Complex Exam 1 RM
Risk factors for COPD? *** -older adults
-cigarette smoking
-alpha 1- antitrypsin (AAT) deficiency
-environmental factors
Patho of COPD *** mixed disease of emphysema and chronic bronchitis, typically affects middle-age to
older adults
emphysemia *** loss of lung elasticity and hyperinflation of lung tissue, destruction of alveoli
chronic bronchitis *** inflammation of the bronchi and bronchioles due to chronic exposure to irritants
Pt ed for COPD *** -promote smoking cessation
-avoid exposure to second hand smoke
-flu and pneumonia vaccines
Assessment of COPD *** -chronic dyspnea
-productive cough
-hypoxemia
-crackles/ wheezes
-rapid & shallow respirations
-clubbing of fingers
-cyanosis of nail beds
-low O2 stat
,-use of accessory muscles
-barrel chest
-"trapped air"
-irregular breathing pattern
-enlarged neck muscles
-older adults dark colored skin
Labs and Diagnostics for COPD *** -increased hematocrit levels due to decreased O2 levels
-sputum cultures/ WBC count
-ABGs
-blood electrolytes
-pulmonary function tests
-chest xray
-alpha1 antitrypsin levels
Nursing Interventions for COPD *** -high fowlers
-coughing/ suctioning to remove secretions
-deep breathing
-breathing treatments & meds
-admin O2 (O2 levels usually require 1-2L/min via nasal cannula
-promote adequate nutrition
-monitor weight/ practice breathing techniques
-positive expiratory pressure device-assist client to remove airway secretions
-exercise condition: improved pulmonary status by strengthen the lungs by exercise
,Meds for COPD *** -Bronchodilators (inhalers): short acting beta 2 agonists, cholinergic antagonists,
methylxanthines
-Anti-inflammatory agents: corticosteroids, leukotriene antagonists
-Mucolytic agents: help thin secretions, easier for pt to expel, nebulizer treatments, guaifenesin
Complications of COPD *** -Respiratory infection: result from increased mucus production and poor O2
levels
-Right-sided heart failure: air trapping/ collapse, and stiff alveoli lead to increased pulmonary pressures;
blood flow to lungs is difficult and increased workload lead to enlargement & thickening of the right
atrium and ventricle
-S/sx of right-sided heart failure: low O2 levels, cyanosis, enlarged & tender liver, distended neck veins,
edema
Risk factors of TB *** -close contact w/ other untreated individuals
-low socioeconomic status
-w/ out housing
-immunocompromised
-substance use
-poorly ventilated/ crowded environments
-recent travel outside the US (high TB countries)
-health occupation
-immigrant from high prevalence rate areas
Patho of TB *** -caused by Mycobacterium tuberculosis
-airborne
-encases the TB bacillus w/collagen and other cells, appear as round nodule on chest xray
-can lie dormant for years
, -primarily affects lungs but can spread to other organs
Pt ed for TB *** -live in high-risk areas should be screened yearly
-family members of pts w/ TB
-people born outside US/ immigrant workers should be screened
-adherence to meds (6 months - 1 yr)
-follow-up care
-diet increase in protein, iron, vit. c&b
Assessment for TB *** -persistent cough >3 weeks
-purulent sputum/ blood tinged
-fatigue
-lethargy
-weight loss
-anorexia
-night sweats
-low grade fever in afternoon
Labs and Diagnostic for TB *** -nucleic acid amplification testing: presence of TB in secretions
-QuantiFERON-TB Gold & TB Spot: gamma (IFN-g)
-acid fast bacilli smear (AFB smear) & culture: suggest active infection
-Mantoux test/PPD: intradermal TB test, positive test can indicate that the pt has developed an immune
response to TB, does not confirm that active disease is present
Meds for TB *** combination therapy (2+ meds)
-Isoniazid: inhibits growth of mycobacteria, take on empty stomach, HEPATOtoxic, vit. B6 is prescribed
Risk factors for COPD? *** -older adults
-cigarette smoking
-alpha 1- antitrypsin (AAT) deficiency
-environmental factors
Patho of COPD *** mixed disease of emphysema and chronic bronchitis, typically affects middle-age to
older adults
emphysemia *** loss of lung elasticity and hyperinflation of lung tissue, destruction of alveoli
chronic bronchitis *** inflammation of the bronchi and bronchioles due to chronic exposure to irritants
Pt ed for COPD *** -promote smoking cessation
-avoid exposure to second hand smoke
-flu and pneumonia vaccines
Assessment of COPD *** -chronic dyspnea
-productive cough
-hypoxemia
-crackles/ wheezes
-rapid & shallow respirations
-clubbing of fingers
-cyanosis of nail beds
-low O2 stat
,-use of accessory muscles
-barrel chest
-"trapped air"
-irregular breathing pattern
-enlarged neck muscles
-older adults dark colored skin
Labs and Diagnostics for COPD *** -increased hematocrit levels due to decreased O2 levels
-sputum cultures/ WBC count
-ABGs
-blood electrolytes
-pulmonary function tests
-chest xray
-alpha1 antitrypsin levels
Nursing Interventions for COPD *** -high fowlers
-coughing/ suctioning to remove secretions
-deep breathing
-breathing treatments & meds
-admin O2 (O2 levels usually require 1-2L/min via nasal cannula
-promote adequate nutrition
-monitor weight/ practice breathing techniques
-positive expiratory pressure device-assist client to remove airway secretions
-exercise condition: improved pulmonary status by strengthen the lungs by exercise
,Meds for COPD *** -Bronchodilators (inhalers): short acting beta 2 agonists, cholinergic antagonists,
methylxanthines
-Anti-inflammatory agents: corticosteroids, leukotriene antagonists
-Mucolytic agents: help thin secretions, easier for pt to expel, nebulizer treatments, guaifenesin
Complications of COPD *** -Respiratory infection: result from increased mucus production and poor O2
levels
-Right-sided heart failure: air trapping/ collapse, and stiff alveoli lead to increased pulmonary pressures;
blood flow to lungs is difficult and increased workload lead to enlargement & thickening of the right
atrium and ventricle
-S/sx of right-sided heart failure: low O2 levels, cyanosis, enlarged & tender liver, distended neck veins,
edema
Risk factors of TB *** -close contact w/ other untreated individuals
-low socioeconomic status
-w/ out housing
-immunocompromised
-substance use
-poorly ventilated/ crowded environments
-recent travel outside the US (high TB countries)
-health occupation
-immigrant from high prevalence rate areas
Patho of TB *** -caused by Mycobacterium tuberculosis
-airborne
-encases the TB bacillus w/collagen and other cells, appear as round nodule on chest xray
-can lie dormant for years
, -primarily affects lungs but can spread to other organs
Pt ed for TB *** -live in high-risk areas should be screened yearly
-family members of pts w/ TB
-people born outside US/ immigrant workers should be screened
-adherence to meds (6 months - 1 yr)
-follow-up care
-diet increase in protein, iron, vit. c&b
Assessment for TB *** -persistent cough >3 weeks
-purulent sputum/ blood tinged
-fatigue
-lethargy
-weight loss
-anorexia
-night sweats
-low grade fever in afternoon
Labs and Diagnostic for TB *** -nucleic acid amplification testing: presence of TB in secretions
-QuantiFERON-TB Gold & TB Spot: gamma (IFN-g)
-acid fast bacilli smear (AFB smear) & culture: suggest active infection
-Mantoux test/PPD: intradermal TB test, positive test can indicate that the pt has developed an immune
response to TB, does not confirm that active disease is present
Meds for TB *** combination therapy (2+ meds)
-Isoniazid: inhibits growth of mycobacteria, take on empty stomach, HEPATOtoxic, vit. B6 is prescribed
