show a therapeutic increase in hematocrit a. within 72 hours. b. within 2 to 3 weeks. c. within 6 to 10 months. d. within 1 to 2 week
D a decongestant
A patient with sinus pressure and pain related to seasonal rhinitis would benefit from taking a. an antitussive. b. an expectorant. c. a mucolytic. d. a decongestant.
COPD COPD and lower respiratory diseases are the third leading cause of death in the United States, with heart disease and cancer being number one and two
A preventable and treatable slowly progressive respiratory disease of airflow obstruction involving the airways, pulmonary parenchyma, or both. Most patients with this disease present with overlapping signs and symptoms of emphysema and chronic bronchitis.
Vagal response (vasovagal syncope)
A sudden drop in heart rate and blood pressure leading to fainting, often in reaction to a stressful trigger.
Acute Chest Syndrome
A symptom associated with sickle cell anemia where sickle cells get trapped in the lung and cause infection. Manifested by fever, respiratory distress (tachypnea, cough, wheezing). Etiology appears to be atypical bacteria such as Chlamydia pneumoniae and Mycoplasma pneumoniae as well as viruses such as respiratory syncytial virus and parvovirus. It is the main cause of death in young adults with SCD
Cheyne-Stokes respirations
A type of abnormal breathing. It's characterized by a gradual increase in breathing, and then a decrease. This pattern is followed by a period of apnea where breathing temporarily stops. The cycle then repeats itself
Hemolytic anemia
A type of anemia in which red blood cells are destroyed faster than they can be made. Sickle cell anemia is an example.
Kussmaul breathing
A type of deep, rapid, and labored breathing
Apnea
Absence of respirations for 15 sec or more.
cystic fibrosis
An inherited life-threatening disorder that damages the lungs and digestive system. It affects the cells that produce mucus, sweat, and digestive juices by causing these fluids to become thick and sticky. These thick juices then plug up tubes, ducts, and passageways.
Hemoglobin
An iron-containing protein in red blood cells that carries oxygen for delivery to cells
C erythropoietin
After teaching a group of students about RBC production, the instructor determines that the teaching was effective when the group states that the rate of RBC production is controlled by a. iron. b. folic acid. c. erythropoietin. d. vitamin B12.
D "I need to inject this drug IM every 5 to 10 days."
After teaching a patient with pernicious anemia about vitamin B12 therapy, which patient statement would indicate that the teaching was successful? a. "I can take this pill with breakfast." b. "I should take this pill at bedtime." c. "I need to inject this drug subcutaneously every day." d. "I need to inject this drug IM every 5 to 10 days."
Ineffective Airway Clearance Ineffective Breathing Pattern Impaired Gas Exchange Activity Intolerance related to imbalance between oxygen supply and demand Anxiety related to feeling of suffocation Fatigue related to impaired oxygen transport system
After the oxygenation assessment is completed and the data are examined, the nurse concludes either that there is no problem at this time or that there is an actual or potential oxygenation problem. What are three nursing diagnoses indicating alterations in oxygenation the nurse can make? What are three nursing diagnoses where oxygenation is the etiologic factor?
Alpha-1-antitrypsin deficiency Alpha-1-antitrypsin deficiency may predispose a client to lung issues like COPD
An inherited condition that raises your risk for lung disease. ________________ is a protein that protects the lungs.
C Patients with a dry irritating cough
Antitussives are useful in blocking the cough reflex and preserving the energy associated with prolonged, nonproductive coughing. Antitussives are best used with a. postoperative patients. b. asthma patients. c. patients with a dry, irritating cough. d. COPD patients who tire easily.
1) Women are 62% more likely to have asthma than men 2) African Americans and Hispanics have higher rates of poorly controlled asthma and deaths
As far as asthma goes, how does it affect women, African Americans, and Hispanics?
high-Fowler's
People with dyspnea and orthopnea are most comfortable in a _____________ ___________ position because accessory muscles can easily be used to promote respiration.
Lung cancer Additionally, occupational exposure to asbestos, silica, or coal dust, as well as environmental pollution, can lead to chronic pulmonary disease
Chronic exposure to radon, radiation, asbestos, and arsenic can lead to what?
B the potential for constipation C keeping these potentially toxic pills away from children. E having periodic blood tests to evaluate the drug effect F being aware that stools may be colored green
Clients are often given iron pills by their clinic. Instructions in giving these pills should include a. taking the drug with milk to avoid GI problems. b. the potential for constipation. c. keeping these potentially toxic pills away from children. d. taking the drug with antacids to alleviate GI upset. e. having periodic blood tests to evaluate the drug effect. f. being aware that stools may be colored green.
1) COPD is mainly due to damage caused by smoking, while asthma is due to an inflammatory reaction. 2) COPD is a progressive disease, while allergic reactions of asthma can be reversible. 3) Initial symptoms can be similar in both diseases, for example, shortness of breath, chest tightness, wheezing, and cough, which can lead to confusion or misdiagnosis. 4) Initial treatments of COPD include bronchodilators, while initial treatments for asthma include inhaled corticosteroids . 5) COPD usually develops after age 40 and often becomes a chronic disease of lung function. Asthma may develop in people of almost any age.
Compare and contrast COPD vs Asthma
antitussives
Drugs that block the cough reflex These drugs should not be used longer than 1 week; patients with persistent cough after that time should seek medical evaluation
What is COPD? COPD (chronic obstructive pulmonary disease) is a lung disease caused by chronic interference with lung airflow that impairs breathing, and is not fully reversible. Usually symptoms, for example, shortness of breath, recurrent coughing, clearing throat, and progressive exercisetolerance, worsen over time. Many doctors and researchers consider terms such as chronic bronchitis and emphysema as forms of COPD. The major cause of COPD is smoking. What is asthma? Asthma is a respiratory condition marked by spasms of the bronchi, due to inflamed and narrowed airways in the lungs. Asthma causes difficulty in breathing that often results from an allergic reaction. Many substances may trigger asthma attacks. Asthma usually causes recurring periods of shortness of breath, wheezing and/or chest tightness. Often, asthma can be fully reversible with medical treatment and breathing can return to normal.
Define COPD verses the definition of Asthma
1) Pain levels and the impact of fatigue on ADLs 2) The abdomen is assessed for pain and tenderness because of the possibility of splenic infarction. 3) Because the sickling process can interrupt circulation in any tissue or organ, with resultant hypoxia and ischemia, a careful assessment of all body systems is necessary. Particular emphasis is placed on pain, swelling, and fever. 4) The patient is assessed for signs of dehydration by a history of fluid intake and careful examination of mucous membranes, skin turgor, urine output, and serum creatinine and blood urea nitrogen values. 5) The cardiopulmonary systems must be assessed carefully, including auscultation of breath sounds, measurement of oxygen saturation levels, and signs of cardiac failure 6) Assess LOC. Cognitive dysfunction frequently occurs and may reflect inadequate oxygen delivery to the brain;
Describe key assessments the nurse should make when assessing a patient sickle cell anemia.
1) Infant RR = 20-40 bpm Pattern = Abdominal breathing, irregular in rate and depth Breath Sounds = Loud, harsh crackles at end of deep inspiration 2) Early childhood RR = 25-32 bpm Pattern = Abdominal breathing, irregular Breath Sounds = Loud, harsh expiration longer than inspiration 3) Late childhood RR = 18-26 bpm Pattern = Thoracic, regular Breath Sounds = Clear inspiration is longer than expiration 4) Older Adult RR = 16-24 bpm Pattern = Thoracic, regular Breath Sounds = Clear Normal RR for adults is 12-20 bpm All respirations except for the infants have a range of 8 breaths
Describe the RR, pattern, and expected breath sounds for the following four age groups: 1) Infant (birth to 1 year) 2) Early childhood (1-5 years) 3) Late childhood (6-12 years) 4) Older Adult (65 and up)
1) commonly becomes symptomatic during the middle adult years, and the incidence of the disease increases with age 2) Airflow limitation is progressive and associated with the lungs' abnormal inflammatory response to noxious particles or gases (lung parenchyma becomes inflamed) 3) Because of the chronic inflammation, narrowing occur in the airways. 4) Goblet cells in the trachea and bronchi cause a hypersecretion of mucus 5) The bronchioles thicken and narrow 6) Over time, this ongoing injury-and-repair process causes scar tissue formation and narrowing 7) Alveolar walls decrease in elastic recoil and can be destroyed 8) Finally, the chronic inflammatory process affects the pulmonary vasculature and causes thickening of the lining of the vessel and hypertrophy of smooth muscle, which may lead to pulmonary hypertension
Describe the pathophysiology of COPD
Inspection. Observe the child's general appearance and color. During mild exacerbations, the child's color might remain pink, but as the child worsens, cyanosis might result. Some children present with mild retractions, while others demonstrate significant accessory muscle use and eventually head bobbing if not treated effectively. The child may appear anxious and fearful or may be lethargic and irritable. An audible wheeze might be present. Children with persistent severe asthma may have a barrel chest and routinely demonstrate mildly increased work of breathing. Auscultation and Percussion. A thorough assessment of lung fields is necessary. Wheezing is the hallmark of airway obstruction and might vary throughout the lung fields. Breath sounds might be diminished in the bases or throughout. A quiet chest in an asthmatic child can be an ominous sign. With severe airway obstruction, air movement can be so poor that wheezes might not be heard upon auscultation. Percussion may yield hyperresonance.
Describe the physical examination of a child with asthma including inspection, auscultation, and percussion.
Adventitious breath sounds
Extra, abnormal breath sounds. Abnormal lung sounds can occur as a result of alterations in the respiratory and cardiovascular systems and lead to impaired oxygenation.
Crackles (adventitious sound)
Frequently heard on inspiration, are soft, high-pitched intermittent popping sounds. They are produced by air passing through fluid in the airways and opening of deflated small airways and alveoli. They occur due to inflammation or congestion and are associated with pneumonia, heart failure, bronchitis, and COPD.
Platelet concentrates
Given to patients with abnormal platelets or a reduced number of platelets. Platelet transfusion is used to prevent or treat bleeding in people with either a low platelet count or poor platelet function. Often this occurs in people receiving cancer chemotherapy.
If hemoglobin levels are low, the amount of oxygen circulating in his blood will also be low. The body recognizes the low levels of oxygen and tries to compensate for the loss of O2 by increasing the individual's breathing rate. Therefore, this causes him to experience shortness of breath.
How do low levels of hemoglobin contribute to an individual's shortness of breath?
Newborns are obligatory nose breathers.
How do newborns typically breath?
Exhaling through pursed lips creates a smaller opening for air movement, effectively slowing and prolonging expiration. Prolonged expiration prevents the collapse of small airways which promotes gas exchange. Pursed-lip breathing also helps the patient to control the rate and depth of respiration, helping to reduce feelings of dyspnea. This encourages relaxation, which aids the patient to gain control of dyspnea and reduce feelings of panic.
How does pursed lip breathing promote breathing?
1) Increases narrowing of the airways 2) Decreases elasticity of parenchyma
How does scar tissue affect the respiratory tract?
Sickle cells can block the blood vessels leading out of the spleen. When this happens, blood stays in the spleen instead of flowing through it. This causes the spleen to get bigger, and the blood counts to fall.
How is the spleen affected by sickle cell disease?
1) Each breath should move the bottom ribs 2) Inhale through nose slowly 3) Exhale through mouth slowly 4) Should be done once every hour or at least 4 times a day Breathing through the nose warms, filters, and humidifies the air
How should the client perform deep breathing?
1 unaffected 2 carriers 1 will have SCD
If a mother and a father are both sickle cell carries, how many of their children will be carriers, have SCD, and be unaffected?
*Stop the transfusion *Assess the patient *Notify primary provider and implement prescribed treatments. *Continue to monitor *Return blood *Obtain any samples needed *Document
If the patient begins to have a reaction to the blood transfusion, what should the nurse do?
electrocardiogram (ECG or EKG)
Impulses moving through the heart's conduction system create electric currents that can be monitored on the body's surface. Electrodes attached to the skin can detect these electric currents and transmit them to an instrument that produces a record of cardiac activity. What is this called?
A heavy menstrual flow C internal bleeding D penetrating traumatic injury
In a healthy person, little iron is needed on a daily basis. Loss of iron is associated with which conditions? a. Heavy menstrual flow b. Bile duct obstruction c. Internal bleeding d. Penetrating traumatic injury e. Bone marrow suppression f. Alcoholic cirrhosis
heart failure and low sodium levels
Increased fluids are needed by patients who have an elevated temperature, who are breathing through the mouth, who are coughing, or who are losing excessive body fluids in other ways. However, fluid intake should be limited to 1.5L/day in clients with what?
Chronic Bronchitis
Inflammation (swelling) and irritation of the bronchial tubes. These tubes are the airways that carry air to and from the air sacs in your lungs. The irritation of the tubes causes mucus to build up. This mucus and the swelling of the tubes make it harder for your lungs to move oxygen in and carbon dioxide out of your body. The presence of cough and sputum production for at least 3 months in each of 2 consecutive years.
1. In asthma, breathing can return to normal between attacks, while breathing with COPD usually does not return to normal. 2. The symptoms of COPD gradually become more severe. (This also may occur if you have asthma.) 3. COPD produces more mucus and phlegm compared to asthma. 4.Chronic cough is common with COPD. 5. People with COPD often have chronic blueness to fingernail beds and/or lips (cyanosis). 6. Asthma can occur in a person of almost any age, while COPD usually occurs in those over age 40. (Although it is possible in some individuals to develop COPD a younger age.)
List 6 differences regarding signs and symptoms of COPD and asthma
1) Pulse oximetry: oxygen saturation may be decreased significantly or normal during a mild exacerbation 2) Chest x-ray: usually reveals hyperinflation 3) Blood gases: might show carbon dioxide retention and hypoxemia 4) Pulmonary function tests (PFTs): can be very useful in determining the degree of disease but are not useful during an acute attack. 5) Children as young as 5 or 6 years might be able to comply with spirometry. 6) Peak expiratory flow rate (PEFR): is decreased during an exacerbation 7) Allergy testing: skin test or RAST can determine allergic triggers for the asthmatic child
List 7 lab and diagnostic tests used to assess asthma?
1) Zafirlukast - Bronchodilator 2) Montelukast - Inhibits inflammatory reaction 3) Albuterol - Bronchodilator 4) Theophylline - Bronchodilator 5) Corticosteroids - Reduces inflammation 6) Diphenhydramine - Antihistamine H1-receptor antagonist 7) Cetirizine - Antihistamine H1-receptor antagonist 8) Fexofenadine - Antihistamine H1-receptor antagonist 9) Cromolyn sodium - Mast cell stabilizer Asthma prophylactic agent—no bronchodilator, antihistamine, or vasoconstrictor properties
List 9 medications used to improve respiratory function
bronchospasm
contraction of the muscular coat of the bronchial tubes. This results in a narrowing and obstruction of the breathing airways.
1) Hypoxia, ischemia, infection, and poor wound healing leading to skin breakdown and ulcers 2) Dehydration 3) Cerebrovascular disease (stroke) 4) Acute kidney injury and chronic kidney failure 5) Heart failure, pulmonary hypertension, and acute chest syndrome 6) Impotence and impaired fertility 7) Cognitive dysfunction 8) Poor adherence to therapy 9) Mutual conflict and distrust between patient and health care provider due to poorly managed acute and chronic pain
List some potential complications of sickle cell anemia.
1) Healthy lifestyle (healthy diet, regular exercise, limit alcohol, stop smoking, monitor cholesterol levels and BP) 2) Get the flu vaccine 3) Get the pneumococcal vaccine 4) Prevent or limit exposure to pollutants and triggers (job change, PPE, keeping a clean home 5) Reduce anxiety
List some ways for the client to maintain optimal cardiopulmonary/respiratory function.
Ipratropium
Maintenance treatment of bronchospasm associated with chronic obstructive pulmonary disease; treatment of seasonal allergic rhinitis as a nasal spray. Anticholinergic that blocks vagally mediated reflexes by antagonizing the action of acetylcholine. Anticholinergics can be used as bronchodilators because of their effect on the vagus nerve, resulting in relaxation of smooth muscle in the bronchi, which leads to bronchodilation.
Vital capacity
Maximum amount of air exhaled after maximum inspiration
Forced vital cpacity
Maximum amount of air that can be forcefully exhaled after a full inspiration
Chelating agents
Medications that bind with heavy metals in the body and create a compound that can be eliminated; used in cases of ingestion or poisoning.
C rapidly turning over cells
Megaloblastic anemia is a result of insufficient folic acid or vitamin B12, affecting which? a. White blood cell production b. Vegetarians c. Rapidly turning over cells d. Slow-growing cells
clubbing
Nail ____________ is sometimes the result of low oxygen in the blood and could be a sign of various types of lung disease.
Incentive Spirometry
Provides visual reinforcement for deep breathing by the patient. It assists the patient to breathe slowly and deeply and to sustain maximal inspiration. It encourages the patient to maximize lung inflation and prevent or reduce atelectasis.
B RBCs cannot maintain themselves and wear out.
RBCs must be continually produced by the body because a. the iron within the RBC wears out and must be replaced. b. RBCs cannot maintain themselves and wear out. c. RBCs are continuously entering and being lost from the GI tract. d. RBCs are processed into bile salts and must be replaced.
Prone
Research has demonstrated that in patients with pulmonary disease who are acutely ill, such as those with acute respiratory distress syndrome (ARDS), turning to the _______ position on a regular basis promotes oxygenation. In this position, the posterior dependent sections of the lungs are better ventilated and perfused.
Respiratory activity is primarily abdominal in infants.
Respiratory activity is primarily ____________ in infants.
People who are homozygous for the HbS geneexperience severe hemolytic anemia, chronic hyperbilirubinemia, and vaso-occlusive crises. The hyperbilirubinemia resulting from the breakdown products of hemoglobin often leads to jaundice and the production of pigment stones in the gallbladder. Blood vessel occlusion causes most of the severe complications. An acute pain episode results from vessel occlusion and hypoxia and can occur suddenly in almost any part of the body.5 Commonly, obstruction by sickled cells occurs in the abdomen, chest, bones, and joints. Many areas may be affected simultaneously. Infarctions caused by sluggish blood flow may cause chronic damage to the liver, spleen, heart, kidneys, retina, and other organs (Fig. 23-9). Acute chest syndrome occurs with vessel occlusion in the lungs and is a leading cause of death in people with sickle cell disease.14 Acute chest syndrome is characterized by sudden chest pain. Cough develops due to pulmonary infiltrates. Respiratory insufficiency results in dyspnea.5 Painful bone crises may be caused by marrow infarcts. Children have an increased susceptibility to osteomyelitis and may experience growth retardation. Transient ischemic attack or cerebral hemorrhage may precede a stroke, and approximately one quarter of people with sickle cell disease develop neurologic complications.5 Clinical manifestations of sickle cell disease. The spleen is especially susceptible to damage by HbS. Because of the spleen's sluggish blood flow and low oxygen tension, hemoglobin in red cells traversing the spleen becomes deoxygenated, causing ischemia. Splenic injury begins in early childhood, characterized by intense congestion, and is usually asymptomatic. The congestion causes functional asplenia and predisposes the person to life-threatening infections by encapsulated organisms, including Streptococcus pneumoniae, Haemophilus influenzae type b, and Klebsiella species. Neonates and small children do not have time to create antibodies to these organisms and rely on the spleen for their removal. In the absence of specific antibody to the polysaccharide capsular antigens of these organisms, splenic activity is essential for removing these organisms when they enter the blood.
Review this info
Reticulocytes
Slightly immature RBCs, usually only 1% of total circulating RBCs
asphyxiation
Suffocation. The state or process of being deprived of oxygen, which can result in unconsciousness or death.
Total lung capacity
The amount of air contained within the lungs at maximum inspiration (vital capacity + residual volume)
Forced expiratory volume
The amount of air exhaled at a specific time interval; for example, in the first, second, and third seconds after a full inspiration
Residual volume
The amount of air left in the lungs at maximal expiration
Sinoatrial node (SA node)
The contraction of the muscles of the heart is controlled by electrical impulses produced in and carried over the heart's conduction system. The ____________ _______ initiates transmission of electrical impulses, which then travel through both atria and on to the ventricles. A dysrhythmia or arrhythmia is a result of problems with electrical impulse generation, or abnormal conduction of electrical impulses through the heart.
1) Monitor the severity of symptoms 2) Breath sounds 3) Peak flow 4) Pulse oximetry, and vital signs. 5) Obtain hx of allergic reactions to medications before administering medications. 6) ID medications the patient is taking. 7) Administer medications as prescribed and monitors the patient's responses to those medications. These medications may include an antibiotic if the patient has an underlying respiratory infection. 8) Administers fluids if the patient is dehydrated.
The immediate nursing care of patients with asthma depends on the severity of symptoms. The patient and family are often frightened and anxious because of the patient's dyspnea. Therefore, a calm approach is an important aspect of care. How can the nurse assesses the patient's respiratory status?
Ventilation
The movement of air into and out of the lungs. (inhaling and exhaling)
D for treatment of anemia associated with renal failure.
The nurse would expect the physician to prescribe epoetin alfa (Epogen) as the drug of choice a. for acute blood loss during surgery. b. to replace blood loss from traumatic injury. c. for treatment of anemia during lactation. d. for treatment of anemia associated with renal failure.
Gas Exchange
The process by which oxygen is transported to cells and carbon dioxide is transported from cells.
Medulla
The respiratory center is located in the __________ in the brainstem, immediately above the spinal cord. Stimulation of the _________ increases the rate and depth of ventilation to blow off carbon dioxide and hydrogen and increase oxygen levels.
Alveoli
The transfer of oxygen and carbon dioxide in the lungs takes place in the walls of the _____________.
Inspect: Is the patient conscious? Is there any inspiratory effort? Does the chest rise symmetrically? Is there use or retraction of accessory muscles? What is the skin color? Are there any obvious signs of deformity or obstruction (trauma, food, teeth, vomitus)? Is the trachea midline? Palpate: Do both sides of the chest rise equally with inspiration? Are there any specific areas of tenderness, fracture, or subcutaneous emphysema (crepitus)? Auscultate: Is there any audible air movement, stridor (inspiratory sound), or wheezing (expiratory sound)? Are breath sounds present over the lower trachea and all lobes?
To assess rapidly for signs and symptoms of upper airway obstruction, what should the nurse do?
Do not take with dairy products or antacids
To ensure maximum absorption, a nurse instructs a patient receiving oral iron therapy to avoid taking the iron with a. protein. b. antibiotics. c. Dairy products d. antiplatelet medications.
Tidal volume
Total amount of air inhaled and exhaled with one breath
Hypoproliferative anemia
Type of anemia that results from the inability of bone marrow to produce adequate numbers of red blood cells. This can be caused by iron deficiency. (iron deficiency anemia)
Fresh Frozen Plasma (FFP)
Used for management and prevention of bleeding, as a coagulation factors replacement, and to treat thrombotic thrombocytopenic purpura (TTP)
1) Arterial Blood Gas and pH Analysis examine arterial blood to determine the pressure exerted by oxygen and carbon dioxide in the blood and blood pH. This test measures the adequacy of oxygenation, ventilation, and perfusion. 2) Cardiac Biomarkers These biomarkers (creatine kinase and Troponin) are used to monitor cardiac injury and myocardial infarction. Measuring the levels of these enzymes can help determine the extent and timing of the damage. Obtained from a venipuncture. 3) CBC (complete blood count) a group of tests that evaluate the cells that circulate in blood, including red blood cells (RBCs), white blood cells (WBCs), and platelets (PLTs). The CBC can evaluate your overall health and detect a variety of diseases and conditions, such as infections, anemia and leukemia. Can also measure hemoglobin and hematocrit levels 4) Cytologic Study This involves a microscopic examination of sputum and the cells it contains. It is done primarily to detect cells that may be malignant, determine organisms causing infection, and identify blood or pus in the sputum.
What are 4 common lab studies/tests that are used to assess cardiopulmonary function and oxygenation? Describe what each test is looking for/testing.
1) Acute pain and fatigue related to tissue hypoxia due to agglutination of sickled cells within blood vessels 2) Risk for infection 3) Risk for powerlessness related to illness-induced helplessness 4) Deficient knowledge regarding sickle crisis prevention •Acute pain and fatigue •Risk for infection •Risk for powerlessness •Deficient knowledge
What are 4 major nursing diagnoses for patients with sickle cell anemia
1) promoting smoking cessation as appropriate 2) prescribing medications that typically include bronchodilators (widens bronchi) and may include corticosteroids (anti-inflammatory) 3) managing exacerbations (manage worsening changes in disease process) 4) providing supplemental oxygen therapy as indicated.
What are 4 ways to help manage COPD?
1) Decreased skin temperature 2) Pallor 3) Cyanosis 4) Decreased pulses 5) Prolonged capillary refill 6) Edema (cardiovascular issue)
What are 6 findings that indicate less than optimal cardiac function and oxygenation
1) Demonstrate improved gas exchange in the lungs by an absence of cyanosis or chest pain and a pulse oximetry reading more than 95% 2) Relate the causative factors, if known, and demonstrate a method of coping with these factors 3) Preserve cardiopulmonary function by maintaining an optimal level of activity 4) Demonstrate self-care behaviors that provide relief from symptoms and prevent further cardiopulmonary problems.
What are four patient outcomes for clients with oxygenation problems?
*Febrile nonhemolytic reaction *Acute hemolytic reaction *Allergic reaction *Circulatory overload *Bacterial contamination* Transfusion-related acute lung injury *Delayed hemolytic reaction *Disease acquisition *Long-term transfusion therapy
What are some blood transfusion complications?
Common mistakes that patients make when using MDIs include: Failing to shake the canister Holding the inhaler upside down Inhaling through the nose rather than the mouth Inhaling too rapidly Stopping the inhalation when the cold propellant is felt in the throat Failing to hold their breath after inhalation Inhaling two sprays with one breath.
What are some common mistakes a patient makes when inhaling medication using an inhaler?
Common seasonal allergens: grass, tree, and weed pollen mold dust roaches animal dander Common airway irritants air pollutants cold, heat, weather changes strong odors or perfumes smoke occupational exposure Other common asthma triggers: foods (e.g., shellfish, nuts) exercise, stress hormonal factors medications viral respiratory tract infections gastroesophageal reflux. Most people who have asthma are sensitive to a variety of triggers.
What are some common seasonal allergens that trigger asthma? What are some common airway irritants? What are some other common triggers of asthma?
Iron products are used to replace iron in cases of iron deficiency anemia, which can occur because of deficient iron intake or because of blood loss leading to lower iron levels. Iron products commonly cause constipation, nausea, green stools, and GI upset. Iron toxicity can cause severe CNS toxicity, coma, and even death because high iron levels are toxic to nerve cell membranes.
What are some key points to remember when taking iron supplements?
*Sensation of heat along the vein where the blood is being infused *Flushing of the face *Urticaria, headache, pain in the lumbar area *Chills, fever, constricting pain in the chest *Cramping pain in the abdomen *Nausea, vomiting *Tachycardia, hypotension, and dyspnea
What are some signs and symptoms or reactions a patient may have from a blood transfusion?
1) chronic bronchitis 2) Emphysema
What are the 2 main types of COPD (chronic obstructive pulmonary disease)
Asthma-child, COPD-adult, Anemias
What are the 3 exemplars of this concept?
1) cough 2) dyspnea 3) wheezing
What are the 3 most common symptoms of asthma?
1) Vesicular Heard in the peripheral lung fields Pitch = Low 2) Bronchovesicular Heard over the major bronchi Pitch = Medium 3) Bronchial Heard over the trachea and larynx Pitch = High and loud
What are the 3 normal breath sounds and where should you expect to hear each sound? Describe the pitch of each sound as well.
1) Intermittent = symptoms occur 1 or 2 times a week. Nighttime symptoms 1 or 2 times a month. 2) Mild persistent = Symptoms occur more than twice a week but less than once a day. Nighttime symptoms 3 or 4 times a month 3) Moderate persistent = Daily symptoms. Nighttime symptoms >1 time a week, but not nightly 4) Severe persistent = Symptoms occur throughout the day. Nighttime symptoms often 7 times per week
What are the 4 classifications of asthma severity in children not taking long term medications?
Positive and negative A B AB O B- is rarest, O+ is most common, O- is universal donor.
What are the 4 major blood types?
1) Chronic cough 2) Sputum production 3) Dyspnea and shortness of breath
What are the three primary symptoms of COPD
Green: Good control PEFR = >80% personal best No symptoms Action = Take usual medications. Yellow: Caution PEFR = 50-80% personal best symptoms possibly present Action = Take short-acting inhaled β2-agonist right away. Talk to your physician or nurse practitioner. Red: Medical alert PEFR = <50% personal best symptoms usually present Action = Take short-acting inhaled β2-agonist right away. Go to office or emergency department.
What are the three zones of peak expiratory flow rate?
1) Quick-relief medications for immediate treatment of asthma symptoms and exacerbations and long-acting medications to achieve and maintain control of persistent asthma 2) Long acting control medications
What are the two general classes of asthma medications?
Wheezing and Crackles
What are the two types of adventitious breath sounds?
1) Position in high fowlers 2) Maintain adequate fluid intake 3) Provide humidified air
What are three things a nurse can to do promote comfort in a client with oxygenation issues?
Three types of bronchodilators 1) β2-Adrenergic agonists (albuterol) 2) Methylxanthines (theophylline) 3) Anticholinergics (ipratropium)
What are three types of bronchodilators?
1) Short-acting beta2-adrenergic agonists (SABA) ex. albuterol (works by relaxing smooth muscle 2) Anticholinergics 1) Corticosteroids 2) Cromolyn sodium 3) Long-acting beta2-agonists (LABA)
What are two quick relief medications used to treat asthma and three long acting control medications?
Shortness of breath
What does SOB mean?
The spleen recognizes old, or damaged red blood cells and removes them from your body by breaking them down and saving any useful components, such as iron, in the process. This keeps the blood circulating in your body clean and functioning at its best.
What does the spleen do?
1) Encourage deep breathing 2) Incentive spirometry 3) Pursed lip breathing 4) Diaphragmatic breathing
What four things can a nurse do to promote proper breathing?
Folic acid
What is B vitamin that helps your body make red blood cells which therefore treats megaloblastic anemia?
A tension pneumothorax is a life-threatening event in which air progressively accumulates in the thorax, collapsing the lung on the injured side and progressively shifting the mediastinum to the opposite side of the thorax, producing severe cardiac and respiratory impairment.
What is a tension pneumothorax?
Quiet chest in asthmatic child can be an ominous sign: with severe obstruction of the airways the movement of air can be so poor wheezes may not be auscultated
What is an ominous assessment finding in a child with asthma?
Many people with COPD breathe in a shallow, rapid, and exhausting pattern. Teach the patient with COPD to change this type of upper chest breathing to diaphragmatic breathing. Diaphragmatic breathing = patient places one hand on the stomach and the other on the middle of the chest. The patient breathes in slowly through the nose, letting the abdomen protrude as far as it will go, then breathes out through pursed lips while contracting the abdominal muscles, with one hand pressing inward and upward on the abdomen. The patient repeats these steps for 1 minute, followed by a rest for 2 minutes.
What is diaphragmatic breathing?
RBC = 120 days Sickle cell = 10-20 days
What is the average lifespan of a healthy RBC? What is the average lifespan of a sickle cell?
Smoking
What is the most common cause of COPD, and increases the risk of cancers of the oral cavity, esophagus, lung, urinary bladder, and kidneys.
Thoracic excursion Also called, diaphragmatic excursion
What is the nurse assessing when he/she is measuring the expansion of the thorax posteriorly and anteriorly? Should expand symmetrically.
Step-wise approach
What is the step-wise approach used to help treat asthma?
Hydroxyurea
What medication makes your red blood cells bigger? It helps them stay rounder and more flexible — and makes them less likely to turn into a sickle shape. The medicine does this by increasing a special kind of hemoglobin called hemoglobin F. Hemoglobin F is also called fetal hemoglobin because newborn babies have it. It reduces the frequency of pain crisis and reduced the need for blood transfusion.
TCDB (Turn Cough Deep Breath)
What method is used to teach patients to cough those secretions out frequently or else they'll be stuck in the hospital for a lot longer with pneumonia. If they say, "But I don't have to cough," I explain that the cough reflex only works to about half the lung, so they won't feel the urge to cough, but that the junk is still in there, and it needs to come out.
1) Menstruating women who lose RBCs monthly 2) Pregnant and nursing women (Increased demands for iron) 3) Rapidly growing adolescents (Especially those who do not have a nutritious diet) 4) Persons with Gastrointestinal bleeding
What people are at risk for iron deficiency anemia?
Hemoglobin and hematocrit Reticulocyte count RBC indices Iron studies Vitamin B12 Folate Bone marrow aspiration
What tests can be done to determine sickle cell disease?
Alterations in oxygenation to body tissues can be a result of respiratory or cardiac distress and lead to altered mental status. Pallor (lack of color) of skin and mucous membranes can indicate less than optimal oxygenation. Cyanosis (bluish discoloration) of these areas indicates decreased blood flow or poor blood oxygenation.
When assessing a client's oxygenation, why does a nurse inspect the clients LOC, skin, and mucous membranes?
A, B, D, E Close assessment of the patient before, during, and after the procedure is necessary to limit negative effects. Risks include hypoxia, infection, tracheal tissue damage, dysrhythmias, and atelectasis. The nurse should hyperoxygenate the patient before and after suctioning and limit the application of suction to 10 to 20 seconds. The nurse should also take the patient's pulse frequently to detect potential effects of hypoxia and stimulation of the vagus nerve. Using an appropriate suction pressure (80 to 150 mm Hg) will help prevent atelectasis related to the use of high negative pressure. Research suggests that insertion of the suction catheter should be limited to a predetermined length (no further than 1 cm past the length of the tracheal or endotracheal tube) to avoid tracheal mucosal damage, including epithelial denudement, loss of cilia, edema, and fibrosis.
Which assessments and interventions should the nurse consider when performing tracheal suctioning? Select all that apply. A) Closely assess the patient before, during, and after the procedure. B) Hyperoxygenate the patient before and after suctioning. C) Limit the application of suction to 20 to 30 seconds. Monitor the patient's pulse frequently to detect potential effects of hypoxia and stimulation of the vagus nerve. D) Use an appropriate suction pressure (80 to 150 mm Hg). E) Insert the suction catheter no further than 1 cm past the length of the tracheal or endotracheal tube.
A A decreased number of or abnormal RBCs
Which would the nurse include in the teaching plan when describing all types of anemia to a patient? a. A decreased number of or abnormal RBCs b. A lack of iron in the body c. A lack of vitamin B12 in the body d. An excessive number of platelets
The spleen is a major part of the immune system. Just as it detects faulty red blood cells, your spleen can pick out any unwelcome micro-organisms (like bacteria or viruses) in your blood. In sickle cell anemia, the spleen is commonly damaged which therefore makes them more prone to infection.
Why are individuals with sickle cell anemia more susceptible to infection?
Viral infections are hazardous to the patient because they are often followed by infections caused by bacterial organisms, such as Streptococcus pneumoniae, Moraxella catarrhalis, and Haemophilus influenzae To prevent infection, the nurse encourages the patient with COPD to be immunized against influenza and pneumococcal pneumonia, because the patient is prone to respiratory infection.
Why are upper respiratory infections and viral infections so hazardous to patients with COPD?
The lungs are chronically overinflated with air, so the rib cage stays partially expanded all the time. Barrel chest deformity: increased anteroposterior diameter. (ratio is 1/1 instead of 1/2)
Why do patients with COPD typically present with a barrel chest?
The patient with an altered LOC from any cause is at risk for upper airway obstruction because of: 1) loss of the protective reflexes (cough and swallowing) 2) loss of the tone of the pharyngeal muscles, which causes the tongue to fall back and block the airway.
Why is an uncounsious patient or a patient with an altered LOC at risk for upper airway obstruction?
o Patients may be obese. o Frequent cough and expectoration are typical. o Use of accessory muscles of respiration is common. o Wheezing may be heard on auscultation. o Patients may have signs of right heart failure, such as edema and cyanosis
Why is chronic bronchitis referred to as "Blue Bloaters"?
o Patients may be very thin with a barrel chest. o They typically have little or no cough or expectoration. o Breathing may be assisted by pursed lips and use of accessory respiratory muscles; they may adopt the tripod sitting position. o The chest may be hyper resonant, and wheezing may be heard; heart sounds are very distant.
Why is emphysema referred to as "Pink Puffers"?
People who work hard at breathing often do not have much energy for eating. Many of the medications used for treatment can cause anorexia and nausea. (consider 6 small meals instead of 3 large ones) Patients who have COPD require a high-protein/high-calorie diet to counter malnutrition. Eating and digestion require energy, which causes the body to use more oxygen. (encourage wearing cannula during and after meals)
Why is it so important for individuals with impaired gas exchange to maintain adequate nutritional intake?
Without enough RBCs, your body can't get enough oxygen, causing fatigue and episodes of pain. Periodic episodes of pain, called pain crises, are a major symptom of sickle cell anemia. Pain develops when sickle-shaped red blood cells block blood flow through tiny blood vessels to your chest, abdomen and joints
Why is pain so common in individuals with sickle cell anemia
Weight loss is common, because dyspnea interferes with eating and the work of breathing is energy depleting.
Why is weight loss common in individuals with COPD
Opioids decrease the rate and depth of respirations.
Why should a nurse closely monitor respiratory function of a client taking opioids?
Heat increases the body temperature, thereby raising oxygen requirements, and cold tends to promote bronchospasm
Why should the nurse instructs the patient with COPD to avoid extremes of heat and cold?
Packed Red Blood Cells (PRBCs) 200 ml of RBC with additive solution (packed cell volume = 60%)
_________ _______ ________ __________ are what remains of whole blood after the plasma and platelets have been removed. Used to increase oxygen-carrying capacity in patients with anemia, in patients with substantial hemoglobin deficits, and in patients who have lost up to 25% of their total blood volume
Peak flow monitoring (peak flow meter) *Green zone = 80% to 100% of personal best *Yellow, 60% to 80 *Red, less than 60%: serious problem, seek help!
____________ ______ ___________helps measure asthma severity and, when added to symptom monitoring, indicates the current degree of asthma control.
Megaloblastic anemia
a blood disorder characterized by anemia in which the red blood cells are larger than normal
Albuterol
a bronchodilator used for asthma and emphysema and other lung conditions. Prevents/treats bronchospasm
cachexia
a condition of physical wasting away due to the loss of weight and muscle mass that occurs in patients with chronic diseases such as advanced cancer, COPD, or AIDS
capnography
a method to monitor ventilation and, indirectly, blood flow through the lungs. Exhaled air passes through a sensor that measures the amount of carbon dioxide (CO2) exhaled with each breath.
status asthmaticus
a severe, life-threatening asthma attack that is refractory to usual treatment and places the patient at risk for developing respiratory failure. The attacks can occur with little or no warning and can progress rapidly to asphyxiation. Infection, anxiety, nebulizer abuse, dehydration, increased adrenergic blockage, and nonspecific irritants may contribute to these episodes.
pneumothorax
air in the pleural cavity caused by a puncture of the lung or chest wall
Hemoptysis
coughing up blood
icterus
another name for jaundice
Dry powder inhalers
breath-activated delivery of medications
Atelectasis
collapsed lung; incomplete expansion of alveoli
Wheezing (adventitious sound)
continuous musical sounds, produced as air passes through airways constricted by swelling, narrowing, secretions, or tumors. They are often heard in patients with asthma, tumors, or a buildup of secretions.
Tracheostomy Tracheostomies are use to: - Replace an endotracheal tube - To provide a method for mechanical ventilation of the patient - To bypass an upper airway obstruction - To remove tracheobronchial secretions.
creation of an artificial opening into the trachea
Meter-dose inhalers
deliver a controlled dose of medication with each compression of the canister
dysphonia
difficulty speaking/hoarsness
Nebulizers
disperse fine particles of liquid medication into the deeper passages of the respiratory tract
antihistamines
drugs that block the release or action of histamine, a chemical released during inflammation that increases secretions and narrows airways
expectorants
drugs that increase productive cough to clear the airways
Hypercapnia
excessive carbon dioxide in the blood
FEV
forced expiratory volume
urticaria
hives
Air Trapping
incomplete emptying of alveoli during expiration due to loss of lung tissue elasticity (emphysema), bronchospasm (asthma), or airway obstruction
endotracheal intubation
insertion of a breathing tube (type of artificial airway) through the nose or mouth into the trachea
Bronchiectasis
irreversible dilation of the bronchi and bronchioles that results from destruction of muscles and elastic connective tissue. The walls become permanently distended and distorted, impairing mucociliary clearance. The retention of secretions and subsequent obstruction ultimately cause the alveoli distal to the obstruction to collapse (atelectasis).
Erythrocytes
mature red blood cells
Ferrous Sulfate onset = 4 days peak = 7-10 days duration = 2-4 months
prevents/treats iron deficiency anemia elevates serum iron concentration and is converted into hemoglobin or is stored to be converted into a usable form of iron. (used as an iron supplement)
Thoracentesis
procedure of puncturing the chest wall and aspirating pleural fluid.
electrocardiography
process of recording the electrical activity of the heart
Erythropoiesis
production of red blood cells
Hypoventilation
ventilation of the lungs that does not fulfill the body's gas exchange needs