Medical Surgical Nursing 2023 EXAMS

Medical Surgical Nursing 2023 EXAMS COPD - inhalation of irritants triggers what? An inflammatory response COPD - what leukocyte is triggered during the inflammatory response caused by pathogens, or irritants? Neutrophils are triggered when inflammation occurs. Brainpower Read More Previous Play Next Rewind 10 seconds Move forward 10 seconds Unmute 0:07 / 0:15 Full screen COPD - How do neutrophils respond to reduce inflammation cause by pathogens or irritants? By releasing proteolytic enzymes COPD- Neutrophils release proteolytic enzymes, what else do they release to destroy proteolytic enzymes (which destroy elastin fibres if not removed)? Elastase, (alpha-1 antitrypsin) COPD- If elastin fibres are destroyed how does this effect homeostasis? Reduces the lungs recoil causing an inability to release CO2 into atmosphere. COPD - What causes the lungs to have reduced elasticity? The presence of neutrophils and macrophages, causes lung damage, reoccurring pathogens or irritants causes neutrophils and macrophages to be continuously activated. COPD - What are possible patient presentations with respiratory diseases? - Decreased lung compliance - Impaired gas exchange Aetiology of COPD? Irritants - pollution, gases, smoke, occupational dusts. Genes - Alpha1 antitrypsin deficiency History - frequent LRI during childhood What are Nursing based assessments used to help determine impaired lung function or airway disease? - Visual assessment - Vital signs - Pt Hx & medications - Pulmonary function tests - Sputum specimen to lab - Chest x-ray - Arterial blood gas tests What to look for visually when assessing for COPD? - Blueness of the lips or fingernail beds (cyanosis) - Swelling in ankles, feet or legs - Wheezing - A chronic cough that may produce mucus (sputum) that may be clear, white, yellow or greenish - Barrel chest in late stages due to inability to exhale air, therefore leaves lungs bloated. COPD is a primary pulmonary condition, but it is recognised as... ...a multi-system disease associated with systemic consequences including systemic inflammation and complex chronic comorbidities. Can respiratory disease, impact mental health? People whom have shortness of breath will slowly have deconditioning (a subsequent muscle wastage), engage less in social situations, therefore become socially isolated, as lung function decreases there is a risk of clinical depression. + 1 more side What would be reg flags in vital signs that may indicate COPD? - Increased respiratory rate (21-35+). - Aterial oxygen saturation (spO2) below 88%, (O2 should be titrated to 88-92% spO2). - HR above 94bpm - Decrease in temperature, however fevers and increased temp are common as viral and bacterial infection (acute bronchitis, pneumonia, cold and flu) - Loss of consciousness (LOC) - Unrelieved pain What are signs and symptoms of COPD? - SOBE - Chronic cough - Chronic septum production - Progressive dyspnoea - Wheeze - Chest tightness - Hypoxemia & hypercapnia (low oxygen in blood & high arterial CO2) What would you look for with Pt Hx and medication? - Hx of lung infection, breathing problems such as asthma. Also Hx of smoking or occupational irritants. - Medications: bronchodilator. What are pulmonary function tests for assessment of respiratory symptoms? - Spirometry measures the rate of air flow and estimates lung size - Lung volume tests are the most accurate way to measure how much air your lungs can hold. - Lung diffusion capacity assesses how well oxygen gets into the blood from the air you breathe. - Pulse oximetry estimates oxygen levels in your blood -Arterial blood gas tests directly measure the levels of gases, such as oxygen and carbon dioxide, in your blood. - Fractional exhaled nitric oxide tests measure how much nitric oxide is in the air that you exhale. + 1 more side What would you need to take from the patient to send to the lab for testing? Sputum specimen What may you need to refer the patient on to get done? Chest X-ray What may you need to get a trained RN to take from the patient? Set of bloods, looking at arterial blood gases. What are nursing diagnoses for COPD? - Ineffective airway clearance r/t airflow obstruction - Impaired gas exchange r/t alveolar hypoventilation - Impaired nutrition r/t fatigue / SOB Nursing interventions for COPD? - Positioning - sit patient up to expand lungs - Administer prescribed oxygen to increase O2 supply / prevent hypoxaemia/hypoxia - Administer prescribed bronchodilators/nebulisers (other meds) to open bronchioles increase air exchange - Fluids - to meet increased fluid use via respiration - Purse lipped breathing - to help release trapped air. - Provide tissues - sputum How would you evaluate if nursing interventions are effective? - Pt understanding of medications - SpO2 of 88% to 92% preventing hypoxaemia/hypoxia - Patient stays hydrated evidenced by stable blood pressure - Patient practices sitting up and lipped pursed breathing technique