Module 3 - Nursing Care of Patients with Disorders of the Respiratory System Learning Content

K.R. is a 30-year-old female patient whose father was diagnosed with active TB. K.R.'s physician recommended that K.R. take a prophylactic antibiotic for 6 months, and she was placed on rifampin (Rifadin). K.R. calls the office today and is quite anxious because her urine was bright orange when she voided this morning. 1. What is the cause of the orange urine, and should K.R. be concerned? 2. K.R. read that antibiotics may cause birth control pills to be ineffective, and she asks the nurse if this is the case with rifampin. Should K.R. be concerned about the effectiveness of her birth control pills?

1. Answer: The discoloration of the urine is a harmless expected effect of rifampin. The patient may note that all body fluids are discolored while taking this medication. K.R. should not be concerned, but the nurse should advise her that the discoloration may stain clothing. Rationale: Patients taking rifampin, rifabutin, or rifapentine may experience red-orange-brown discoloration of the skin, sweat, tears, urine, feces, sputum, saliva, and tongue as an adverse effect of the drug. The discoloration reverses with discontinuation of the drug; however, contact lenses may be permanently stained. 2. Answer: Yes, the patient does need to be concerned. K.R. must use a different form of contraception during rifampin therapy. Rationale: Women taking oral contraceptives who are prescribed rifampin must be switched to another form of birth control. Oral contraceptives become ineffective when given with rifampin.

Granulomas, new tissue masses of live and dead bacilli, are surrounded by macrophages, which form a protective wall. They are then transformed to a fibrous tissue mass, the central portion of which is called a ______________ tubercle.

Ghon

A positive family history and environmental factors, including which of the following? Select all that apply. Seasonal changes Air pollution Mold Low pollen count

A positive family history and environmental factors, including seasonal changes, high pollen counts, mold, pet dander, climate changes (particularly cold air), and air pollution, are primarily associated with asthma.

Which of the following is key in treating the disease and controlling the spread of infection? Doctor office visits Adherence Justification Home environment

Adherence to the prescribed treatment regimen is key in treating the disease and controlling the spread of infection

Case Study Terry Lee is a 38-year-old client who presented to the emergency department in severe respiratory distress, including profound dyspnea, wheezing, and circumoral cyanosis. He was diagnosed with asthma at age 10. Terry was admitted to the intensive care unit (ICU). His treatment regimen includes albuterol via inhalation every 20 minutes for four doses and IV corticosteroids every 6 hours. Describe the potential adverse effects of administering albuterol as ordered. For what signs and symptoms should the nurse be alert? 1. Terry's wife is at his bedside. She expresses concern about his treatment with IV corticosteroids, stating that she has heard that many adverse effects are associated with these drugs. Discuss the rationale for the use of IV corticosteroids in this case. 2. Terry's symptoms subside and he is transferred to a medical unit. Terry tells the nurse that he hopes he does not have another episode of this type again. What efforts should be employed in order to reduce the risk of future episodes?

Answers 1. High doses of albuterol as often as every 20 minutes for 1 to 2 hours are indicated for the treatment of status asthmaticus. Adverse effects associated with this treatment include excessive cardiac and CNS stimulation. Symptoms of cardiac stimulation include angina, tachycardia, and palpitations. Symptoms of CNS stimulation consist of agitation, anxiety, insomnia, seizures, and tremors. Other reported effects may include serious dysrhythmias and cardiac arrest. 2. The nurse should explain that corticosteroids reduce inflammation and will increase the effectiveness of other drugs used for Terry's symptoms. Beneficial effects for Terry include decreased mucus production, decreased edema of the airways, and reduced reactivity of the airways. Corticosteroids also increase the effectiveness of beta2-adrenergic bronchodilators, such as albuterol. In acute, severe asthma, the drug is usually continued for 7 to 10 days. The nurse should stress that Terry will be monitored for any adverse effects. 3. Efforts to reduce the risk of future episodes should center on identifying suspected triggers, implementing a plan to avoid these triggers, and evaluating Terry's treatment regimen. The evaluation of his treatment regimen should include an assessment of Terry's understanding and adherence to the current regimen, factors that may be impacting his adherence, and his implementation of any adjustments that are deemed necessary.

Which of the following are common triggers of asthma? Select all that apply. Stress Irritants Strong odors Altitude

Common triggers for asthma symptoms and exacerbations include airway irritants (e.g., air pollutants, cold, heat, weather changes, strong odors or perfumes, smoke, occupational exposure), foods (e.g., shellfish, nuts), exercise, stress, hormonal factors, medications, viral respiratory tract infections, and gastroesophageal reflux. Most people who have asthma are sensitive to a variety of triggers.

With peak flow meters, the patient takes a __________ breath and places their lips around the mouthpiece.

Deep

T/F Bronchodilators are key for symptom management in unstable COPD.

False Bronchodilators are key for symptom management in stable COPD.

T/F Oxygen supplementation is not necessary in treating asthma exacerbations.

False In some patients, oxygen supplementation may be required to relieve hypoxemia associated with moderate to severe exacerbations.

T/F Ineffective breathing patterns and shortness of breath are due to the modified respiratory mechanics of the chest wall and lung resulting from pursed lip breathing.

False Ineffective breathing patterns and shortness of breath are due to the modified respiratory mechanics of the chest wall and lung resulting from air trapping (i.e., incomplete emptying of alveoli during expiration), ineffective diaphragmatic movement, airway obstruction, the metabolic cost of breathing, and stress.

T/F Most patients with status asthmaticus will need mechanical ventilation.

False Most patients do not need mechanical ventilation, but it is used for patients in respiratory failure, for those who tire and are too fatigued by the attempt to breathe, and for those whose condition does not respond to initial treatment.

T/F Prednisone is an inhaled corticosteroid.

False Prednisone is a systemic corticosteroid.

T/F Primary causes of a COPD exacerbation include changes in the medication regimen.

False Primary causes of an acute exacerbation include tracheobronchial infection and air pollution. However, the cause of approximately one third of severe exacerbations cannot be identified (GOLD, 2015).

TB spreads from person to person by contact. True/False

False TB spreads from person to person by airborne transmission.

T/F The underlying pathology in asthma is irreversible diffuse airway inflammation that leads to long-term airway narrowing

False The underlying pathology in asthma is reversible diffuse airway inflammation that leads to long-term airway narrowing. This narrowing, which is exacerbated by various changes in the airway, includes bronchoconstriction, airway edema, airway hyper-responsiveness, and airway remodeling.

Granulomas, new tissue masses of live and dead bacilli, are surrounded by macrophages, which form a protective wall. They are then transformed to a fibrous tissue mass, the central portion of which is called which of the following? Necrotic tubercle Collagenous scar Cancer tumor Ghon tubercle

Granulomas, new tissue masses of live and dead bacilli, are surrounded by macrophages, which form a protective wall. They are then transformed to a fibrous tissue mass, the central portion of which is called a Ghon tubercle.

Which of the following are teaching guidelines for isoniazid? Select all that apply. If you begin to experience numbness, burning, or tingling of your arms or legs, notify the TB health care provider. Take INH with a meal if possible Avoid alcoholic beverages while taking INH. Take all other anti-TB drugs prescribed along with INH.

If you begin to experience numbness, burning, or tingling of your arms or legs, notify the TB health care provider. Avoid alcoholic beverages while taking INH. Take all other anti-TB drugs prescribed along with INH.

Adherence to the prescribed treatment regimen is key in treating the disease and controlling the spread of ___________.

Infection

Tuberculosis (TB) is an infectious disease that primarily affects the _________________ parenchyma, It also may be transmitted to other parts of the body, including the meninges, kidneys, bones, and lymph nodes.

Lung

_______________ flow meters measure the highest airflow during a forced expiration.

Peak

Which of the following are the first-line medications to treat TB? Select all that apply. Rifampin Myambutol INH Desmopressin PZA

Rifampin Myambutol INH PZA

The nurse should obtain current educational materials for the patient based on which of the following? Select all that apply. Cultural background Diagnosis Number of relapses Educational level

The nurse should obtain current educational materials for the patient based on the patient's diagnosis, causative factors, educational level, and cultural background.

Which term is sometimes used to describe rapid onset, severe, and persistent asthma that does not respond to conventional therapy? Asthma attack Asthma Status asthmaticus Difficulty breathing

The term status asthmaticus is sometimes used to describe rapid onset, severe, and persistent asthma that does not respond to conventional therapy.

To prevent transmission of TB to others, the nurse carefully instructs the patient about which of the following? Select all that apply. hand hygiene when coughing and sneezing do so into palm of hand hygiene measures proper disposal of tissues mouth care

To prevent transmission of TB to others, the nurse carefully instructs the patient about important hygiene measures, including mouth care, covering the mouth and nose when coughing and sneezing, proper disposal of tissues, and hand hygiene.

To prevent _____________ of TB to others, the nurse carefully instructs the patient about important hygiene measures, including mouth care, covering the mouth and nose when coughing and sneezing, proper disposal of tissues, and hand hygiene

Transmission

Adherence to the prescribed treatment regimen is key in treating the disease and controlling the spread of infection. False/True

True

T/F Although inhaled and systemic corticosteroids may improve the symptoms of COPD, they do not slow the decline in lung function.

True

T/F Granulomas, new tissue masses of live and dead bacilli, are surrounded by macrophages, which form a protective wall. They are then transformed to a fibrous tissue mass, the central portion of which is called a Ghon tubercle.

True

T/F The immediate nursing care of patients with asthma depends on the severity of symptoms

True

T/F The three most common symptoms of asthma are cough, dyspnea, and wheezing

True

T/F With asthma exacerbations, quick-acting beta2-adrenergic agonist medications are first used for prompt relief of airflow obstruction.

True

To prevent transmission of TB to others, the nurse carefully instructs the patient about important hygiene measures, including mouth care, covering the mouth and nose when coughing and sneezing, proper disposal of tissues, and hand hygiene. True/False

True

T/F Bronchospasm, which occurs in many pulmonary diseases, reduces the caliber of the small bronchi and may cause dyspnea, static secretions, and infection.

True Bronchospasm, which occurs in many pulmonary diseases, reduces the caliber of the small bronchi and may cause dyspnea, static secretions, and infection.

T/F Tuberculosis (TB) is an infectious disease that primarily affects the lung parenchyma

True Tuberculosis (TB) is an infectious disease that primarily affects the lung parenchyma. It also may be transmitted to other parts of the body, including the meninges, kidneys, bones, and lymph nodes.

Tuberculosis (TB) is an infectious disease that primarily affects the lung parenchyma. It also may be transmitted to other parts of the body, including which of the following? Select all that apply. skin bones kidneys meninges Lymph nodes

Tuberculosis (TB) is an infectious disease that primarily affects the lung parenchyma. It also may be transmitted to other parts of the body, including the meninges, kidneys, bones, and lymph nodes.

Which of the following are clinical manifestations of Tuberculosis? Select all that apply. Cough night sweats hair loss fever increased appetite fatigue

cough, night sweats, fever, fatigue