Exam 4 content 3

A severe prolonged asthma that does not respond to routine treatment. Without agressive therapy this can lead to respiratory failure with hypoxemia, hypercapnia, and acidosis?

What is chronic bronchitis?

A disorder of excessive bronchial mucous secretions, characterized by a productive cough lasting more than 3 or months in 2 consecutive years is known as what?

A distruction of the walls of the aveoli, resulting in enlargment of abnormal air spaces. what is this?

what is emphysema?

what are these adverse reactions associated with?
Increased blood sugar
MoonFace & Buffalo Hump (abnormal fat deposits in face & truck)
Glaucoma
Growth retardation
Long term use can cause adrenalatrophy

Theophylline levels can become toxic at what level, so assessmentas of this should be monitored while on bronchodilators?

How long should you wait to take a second dose, if it is required, of a bronchodilator?

If you are taking a bronchodilator and a steroid inhaler together, which should you administer first?

How long should you wait during the use of a bronchodilator and steroid?

When taking a bronchodilator, what can happens to blood pressure and heart rate?

You should NOT adminster this for an acute asthma attack?

What over the counter medication decreases the montelukast concentration?

If perscribed an oral granule dose of montelukast, how soon after opening the packet should the dose be administered?

What type of drug is prednisone?

When perscribed prednisone, you should report a weight gain of ____ in several days, to your doctor?

What happens to serum potassium levels while taking glucocorticoids?

What happens to blood pressure and blood sugar levels while taking prednisone (glucocorticoids)?

When should your dose of glucocorticoids be taken? with or without food?

What are some foods rich in potassium?

What types of food should be increased while on glucocorticoids?
And what are some examples?

What is caused by chronic airflow obstruction due to emphysema and/ or chronic bronchitis?

COPD is the ____ leading cause of death in US?

COPD is the ____ leading cause of disability?

What is the primary cause of COPD?

This is a disorder of excessive bronchial mucous secretions and narrowed airways?

This is characterized by a productive cough lasting 3 or more months for 2 consectutive years?

Recurrent respiratory infections are common with someone with _____ ?

This type of gas exchange disorder is known as Blue Bloaters?

This gas exchange disorder is associated with right sided heart failure, cyanosis, and thick sputum?

How does chronic bronchitis affect the heart?

Why does COPD cause Right Sided Heart Failure?

Because the lungs become stiff, causing pressure in the lungs to rise, causing the right side of the heart to work harder to pump blood though lungs and to left atrium, is a reaction from what?

What are some signs/ symptoms associated with right sided heart failure due to COPD?

What can be caused by the excessive breathing pattern of a COPD'er?

If patient has COPD, oxygen should be started at ___L, why?

Blue Bloaters have an increased level of ____

They are known as the pink puffers?

Destruction of the walls of the aveoli with resulting enlargment of abnormal air spaces and loss of elastic recoil are due to what respiratory disorder?

To these respiratory patients, its easy to get air into the lungs, but not out of the lungs?

Why is it easier for emphysema patients to get air into the lungs, but not easy to get air out?

What is the initial symptom of emphysema?

An emphysema patient is described as having what look to them?

If a patient has more fluid in the lunds, you will notice it at what location of the lungs first?

Assessment for fluid volume overload should be monitored how in a patient with COPD?

This is a chronic airway obstruction disorder, a constriction of the bronchial airways, increased mucous production, and airway remodeling

Manifestions of acute asthma include?

What are some common asthma triggers?

What are some food choices & medicines that can trigger asthma?

Exercise induced asthma, affects ___ to ___ % of people with asthma?

This should be used on a daily basis for monitoring & measuring asthma

What color on a peak flow rate is...
- using rescue inhaler less than 2 X a week
- able to do normal activities
- no problems sleeping
- under control

What color on a peak flow rate is...
- frequent coughing
- wheezing, tight chest, SOB
- unable to do normal activities
- cold symptoms
- give rescue medication

What color on a peak flow rate is...
- very hard time breathing
- constant coughing (5 min continuously)
- trouble talking, walking
- may or may not wheeze
- give rescue medication

What type of inhaler is used as a rescue inhaler?

What type of agents are used to promote bronchodilation?

How much fluids should be encouraged during nursing intervention for asthma attack patients?

What is severe prolonged asthma that does not respond to routine treatment?

A patient with asthma in an emergency room, should be assessed how often?

What is the first line of defense medication for acute asthma attack?

This can be used in an emergency for airway patency?

What metered dose inhaler medication that is a short acting beta 2 agonist, is used for an acute asthma attach?

What is albuterol generally used for?

This is a nebulizer treatment often given in the emergency room for asthma attacks

Using a short acting beta agonist, like Albuterol, can do what to the heart rate?

These are the most potent natural anti-inflammatory substance known?

These can help restore the activity of sympathomimetics when they lose thier effects in hypoxia?

Wat route of corticosteroids have the fewest systemic effects?

While on corticosteroids, blood sugar levels should be monitored, Why?

Excess use of glucocoriticoids can cause this?

Cushings syndrome can be caused by this?

Moon face and buffalo humps are associated with what syndrome?

If taking a glucocoriticoid what anticoagulants effect could be decreased?

What anticoagulant should be questioned while on a glucocoriticoid?

What are preventative drugs for asthma?

What do Antocholinergics do?

Wat is the prototype drug for Leukotriene Receptor Agonist?

If a patient is an alcoholic or has liver dysfunction, then we know not to give him what type of preventive therapy for asthma?

A patient who is allergic t dogs experiences a sudden "asthma attack". Which assessment finding does the nurse expect to find for this patient?
A- Slow deep, pursed lip respirations
B- Breathlessness & difficulty completing sentences
C- Clubbing of the fingers & cyanosis of the nailbed
D- Bradycardia & irregular pulse

A patient is admitted with asthma. Which assessment findings are most likely to indicate that the patients asthma condition is deteriorating & progressing towards reiratory failure?
A- Rales, rhoncho, & productive cough wih yellow sputum
B- Tachypnea, Tachycardia, thick tenacious sputum, & hemoptysis
C- Decreased wheezing, inaudible breath sounds, & use of accessory muscles
D- Respiratory alkalosis, tachycardia, slow & shallow respirations

The patient taking oral parental glucocorticoids is at risk for experiencing ______?

An active infection is usually a contradiction for glucocorticoid therapy, why??

Patiens on glucocorticoid therapy are at higher risk for experincing fractures due to _____ ?

Long term use of glucocorticosteroids can cause ______?

All of the following are appropriate nursing diagnosis for a patient with acute asthma attack, which is th highest priority?
A- Anxiety related to difficulty breathing
B- Ineffective airway clearance related to bronchoconstriction & increased mucous production
C- Ineffective breathing pattern related to anxiety
D- Ineffective health maintenance related to lack of knowledge about attack triggers & appropriate use of medications

The nurse caring for a patient with asthma notices that the patient's respirations have slowed and no longer coughing. Breathsounds are diminished thoughout his lung fields & absent in bases. The nurse should do which of the following?
A- Notify healthcare provider
B- Allow patient to rest undisturbed
C- Obtain chest x-ray
D- Askfamily members to leave

When teaching use of a metered dose inhaler (MDI), the RN instructs the patient to do which of the following?
A- Take quick shallow breaths while holding canister down
B- Use the inhaler of the anti-inflammatory drug first, then bronchodiolator
C- Use anti-inflammatory inhaler as needed to treat acute episodes of wheezing
D- Rinse mouth after using inhaler to reduce systemic absorption of the drug

Which of the following would be an expected assessment finding in a patient with chronic obstructive airway disease?
A- AP chest diameter equal to or greater than lateral chest diameter
B- Mental confusion and lethargy
C- Three + pitting edema in ankels and lower legs
D- Oxygen saturation readings of 85% or less

An appropriate goal for a patient admitted with acute exacerbation of COPD would be which of the following?
A- Will verbalize self care measure to regain lost lung function
B- Arterial blood gases will be within normal limits by time of discharge
C- Will maintain SaO2 of 90% or higher
D- Will identify strategies to help reduce number of cigarettes smoked per day

Which of the following best represents the RN understanding the use of supplemental O2 in patients with COPD?
A- Patient should not smoke, b/c O2 is flammable
B- O2 is only used at night for COPD patient
C- O2 is never used for COPD patient, as they may become dependent on it
D- Patients needs to be closely monitored for signs of respiratory destress

The nurse working with a patient with Cystic Fibrosis specifically directs the home care aid to report which of the following? (select all that apply)
A- Thick, tenacious, milky, white sputum
B- Fever
C- Bulky fatty stools
D- Difficulty clearing mucous secretions
E- Increased shortness of breath & fatigue

A patient in skeletal traction suddenly develops right sided chestpain & shortness of breath, what should the RN do?
A- Check for Homan's sign
B- Start oxygen per nasal cannula
C- Administer perscribed analgesic
D- Elevate HOB to 45 degrees

The RN caring for a patient with COPD recognizes which of the following as an early sign of possible respiratory failure?
A- Restlessness & tachypnea
B- Deep Coma
C- Hypotension & tachycardia
D- Decreased urine output

The RN caring for a patient undergoing mechanical ventilation for acute respiratory failure plans & implements which of the following to help maintain effective alveolar ventilation?
A- Keep patient in supine position
B- Increase tidal volume on ventilator
C- Maintains ordered O2 concentration
D- Performs endotracheal suctioning as needed

A patient is diagnosed with a pulmonary disorder that causes COPD. Lung tissue changes are normally reversable with this condition. The nurse understands that which is the clinets most likely diagnosis?
A- Asthma
B- Emphysema
C- Bronchiectasis
D- Chronic Bronchitis

A patient with COPD has an acute bronchospsm. The nurse knows that which medication is best for this emergency situation?
A- zafirlukast (Accolate)
B- epinephrine (Adrenalin)
C- dexamethasone (Decadron)
D- oxtriphylline- theophyllinate (Choledyl)

A patient is taking aminophylline- theophylline ethylenediamine (Somophyllin). What should the nurse monitor?
A- Drowsiness
B- Hypoglycemia
C- Increased heart rate
D- Decreased white blood cell count

A patient is perscribed theophylline to relax the smooth muscles of the bronchi. The nurse monitors the patients theophylline serum levels to maintain which therapeutic range?
A- 1-10 mcg/mL
B- 10-20 mcg/mL
C- 20-30 mcg/mL
D- 30-40 mcg/mL

A patient with COPD is taking a leukotriene antagonist, montelukast (Singular). The RN is aware that this medication is for which purpose?
A- Maintenance treatment for asthma
B- Treatment of an acute asthma attack
C- Reversing bronchospasm associate with COPD
D- Treatment of inflammation in chronic bronchitis