Week 4: Mid-term Study Guide NUR507-NP questions and answers graded A+

Week 4: Mid-term Study Guide NUR507-NP
ii ii ii ii ii ii ii ii




questions and answers graded A+
ii ii ii ii ii


Pulmonary ii
Review iiconcepts iirelated iito ii
• Anticholinergic iidrugs iio iiAnticholinergic iiagents ii– iiblock
iiacetylcholine iibinding ii


▪ ii Primarily iiin iilung iibronchodilation iithrough ii( iiDecreased
iiparasympathetic iiresponse) ii


• Tiotropium, iiipratropium ii
• Asthma ii ii
▪ iiIs iia iichronic iiinflammatory iidisorder iiof iithe iibronchial iimucosa iithat
iicauses iibronchial iihyperresponsiveness, iiconstriction iiof ii the


iiairways, iiand iivariable iiairflow iiobstruction iithat iiis iireversible ii


o iichronic iidisease iicharacterized iiby ii
▪ ii airway iiinflammation ii
▪ iibronchial iihyperreactivity iiand iismooth iimuscle iispasm ii
▪ ii intermittent, iireversible iiairflow


iiobstruction ii o iicaused iiby ii


▪ ii complex iiinteraction iiof iigenetic iiand iienvironmental
iifactors iio iiresulting iiin ii


▪ iiexcess iimucus iiproduction iiand iiaccumulation ii
▪ iihypertrophy iiof iibronchial iismooth iimuscle ii
▪ ii airflow
iiobstruction ii o iiasthma iican


iitake iitwo iiforms ii


▪ ii extrinsic iiasthma ii
• triggered iiby iia iichronic iiallergic iireaction iio ii(mold, iipollen,
iidust iimites, iipet iidander) ii


• Elevated iiIgE iilevel iiis iidiagnostic ii
• More iicommon iiespecially iiin iichildren ii(males: iifemales ii=
ii2:1) ii


▪ ii Intrinsic iiasthma ii
• Triggered iiby iia iivariety iiof iinon-allergic iifactors iio
ii(chemicals, iiairborne iiirritants, iiinfections- iiviral, iiexercise,


iistress, iianxiety, iiGERD, iiobesity) ii


o No iiinitial iielevation iiin iiIgE iilevel ii
o Typically iiseen iiin iiadults ii(<40yrs) ii– iislightly iimore
iicommon iiin iifemales ii

, o Most iicommon iisymptoms iiof iiextrinsic iiand iiintrinsic
iiasthma ii


▪ iiCoughing, iiwheezing, iiSOB ii
▪ ii Rapid iibreathing, iichest


iitightness iio iiTreatment ii


▪ ii Immediate iiadministration iiof iioxygen iiand iiinhaled iibeta-agonist
iibronchodilators ii


▪ ii Inhaled iicorticosteroids iishould iibe iiadministered iiearly iiin iithe
iicourse iiof iimanagement. ii


▪ iiAvoidance iiof iiallergens iiand iiirritants, iicontrol iiof iisymptoms iiand
iiprevention iiof iiexacerbations ii


▪ iiSevere iiasthma- iilong-acting iibeta iiagonists iican iibe iiused iito
iicontrol iipersistent iibronchospasm ii o ii Signs iiand iisymptoms ii


▪ iiChest iiconstriction, iiexpiratory iiwheezing, iidyspnea, iinonproductive
iicoughing, iiprolonged iiexpiration, iitachycardia, iitachypnea ii


• iiBronchitis iiand iiassociated
iipathogenesis ii iio iiA iichronic


iidisease iicharacterized iiby ii


▪ ii Bronchial iiinflammation ii
▪ iiHypersecretion iiof iimucus ii
▪ ii Chronic iiproductive iicough, iipersisting iifor iiat iileast ii3 iiconsecutive
iimonths iifor iiat iileast ii2 iisuccessive iiyears ii o ii Caused iiby ii


▪ iiLong-term iiexposure iito iienvironmental iiirritants ii
▪ iiRepeated iiepisodes iiof iiacute iibronchitis ii(infection) ii
▪ ii Factors iiaffecting iigestational iior iichildhood iilung
iidevelopment iio iiResulting iiin ii


▪ iiExcess iimucus iiproduction iiand iiaccumulation ii
▪ iiHypertrophy iiof iibronchial iismooth iimuscle ii
▪ iiHypertrophy iiand iihyperplasia iiof iibronchial iimucus iiproducing iicells
ii

▪ ii Airflow iiobstruction ii
▪ ii Decreased iialveolar iiventilation iio iithe iilung iidamage iifrom
chronic iibronchitis iiis iitypically iiconsidered iiirreversible ii
ii


o most iicommon iisymptoms iiof iichronic iibronchitis iiare ii
▪ iiproductive, iipurulent iicough ii
▪ iicopious iisputum iiproduction ii
▪ ii shortness iiof iibreath ii
▪ ii wheezing, iirhonchi ii

, ▪ ii cyanosis, iiperipheral


iiedema iio iipathogenesis iiof iichronic


iibronchitis ii


▪ ii1. iiExposure iito iiairborne iiirritants iiactivated iibronchial ii
• Smooth iimuscle iiconstriction ii
• Mucus iisecretion ii
• Release iiof iiinflammatory iimediators iifrom iiimmune iicells iiin
iithe iilamina iipropria iio ii(histamine, ii prostaglandins,


iileukotrienes, iiinterleukins) ii


▪ ii2. iiLong iiterm iiexposure iito iiairborne iiirritants iipromotes ii
• Smooth iimuscle ii hypertrophy ii- iiincreased


iibronchoconstriction ii


• Hypertrophy iiand iihyperplasia iiof iigoblet iicells ii iimucus
iihypersecretion ii


• Epithelial iicell iimetaplasia ii iinon-ciliated iisquamous iicells ii
• Migration iiof iimore iiWBC iito iisite ii iiinflammation ii& iifibrosis
iiin iibronchial iiwall ii


• Thickening iiand iirigidity iiof iibronchial iibasement iimembrane
ii ii narrowing iiof iibronchial iipassageways ii
▪ ii3. iiVentilation, iiespecially iiexhalation iiis iidecreased iiresulting iiin ii
• Alveolar iihyperinflation ii iiexpanded iithorax ii
• Hypercapnia ii(CO2 iiretention) ii iirespiratory iiacidosis ii
• Decreased iiO2 iiexchange ii iiventilation/perfusion ii(V/Q)
iimismatch ii


• Chronic iipulmonary iihypoxia iicyanosis ii(blue iibloater) iio
iiRight iito iileft iishunting ii = iiblood iipasses iifrom iiRV iito iilungs


iito iiLV iiwithout iiperfusion ii(gas iiexchange) ii


• Chronic iihypoxemia ii iiincreased iierythropoietin iisecretion ii
elevated iihct ii(secondary iipolycythemia iivera) ii
ii


• Pulmonary iihypertension ii cor iipulmonale, iienlarge iiheart
ii


iiand iiperipheral iiedema ii


o Treatment ii
▪ iiAntitussives iiand iiexpectorants ii
▪ ii Bronchodilators, iisystemic iicorticosteroids,


iiantibiotics iio iiPhysical iimeasures ii


▪ iiChest iiphysiotherapy iiusing iipostural iidrainage iiand iigravity iito
iifacilitate iimovement iiof iimucus iifrom iithe ii congested iilower


iibronchial iiairways iito iithe ii trachea iifor iieasier iiexpulsion ii