Pathophysiology of Asthma and COPD
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Questions and Answers

Which of the following statements describes the pathophysiology of asthma?

  • Asthma is characterized by irreversible airflow limitation.
  • Asthma does not involve mucus secretion.
  • Asthma involves chronic inflammation and bronchoconstriction. (correct)
  • Asthma is primarily caused by aging.

Cigarette smoking can trigger asthma attacks.

True (A)

What are the expected patient outcomes for asthma in terms of airway management?

Maintain open airway, normal breath sounds and respiratory rate, normal or personal best objective lung function measurements, and participation in activities of daily living (ADLs).

The primary characteristic of Chronic Obstructive Pulmonary Disease (COPD) is persistent _______ limitation.

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

Match the following conditions with their characteristics:

<p>Asthma = Reversible airflow limitation with bronchoconstriction COPD = Progressive airflow limitation and chronic inflammation Mucus hypersecretion = Contributes to airway obstruction in asthma Bronchospasm = Narrowing of airways due to muscle contraction</p> Signup and view all the answers

What is a key characteristic of asthma?

<p>Episodic and reversible airway obstruction (C)</p> Signup and view all the answers

Airway inflammation in asthma is caused only by allergens.

<p>False (B)</p> Signup and view all the answers

Name one mechanism that leads to airway obstruction in obstructive pulmonary diseases.

<p>Accumulated secretions, edema, inflammation of the airways, bronchospasm, or destruction of lung tissue.</p> Signup and view all the answers

In asthma, bronchoconstriction is primarily caused by __________ of smooth muscle.

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

Match the following triggers for asthma attacks with their descriptions:

<p>Allergens = Substances that trigger allergic responses Infections = Pathogens that cause respiratory illnesses Irritants = Environmental factors that provoke airway constriction Exercise = Physical activity that may induce breathing difficulty</p> Signup and view all the answers

Which of the following is a common clinical manifestation of COPD?

<p>Wheezing (C)</p> Signup and view all the answers

Barrel chest is a characteristic feature of COPD.

<p>True (A)</p> Signup and view all the answers

What is the primary treatment goal in managing COPD symptoms?

<p>To alleviate breathlessness and reduce the frequency of exacerbations.</p> Signup and view all the answers

A patient with COPD may experience an increased work of breathing due to __________.

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

Match the following medications to their types used in COPD management:

<p>Beta 2 adrenergic agonists = Bronchodilator therapy Corticosteroids = Anti-inflammatory therapy Antibiotics = Infection treatment NSAIDs = Pain relief</p> Signup and view all the answers

What best describes cor pulmonale in relation to COPD?

<p>Hypertrophy of the right side of the heart (C)</p> Signup and view all the answers

Pursed lip breathing can help patients with COPD by prolonging expiration.

<p>True (A)</p> Signup and view all the answers

What is a significant complication that can arise due to worsening COPD?

<p>Acute respiratory failure</p> Signup and view all the answers

The use of _________ muscles signifies advanced respiratory distress in COPD patients.

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

Which of the following interventions is NOT used in the management of COPD?

<p>Weight gain medication (A)</p> Signup and view all the answers

What is a major characteristic of asthma's early phase response?

<p>Bronchial smooth muscle contraction (B)</p> Signup and view all the answers

The late phase response of asthma peaks 15-30 minutes after exposure to a trigger.

<p>False (B)</p> Signup and view all the answers

Name two inflammatory cells involved in asthma.

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

Increased vascular permeability in asthma leads to __________ formation.

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

Match the following asthma characteristics with their descriptions:

<p>Early phase response = Peaks within 30-90 minutes after exposure Late phase response = Inflammation as a primary characteristic Bronchospasm = Caused by bronchial smooth muscle contraction Mucus secretion = Can lead to shortness of breath and coughing</p> Signup and view all the answers

What is one of the expected patient outcomes for asthma management?

<p>Maintain open airway (B)</p> Signup and view all the answers

Chronic obstructive pulmonary disease (COPD) can be fully reversed with treatment.

<p>False (B)</p> Signup and view all the answers

Name one trigger for COPD as mentioned in the content.

<p>Cigarette smoking</p> Signup and view all the answers

The presence of mucosal edema leads to bronchial __________ in COPD patients.

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

Match the following COPD characteristics with their descriptions:

<p>Cigarette smoking = A primary cause of COPD Inflammatory response = Affects lung parenchyma and airways Airflow limitation = Usually progressive and not fully reversible Mucus hypersecretion = Contributes to airflow obstruction in COPD</p> Signup and view all the answers

What is the primary characteristic of asthma?

<p>Episodic and reversible airway obstruction (A)</p> Signup and view all the answers

Airway obstruction in asthma can only occur due to allergens.

<p>False (B)</p> Signup and view all the answers

Name one factor that can lead to airway obstruction in obstructive pulmonary diseases.

<p>Accumulated secretions</p> Signup and view all the answers

In asthma, airway hyper-responsiveness is a key feature influenced by exposure to __________.

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

Match the airway obstruction causes to their descriptions:

<p>Accumulated secretions = Mucus buildup in airway Edema = Swelling due to inflammation Bronchospasm = Contraction of airway smooth muscle Destruction of lung tissue = Loss of lung function over time</p> Signup and view all the answers

Which symptom is typically the earliest indicator of COPD?

<p>Cough (C)</p> Signup and view all the answers

Cor pulmonale is characterized by the enlargement of the left side of the heart due to COPD.

<p>False (B)</p> Signup and view all the answers

What condition is an acute exacerbation of COPD most commonly caused by?

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

The barrel-shaped chest results from impaired _______ function in COPD.

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

Match the following types of oxygen therapy with their flow rates:

<p>Simple face mask = 6-12L Nasal cannula = 1-6L Nonrebreathing mask = 60-90% Venturi mask = 24%, 28%, 31%, 35%, 40% and 50%</p> Signup and view all the answers

Which of the following is a common medication used for bronchodilator therapy in COPD?

<p>Beta 2 adrenergic agonists (A)</p> Signup and view all the answers

Pursed lip breathing can help reduce feelings of breathlessness in COPD patients.

<p>True (A)</p> Signup and view all the answers

List one lifestyle change that can help prevent disease progression in COPD.

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

What is one of the primary goals of interprofessional care for COPD patients?

<p>Prevent disease progression (D)</p> Signup and view all the answers

Common clinical manifestations of COPD include cough, _______ production, and dyspnea.

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

Which of the following medications is a long-acting inhaled beta 2 adrenergic agonist?

<p>Salmeterol (D)</p> Signup and view all the answers

Anticholinergics are used mainly as long-term control medications for asthma.

<p>False (B)</p> Signup and view all the answers

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

<p>To ensure proper inhalation technique and increase medication delivery to the lungs.</p> Signup and view all the answers

The green zone indicates that a person is ________.

<p>under control</p> Signup and view all the answers

Match the following asthma medications with their types:

<p>Montelukast = Leukotriene modifier Omalizumab = Anti-IgE therapy Prednisone = Oral corticosteroid Ipratropium = Short-acting muscarinic antagonist</p> Signup and view all the answers

Which zone indicates that immediate medical attention is needed for asthma?

<p>Red Zone (B)</p> Signup and view all the answers

Long-acting oral beta 2 adrenergic agonists are intended for quick relief of asthma symptoms.

<p>False (B)</p> Signup and view all the answers

What frequency range indicates that a patient's asthma is in the yellow zone?

<p>50% to 79% of personal best</p> Signup and view all the answers

Which of the following is a common trigger for asthma attacks?

<p>Tobacco smoke (B)</p> Signup and view all the answers

Wheezing can be present in patients with both minor and severe asthma attacks.

<p>True (A)</p> Signup and view all the answers

What is the primary characteristic of status asthmaticus?

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

In asthma management, _________ medications are used for immediate relief.

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

Match the following clinical manifestations with their descriptions:

<p>Wheezing = Sound produced during breathing due to narrowed airways Dyspnea = Difficulty in breathing Chest tightness = Sensation of pressure in the chest Coughing = A reflex to clear the airways</p> Signup and view all the answers

What is one of the diagnostic studies used to confirm airflow obstruction in asthma?

<p>Spirometry (C)</p> Signup and view all the answers

Hyperinflation and air trapping of the alveoli is a sign of asthma exacerbation.

<p>True (A)</p> Signup and view all the answers

Name one factor that can increase work of breathing in asthma.

<p>Mucosal inflammation</p> Signup and view all the answers

In severe cases of asthma, a _______ chest may indicate greatly diminished breath sounds.

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

Which medication type helps to reduce inflammation in asthma patients?

<p>Corticosteroids (A)</p> Signup and view all the answers

Patients with asthma may have no symptoms between attacks.

<p>True (A)</p> Signup and view all the answers

What is the purpose of an asthma action plan?

<p>To provide guidance on managing asthma symptoms and triggers</p> Signup and view all the answers

ABG changes in an asthma patient may indicate ________ and hypercapnia.

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

Match the patterns of asthma medication with their effects:

<p>Reliever medications = Immediate relief of symptoms Controller medications = Prevent asthma attacks Short-acting beta-agonists = Quick bronchodilation Corticosteroids = Reduce airway inflammation</p> Signup and view all the answers

What is one primary characteristic of asthma as an obstructive pulmonary disease?

<p>Episodic and reversible airway obstruction (C)</p> Signup and view all the answers

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

<p>Inflammation of airway tissues (A)</p> Signup and view all the answers

Which of the following mechanisms can lead to airway obstruction in obstructive pulmonary diseases?

<p>Bronchospasm of smooth muscle (C)</p> Signup and view all the answers

Which inflammatory cells play a significant role in asthma pathophysiology during the late-phase response?

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

Which of the following factors contributes to airway hyper-responsiveness in asthma?

<p>Exposure to irritants or allergens (D)</p> Signup and view all the answers

What is predominantly released by mast cells when an allergen attaches to IgE receptors in asthma?

<p>Inflammatory mediators (C)</p> Signup and view all the answers

What is the timeline for the peak of the late-phase response after exposure to a trigger?

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

What role does airway inflammation play in the pathophysiology of asthma?

<p>It contributes to airway hyper-responsiveness. (D)</p> Signup and view all the answers

Which symptom is NOT commonly associated with the early-phase response of asthma?

<p>Prolonged cough (D)</p> Signup and view all the answers

In asthma pathophysiology, what is the primary consequence of mast cell degranulation?

<p>Release of histamine and other mediators (C)</p> Signup and view all the answers

What is the primary benefit of medication given by inhalation compared to systemic administration?

<p>Fewer systemic adverse events (C)</p> Signup and view all the answers

At what percentage of personal best peak flow is a patient in the 'Red Zone'?

<p>Less than 56% (C)</p> Signup and view all the answers

Which medication class is specifically classified as a short-acting muscarinic antagonist?

<p>Ipratropium (A)</p> Signup and view all the answers

Which of the following indicates that a patient is in the 'Yellow Zone' regarding asthma control?

<p>50% to 79% of personal best (B)</p> Signup and view all the answers

What is a common adverse effect of using inhaled medications for asthma?

<p>Oral thrush (B)</p> Signup and view all the answers

What component of asthma medication is exemplified by omalizumab?

<p>Anti-IgE therapy (B)</p> Signup and view all the answers

Which statement regarding the use of beta-2 adrenergic agonists is TRUE?

<p>They can be used as both quick relief and long-term control. (D)</p> Signup and view all the answers

Which method is preferable for ensuring accurate inhaler use by patients?

<p>Using a metered dose inhaler with a spacer (D)</p> Signup and view all the answers

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

<p>Administer medication to improve respiratory function (B)</p> Signup and view all the answers

What is a fundamental characteristic of Chronic Obstructive Pulmonary Disease (COPD)?

<p>Progressive airflow limitation that is usually irreversible (D)</p> Signup and view all the answers

Which factor significantly contributes to the pathophysiological changes in COPD?

<p>Chronic inflammation and tissue destruction (B)</p> Signup and view all the answers

What is one expected objective lung function measurement for a patient effectively managing asthma?

<p>Normal or personal best peak expiratory flow rate (B)</p> Signup and view all the answers

Which of the following statements accurately describes the airway obstruction mechanisms in COPD?

<p>Airflow obstruction results from mucosal edema, hypersecretion, and loss of elastic recoil (A)</p> Signup and view all the answers

What is a potential complication of Status Asthmaticus?

<p>Respiratory failure (B)</p> Signup and view all the answers

Which of the following triggers can precipitate an asthma attack?

<p>Specific medications and food additives (C)</p> Signup and view all the answers

What is the primary method used to assess airflow obstruction in asthma?

<p>Spirometry (B)</p> Signup and view all the answers

Which medication category includes short-acting inhaled beta-adrenergic agonists?

<p>Reliever medications (D)</p> Signup and view all the answers

What is a typical respiratory rate change during an acute asthma attack?

<p>Prolonged expiration (A)</p> Signup and view all the answers

What type of medical assessment helps monitor oxygen levels and need for intervention in asthma management?

<p>Oximetry (C)</p> Signup and view all the answers

Which of the following manifestations indicates severe airway obstruction in asthma patients?

<p>Silent chest (B)</p> Signup and view all the answers

Which of the following symptoms may vary in an asthma attack?

<p>Intensity of wheezing (D)</p> Signup and view all the answers

What is the primary goal of interprofessional care for asthma management?

<p>Identification of triggers and prevention (C)</p> Signup and view all the answers

Which diagnostic study is NOT typically used for diagnosing asthma?

<p>Electrocardiogram (C)</p> Signup and view all the answers

What changes in breathing mechanics may occur during an asthma episode?

<p>Increased work of breathing (C)</p> Signup and view all the answers

What is a common psychological factor exacerbating asthma symptoms?

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

What is a notable characteristic of cough in asthma patients?

<p>Can have both gradual or abrupt onset (D)</p> Signup and view all the answers

What is a common physiological change seen in patients with COPD regarding lung shape?

<p>Lung hyperinflation (B)</p> Signup and view all the answers

Which of the following is a common sign that may suggest cor pulmonale in COPD patients?

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

What is one of the primary aims of interprofessional care in managing COPD?

<p>Improve exercise tolerance (C)</p> Signup and view all the answers

Which of the following is NOT commonly used in the treatment of acute exacerbations of COPD?

<p>Long-acting theophylline (D)</p> Signup and view all the answers

What breathing technique is beneficial for COPD patients during dyspnea?

<p>Pursed lip breathing (B)</p> Signup and view all the answers

Which of the following statements about the clinical manifestations of COPD is FALSE?

<p>Dyspnea is usually mild at first. (A)</p> Signup and view all the answers

What type of oxygen therapy flow rate is typically associated with a Venturi mask?

<p>Variable flow rates (24%-50%) (B)</p> Signup and view all the answers

In COPD management, which medication class is typically prescribed to help alleviate shortness of breath due to bronchospasm?

<p>Beta 2 adrenergic agonists (A)</p> Signup and view all the answers

What is a primary complication associated with acute exacerbations of COPD?

<p>Acute respiratory failure (A)</p> Signup and view all the answers

Which of the following is a characteristic feature of COPD that may significantly impact a patient's posture?

<p>Tripod positioning (A)</p> Signup and view all the answers

Flashcards

Asthma Nursing Care Plan

A plan for managing asthma focusing on maintaining a patent airway, normal breathing, and lung function, allowing for daily activities.

COPD (Chronic Obstructive Pulmonary Disease)

A progressive, preventable lung disease marked by persistent airflow limitation. It involves chronic inflammation in airways and lungs.

COPD Pathophysiology

COPD's cause: chronic inflammation in airways, lung tissues, and blood vessels, leading to irreversible airflow limitation during exhalation.

COPD Causes

Factors that increase risk/cause COPD include smoking, pollutants, and infections. It also has a genetic and aging component.

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Airflow Limitation in COPD

In COPD, difficulty exhaling air due to reduced lung elasticity (recoil), mucus buildup, swelling of airways (edema), and tightening (bronchospasm).

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COPD

Chronic Obstructive Pulmonary Disease, a group of lung diseases causing difficulty breathing

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Symptoms of COPD

Cough, sputum production, dyspnea (shortness of breath), weight loss, anorexia, and wheezing

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COPD Complications

Cor pulmonale (heart issues), acute exacerbation (worsening symptoms), respiratory failure, and depression/anxiety

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COPD Treatment - Medications

Includes bronchodilators (e.g., beta 2 agonists, anticholinergics), corticosteroids, antibiotics, etc.

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Oxygen Therapy in COPD

Using supplemental oxygen to improve breathing.

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COPD Pulmonary Rehabilitation

Improving physical function and quality of life through exercise and breathing techniques.

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Acute Exacerbation of COPD

A sudden worsening of COPD symptoms

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Cor Pulmonale

Right-sided heart enlargement due to high blood pressure in the lungs caused by COPD.

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Dyspnea

Shortness of breath, a common symptom of COPD and other diseases

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Barrel Chest

Chest that is wider than normal, a result of the respiratory muscles not working as effectively due to COPD.

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What is the most common airway obstruction?

Inflammation, narrowed airways (bronchospasm), accumulated secretions, edema, and destruction of lung tissue can all lead to airway obstruction.

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What is a key characteristic of asthma?

Asthma is characterized by reversible airway obstruction episodes triggered by various factors.

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What are the hallmarks of asthma?

Airway inflammation and hyper-responsiveness to triggers are the hallmarks of asthma.

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What causes early phase asthma response?

Allergens or irritants attach to IgE receptors on mast cells, releasing inflammatory mediators.

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What are examples of inflammatory mediators released in asthma?

Histamine, leukotrienes, and prostaglandins are examples of inflammatory mediators released in asthma.

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Early Asthma Response

The initial reaction to an asthma trigger, characterized by mast cell degranulation, histamine release, and symptoms like bronchospasm, increased mucus, and shortness of breath. This phase peaks within 30-90 minutes after exposure and subsides within another 30-90 minutes.

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Late Asthma Response

The delayed, more severe inflammatory response in asthma, occurring 5-12 hours after exposure and lasting for hours to days. Characterized by inflammation, with a major role played by eosinophils and neutrophils, leading to airway hyper-responsiveness.

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What triggers late phase asthma response?

The late phase response is triggered by the inflammatory cells involved in asthma, such as eosinophils and neutrophils, infiltrating the airway and releasing mediators that further stimulate mast cells, perpetuating a self-sustaining cycle of inflammation.

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What distinguishes late phase from early phase?

The late phase response is characterized by inflammation, with a major role played by eosinophils and neutrophils, leading to airway hyper-responsiveness. The early phase response is marked by bronchospasm and mucus secretion due to histamine release.

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What is airway hyper-responsiveness?

An exaggerated reaction of the airways to stimuli, leading to airway narrowing and increased symptoms. This is a major hallmark of asthma, particularly in the late phase response.

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COPD Cause: Smoking

Cigarette smoking is the most common cause of COPD. It damages the lungs and causes chronic inflammation.

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COPD Patho: Airflow Limitation

COPD causes airflow limitation due to loss of lung elasticity, mucus buildup, and airway narrowing.

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COPD Inflammation

Inflammation is the core problem in COPD. It affects airways, lung tissue, and blood vessels.

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COPD Structural Changes

Chronic inflammation in COPD leads to structural changes like airway narrowing and lung tissue destruction.

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COPD: Irreversible?

COPD may be progressive, meaning it worsens over time. Airflow limitations are often not fully reversible.

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COPD: Air Trapping

The inability to exhale air fully due to impaired lung function, leading to air being trapped in the lungs.

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COPD: Barrel Chest

An outward expansion of the chest, giving it a rounded shape, due to air trapping and the increased effort of breathing.

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COPD: Prolonged Expiratory Phase

Difficulty in exhaling air, resulting in a longer exhalation time compared to inhalation.

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COPD: Weight Loss and Anorexia

Loss of appetite and weight due to increased energy expenditure from breathing difficulty and inflammation.

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COPD: Tripod Positioning

A posture often adopted by patients with COPD, involving leaning forward and using their arms to support their body.

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COPD: Cor Pulmonale

Right-sided heart failure caused by high blood pressure in the lungs due to COPD.

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COPD: Acute Exacerbation

A sudden worsening of COPD symptoms, often triggered by infections or environmental factors.

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COPD: Acute Respiratory Failure

A severe decline in lung function, leading to insufficient oxygen levels and potentially life-threatening complications.

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COPD: Depression and Anxiety

Mental health issues associated with COPD, often driven by the frustration and limitations imposed by the disease.

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COPD: Oxygen Therapy

Providing supplemental oxygen to improve blood oxygen levels and breathing in COPD patients.

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Airway Obstruction in Asthma

Asthma causes narrowing of the airways due to inflammation, muscle tightening (bronchospasm), excess mucus, and thickened airway lining.

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Asthma Triggers

Factors that can start an asthma attack, including allergens, smoke, pollutants, exercise, stress, and certain medications.

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What are the classic signs of an asthma attack?

A combination of wheezing, breathlessness, chest tightness, coughing, and difficulty breathing out.

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Status Asthmaticus

A life-threatening severe asthma attack that doesn't respond to regular treatment.

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What are the key characteristics of status asthmaticus?

Persistent wheezing, shortness of breath, and lack of response to usual asthma medications.

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Why is status asthmaticus a medical emergency?

It can lead to serious lung damage, respiratory failure, and even death.

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Asthma Action Plan

A personalized plan to manage asthma by identifying triggers, monitoring symptoms, and using medications effectively.

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What are the two main categories of asthma medications?

Reliever medications (fast-acting) provide quick symptom relief, while controller medications (long-term) prevent attacks.

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What are examples of 'reliever' asthma medications?

Short-acting inhaled bronchodilators that help open the airways during an asthma attack.

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What are examples of 'controller' asthma medications?

Long-term medications like inhaled corticosteroids that reduce airway inflammation and prevent asthma attacks.

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Why is it important to identify and avoid asthma triggers?

Triggers can start an asthma attack, so avoiding them is essential for managing asthma.

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How can regularly monitoring lung function help manage asthma?

Regular lung function tests (PEF or spirometry) can help detect early signs of asthma worsening, allowing for timely intervention.

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How can patient education and family involvement improve asthma management?

Understanding asthma, triggers, medications, and action plans empowers patients and families to actively manage the condition.

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What is the goal of asthma treatment?

To control symptoms, prevent attacks, improve lung function, and allow patients to live a normal life.

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What is the hallmark of asthma?

Asthma's hallmark is inflammation and increased sensitivity (hyper-responsiveness) of the airways.

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What's the early phase response in asthma?

The initial reaction to an asthma trigger involves mast cells releasing chemical mediators that cause inflammation, bronchospasm, and mucus production. This phase peaks within 30-90 minutes and subsides within another 30-90 minutes.

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What characterizes the late phase response in asthma?

The late phase response is a delayed, more severe inflammatory reaction characterized by the influx of inflammatory cells like eosinophils and neutrophils, leading to airway hyper-responsiveness. This phase occurs 5-12 hours after exposure and lasts for hours to days.

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Why is asthma reversible?

Asthma is considered reversible because the inflammation and airway narrowing caused by triggers can be reversed with appropriate treatment, like medications that open up the airways.

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What are the key features of obstructive pulmonary diseases?

Obstructive pulmonary diseases are characterized by a narrowing of the airways, causing increased airflow resistance. This narrowing can be caused by inflammation, swelling, mucus buildup, bronchospasm, and destruction of lung tissue.

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Asthma Medications: Quick Relief

These medications quickly open airways during an asthma attack, providing temporary relief. Examples include inhaled bronchodilators like albuterol.

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Asthma Medications: Long-Term Control

These medications are taken regularly to prevent asthma attacks by reducing airway inflammation. Examples include inhaled corticosteroids like fluticasone.

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Peak Flow Meter: Green Zone

This indicates your asthma is well-controlled, and you are breathing comfortably. Your peak flow readings are usually between 80% to 100% of your personal best.

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Peak Flow Meter: Yellow Zone

Your asthma is not fully controlled, and you need to take more action. Your peak flow readings are between 50% to 79% of your personal best.

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Peak Flow Meter: Red Zone

This means your asthma is serious, and you need immediate medical attention. Your peak flow readings are 56% to 60% or less of your personal best.

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Inhaler Spacer

A device that attaches to an inhaler, helping to deliver medication more effectively to the lungs. It's especially useful for children and people with poor inhaler technique.

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Inhalation vs. Oral Medications: Asthma

Inhalation medications are often preferred for asthma treatment because they deliver the medication directly to the lungs, achieving faster results with fewer side effects.

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What is Obstructive Pulmonary Disease?

A common group of lung conditions where airways become narrowed, making it harder to breathe out. The narrowing is caused by things like inflammation, swelling, mucus, or muscle tightening.

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Key Feature of Asthma?

Asthma is characterized by reversible airway obstruction. This means the narrowed airways can go back to normal after treatment.

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Asthma: Early Phase Response

The first reaction to an asthma trigger. Mast cells release chemicals like histamine, causing inflammation, bronchospasm, and mucus production. This phase happens quickly, within 30-90 minutes.

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Asthma: Late Phase Response

A delayed, more severe reaction. More inflammatory cells arrive, making the airways even more sensitive and causing further narrowing. This phase occurs 5-12 hours after exposure and can last longer.

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Airway Hyper-responsiveness in Asthma

The airways become overly sensitive to triggers like allergens or exercise. This causes inflammation and bronchospasm, making breathing difficult.

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Early Phase Asthma Response

The immediate reaction to an asthma trigger, involving mast cells releasing histamine and other inflammatory mediators, leading to bronchospasm, increased mucus production, and shortness of breath. This phase peaks within 30-90 minutes after exposure and typically subsides within another 30-90 minutes.

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Late Phase Asthma Response

A delayed, more severe inflammatory response occurring 5-12 hours after exposure to an asthma trigger. This phase is characterized by the infiltration of eosinophils and neutrophils, leading to sustained airway inflammation and hyper-responsiveness. It can last for hours to days.

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What distinguishes late phase asthma from early phase?

The late phase response is primarily driven by inflammation, with eosinophils and neutrophils playing a key role, leading to airway hyper-responsiveness. In contrast, the early phase response is dominated by bronchospasm and mucus production due to histamine release.

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Airway Hyper-responsiveness

An exaggerated reaction of the airways to stimuli, causing airway narrowing and increased symptoms. This is a hallmark of asthma, particularly in the late phase response.

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COPD: What is it?

COPD is a chronic lung disease that causes airflow limitations and makes breathing difficult. It's often progressive and gets worse over time.

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COPD: What are the main causes?

Smoking is the biggest culprit, but air pollution, dust, and even genetics can play a role in COPD.

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COPD: How does it affect breathing?

COPD damages the airways and lung tissue, making it hard to exhale air fully. It can also cause mucus buildup and inflammation.

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COPD: What are some common symptoms?

Common symptoms include cough, shortness of breath, wheezing, and mucus production. In severe cases, a 'barrel chest' can also develop.

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Asthma: What is it?

Asthma is a lung condition where the airways become inflamed and narrow, causing wheezing, coughing, and shortness of breath.

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Inhaled Medications for Asthma

Medications delivered directly to the lungs through an inhaler to quickly open airways and reduce inflammation.

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Oral Medications for Asthma

Medications taken by mouth, often used for long-term management to reduce inflammation and prevent attacks.

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COPD: Who gets it?

Most commonly caused by smoking, air pollution, and dust exposure, but genetics and getting older also play a role.

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COPD: What does it look like?

Symptoms include cough, shortness of breath, wheezing, using extra muscles to breathe, and a barrel-shaped chest.

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COPD: Why is exhaling hard?

Air gets trapped in the lungs because the airways are narrowed and the lung tissue can't recoil properly.

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COPD: How does it affect the heart?

The right side of the heart has to work harder to pump blood through the lungs, leading to cor pulmonale.

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COPD: What are exacerbations?

Sudden worsening of symptoms that can be triggered by infections, pollution, or other factors.

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COPD: What does oxygen therapy do?

Provides extra oxygen to help the body absorb more, improving breathing and overall function.

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COPD: What is pulmonary rehab?

A program that helps people with COPD improve their breathing, exercise tolerance, and overall quality of life.

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COPD: What are some key medications?

Bronchodilators to open airways, corticosteroids to reduce inflammation, and antibiotics for infections.

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COPD: What can I do to prevent it?

Don't smoke, avoid polluted air, and get vaccinated against flu and pneumonia.

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Study Notes

Week 10: NURS 2055: Adult Illness Concepts I

  • Course is NURS 2055: Adult Illness Concepts I
  • Specific chapter covered is Chapter 31: Nursing Management of Obstructive Pulmonary Diseases
  • Instructor is Ainsley Miller, 2024
  • Course is offered at Lakehead University

Obstructive Pulmonary Disease

  • Most common pulmonary disorder
  • Characterized by increased airway resistance
  • Obstruction or narrowing of the airway causes resistance
  • Airway obstruction results from:
    • Accumulated secretions
    • Edema
    • Inflammation of the airways
    • Bronchospasm of smooth muscle
    • Destruction of lung tissue
    • Combination of the above

Asthma

  • Chronic inflammatory disorder of the airway
  • Key characteristic is episodic and reversible airway obstruction.
  • Hallmarks are airway inflammation and airway hyper-responsiveness.
  • Degree of bronchoconstriction is related to airway narrowing, making it harder to breathe.
  • Asthma has varying degrees of airway inflammation and hyper-responsiveness.
  • Exposure to triggers (infections, allergens) lead to symptoms like wheezing, coughing, and shortness of breath.

Asthma - Early Phase Response

  • Allergens or irritants bind to IgE receptors on mast cells
  • Mast cells release inflammatory mediators (e.g., histamine)
  • Intense inflammation leads to bronchial smooth muscle constriction.
  • Increased vasodilation and permeability leads to swelling, and fluid build up
  • Epithelial damage occurs from the inflammation and chemicals
  • Peaks within 30-90 minutes of exposure to a trigger
  • Subsides within another 30-90 minutes.

Asthma - Late Phase Response

  • Inflammatory cells (eosinophils and neutrophils) infiltrate the airway and release mediators.
  • Inflammation leads to mast cell degranulation and the release of histamine and other mediators.
  • This creates a self-sustaining cycle of inflammation.
  • Airway hyper-responsiveness increases.
  • Peaks 5-12 hours after exposure to trigger
  • May last for several hours to days.
  • Inflammation is the primary characteristic, not bronchial smooth muscle contraction.

Asthma - Key Take Aways

  • Reduction in airway diameter and increased airway resistance.
  • Mucosal inflammation.
  • Bronchial smooth muscle constriction.
  • Excess mucus production.
  • Hypertrophy of bronchial smooth muscle and thickening of basement membrane.
  • Secretion of tenacious sputum.
  • Hyperinflation and air trapping in the alveoli.
  • Increased respiratory work.
  • Respiratory function problems.
  • Distribution of ventilation issues.
  • Difficulty breathing.

Asthma Triggers

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

Asthma Clinical Manifestations

  • Unpredictable, episodic, variable attacks.
  • Wheezing.
  • Breathlessness (dyspnea).
  • Sensation of chest tightness.
  • Coughing.
  • Gradual or abrupt onset of symptoms.
  • No symptoms between attacks.
  • Prolonged expiration (1:3 or 1:4 ratio).
  • Sitting upright or slightly bent forward using accessory muscles.
  • Anxiety.
  • Wheezing can be a sign for severe attacks as well as mild attacks.
  • Silent chest may indicate severely diminished or absent breaths sounds.

Asthma Status Asthmaticus

  • Life-threatening medical emergency
  • Extreme form of acute asthma attack.
  • Hypoxia, hypercapnia, acute respiratory failure.
  • Precipitated by viral illnesses, environmental pollutants/allergens, drug allergies, or changes in medication regimen.
  • Forced exhalation increases intrathoracic pressure.
  • Hypoxemia and hypocapnia occur as the patient hyperventilates to maintain oxygenation, but they tire and CO2 is retained.

Asthma Diagnostic Studies

  • Detailed history and physical examination.
  • Family history of asthma, allergies, and eczema.
  • Pulmonary function studies (spirometry, peak expiratory flow).
  • Allergy assessment.
  • Chest x-rays (may show hyperinflation but not diagnostic for asthma).
  • Blood tests (eosinophils to assess airway inflammation).
  • ABGs.
  • Oximetry to assess oxygen levels.

Asthma Interprofessional Care

  • Establishing partnerships with patients/families to identify and eliminate triggers.
  • Patient and family teaching.
  • Continuous assessment of asthma control and severity.
  • Appropriate medication (relievers, rescue medications, controllers, maintenance medications).
  • Asthma action plan.
  • Regular follow-up.

Categories of Asthma Medications

  • Relievers (fast acting): Bronchodilators, anticholinergics.

    • Short-acting beta-adrenergic agonists (e.g., salbutamol/ventolin).
    • Anticholinergics/short-acting muscarinic antagonists (e.g., ipratropium/atrovent
  • Controllers (long-term): Anti-inflammatory medications.

    • Corticosteroids -Leukotriene modifiers
    • Anti-IgE -Long-acting beta adrenergic agonists (LABA) -Methylxanthines

Asthma Patient Education

  • Name, dosage, administration method, frequency, indications, adverse effects, improper use consequences and importance of adherence.
  • Assess patient's ability to use an inhaler accurately.
  • Medications are typically via inhalation route
  • Lower dose needed when using inhalers.
  • Systemic adverse events/ side effects are reduced when using the inhaler method.
  • Faster onset of action.
  • Use of inhaler with spacer/meter dose inhaler

COPD

  • Preventable disease characterized by persistent and progressive airflow limitation.
  • Chronic inflammatory response in the airways and lungs leads to damage.
  • Causes include smoking, noxious particles/gases, occupational chemicals and dusts, infection, heredity, and aging.
  • Airflow limitations during forced exhalation due to loss of elastic recoil and are not easily reversed.
  • Mucus hypersecretion, mucosal edema, and bronchospasm are contributors to the airflow limitations

COPD Clinical Manifestations

  • Suspected when patient presents with cough, sputum production, and dyspnea+ history of smoking.
  • Intermittent cough is an initial symptom.
  • Interrupts daily activities due to breathing issues and difficulty performing daily tasks.
  • Dyspnea usually triggers medical assessment.
  • Barrel chest.
  • Use of intercostal or accessory muscles
  • Prolonged Expiratory phase
  • Wheezes
  • Decreased lung sounds
  • Tripod position
  • Purse lips when exhaling
  • Edema is a sign of right-sided heart failure (HF).

COPD Complications

  • Cor pulmonale (right-sided heart hypertrophy, often with or without heart failure) due to pulmonary hypertension.
  • Sustained worsening of COPD symptoms during outbreaks can be due to bacterial issues.
  • Acute respiratory failure (overall decline in lung function, deterioration in health status, and risk of death).
  • Patients wait too long to reach health care providers when symptoms present as significant acute exacerbation of COPD.
  • Depression and anxiety are possible experiences.

COPD Interprofessional Care

  • Prevent disease progression through smoking cessation
  • Reduce frequency and severity of exacerbations.
  • Address respiratory symptoms and shortness of breath.
  • Improve exercise tolerance.
  • Treat exacerbations and complications of the disease
  • Improve health status, quality of life, morbidity, and mortality.

COPD Medications

  • Bronchodilator therapy (Beta 2 adrenergic agonists, anticholinergic medications).
  • Long-acting theophylline preparations.
  • Corticosteroids (oral for exacerbations).
  • NSAIDs.
  • Antibiotics (for exacerbations with purulent sputum).
  • Influenza and pneumonia vaccinations.

COPD Pulmonary Rehabilitation

  • Optimize functional status and quality of life.
  • Implement aerobic conditioning (upper/lower body).
  • Teach and utilize breathing exercises (e.g., pursed lip breathing).
  • Address energy conservation techniques (e.g., huff coughing)
  • Teach and address nutrition, smoking cessation, and environmental factors.
  • Provide health promotion, patient education, and self-management strategies.
  • Offer support and counselling for emotional well-being.

Comparison of COPD and Asthma

Feature COPD Asthma
Age at onset Usually >40 years Usually <40 years
Smoking history Usually >10 pack-years Not causal but can be a trigger
Clinical symptoms Persistent Intermittent and variable
Sputum production Often Infrequent
Allergies Infrequent Often
Spirometry Findings may improve but never normalize Findings often normalize
Disease course Progressive worsening with exacerbations Stable with exacerbations

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Description

This quiz explores the pathophysiology of asthma and chronic obstructive pulmonary disease (COPD), focusing on their characteristics and patient outcomes related to airway management. Test your knowledge on triggers, expected outcomes, and key features of these respiratory conditions.

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