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Questions and Answers
What is the primary pathophysiological feature of emphysema?
Which of the following best describes the hallmark of chronic bronchitis?
What consequence does CO2 retention have in patients with COPD?
What is NOT a consequence of chronic bronchitis?
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Which symptom is commonly associated with the increased work of breathing in COPD patients?
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What anatomical structure is positioned between the pharynx and the trachea and is essential for voice production?
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Which characteristic is indicative of the pediatric respiratory system compared to the adult respiratory system?
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Which of the following best describes a primary effect of asthma on the airways?
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What age group shows the highest incidence and prevalence of asthma?
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Which of the following factors is associated with a higher occurrence of asthma in certain populations?
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What does a reduction in the number of RBCs indicate?
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Which of the following is NOT one of the main causes of decreased RBCs?
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What clinical intervention applies regardless of the cause of anemia?
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What does hematocrit measure in the context of anemia?
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Which condition does NOT contribute to chronic blood loss leading to anemia?
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Which of the following bronchodilators is long-acting and administered via inhalation?
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What is the primary mechanism by which leukotriene modifiers work?
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Which corticosteroid is commonly used in its inhaled form for asthma prevention?
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What is a significant consideration for administering corticosteroids in elderly patients?
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Which drug type is known for its quick action to relieve symptoms of COPD, working within 15-20 minutes?
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Study Notes
Chronic Obstructive Pulmonary Disease (COPD)
- COPD affects approximately 15 million individuals in the U.S. and 900,000 in Canada.
- Fourth leading cause of morbidity and mortality in the U.S.
- Consists of various lower airway disorders that interfere with airflow and gas exchange.
Key Components of COPD
-
Emphysema:
- Deterioration of lung elastic tissue leading to reduced lung recoil and hyperinflation.
- Causes air trapping and increases the work of breathing, resulting in symptoms like "air hunger."
- Decreased gas exchange leads to CO2 retention and respiratory acidosis.
-
Chronic Bronchitis:
- Characterized by inflammation of the bronchi and bronchioles, primarily due to irritants like cigarette smoke.
- Inflammation causes vasodilation, mucosal edema, and bronchospasm.
- Results in thick, excessive mucus production, airway obstruction, and chronic infection risk.
Risk Factors for COPD
- Cigarette smoking is the primary risk factor.
- Genetic predispositions, such as alpha1-antitrypsin deficiency.
- Pre-existing conditions like asthma can increase risk.
Complications of COPD
- Hypoxemia and respiratory acidosis.
- Increased risk of respiratory infections.
- Development of cardiac failure (cor pulmonale) and potential for dysrhythmias.
- Respiratory failure, requiring careful management and monitoring.
Assessment and Diagnosis
- Focus on physical signs such as barrel chest, respiratory and cardiac changes.
- Psychosocial evaluation is crucial given the chronic nature of the disease.
- Laboratory assessments include arterial blood gases (ABGs) to monitor hypoxemia and hypercapnia levels.
- Aim for oxygen saturation between 88-92%, using controlled methods like a Venturi mask.
Management Strategies
-
Weight Loss Prevention:
- Small, frequent meals tailored to dietary needs to manage energy.
- Techniques like pursed lip and diaphragm breathing can ease meal intake and reduce anxiety.
-
Infection Control:
- Focus on preventing pneumonia and other infections.
-
Improving Endurance:
- Encourage energy conservation strategies and gradual increase in activity levels.
Health Promotion and Coordination
- Emphasize smoking cessation and teach the I-PREPARE model (Identify, Prepare, Engage).
- Self-management education should cover drug therapy and breathing techniques.
- Address home care management, including the appropriate use of oxygen therapy.
Evaluation of Outcomes
- Goals include maintaining baseline gas exchange levels, effective breathing patterns, and anxiety reduction.
- Regular assessment of body weight in relation to ideal weight and activity levels is vital.
- Prevention of serious respiratory infections should be prioritized.
Gas Exchange and Related Concepts
- Priority concept: Gas Exchange
- Interrelated concepts: Perfusion, Inflammation, Cellular Regulation
Respiratory System Overview
- Upper airway includes: Nares, pharynx, larynx (houses vocal cords), ciliated mucous membranes, tonsils
- Lower airway comprises: Trachea, bronchi, bronchioles, alveoli (site of gas exchange)
Pediatric vs. Adult Respiratory System Differences
- Lack of or insufficient surfactant in infants
- Smaller airways with underdeveloped cartilage
- Infants are obligatory nose breathers
- Less developed intercostal muscles; brief periods of apnea are common
- Faster respiratory rates in children to meet higher metabolic needs
- Horizontal Eustachian tubes and tonsillar tissue enlargement
- More flexible larynx, prone to spasms
- Breathing patterns: abdominal breathers in infants
Asthma: Incidence and Prevalence
- Can develop at any age, most prevalent in those 10-17 years old
- Leading cause of acute and chronic illness in children
- Asthma affects approximately 8.3% of children in the US
- Higher prevalence in African American and urban populations
Asthma Pathophysiology
- Chronic condition with intermittent symptoms influenced by genetic and environmental factors
- Characterized by reversible obstruction and increased airway responsiveness
- Results in bronchospasm, inflammation, and mucous accumulation
Asthma Pathophysiology: Reactions
- Immediate Reaction: Allergens activate IgE receptors, leading to bronchoconstriction
- Late Reaction: Eosinophils and neutrophils cause extended inflammation and mucous production
Asthma Assessment: History
- History of premature birth, family asthma history, previous wheezing episodes, cough (especially at night), shortness of breath
- Allergic rhinitis or eczema, previous hospitalizations for asthma
Asthma Risk Factors
- Family history of asthma, severe lower respiratory infections, allergies or atopy
- The "Allergic triad": Asthma, allergic rhinitis, and eczema
- More common in boys; prematurity increases risk
Common Asthma Triggers
- Environmental: Cold air, weather changes, smoke, allergens (pollen, dust, etc.), viral infections
- Psychological: Stress, exercise
- Food and medications can also be triggers
Asthma Symptoms and Signs
- Key assessments include vital signs, lung sounds (wheezing, stridor), and accessory muscle use
- Symptoms: Restlessness, anxiety, diaphoresis, tripod position
- Symptoms often worsen at night, causing difficulty in talking, eating, and breathing
Asthma Diagnostics
- Laboratory assessments: Pulse oximetry, end-tidal CO2 monitoring, arterial blood gases
- Daily peak flow meter readings, chest X-ray, and pulmonary function tests
- Observations may include eosinophils upon blood and sputum examination
Recognition of Asthma Cues
- Controlled: No daytime symptoms, no night symptoms, minimal need for rescue drugs
- Partly Controlled: Daytime symptoms more than twice weekly, occasional night symptoms, frequent need for rescue drugs
- Uncontrolled: Severe symptoms and frequent activity limitations
Classification of Asthma
- Intermittent
- Mild persistent
- Moderate persistent
- Severe persistent
Therapeutic Management of Asthma
- Main goals: Improve airflow and gas exchange
- Approaches include: Recognizing early signs, following action plans, avoiding triggers, and education
Asthma Medications
- Rescue drugs for acute attacks: SABA (e.g., Albuterol), anticholinergics (e.g., Ipratropium)
- Corticosteroids for short-term use (e.g., Prednisone)
- Long-term control medications: Inhaled corticosteroids (e.g., Budesonide), LABAs (e.g., Salmeterol), combination medications (e.g., Advair)
- Leukotriene inhibitors (e.g., Montelukast) for young children
- Anti-IgE antibodies (e.g., Omalizumab) for allergic asthma
Emergency Treatment Indicators
- Seek emergency care for: Worsening wheezing/cough, no improvement after bronchodilators, trouble breathing, gray/blue lips
- Symptoms like listlessness or cessation of play suggest critical need for intervention
Status Asthmaticus
- Severe, life-threatening asthma episode that may not respond to standard treatments
- Risks include pneumothorax and cardiac/respiratory arrest
- Requires urgent interventions like IV fluids, bronchodilators, steroids, and possible intubation
Environmental Modifications
- Recommendations include: Washing bedding weekly in hot water, using dust-proof covers, replacing carpets, maintaining household humidity levels, using air filters, and cleaning regularly with dust-attracting products
Anemia Overview
- Anemia is characterized by a reduction in the number of red blood cells (RBCs), hemoglobin levels, and hematocrit percentage.
- It serves as a clinical indicator rather than a specific disease, with various underlying causes.
Causes of Anemia
- Main causes include:
- Increased destruction of RBCs, seen in conditions such as autoimmune hemolytic anemia and G6PD deficiency anemia.
- Decreased production of RBCs, often linked to iron deficiency due to insufficient dietary iron.
- Chronic blood loss, which can result from:
- Acute trauma
- Gastritis
- Menstruation
- Hemorrhoids
Hemoglobin and Hematocrit
- Hemoglobin (Hgb):
- An iron-rich protein in RBCs responsible for oxygen transport.
- Measured in grams per deciliter (g/dL) and varies with age.
- Hematocrit (Hct):
- Represents the percentage of packed RBCs in blood.
- Label is a percentage (%) and also varies with age, with differing normal ranges for men and women.
Nursing Interventions
- Nursing interventions for anemia are consistent regardless of the specific cause, focusing on increasing RBC production, managing symptoms, and treating underlying conditions.
Respiratory Drugs Overview
- Bronchodilators enhance airway diameter and improve airflow in respiratory diseases.
- Categories: Beta2-adrenergic agonists, anticholinergics, corticosteroids, leukotriene modifiers, mast cell stabilizers, methylxanthines, expectorants, antitussives, mucolytics, and decongestants.
Beta2-Adrenergic Agonists
- Types: Short-acting (S), long-acting (L), systemic (S), and inhalation (I) forms.
- Common examples:
- Albuterol (S, I), effective for acute asthma attacks.
- Formoterol and Salmeterol (L, I), used for chronic asthma or COPD management.
- Beta-adrenergic blockers can inhibit bronchodilation effects.
Anticholinergics
- Local bronchodilators used primarily for COPD and asthma relief.
- Example: Ipratropium bromide (Atrovent) works within 15-20 minutes, lasting 3-5 hours.
Corticosteroids
- Delivery methods include inhaled and systemic (IV, oral).
- Beclomethasone (inhaled) and Prednisone (po) are examples.
- Most effective for acute asthma attacks prevention.
- Special considerations for pediatric growth, osteoporosis in elderly, and blood glucose control in diabetics.
Leukotriene Modifiers
- Function: Mitigate effects of leukotrienes, reducing airway constriction, permeability, secretions, and inflammatory responses.
- Common medications: Montelukast (Singulair), Zafirlukast, and Zileuton, suitable for mild to moderate asthma management.
Mast Cell Stabilizers
- Prevent release of inflammatory mediators from mast cells; best for long-term asthma control.
- Cromolyn sodium (Intal) is particularly effective for children and exercise-induced asthma.
Methylxanthines
- Increase bronchodilation and reduce airway reactivity.
- Therapeutic range for Theophylline is 10-20 mcg/mL. Monitor for toxicity, especially with high-fat meals.
- Caffeine also provides similar bronchodilatory effects.
Expectorants
- Guaifenesin is the most commonly used; thins mucus to aid clearance from the airways.
- Helps with symptoms related to bronchitis, colds, and other respiratory conditions.
Antitussives
- Dextromethorphan is widely used; caution with CNS depressants and specific chronic conditions.
- Codeine, a more controlled substance, may enhance CNS effects leading to serious respiratory depression.
Mucolytics
- Break down thick mucus, facilitating easier expectoration.
- Acetylcysteine is used in bronchitis and cystic fibrosis and serves as an antidote for acetaminophen toxicity.
Decongestants
- Primarily used for nasal congestion-related conditions.
- Topical forms (e.g., Oxymetazoline) have rapid action with minimal side effects.
- Systemic forms (e.g., Pseudoephedrine) may cause jitteriness; regulated due to misuse potential.
Colony Stimulating Factors
- Epogen increases red blood cell production, aiding in anemia treatment by mimicking erythropoietin hormone effects.
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Description
This quiz covers the key aspects of Chronic Obstructive Pulmonary Disease (COPD), including its incidence and prevalence in the U.S. and Canada. Explore the pathophysiology and understand the impact of this leading cause of morbidity and mortality. Test your knowledge on gas exchange and the concept of lower airway disorders.
