NUR-240 Final Exam Grid
COPD, Pneumonia, and Pulmonary Embolism
(PE).
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NUR-240 Final Exam Grid
COPD: disease complications
➣ cor pulmonale (right-sided HF)
➣ pulmonary hypertension
➣ Wt loss
➣ PNEUMOTHORAX can developed due to ruptured bullae or "blebs"
➣ death from respiratory failure/infection
COPD: pathophysiology
➣ combination of chronic bronchitis & emphysema
➣ chronic airflow restriction
➣ difficulty exhaling
(narrowed airways = more effort required to push air through them)
➣ PREVENTABLE and TREATABLE disease characterized by persistent airflow
limitation and is progressive
signs and symptoms of COPD
dyspnea
frequent coughing
wheezing
tachypnea
tightness in the chest
chronic cough
excessive sputum production
poor exercise/appetite tolerance
prolonged expiration
barrel chest
polycythemia
COPD: clinical manifestations
➣ can be "pink + skinny" or "bloated + blue"
➣ easily fatigued ~ Dyspnea
➣ frequent respiratory infections
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➣ use of accessory muscles to breathe; flattened diaphragm
➣ prolonged expiratory time
➣ wheezing
➣ pursed-lip breathing + puffed-out-cheeks
➣ chronic non-productive cough
➣ barrel chest + tripoding (obese = lack of movement)
➣ orthopneic
➣ digital clubbing (chronic hypoxia)
COPD: nursing care
➣ assess + monitor LOC (restlessness)
➣ HOB elevated
➣ lung sounds (dyspnea, wheezing)
➣ encourage rest - but also some movement
➣ TEACH TO STOP SMOKING ! ! ! ! ! ! ! 🚫🚬
COPD: risk factors
➣ SMOKING
➣ pollutants (2nd-hand smoke; air pollution; exposure to industrial chemicals)
➣ familial disposition to chronic bronchitis
➣ alpha-1 Antitrypsin deficiency (AAT) (EMPHYSEMA)
COPD: LABS to monitor
➣ RBCs (polycythemia)
➣ HGB (< 6..0 ~ then we are worried)
➣ ABGs (hypercapnia - hypoxia)
➣ sputum culture
COPD: diagnostic tests
➣ CXR - CT scan 🩻
➣ PFTs
➣ Spirometry
COPD: medical treatment
➣ bronchodilators 🫁
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➣ expectorants 💊
➣ PRN corticosteroids (airway inflammation)
➣ NMT / MDIs
➣ ABX (ONLY if reasonable evidence of bacterial infection)
➣ O2 ~ 1-2 L/min
➣ chest physiotherapy
➣ pulmonary rehab
(to increase exercise tolerance)
➣ lung transplant 🫣
Pneumonia: risk factors
➣ > 65 yo
➣ hospitalization; intubation; immobilization
➣ smoker
➣ immunocompromised (HIV)
➣ IV drug-user
Pneumonia: pathophysiology
➣ acute inflammation or infection
➣ exudate fills alveoli
(a mass of cells and fluid that has seeped out of blood vessels or an organ,
especially in inflammation)
➣ reduced surface area for gas exchange
Pneumonia: diagnostic tests
➣ CXR (identifies infiltrates)
➣ sputum culture (prior to starting ABX)
➣ blood cultures (can be taken prior/after starting ABX)
Pneumonia: LABS to monitor
➣ AST/ALT & bilirubin (liver labs)
➣ creatinine & BUN (kidney labs)
➣ ABGs (insight into metabolic/respiratory status)
Pneumonia: nursing considerations (+ Pt teaching)