NUR 321 - Oxygenation part 2
For each of the following: emphysema, bronchitis, and asthma: what happens, what is
primarily affected, and is it reversible? - ANS-1. Emphysema:
- Air trapping and premature closing of airways
- alveoli
- irreversible
2. Bronchitis
- obstruction due to thick mucus
- airways
- irreversible
3. Asthma
- Obstruction due to inflammation and mucus
- Airways
- reversible
How can we prevent lung cancer? - ANS-1. Smoking cessation - ask if they're ready to
stop and help provide resources to help them stop
2. Environmental/occupational exposure = wear masks
3. If genetic (Tp53gene) - refer them to get genetic testing and genetic counseling -
- Also look at their alpha1-antitrypsin levels because this helps protect the lungs
How do we diagnose asthma? - ANS-1. Pulse Ox
2. Labs
3. ABGs
- If they're getting close to status asthmaticus, their CO2 will be climbing
- Eosinophils - if they have asthma due to allergies
- Immunoglobulin E levels - for asthma due to allergies
- Sputum - bacteria can indicate infection
3. PFTs - need a baseline tests for all asthma patients
How do we diagnose COPD? - ANS-1. History and physical exam - ask about family
history, work exposures, where they live, etc
2. Lab values
3. Procedures
,How do we diagnose sarcoidosis, what is the goal of treatment, and what is the
treatment for sarcoidosis? - ANS-Sarcoidosis diagnosis:
1. Seen on a chest X Ray
2. Bronchoscopy can confirm
3. Decreased in PFTs
Goal = lessen symptoms and prevent fibrosis
Treatment:
1. Glucocorticoids - anti-inflammatories such as predinoses and decadrons
2. Mineralocorticoids (ex flurostef)
How do we prevent infections in COPD patients? - ANS-1. Vaccines: flu vaccine every
year and get the pneumonia vaccine every 5 years
2. Avoid others who are ill
How do we provide palliative care for patients with lung cancer? - ANS-1. O2 for
hypoxemia
2. Bronchodilators/corticosteroids
3. Mucolytics
4. Radiation - to shrink tumors (may have surgery after the tumor shrinks some)
5. Thoracentesis - because some cancer cells cause leaking of fluids
6. Morphine and positioning to manage dyspnea - watch that you don't decrease their
respirations too much though
7. Pain management
a. Pharmacologic = morphine
b. Non-pharmacologic = positioning, guided imagery, music therapy, stuff to get their
mind off what's going on, essential oils and diffusing smells, pictures of family, etc
8. Hospice care
What anti-inflammatories are used to treat asthma? - ANS-1. Leukotriene inhibitors =
montelukast (Singulair)
2. Corticosteroids = used for inflammation
- Ex = fluticasone (Flovent)
- Prednisone (Deltason)
- Rinse mouth after inhalers
What anticholinergic drugs are used for COPD patients? - ANS-ex ipratropium
- dries secretions (can't see, can't pee, can't spit, can't shit)
, What are complications of COPD? - ANS-1. Hypoxemia
2. Respiratory infections - due to mucus
3. Cardiac failure
- Cor pulmonale - right-sided HF
- Cardiac dysrhythmias
4. Decreased nutritional intake - patients should have small, frequent meals
What are interstitial pulmonary diseases? - ANS-Interstitial pulmonary diseases =
Fibrotic lung diseases - ex CF and sarcoidosis
Alveoli, blood vessels, and surrounding support tissues are restricted or stiff
Does NOT affect the actual airway
- Does not obstruct and cause air trapping, rather it prevents good expansion and recoil
What are Red blood cells and hemoglobin? - ANS-The primary function of RBCs = to
transport oxygen from the lungs to the cells of the body
RBCs contain a protein called hemoglobin that actually carries the oxygen
Females have lower hemoglobin than males because we are losing blood once a month
- Normal hemoglobin = 14 for females and 15.4 for males
We have hypoxia if we have low levels of O2 on hemoglobin
What are some non-surgical interventions we can perform on patients with COPD? -
ANS-1. Maintain O2 saturation (remember below 90 may be normal)
2. Remember, low arterial oxygen is the primary drive to breathe in COPD patients
3. Regular exercise
4. Nutrition
5. Minimize anxiety
6. Prevent infections
7. Smoking cessation
8. collaborate with case management
9. Peak flow meter
10. Drug therapy
What are some overall symptoms of COPD? - ANS-1. Easily fatigued
2. Frequent respiratory infections
For each of the following: emphysema, bronchitis, and asthma: what happens, what is
primarily affected, and is it reversible? - ANS-1. Emphysema:
- Air trapping and premature closing of airways
- alveoli
- irreversible
2. Bronchitis
- obstruction due to thick mucus
- airways
- irreversible
3. Asthma
- Obstruction due to inflammation and mucus
- Airways
- reversible
How can we prevent lung cancer? - ANS-1. Smoking cessation - ask if they're ready to
stop and help provide resources to help them stop
2. Environmental/occupational exposure = wear masks
3. If genetic (Tp53gene) - refer them to get genetic testing and genetic counseling -
- Also look at their alpha1-antitrypsin levels because this helps protect the lungs
How do we diagnose asthma? - ANS-1. Pulse Ox
2. Labs
3. ABGs
- If they're getting close to status asthmaticus, their CO2 will be climbing
- Eosinophils - if they have asthma due to allergies
- Immunoglobulin E levels - for asthma due to allergies
- Sputum - bacteria can indicate infection
3. PFTs - need a baseline tests for all asthma patients
How do we diagnose COPD? - ANS-1. History and physical exam - ask about family
history, work exposures, where they live, etc
2. Lab values
3. Procedures
,How do we diagnose sarcoidosis, what is the goal of treatment, and what is the
treatment for sarcoidosis? - ANS-Sarcoidosis diagnosis:
1. Seen on a chest X Ray
2. Bronchoscopy can confirm
3. Decreased in PFTs
Goal = lessen symptoms and prevent fibrosis
Treatment:
1. Glucocorticoids - anti-inflammatories such as predinoses and decadrons
2. Mineralocorticoids (ex flurostef)
How do we prevent infections in COPD patients? - ANS-1. Vaccines: flu vaccine every
year and get the pneumonia vaccine every 5 years
2. Avoid others who are ill
How do we provide palliative care for patients with lung cancer? - ANS-1. O2 for
hypoxemia
2. Bronchodilators/corticosteroids
3. Mucolytics
4. Radiation - to shrink tumors (may have surgery after the tumor shrinks some)
5. Thoracentesis - because some cancer cells cause leaking of fluids
6. Morphine and positioning to manage dyspnea - watch that you don't decrease their
respirations too much though
7. Pain management
a. Pharmacologic = morphine
b. Non-pharmacologic = positioning, guided imagery, music therapy, stuff to get their
mind off what's going on, essential oils and diffusing smells, pictures of family, etc
8. Hospice care
What anti-inflammatories are used to treat asthma? - ANS-1. Leukotriene inhibitors =
montelukast (Singulair)
2. Corticosteroids = used for inflammation
- Ex = fluticasone (Flovent)
- Prednisone (Deltason)
- Rinse mouth after inhalers
What anticholinergic drugs are used for COPD patients? - ANS-ex ipratropium
- dries secretions (can't see, can't pee, can't spit, can't shit)
, What are complications of COPD? - ANS-1. Hypoxemia
2. Respiratory infections - due to mucus
3. Cardiac failure
- Cor pulmonale - right-sided HF
- Cardiac dysrhythmias
4. Decreased nutritional intake - patients should have small, frequent meals
What are interstitial pulmonary diseases? - ANS-Interstitial pulmonary diseases =
Fibrotic lung diseases - ex CF and sarcoidosis
Alveoli, blood vessels, and surrounding support tissues are restricted or stiff
Does NOT affect the actual airway
- Does not obstruct and cause air trapping, rather it prevents good expansion and recoil
What are Red blood cells and hemoglobin? - ANS-The primary function of RBCs = to
transport oxygen from the lungs to the cells of the body
RBCs contain a protein called hemoglobin that actually carries the oxygen
Females have lower hemoglobin than males because we are losing blood once a month
- Normal hemoglobin = 14 for females and 15.4 for males
We have hypoxia if we have low levels of O2 on hemoglobin
What are some non-surgical interventions we can perform on patients with COPD? -
ANS-1. Maintain O2 saturation (remember below 90 may be normal)
2. Remember, low arterial oxygen is the primary drive to breathe in COPD patients
3. Regular exercise
4. Nutrition
5. Minimize anxiety
6. Prevent infections
7. Smoking cessation
8. collaborate with case management
9. Peak flow meter
10. Drug therapy
What are some overall symptoms of COPD? - ANS-1. Easily fatigued
2. Frequent respiratory infections
