Ch. 18 Obstructive Lung Disorders

The nurse reviews the process of an asthma attack with the parent of a 6-year-old patient with the disorder. Which statement by the parent should indicate to the nurse that teaching has been effective?

"The exposure to the irritant leads to an increase in IgE and mast cell production."

The nurse is caring for a patient who has smoked 2.5 packs of cigarettes a day for 15 years. Which pack-year smoking history should the nurse calculate for this patient?

37.5 pack-years. Cigarette pack-years are calculated as the number of packs smoked each day for 1 year. In a patient who has smoked 2.5 packs for 15 years, it would be: 2.5 × 15 = 37.5 pack-years.

18.6 Bronchiectasis

A definitive diagnosis is made with a fine section CT scan that demonstrated the dilated bronchi.

trigger

A stimulus that precipitates or incites a physiological response

Which intervention is important for improved bronchial hygiene for individuals with bronchiectasis?

A. Use of an incentive spirometer to stimulate deep breathing. B.Lifelong use of bronchodilators to open the airways.

18.6 Bronchiectasis

Abnormally dilated broncho fill with infected mucus and do not empty with coughing, so respiratory infections frequently recur.

The main treatment goal for bronchiectasis is the control or eradication of infection and the improvement of bronchial hygiene. Which route of administration for medications should the nurse expect to be prescribed if the patient has a Pseudomonas aeruginosa infection as a result of cystic fibrosis?

Aerosolized

Which phenomenon occurs as a result of mucosal inflammation and other factors that make exhalation especially difficult for people with chronic obstructive pulmonary disease (COPD)?

Airway obstruction

18.2 Alterations in Respiratory Structure and Function

Airway obstruction increases resistance to airflow resulting in a decreased volume and speed of airflow per unit of time.

18.2 Alterations in Respiratory Structure and Function

Airway obstruction, which is a hallmark of obstructive lung disorders, worsens during exhalation because of inflammation, the loss of support for small airways, bronchoconstriction and mucus in airways

18.3 Asthma

Allergic asthma, the most common type of asthma, is precipitating by the inhalation of an allergen that causes a type 1 hypersensitivity response.

wheeze

An abnormal breath sound associated with obstruction of air-flow through bronchial tubes.

A child with an acute exacerbation of asthma is brought for emergency medical care. Which assessment finding should the nurse​ expect? (Select all that​ apply.)

An exacerbation of asthma includes the clinical manifestations of​ coughing, wheezing, and chest tightness.​ Tachycardia, not​ bradycardia, is likely to be present. Secretions will be thick and​ tenacious, not thin.

Hyperreactivity

An exaggerated response to a stimulus.

The client with intermittent asthma that was previously controlled with an inhaled bronchodilator is now experiencing more persistent symptoms. Which medication should the nurse anticipate being prescribed for this​ client?

An inhaled corticosteroid would likely be added to the treatment of this​ client's asthma to better control symptoms. Antibiotics are needed if there were signs of bacterial infection. Vitamins and pain medication are not indicated for the prevention of asthma symptoms.

chronic obstructive pulmonary disease (COPD)

An umbrella term for progressive lung disorders such as chronic bronchitis and emphysema.

18.3 Asthma

Asthma control is assessed by the degree to which asthma symptoms are relieved.

The nurse is caring for a​ 5-year-old client with asthma. Which information should the nurse obtain from the​ parent? (Select all that​ apply.)

Asthma hypersensitivity reaction to extrinsic antigen or allergen has genetic origins and is more likely to be present in clients with a family history of asthma. Clients with asthma experience an exaggerated bronchial response to exogenous and endogenous stimuli. With insignificant allergen​ exposures, symptoms can recur 4 to 8 hours after the initial attack because of persistent eosinophil and lymphocyte activity. Knowledge of the cause can help prevent or alleviate further attacks. The nurse can anticipate appropriate nursing interventions by knowing the onset of the last attack. Knowledge of the immunization and infection history is not of immediate need in asthma management.

18.3 Asthma

Asthma is expressed clinically when a precipitating stimulus triggers expression of a genetic susceptibility for asthma.

18.3 Asthma

Asthma severity is classified by the degree of biologic intensity and number of exacerbations.

18.3 Asthma

Asthma triggers are specific to an individual, but all result in persistent airway inflammation and bronchial hyperreactivity.

Which assessment findings are expected in the individual with long-standing COPD? Select all the apply

Barrel chest

A patient with obesity is experiencing symptoms of restrictive pulmonary disease and seeks medical attention. Which information should the nurse identify as being helpful when determining the type of disease this patient is experiencing?

Body mass index (BMI). A body mass index (BMI) greater than 30 kg/m2 resulting from increased adipose deposits around the waist and chest is diagnostic of obesity, which can result in extrinsic restrictive pulmonary disease. Fluoroscopy may be used to recognize diaphragm paralysis, and chest X-ray is used to identify the low lung volume and atelectasis seen with Guillain-Barré syndrome. High-resolution CT is helpful in identifying intrinsic lung disease. Additional Learning Additional risk factors for restrictive pulmonary disease include: Genetic factors. History of severe respiratory syncytial virus. Gender (females at a higher risk than males). Exposure to allergens. Exposure to irritants. Maternal smoking/environmental tobacco exposure.

While completing the health history of a patient with cystic fibrosis, the nurse recalls that this disease process produces extremely viscous sputum that easily grows Pseudomonas aeruginosa. Which medical condition should the nurse understand that this patient is at risk for developing?

Bronchiectasis Bronchiectasis is common in individuals with cystic fibrosis because of their extremely viscous sputum, which easily grows Pseudomonas aeruginosa. P. aeruginosa is not a causative agent of emphysema, asthma, or chronic bronchitis. Cigarette smoking is the main cause of emphysema and chronic bronchitis. Asthma is caused by a reaction to a stimulus. Additional Learning Risk factors for bronchiectasis include: Bronchial obstruction caused by lung tumors, aspiration of foreign bodies, impacted mucous, or atelectasis. Congenital or hereditary conditions including problems such as congenital weakness of the bronchial wall, cystic fibrosis, or an impaired immune system. Repeated infections over many years, although a single severe infection with pertussis, tuberculosis, mycoplasmas, or Mycobacterium avium or a bacterial pneumonia can also cause bronchiectasis.

The nurse is caring for a client with bronchiectasis. Which medication should the nurse anticipate being prescribed for this​ client?

Bronchiectasis is the presence of a persistent necrotizing infection in the lung that results in the dilation of airways and requires treatment with antibiotics.​ Vitamins, pain​ medication, and corticosteroids are not indicated in the care of the client with bronchiectasis.

A client seeks medical attention for a productive cough of mucopurulent sputum that has persisted for 4 months. Which obstructive lung disease should the nurse suspect as likely in this​ client?

Bronchiectasis manifests as a persistent mucopurulent cough from chronic infection of the lung that lasts from months to years. The productive coughs of asthma and cystic fibrosis are not mucopurulent. Emphysema is characterized by little or no cough.

18.6 Bronchiectasis

Bronchiectasis occurs when there is airway blockage and an acute necrotizing infection or a mutation affecting epithelial ion transport

18.4 Chronic Obstructive Pulmonary Disease

CF is a recessive genetic disorder that affects the epithelial transport of fluids. Reabsorption of sodium is inhibited in the skin by enhanced in epithelial exocrine cells in the lung, pancreas, bile duct, and sperm ducts.

18.4 Chronic Obstructive Pulmonary Disease

CF is diagnosed by a skin sweat test.

Which of the following statements are true about CF?

CF is most common in Caucasians and uncommon in blacks and Asians. CF is not related to the development of bronchiectasis.

18.4 Chronic Obstructive Pulmonary Disease

COPD includes chronic bronchitis and emphysema; often, individuals with COPD demonstrate manifestations that combine the two disorders.

18.4 Chronic Obstructive Pulmonary Disease

COPD is classified in four grades according to the progressive degree of airflow limitations, as measured by the FEV1 and FEV1/ FVC and by symptoms.

18.4 Chronic Obstructive Pulmonary Disease

Chloride transports is abnormal due to an abnormal epithelial chloride channel encoded by the cystic fibrosis transmembrane conductance regulator (CFTR) gene.

A patient with chronic obstructive pulmonary disease (COPD) has an increase in mucus production caused by goblet cell proliferation and submucosal gland hypertrophy. Which form of COPD should the nurse suspect this patient is experiencing?

Chronic bronchitis. Long-term exposure to cigarette smoke and other noxious agents causes chronic irritation of the airways, leading to an increase in the number of goblet cells and an increase in the size of submucosal glands. Subsequently, goblet cell proliferation and submucosal gland hypertrophy may cause an increase in mucous production. Asthma is the result of an exaggerated response to a stimulus. Emphysema is caused by damage to the alveolar walls. Bronchiectasis occurs when there is an airway blockage and an acute necrotizing infection or a mutation affecting epithelial ion support. Additional Learning In chronic bronchitis, inflammatory changes cause an increase in the thickness of the basement membrane and loss of structural support for small airways. The result is airway fixation. In many cases, hypersecretion of mucus leads to the development of a chronic cough. However, not every patient with COPD is affected by symptomatic hypersecretion of mucus or a chronic cough.

Patients with emphysema often exhibit a barrel chest, with an increased anterior-posterior diameter, because of hyperinflation. In which other form of chronic obstructive pulmonary disease (COPD) is this finding also assessed?

Chronic bronchitis. Physical findings are similar for chronic bronchitis and emphysema: Barrel chest, with an increased anterior-posterior diameter because of hyperinflation Respiratory muscles in a partially contracted position with hyperinflation require more energy because they must do more work to move same amount of air. Accessory muscles used to maintain ventilation Soft distant breath sounds are heard with a prolonged exhalation. Coarse rales may be heard if an infection is present. Clubbing of distal fingers Ruddy complexion Foot and ankle swelling

Asthma

Chronic inflammatory disorder of the airway characterized by recurrent episodes of reversible airway obstruction and hyperreactive airways.

18.4 Chronic Obstructive Pulmonary Disease

Chronic obstructive pulmonary disease is characterized by progressive airflow limitation caused by abnormal pulmonary inflammation secondary to inhalation of noxious substances.

Which lung disorder should the nurse caring for clients in a pulmonary rehabilitation outpatient clinic recognize as the​ third-leading cause of morbidity and mortality in the United​ States?

Chronic obstructive pulmonary disease is the​ third-leading cause of morbidity and mortality in the United States. The incidence of asthma has increased over the past​ decades, but the disorder is not the​ third-leading cause of morbidity and mortality in the United States. Bronchiectasis and cystic fibrosis are​ rarer, not leading causes of morbidity or mortality in the United States.

A client attending an informational program on respiratory health asks why cigarette smoking should be avoided. Which response should the nurse​ make?

Cigarette smoke contributes to the risk of obstructive pulmonary disease in the smoker and in those exposed to secondhand smoke. The nurse should not respond with judgmental or false statements.

18.4 Chronic Obstructive Pulmonary Disease

Clinical manifestations of CF include thick pulmonary secretions, frequent respiratory infections, chronic cough, abdominal distention, and large, fatty, foul-smelling stools.

18.3 Asthma

Common asthma symptoms include chest tightness, shortness of breath, wheezing, and cough with or without the production of thick sputum. Classic confirmatory tests are challenge tests performed with an irritating chemical, cold air, or exercise.

18.3 Asthma

Common asthma triggers include allergies, infections, exercise, and medications.

A patient with emphysema is showing signs of increasing dyspnea and tachypnea. Which complication should the nurse aim to prevent in this patient?

Cyanosis

A patient has difficulty breathing and experiences frequent lung infections. Which medical condition should the nurse suspect?

Cystic fibrosis (CF)

The parents of a child with cystic fibrosis ask how this illness will affect the child. Which response should the nurse​ make?

Cystic fibrosis causes the production of​ thick, sticky mucus in the lungs. In the gastrointestinal​ system, the pancreas and​ bowel, not the​ liver, are affected by digestive malfunctions. Development and growth are delayed. The child may be prone to depression and anxiety​ disorders, not schizophrenia.

A couple planning to start a family expresses concern that the​ would-be mother has a brother with cystic fibrosis. How should the nurse​ respond?

Cystic fibrosis is a recessive genetic disorder where both parents would need to pass on the recessive gene. It is best to seek genetic counseling when family history is known. The potential mother could be a carrier. While the incidence of disease is​ low, the most therapeutic answer is to seek genetic counseling.

18.5 Cystic Fibrosis

Cystic fibrosis is the most common lethal genetic disorder, with lifelong morbidity that primarily affects Caucasians. It is estimated that between 2% and 5% of Caucasians carry the gene for CF, but it is uncommon in blacks and Asians.

The nurse is administering antibiotic therapy to a client with bronchiectasis. Which risk factor should the nurse consider as contributing to the development of this health problem in the​ client? (Select all that​ apply.)

Cystic​ fibrosis, repeated​ infections, obstruction of the airway by​ tumor, and bronchial airway weakness are all risk factors for bronchiectasis. Being male does not increase the risk of bronchiectasis.

The nurse is caring for an adolescent client with daily symptoms of​ asthma, an FEV1 of​ 75% predicted, and reports of waking up a few times a week at night with symptoms. Which classification of asthma aligns with the clinical manifestations of asthma in this​ client?

Daily​ symptoms, an FEV1 of​ 60-80% of​ predicted, and reports of waking up a few times a week at night with symptoms align with moderate asthma. Mild asthma includes symptoms twice or more per week but not​ daily, an FEV1 of​ 80% or​ greater, and nighttime awakening a few times per month. Severe asthma is marked by symptoms throughout the day and nightly awakening with symptoms. Intermittent status is denoted by symptoms 2 or fewer days per week with normal FEV1 and nighttime awakening twice or less a month.

The nurse is teaching a pregnant patient about the risks of smoking during pregnancy. Which effect of maternal smoking increases the risk of the fetus developing chronic obstructive pulmonary disease (COPD)?

Decreased fetal lung growth

Which pulmonary function test should alert the nurse to restrictive pulmonary alterations?

Decreased forced vital capacity (FVC) is seen in restrictive lung disease. Increased FEV1, increased FEF, and increased TV are not diagnostic of restrictive lung disease.

Which pulmonary function test should alert the nurse to restrictive pulmonary alterations?

Decreased forced vital capacity (FVC). Decreased forced vital capacity (FVC) is seen in restrictive lung disease. Increased FEV1, increased FEF, and increased TV are not diagnostic of restrictive lung disease.

18.1

Dyspnea, which is the subjective experience of difficulty breathing, is a common feature of obstructive lung disorders

A patient seeks medical attention for an obstructive lung disorder. Which symptom should the nurse expect to assess in this patient?

Dyspnea. Chronic obstructive pulmonary disease (COPD) is an umbrella term for progressive lung disorders such as chronic bronchitis and emphysema. Inflammation plays an important role in the development of obstructive lung disorders, and they share dyspnea as a common symptom. Dyspnea is the term for difficulty breathing. Wheezing is generally associated with asthma. Hemoptysis is associated with chronic bronchitis. Hypercapnia is associated with air trapping and impaired ventilation. Additional Learning When smooth muscles become irritable, or "twitch," with inflammation, they constrict strongly but to do not readily relax. With chest expansion during inhalation, inflamed airways are pulled open, helping counteract the muscle contraction. However, with exhalation, the thorax is smaller and the effects of smooth muscle contraction become more dominant, so airway obstruction worsens.

18.4 Chronic Obstructive Pulmonary Disease

Emphysema is associated with damage to the lungs parenchyma, destruction of gas-exchanging pulmonary surfaces (including the alveolar walls), and subsequent pulmonary hyperinflation.

Which of the following are critical effector cells in both allergic and nonallergic asthma? Select all that apply.

Eosinophils, Th-2 T lymphocytes

hemoptysis

Expectoration of blood from the airway caused by an erosion through a pulmonary or bronchial blood vessel wall.

Which value would be useful in evaluation of airway obstruction in a client with obstructive lung disease?

FEV1/FVC

18.4 Chronic Obstructive Pulmonary Disease

Fixed airway obstruction is caused by scarring that thickens the basement membranes, the increased number and size of mucus glands, and the loss of support for small airways.

Chronic bronchitis

Form of chronic obstructive pulmonary disease; characterized by persistent, inflammation-induced narrowing of the airway, copious mucus production, and chronic productive cough.

Emphysema

Form of chronic obstructive pulmonary disease; characterized by the irreversible loss of walls between alveoli with no evidence of fibrosis.

Atopy

Genetic predisposition toward developing allergies

18.4 Chronic Obstructive Pulmonary Disease

Hallmarks of chronic bronchitis include persistent, inflammation-induced narrowing of the airway, copious mucus production, and a chronic productive cough

What is the reason for the assessment finding of increased anterior-posterior diameter of the chest in an individual with COPD?

Hypoventilation, Dilation of the bronchi, Hyperinflation of the lungs

18.3 Asthma

In recurrent asthma, airway are remodeled and bronchial smooth muscles hypertrophy, increasing their capacity for bronchoconstriction

Hypercapnia

Increase in arterial carbon dioxide levels.

18.6 Bronchiectasis

Individuals with bronchiectasis have a hard cough that produces mucopurulent sputum over periods of weeks to months.

18.1

Inflammation plays a key role in the development of obstructive lung disorders

Which factors contribute to diminished expiratory airflow in individuals with obstructive lung disease?

Loss of elastic recoil in small airways; Increased mucus secretion

Air trapping

Mechanism by which airway obstruction prohibits expiration of pulmonary gases; may produce lung hyperinflation.

The nurse is designing a teaching plan for a client with chronic obstructive pulmonary disease. Which medication type should the nurse anticipate as a safe medication regimen for the​ client? (Select all that​ apply.)

Mucolytics for the thinning of​ secretions, corticosteroids to decrease​ inflammation, and​ long- and​ short-acting bronchodilators to open the airways are all recommended for the care of the client with chronic obstructive pulmonary disease. Antitussives are not recommended.

bronchodilation

Narrowing

The nurse is obtaining a health history from an adult client with newly diagnosed​ exercise-induced asthma. Which risk factor contributed to the development of asthma in this​ client?

Obesity contributes to the development of asthma through gastroesophageal​ reflux, exercise​ intolerance, and inflammation. Asthma affects people of all ages. Smoking contributes to the development of asthma. Asthma is more likely to develop in women after puberty but in boys before puberty.

Bronchiectasis

Obstructive lung disorder characterized by irreversibly dilated bronchi that readily collapse and cause airway obstruction and frequent infections.

181.

Obstructive lung disorders encompass a spectrum of disorders, including asthma, chronic bronchitis, emphysema, cystic fibrosis, and bronchiectasis.

18.1

Obstructive lung disorders impair oxygenation and perfusion

Hyperinflation

Overexpansion of the lungs due to air trapping; often associated with obstructive respiratory disorders such as emphysema, asthma, and cystic fibrosis.

The treatment of cystic fibrosis is largely symptomatic. Which organ normally produces the enzymes that are replaced during the treatment of cystic fibrosis?

Pancreas

The nurse is caring for a patient with chronic obstructive pulmonary disease (COPD). Which test should the nurse consider as the primary test with which to identify the stage of COPD?

Pulmonary function test

18.2 Alterations in Respiratory Structure and Function

Pulmonary function tests used for assessment of obstructive lung disorders include spirometry, body plethysmography, and nitrogen washout.

cystic fibrosis

Recessive genetic disorder that inhibits sodium reabsorption in skin sweat ducts by enhances sodium transport across epithelial cells in the respiratory system, pancreas, bile ducts, and sperm ducts.

Which aspect of a pulmonary function test measures the volume of air remaining in the chest after maximal exhalation?

Residual volume

18.4 Chronic Obstructive Pulmonary Disease

Respiratory symptoms increase, and hypoxemia, hypercapnia, and activity limitation occur with disease progression.

What is the primary reason for airway obstruction early in an allergic asthma attack?

Severe bronchoconstriction

The nurse visits the home of a child recovering from an exacerbation of asthma. Which intervention should the nurse review with the family to prevent future asthma​ attacks? (Select all that​ apply.)

Smoke,​ cockroaches, and dust mites are all triggers for allergic asthma. The use of ceiling fans or central air conditioning is not contraindicated in the home of an individual with asthma.

A client with chronic obstructive pulmonary disease asks how cigarette smoking led to this disease. Which response should the nurse make to this​ client?

Smoking causes inflammation and structural abnormalities in the lung that obstruct the airway. Tumor​ growth, not smoking​ itself, can cause blood to enter the airway. The airway spasms in asthma. Smoking may increase susceptibility to infection but does not itself cause infection.

18.4 Chronic Obstructive Pulmonary Disease

Smoking is the greatest risk factors for COPD. Exposure to secondhand smoke and exposure to environmental or occupations aerosolized particles increase the risk to a lesser degree

The nurse is conducting a community health class on the prevention of lung disease. Which advice should the nurse provide regarding prevention of the leading cause of chronic obstructive lung​ disease?

Smoking is the leading cause of obstructive pulmonary​ disease, contributing to​ 90% of cases. Obesity can contribute to the development of asthma. Air pollution and a genetic component can contribute to chronic lung​ disease, but they are not the leading causes.

18.4 Chronic Obstructive Pulmonary Disease

The airway obstruction of COPD is primarily the result of fixed airway that have an increased resistance to airflow, thus slowing the rate of airflow.

The nurse is caring for a client with chronic bronchitis. Which clinical finding aligns with this​ diagnosis?

The client with chronic bronchitis will experience shortness of breath with activity. Weight loss is associated with the increased muscle work of breathing in emphysema. Chronic bronchitis cough is worse in the morning and is not associated with infection.

18.3 Asthma

The gold standard therapy for persistent asthma is the use of inhaled corticosteroids, but patients are not all equally responsive to corticosteroids.

The nurse notes that a patient with emphysema is underweight and appears thin. Which reason should the nurse suspect is causing this patient's appearance?

The increased energy needed to breathe

The nurse caring for a client with asthma performs a peak flow maneuver. How should the nurse respond when the client asks the purpose of this​ test?

The peak flow meter measures airflow through the large airways. Restriction of the airway leading to a symptomatic asthma attack would be detected by a change in peak flow meter measurements. Infection is detected through​ symptoms, cultures, and a chest​ x-ray. Mucus may be present but is not the only factor in airflow. Vital capacity is measured in pulmonary function testing.

The nurse is preparing to care for a client with bronchiectasis. In which area of the respiratory system should the nurse expect persistent necrotizing​ infection?

The persistent necrotizing infection and ensuing dilation of airways most often affect the lower lobes of the lungs and the right middle lobe. The​ trachea, main stem​ bronchi, and upper lobes of the lungs are not often affected.

shortness of breath

The subjective experience of breathlessness; often used interchangeably with the term dyspnea.

Dyspnea

The subjective experience of difficulty breathing; often used interchangeably with the term shortness of breath.

The nurse is caring for an infant undergoing diagnostic testing for cystic fibrosis. Which test should the nurse anticipate as a priority for this​ client?

The sweat test is used to diagnose cystic​ fibrosis; a high chloride level is considered a positive result. Lung​ imaging, pulmonary function​ testing, and measurement for barrel chest are conducted for the client with suspected chronic obstructive pulmonary disease.

18.4 Chronic Obstructive Pulmonary Disease

Treatment for CF includes symptomatic measure, such as antibiotic administration for treatment of secondary infections, vitamin supplements, and pancreatic digestive enzyme replacement.

18.6 Bronchiectasis

Treatment includes antibiotic regimens and bronchial hygiene

Which common manifestation of an asthma attack is caused by an interrupted airflow through bronchial tubes leading to an audible air vibration?

Wheezing

pulmonary acini

functional units of the lungs in which gas exchange occurs; specifically, the respiratory bronchioles and their associated alveolar ducts and alveolar sacs.