NURS 2055: Nursing Management of Obstructive Pulmonary Diseases
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Questions and Answers

What characterizes obstructive pulmonary diseases?

  • Decreased airflow resistance
  • Complete airway dilation
  • Increased airflow resistance due to airway obstruction (correct)
  • Increased lung elasticity

    • Which of the following can contribute to airway obstruction in obstructive pulmonary disease?

  • Bronchodilation of smooth muscle
  • Increased lung capacity
  • Edema (correct)
  • Accumulated secretions (correct)

    • What is a key feature of asthma?

  • Consistent air passage without symptoms
  • Episodic and reversible airway obstruction (correct)
  • Absence of airway inflammation
  • Chronic and permanent airway obstruction

    • In asthma, what initiates the early phase response in the pathophysiology?

    <p>Attachment of allergens to IgE receptors on mast cells</p> Signup and view all the answers

    What is the relationship between triggers and asthma symptoms?

    <p>Exposure to triggers leads to airway hyper-responsiveness and symptoms</p> Signup and view all the answers

    What is the primary characteristic of the late phase response in asthma?

    <p>Inflammation</p> Signup and view all the answers

    Which inflammatory cells are primarily involved in the late phase response of asthma?

    <p>Eosinophils and neutrophils</p> Signup and view all the answers

    When does the late phase response of asthma typically peak after exposure to a trigger?

    <p>5-12 hours</p> Signup and view all the answers

    What mechanism contributes to the self-sustaining cycle of inflammation in asthma?

    <p>Release of histamine and mediators by mast cells</p> Signup and view all the answers

    Which symptom is not typically associated with the late phase response of asthma?

    <p>Severe coughing fits</p> Signup and view all the answers

    Which nursing intervention is essential for a patient with inadequate airway clearance due to asthma?

    <p>Position patient to maximize ventilation</p> Signup and view all the answers

    What is a characteristic feature of COPD that differentiates it from asthma?

    <p>Persistent airflow limitation</p> Signup and view all the answers

    What factor is NOT typically associated with the development of COPD?

    <p>Frequent upper respiratory infections</p> Signup and view all the answers

    What contributes to airflow limitation during exhalation in patients with COPD?

    <p>Hypersecretion of mucus</p> Signup and view all the answers

    Which of the following outcomes is NOT expected for a patient with inadequate airway clearance related to asthma?

    <p>Complete cessation of all daily activities</p> Signup and view all the answers

    What is the primary purpose of salbutamol (Ventolin)?

    <p>To quickly relieve airway constriction</p> Signup and view all the answers

    Why are inhaled medications preferred over oral medications in asthma therapy?

    <p>They have fewer systemic adverse effects</p> Signup and view all the answers

    What does a peak flow result in the Green Zone indicate?

    <p>Under control and stable condition</p> Signup and view all the answers

    What adverse effects are associated with long-acting bronchodilators?

    <p>Serious cardiovascular problems</p> Signup and view all the answers

    Which medication is categorized as a leukotriene modifier?

    <p>Montelukast</p> Signup and view all the answers

    In which zone is a patient likely to need more assistance if their peak flow results are between 50% to 79% of personal best?

    <p>Yellow Zone</p> Signup and view all the answers

    What is the relevance of using a spacer with a metered dose inhaler?

    <p>It improves inhalation technique and delivery</p> Signup and view all the answers

    Which of the following is NOT a classification of bronchodilators?

    <p>Leukotriene receptor antagonists</p> Signup and view all the answers

    What is a primary factor contributing to increased airway resistance in asthma?

    <p>Excess mucus production</p> Signup and view all the answers

    Which clinical manifestation is commonly associated with an asthma attack?

    <p>Wheezing</p> Signup and view all the answers

    What is the typical breathing pattern observed in asthma during prolonged expiration?

    <p>Prolonged 1:3 to 1:4 ratio</p> Signup and view all the answers

    Which of the following triggers can lead to an asthma attack?

    <p>Emotional stress</p> Signup and view all the answers

    What defines status asthmaticus?

    <p>Life-threatening medical emergency</p> Signup and view all the answers

    Which diagnostic tool is most reliable for determining airflow obstruction in asthma?

    <p>Spirometry</p> Signup and view all the answers

    What happens to the respiratory muscle function in asthma?

    <p>May become compromised</p> Signup and view all the answers

    What occurs due to the inability to expire air in COPD patients?

    <p>Air trapping</p> Signup and view all the answers

    Which statement about wheezing in asthma is true?

    <p>Wheezing can change with severity of attacks</p> Signup and view all the answers

    Which symptom is often an early indicator of COPD?

    <p>Intermittent cough</p> Signup and view all the answers

    What complication can arise from pulmonary hypertension in COPD?

    <p>Cor pulmonale</p> Signup and view all the answers

    What is the main purpose of an asthma action plan?

    <p>To guide management of asthma symptoms</p> Signup and view all the answers

    How can COPD patients improve their overall health status and quality of life?

    <p>Engage in pulmonary rehabilitation</p> Signup and view all the answers

    What is typically measured by peak expiratory flow studies?

    <p>Maximum air forcefully exhaled in one second</p> Signup and view all the answers

    In what way does asthma affect the basement membrane?

    <p>Thickens the membrane</p> Signup and view all the answers

    Which medication class is NOT commonly used for managing COPD?

    <p>Antidepressants</p> Signup and view all the answers

    What indicates the presence of right-sided heart failure in COPD patients?

    <p>Edema in the ankles</p> Signup and view all the answers

    What role do corticosteroids play in asthma management?

    <p>They are a long-term anti-inflammatory medication</p> Signup and view all the answers

    Which feature characterizes hyperinflation in asthma?

    <p>Incomplete exhalation of air</p> Signup and view all the answers

    Which oxygen therapy method delivers the highest concentration of oxygen?

    <p>Nonrebreathing mask</p> Signup and view all the answers

    Which of the following best describes dyspnea in asthma?

    <p>May occur suddenly or gradually</p> Signup and view all the answers

    What is a common impact of COPD on a patient's daily activities?

    <p>Fatigue and breathlessness</p> Signup and view all the answers

    Which of the following is NOT associated with COPD exacerbations?

    <p>Stable lung function</p> Signup and view all the answers

    What lifestyle change is crucial in managing COPD?

    <p>Smoking cessation</p> Signup and view all the answers

    Study Notes

    Week 10: NURS 2055: Adult Illness Concepts I

    • Focus is chapter 31: Nursing Management of Obstructive Pulmonary Diseases

    Obstructive Pulmonary Disease

    • Most common pulmonary disease
    • Characterized by increased airway resistance due to airway narrowing or obstruction
    • Airway obstructions result from accumulated secretions, edema, inflammation of the airways, bronchospasm of smooth muscle, destruction of lung tissue, or a combination of these factors

    Asthma

    • Chronic inflammatory disorder of the airway
    • Key characteristic: episodic and reversible airway obstruction
    • Hallmarks: airway inflammation and airway hyper-responsiveness
    • Degree of bronchoconstriction related to airway narrowing
    • Degrees of airway inflammation and hyper-responsiveness
    • Exposure to triggers (infection, allergens) leads to symptoms (wheezing, coughing, shortness of breath)

    Asthma - Early Phase Response

    • Allergen or irritant attaches to IgE receptors on mast cells
    • Mast cells release chemical inflammatory mediators (e.g., histamine)
    • Intense inflammation, bronchial smooth muscle constriction, increased vasodilation and permeability
    • Epithelial damage
    • Peaks within 30-90 minutes after exposure
    • Subsides in another 30-90 minutes

    Asthma - Late Phase Response

    • Inflammatory cells (eosinophils and neutrophils) infiltrate the airway
    • Release mediators that induce further inflammation
    • Mast cells degranulate, releasing histamine and other mediators
    • Self-sustaining cycle of inflammation
    • Hyper-responsiveness of airway
    • Peaks 5-12 hours after exposure
    • May last several hours to days
    • Primary characteristic is inflammation

    Asthma - Key Takeaways

    • Increased airway resistance
    • Reduction in airway diameter related to the inability for air to pass
    • Mucosal inflammation
    • Constriction of bronchial smooth muscle
    • Excess production of mucous
    • Hypertrophy of bronchial smooth muscle
    • Thickening of basement membrane
    • Hypertrophy of mucous glands
    • Secretion of tenacious sputum
    • Hyperinflation and air trapping of the alveoli

    Asthma Triggers

    • Allergens (tobacco, marijuana smoke, nose/sinus conditions, medications, food additives, GERD, genetics, air pollutants)
    • Emotional stress
    • Exercise-induced (high-intensity workouts)

    Asthma Clinical Manifestations

    • Unpredictable, episodic, variable
    • Wheezing
    • Breathlessness
    • Dyspnea
    • Sensation of chest tightness
    • Coughing
    • Abrupt or gradual onset
    • May have no symptoms between attacks
    • Prolonged expiration (1:3, 1:4 ratio)
    • Sitting upright or slightly bent forward
    • Anxiety
    • Wheezing is variable (loud, silent) as the attack progresses
    • Silent chest, severe, diminished or absent breath sounds might indicate respiratory failure

    Asthma Status Asthmaticus

    • Life-threatening medical emergency
    • Extreme form of an acute asthma attack
    • Hypoxia, hypercapnia, acute respiratory failure
    • Can lead to respiratory failure and death
    • Precipitated by viral illness, environmental pollutants/allergens, food allergy, poor medication adherence or stopping medications

    Asthma Diagnostic Studies

    • Detailed history and physical exam
    • Family history of asthma, allergies, and eczema
    • Pulmonary function studies (spirometry, peak expiratory flow)
    • Allergy assessment
    • Oximetry
    • Chest x-rays (not diagnostic, rule out other conditions; may show hyperinflation)
    • Blood work (sputum sample check for eosinophils)
    • ABGs

    Asthma Interprofessional Care

    • Establishing partnerships with patients/families
    • Identifying and avoiding/eliminating triggers
    • Patient and family teaching
    • Continuous assessment of asthma control and severity
    • Appropriate medications (relievers, rescue medication, controllers, maintenance medication
    • Asthma action plans
    • Regular follow-up

    Categories of Asthma Medications

    • Reliever Medications (fast-acting): Bronchodilators (short-acting inhaled beta-adrenergic agonists), anticholinergics/short-acting muscarinic antagonists
    • Controller Medications (long-term): Anti-inflammatory medications (inhaled corticosteroids, oral corticosteroids, leukotriene modifiers, anti-IgE) 
    • Bronchodilators (long-acting inhaled beta2-adrenergic agonists), anticholinergics/long-acting muscarinic antagonists, medications

    Asthma Patient Education

    • Medication therapy involving name, dosage, administration, frequency, indications of use and consequences of improper use, importance of adherence
    • Assessment of patient's ability to use inhaler accurately
    • Medication typically given via inhalation
    • Lower dose required
    • Fewer and less intense systemic adverse events
    • Quicker onset
    • Use with metered-dose inhaler +/- spacer

    COPD

    • Chronic inflammatory response
    • Preventable disease, usually progressive airflow limitation
    • Chronic inflammatory response in airways and lungs
    • Cigarette smoking and noxious particles/gases
    • Occupational chemicals and dusts
    • Infections
    • Heredity
    • Aging

    COPD Pathophysiology

    • Chronic inflammation in the airways, lung parenchyma (respiratory bronchioles and alveoli) and pulmonary blood vessels—airflow limitations during forced exhalation
    • Airflow obstruction due to mucus hypersecretion, mucosal edema, and bronchospasm
    • Inflammatory process that destroys tissue and disrupts normal lung defense mechanisms and repair
    • Structural changes caused by inflammatory mediators (e.g., leukotrienes, interleukins)
    • Chest hyper-expands leading to a barrel-shaped chest due to the inability to forcefully exhale

    === COPD Clinical Manifestations===

    • Cough, sputum production, dyspnea, history of smoking
    • Intermittent cough is earliest symptom
    • Dyspnea interferes with daily activities
    • Barrel chest
    • Increased work of breathing (WOB)
    • Use of intercostal and accessory muscles
    • Prolonged expiratory phase
    • Wheezing
    • Decreased lung sounds
    • Tripod positioning
    • Edema in ankles (indication of right-sided heart failure)

    COPD Complications

    • Cor pulmonale: hypertrophy of the right side of the heart, with or without heart failure as a result of pulmonary hypertension
    • Acute exacerbation: worsening COPD symptoms
    • Many exacerbations due to bacterial infection
    • Acute respiratory failure: overall decline in lung function, deterioration in health status, and increased risk of death
    • Patients wait too long to contact healthcare providers when symptoms suggest acute exacerbation of chronic obstructive pulmonary disease
    • Depression and anxiety

    COPD Interprofessional Care

    • Prevent disease progression (smoking cessation)
    • Reduce frequency and severity of exacerbations
    • Alleviate respiratory symptoms
    • Improve exercise tolerance
    • Treat exacerbations and complications
    • Improve overall health status and quality of life
    • Reduce associated morbidity and mortality

    COPD Interprofessional Care (Medications)

    • Bronchodilator therapy (beta2-adrenergic agonists, anticholinergic medications)
    • Long-acting theophylline preparations
    • Corticosteroids (oral for exacerbations)
    • NSAIDs
    • Antibiotics (for exacerbations with purulent sputum)
    • Influenza and pneumonia vaccines

    COPD Pulmonary Rehabilitation

    • Optimize functional status and quality of life
    • Aerobic conditioning
    • Upper/lower body conditioning exercises
    • Breathing and energy conservation exercises (pursed lip breathing and huff coughing)
    • Optimize nutrition
    • Smoking cessation
    • Environmental factor management
    • Health promotion strategies
    • Patient education
    • Psychological support and counselling

    Comparison of COPD and Asthma

    • Age at onset: COPD usually after 40, asthma usually before 40
    • Smoking history: COPD usually has a history of smoking >10 pack years; asthma may have a causative link but not a necessary factor
    • Clinical symptoms: COPD symptoms are persistent; asthma symptoms intermittent and variable
    • Sputum production: COPD often has frequent sputum production; asthma sputum production is infrequent
    • Allergies: Allergies present more often in asthma; less common in COPD
    • Spirometry: COPD findings may not improve with therapy; asthma findings often normalize
    • Disease course: COPD is progressive worsening; asthma is usually stable with exacerbations

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    Week 10 - Obstructive Diseases (Asthma, COPD) PDF

    Description

    This quiz focuses on adult illness concepts related to obstructive pulmonary diseases, specifically chapter 31 on nursing management. It covers the characteristics and management of asthma, including its early phase response and related symptoms. Test your knowledge on airway inflammation, bronchoconstriction, and the key factors contributing to airway obstruction.

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