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NURS 3510 Nursing Adults with Chronic Health and Rehabilitation Concerns Active Learning Guide: Respiratory Disorders Purpose/Overview Active lea...

NURS 3510 Nursing Adults with Chronic Health and Rehabilitation Concerns Active Learning Guide: Respiratory Disorders Purpose/Overview Active learning guides help students to focus their study time by using knowledge-level information, then focusing on application and analysis of information to provide context in relation to the course and career skills. Students should review the active learning guide before beginning to engage with the module content, then work to complete the guide during and after to engage with the content. An active learning guide is not the same as a study guide or a test blueprint. It serves as a guide to help the student navigate the course and content. Instructions Review the active learning guide before you begin reading and engaging with other content in the module. Looking at the questions beforehand will give you a preview of the information you will be learning, including the key concepts and takeaways. As you work through the module content, complete the active learning guide. Some questions may be reflective and require that you finish all content prior to responding. The completed learning guide will be turned in one week before the exam. There are a possible 20 points for this learning guide. Brittney- Red, Minton-Purple Harper- Pink, Sean-Blue, Ethan-Green Reading Focus A Sacred Covenant: The Spiritual Ministry of Nursing: (6 points) Please answer the following questions about spiritual ministry. Chapter 3 has information to help support your answer. 1. Share how you were able to bear your patient’s burden with them today: I had a pt. that had metastasized prostate cancer and was only given a prognosis of 3 months. He had battled this for 15 yrs. All he wanted was someone to pray with him and be happy and just live life and be thankful for the blessings they had. I spent every day with this pt. reading Jesus is calling devotional and prayed with this man until his last breath. He felt that someone was always there with him and going through every part of his disease. His wife made sure to tell me that I brought a smile and light to his day every day and it always ended with him having a good day. 2. What conversation or event led to you being able to intervene and give them support? The conversation was when he had come into the clinic and without even knowing much about me told me that I was going to change the world someday and I don't even know it. He would also tell me that I was going to make a great NP one day. So it was almost like God knew I needed  NURS 3510 Nursing Adults with Chronic Health and Rehabilitation Concerns someone like him to reassure me that God was paving my path to do healthcare and take care of people. 3. Provide three examples of open-ended questions that would help you make a stronger spiritual connection with your patients: Do you believe in prayer? Do you have any prayer requests? Is it okay if I read you a scripture today? Minton 1. Share how you were able to bear your patient’s burden with them today. I had a patient with chronic heart failure and terrible leg edema. She was on lasix, which was causing her to urinate very frequently. She wasn’t able to get up very easily, so she had an external catheter that she was quite frustrated with because it kept leaking. I was able to provide emotional support as she expressed her feelings and needs. I was able to bear the burden with her and be an emotional support person listening and offering advice. 2. What conversation or event led to you being able to intervene and give them support? The patient called because her purewick leaked and she was seeming to get frustrated with the system as a whole, and as I was changing her, I was able to listen and feel her frustration. 3. Provide three examples of open-ended questions that would help you make a stronger spiritual connection with your patients. How do you cope with the hard moments like this? What motivates you to get better? Do you have any prayer requests/do you believe in prayer? Harper 1. Share how you were able to bear your patient’s burden with them today. My patient was suffering from chronic lymphocytic lymphoma and, unfortunately, did not have much contact with any family members so she was battling with her illness mostly alone. She had nobody to talk to about her fears or just conversate with so I was able to spend some time with her and just listen. More than anything, my pt just wanted to talk so I sat with her and listened as she spoke about her hobbies and provided her an outlet with some interaction and therapeutic communication. I was patient as I spent time with her and allowed her to talk and offered assistance for moving to the bathroom, eating, and personal care like brushing her teeth and hair to make her feel as good as possible. 2. What conversation or event led to you being able to intervene and give them support? As my patient talked about where she grew up and her past working as a hairdresser, she proposed her sadness associated with the loss of her hair as a result of chemotherapy. I spoke  NURS 3510 Nursing Adults with Chronic Health and Rehabilitation Concerns to her about how beautiful she already is and suggested other ways she could make up for her hair loss like a wig and she appeared pleased by these recommendations. 3. Provide three examples of open-ended questions that would help you make a stronger spiritual connection with your patients. How do you like to cope with going through hardships? How would you describe your spirituality? How can I be supportive of your spirituality through this process? Ethan 1. Share how you were able to bear your patient’s burden with them today. I had a patient with dementia. I used my own experience from my grandmother having it and how it affects my grandfather to build a relationship with both the patient and his wife. He was very confused and needed almost constant redirection, and his wife was starting to seem exasperated so just spending time with them allowed her to have a break while knowing he was safe. 2. What conversation or event led to you being able to intervene and give them support? At home they have chickens that needed to be cared for, so his wife had to leave to feed them. As soon as she left his symptoms of dementia worsened, and I spent almost the entire day in his room until she was able to return. 3. Provide three examples of open-ended questions that would help you make a stronger spiritual connection with your patients. What experiences have you had that you felt God’s presence? What is the earliest memory you have of spirituality? Who in your life introduced you to God? Sean 1. Share how you were able to bear your patient’s burden with them today. My patient is suffering from stage 3 chronic kidney disease. The clinical manifestations of this chronic disease are swelling of the feet, ankles, hands and eyes. This is due to buildup of excess water and waste that the body is not able to get rid of. I was able to assist the patient with ambulation due to balance issues caused by the swelling in the lower extremities. 2. What conversation or event led to you being able to intervene and give them support? My patient made mention of an upcoming ZZ Top concert in Oklahoma that they were hoping to go to. 3. Provide three examples of open-ended questions that would help you make a stronger spiritual connection with your patients. Can you share with me a time you felt a connection with something greater than yourself?  NURS 3510 Nursing Adults with Chronic Health and Rehabilitation Concerns What place does spirituality have in your life to help you cope with health challenges during difficult times? How can I support you in fulfilling any spiritual concerns you may have during this time? In the text, you will see essential boxes, such as Assessment Abnormalities Tables, which discuss abnormal findings in the assessment of adults. Biologic Sex Consideration Boxes which contain a summary of how the disease affects male and female. Clinical Judgment Model Case Studies at the end of every chapter are available to promote your understanding of the decision-making process. Many other tables and boxes are noted in the text that will bring out the most valuable information organized in an effective summary. Bronchiectasis 1. What is a bronchiectasis? permanent, abnormal dilation of the medium sized bronchi 2. What are the hallmark characteristics of bronchiectasis? continuous cycle of inflammation, damage to the airways, and remodeling of the airways 3. What happens when the wall of the bronchial system is injured? the mucociliary mechanism is impaired and mucous and microorganisms can not be removed as effectively 4. What is the result of thick mucus and bacterial growth? inflammatory response, and blockage of bronchi that impairs airway clearance Professor Notes: Clinical Judgement is the process by which the nurse decides how to care for a patient. This decision focuses on gathering data, analyzing that data, arriving at a hypothesis, and then creating solutions and acting to either save or improve health for the patient. We will use the Clinical Judgement Model as we learn how to care for patients with chronic respiratory disorders. Cues (collection of data: each piece of data is called a CUE) Please answer the following questions about assessment cues. 5. What are the abnormal assessment findings (clinical manifestations) in a person that is suffering from bronchiectasis? persistent cough with consistent production of thick, tenacious, purulent sputum In rare situations, there may be no sputum production and little cough  NURS 3510 Nursing Adults with Chronic Health and Rehabilitation Concerns large connections (anastomoses) may develop between blood vessels in the lungs, and hemoptysis may occur In severe cases, bleeding can be life-threatening pleuritic chest pain, dyspnea, wheezing, clubbing, weight loss, and anemia adventitious sounds are heard (e.g., crackles, wheezes) over the lung fields 6. What is the family history in relation to respiratory illness? Cystic fibrosis, COPD from α1-antitrypsin deficiency, and asthma have a strong genetic link so if people have a family history of respiratory problems, they have a greater risk for developing them. 7. List the diagnostic studies used to diagnose bronchiectasis. CT scan is the gold standard for diagnosing bronchiectasis Chest x-rays may show nonspecific abnormalities 8. What laboratory studies may be used to diagnose bronchiectasis? Spirometry usually shows an obstructive pattern, including decreases in FEV1 and FEV1/FVC Sputum cultures may confirm the presence of infection as patients often have Haemophilus influenzae, Staphylococcus aureus, or Pseudomonas aeruginosa complete blood cell count and AAT level may be done Analyze Cues: Develop hypothesis (Nursing Diagnosis) 9. List the clinical problems associated with bronchiectasis. Please provide three completely written nursing diagnoses. Impaired respiratory function Activity intolerance Deficient knowledge Prioritize Hypothesis 10. Explain the process of choosing the priority clinical problem. Maslow’s Hierarchy. Physiological first, then safety, and so on. Generate Solutions 11. What are the goals of nursing care for patients with bronchiectasis? The overall goals for the patient with bronchiectasis include (1) maintain a patent airway; (2) have slow, steady, and unlabored breathing; and (3) develop a routine that permits as much functional independence as possible with activities of daily living (ADLs). Take Action 12. What are the important teaching topics?  NURS 3510 Nursing Adults with Chronic Health and Rehabilitation Concerns Encourage them to follow as healthy a lifestyle as possible. Stress the need to quit smoking or, at minimum, reduce the amount smoked. Stress the need to follow a healthy diet. Encourage the patient to engage in some type of regular exercise (within the comfort and safety of their condition). Discuss how to prevent exacerbations and review airway clearance techniques (ACTs). Maintaining hydration is important to liquefy secretions. Unless contraindicated, the patient should drink at least 2 to 3 L of fluid daily. To achieve this, tell the patient to increase intake by 1 glass per day until they reach that goal. Have the patient use low-sodium fluids to avoid fluid retention. Rest is important to prevent overexertion. Teach the patient and caregiver signs and symptoms to report to the HCP. These include increased work of breathing (WOB), sputum production, or dyspnea. Fever, chills, and chest pain may or may not occur with an exacerbation. Teach patients when to contact the HCP if hemoptysis occurs. Some patients expectorate a “spot” of blood at times. This is usual for them and does not require urgent attention. However, if the patient expectorates a moderate to large amount of blood, they should contact the HCP at once. 13. What are the medications used to treat patients with bronchiectasis? List their actions, side effects, route, and dosage. What teaching is necessary related to the drugs ordered by the physician? Drug therapy (Tables 31.8 and 31.9 and Figs. 31.6 and 31.7) Condensed Version Antibiotics Action->Medicate bacterial infections and decrease exacerbations. Side Effects->Photosensitivity, Allergic Reactions, Nausea, Diarrhea Route->Oral or IV Dosage-> Fluctuates depending on the specified antibiotic and/or severity of infection. Ex, Amoxicillin 500 mg to 1 g q8 hrs. Ciprofloxacin 500 mg q12 hours. Patient Education->Finish the complete course of antibiotics, no matter if symptoms improve. Report any signs/symptoms of an allergic reaction (itching, rash, or swelling) immediately. Continue hydration maintenance to assist with flushing the kidneys. Bronchodilators Action Relax and dilate pathways to assist with breathing. Side Effect Tachycardia, Tremors, Dry Mouth and Palpitations Route  NURS 3510 Nursing Adults with Chronic Health and Rehabilitation Concerns Inhalation (Nebulizer or MDI) Dosage Fluctuates depending on specific medication. Ex, Albuterol 2.5 mg route nebulizer q 4-6 hours as PRN. Patient Education Use as directed, especially before efforts that may cause shortness of breath. Rinse out mouth after using to prevent thrush. Report significant increases in heart rate or palpitations to HCP. Mucolytics Action Loosen and thins out mucus to help with expectoration Side Effects Nausea, Vomiting and Mouth Sores Route Oral and/or inhalation Dosage Depends on prescribed medication. Ex, N-Acetylcystein 600 mg BID. Patient Education Increase fluids to assist with loosening mucus. Medication adherence and prescribed drug therapy needs to be followed. Do not mix with other medications without HCP counseling Inhaled Corticosteroids Action Decreases inflammation throughout the airways Side Effects Hoarseness, Throat Irritation, Oral Thrush Route Inhalation Dosage Fluctuates depending on specific medication. Ex,Fluticasone 100-250 mcg BID.  NURS 3510 Nursing Adults with Chronic Health and Rehabilitation Concerns Patient Education Rinse out mouth after using to prevent thrush. Not to be used as a rescue inhaler for acute signs/sympotms Use as prescribed to sustain control over signs/symptoms Oral Corticosteroids Action Decreases inflammation system wide during acute exacerbations. Side Effects Mood Swings, Increased Blood Sugar, Weight Gain, Osteoporosis with long term administration Route Oral Dosage Fluctuates depending on specific medication. Ex, Prednisone 40-60 mg daily acute course. Patient Education Reduce Gastrointestinal upset by taking with food Do not stop medication abruptly. Taper off may be needed Monitor for mood changes and increased appetite. Microlides Action Anti inflammatory and prevention of infection Side Effects Gastrointestinal upset, Hearing Impairment, Liver Enzyme Elevation Route Oral Dosage Ex, Azithromycin 250-500 mg three times weekly Patient Education Medical adherance needs to be followed even when symptoms are not present Report any changes in hearing or severe gastrointestinal symptoms to HCP.  NURS 3510 Nursing Adults with Chronic Health and Rehabilitation Concerns Drug Therapy Extended Version Corticosteroids All guidelines recommend using ICS as first-line agents in an acute asthma attack and as the first step in acute asthma management. They are the most effective short-term controller drugs for asthma. Corticosteroids are antiinflammatory drugs. They reduce bronchial hyperresponsiveness, block the late-phase response, and inhibit the migration of inflammatory cells. They are more effective in improving asthma control than any other drug. ICSs side effects include easy bruising and decreased bone mineral density. Oropharyngeal candidiasis, hoarseness, and dry cough are local side effects. These problems can be reduced or prevented by using a spacer with the metered-dose inhaler (MDI) and by gargling with water or mouthwash after each use. Using a spacer or holding device can help get more drug into the lungs. Bronchodilators The 3 classes of bronchodilator drugs used in asthma therapy are β2-adrenergic agonists (also referred to as β2-agonists), methylxanthines, and anticholinergics. β2-Adrenergic agonist drugs β2-Adrenergic agonists may be SABAs or LABAs. While inhaled SABAs remain effective drugs for relieving acute bronchospasm (as seen in an acute asthma attack), they are no longer first-line therapy. They do play a key role in asthma management. These drugs have an onset of action within minutes and are effective for 4 to 8 hours. They stimulate β-adrenergic receptors in the bronchioles, producing bronchodilation. They also increase mucociliary clearance. β2-Adrenergic agonists can prevent bronchospasm caused by different triggers because they prevent the release of inflammatory mediators from mast cells. They do not inhibit the late-phase response of asthma or have antiinflammatory effects. If used often, inhaled β2-adrenergic agonists may cause tremors, anxiety, nausea, tachycardia, and palpitations.22 Too frequent use of β2-adrenergic agonists indicates poor asthma control, may mask the severity of the condition, and lead to reduced drug effectiveness. SABAs should not be used alone for recurrent, repeated asthma attacks, or for long-term control. Guidelines suggest that they may be an alternate reliever medication when the patient does not respond to low-dose ICS. Like SABAs, LABAs should not be used alone as primary treatment. They should only be used only if the patient does not respond to medium-dose ICS. In other words, LABAs can be used as an adjunct to treatment. Examples of LABAs used in the treatment of asthma attacks include salmeterol and formoterol. LABAs are effective for 12 hours. Tell patients that LABAs should not be used to treat acute symptoms or to obtain quick relief from bronchospasm. Teach the patient that these drugs are  NURS 3510 Nursing Adults with Chronic Health and Rehabilitation Concerns used only once every 12 hours. Combination therapy using an ICS and a LABA is available in several inhalers (e.g., fluticasone/salmeterol [Advair], budesonide/formoterol [Symbicort]). Combinations are more convenient, improve adherence, and ensure that patients receive the LABA with an ICS. Methylxanthines Sustained-release methylxanthine preparations are not a first-line controller medication. They are used only as an alternative therapy. One example is theophylline, a methylxanthine that is a weak bronchodilator with mild anti-inflammatory effects. Theophylline use has been replaced by newer drugs, namely inhaled ICS and β2-adrenergic agonists. GINA no longer recommends theophylline as part of its treatment guidelines. There are several problems with theophylline. First, there are many side effects. Second, there is well interactions with many other drugs. Third, because theophylline has a very narrow margin of safety, we must check serum blood levels regularly to see if drug levels are within therapeutic range. Anticholinergic drugs Anticholinergic drugs affect the muscles around the bronchi (large airways). When the lungs are irritated, these bands of muscle can tighten, causing bronchoconstriction via the parasympathetic nervous system. Anticholinergics work by preventing these muscles from tightening. Consequently, these drugs promote bronchodilation. Anticholinergic drugs are less effective than equivalent doses of SABAs. Therefore, short-acting anticholinergic drugs are not used except for in severe acute asthma attacks. Examples include ipratropium and tiotropium. Leukotriene Modifiers Leukotrienes are inflammatory mediators produced from arachidonic acid metabolism. They are potent bronchoconstrictors. Some leukotrienes cause airway edema and inflammation, contributing to the worsening symptoms of an acute asthma attack. Leukotriene receptor antagonists (LTRAs) block the release of some substances from mast cells and eosinophils, producing bronchodilator and antiinflammatory effects. LTRAs do not reverse bronchospasm in acute asthma attacks. They are less effective than corticosteroids and used only as adjunct therapy for those patients who do not respond to treatment with ICS. LTRAs include zafirlukast (Accolate), montelukast (Singulair), and zileuton (Zyflo CR). Monoclonal Antibodies Anti-immunoglobulin E Omalizumab (Xolair) is a monoclonal antibody to IgE that decreases circulating free IgE levels. Omalizumab prevents IgE from attaching to mast cells, thus preventing the release of chemical mediators. It is given to patients with moderate to severe asthma or those not controlled with  NURS 3510 Nursing Adults with Chronic Health and Rehabilitation Concerns ICSs alone. There is a risk for anaphylaxis, so patients must receive the injection in a setting where this emergency can be treated. 14. How does the patient liquefy the thick, tenacious secretions? Hydration-> Helps to thin mucus. Assists with making it easier to expectorate. Humidity-> Moisture in the air can assist with loosening and thinning the mucus. Physical Activity-> Routine physical activity can increase lung function and assist in the mobilization of secretions. Medications-> Guaifenesin is a routinely prescribed expectorant. Nebulizer-> Mucolytics as in N-acetylcysteine or a saline solution can be nebulized Chest Physiotherapy-> Postural drainage, vibration and percussion can assist with mobilizing secretions 15. When should a patient call the HCP? Yellow Zone (between __ and __L/min [50% to