Chronic Bronchitis
A patient presents to the hospital with chronic bronchitis. What physical features will the nurse expect to observe?
BLUE BLOATER! Expect to see cyanosis, clubbing, obesity, and peripheral edema.
Your patient has a fever. What effect does the nurse know this will have on the body's hemoglobin?
Hemoglobin loses it's affinity for oxygen the warmer you are. The protein may 'think' you are exercising and have an increased oxygen demand. Thus, the hemoglobin will release oxygen more readily to the tissues.
A patient presents to the hospital with emphysema. What physical features will the nurse expect to observe?
PINK PUFFER! Look for pink skin, cachexia, barrel chest from air trapping in the alveoli, and weight loss from difficulty breathing.
The patient presents to the hospital with pneumonia. What vital signs/lab studies are the nurses watching to monitor for possible sepsis?
- Hypotension
- Fever
- Elevated WBCs
- Increased HR
The doctor is concerned Timmy has asthma. What pulmonary function tests might they order?
- Spirometry
- Peak expiratory flow rate
The nurse is looking at the lab values of someone with chronic bronchitis. What will they see?
- Blood pH that is slightly acidotic!
- Polycythemia!
- Elevated bicarbonate as the body attempts to compensate!
- ABGs with low PaO2 and elevated PaCO2
The patient has an alkalotic blood pH from hyperventilating. What effect does this have on the hemoglobin?
Hemoglobin's affinity for oxygen increases when the blood pH rises. It may hold on more 'tightly' therein decreasing the amount of oxygen released to the tissues.
The nurse is looking at the lab values for someone with emphysema. What will they expect to see?
- Acidotic blood pH from carbon dioxide retention
- Decreased PaO2
- Increased bicarbonate as a compensatory mechanism
- Polycythemia!
What type of pneumonia will the nurse suspect if they observe foul smelling sputum?
Aspiration pneumonia. Particularly common in patients with altered mental status.
Timmy blows into a peak flow meter. Timmy is in the red zone. What does the nurse interpret this finding to mean?
DANGER! This patient may be having an asthma attack. Alert the provider and administer a SABA.
The nurse is listening to the patient's lungs. What do they hear?
- Rales
- Rhonchi
- Wheezing
- Dimished sounds
Your patient is hypothermic. What do you expect their oxygen saturation to do?
These patients may appear cyanotic. Hemoglobin is less inclined to let go of the oxygen it carries in cold temperatures.
The nurse is listening to the patient's lungs. What do they hear?
- Rales
- Wheezing
- Diminished
The patient with pneumonia has a dry, nonproductive cough. Why are antibiotics withheld?
Bacterial pneumonia presents with green/yellow sputum when coughing. This patient likely has viral pneumonia.
A patient with asthma (Timmy) returns to his provider with oral thrush. What has timmy failed to do?
Rinse his mouth and spit after use of his inhaled corticosteroid.
The patient has an elevated WBC count and purulent sputum. Why might this be the case?
Patient's with chronic bronchitis have weakened immune and lung function. As a result, they may suffer from recurrent respiratory infections.
The patient has an acidic blood pH from diabetic ketoacidosis. How does hemoglobin respond?
In acidic conditions, hemoglobin loses its affinity for oxygen and releases it more readily to the tissues.
The patient has an elevated WBC count. Why?
Infection in these patients is common!
What lab values indicate that the pneumonia may have progressed to sepsis?
- Elevated lactate inidicates organ dysfunction caused by a systemic inflammatory response to the bacteria
- Positive blood culture
- Elevated WBC count
- Hyponatremia, hyperkalemia, and elevated BUN & creatinine indicate renal dysfunction from decreased perfusion
Timmy comes back once again because, although he is using his inhaler, his ABGs show low PaO2 and elevated PaCO2. What does the nurse do?
Watch timmy use his inhaler. He is supposed to shake, exhale fully, create a tight seal with the lips, push down, and inhale deeply and slowly for ten seconds.
What complication of chronic bronchitis may the patient come to the hospital for?
- Cor pulmonale (right sided heart failure) from pulmonary hypertension and the resulting strain on right side of the heart!
The patient lives at the top of mount everest where the altitude is quite high. What lab result would they expect to see?
Polycythemia! The amount of RBCs may increase to compensate for the diminished oxygen level. This can be problematic as thicker blood increases the risk of clotting.
What complication of emphysema may the patient come to the ER for?
Pneumothorax! Damaged alveoli can rupture, leaking air into the pleural space and causing collapse. Characterized by sudden, severe chest pain!
A patient with pneumonia is not oxygenating well. At what SpO2 level does the nurse think about swapping the nasal cannula for a nonrebreather mask if levels do not rise?
< 85%
Timmys mom is having an asthmatic attack because she cannot handle her son's asthma attacks. What does the nurse know stress does to the body?
Stress causes inflammation in the body that can narrow the airways. Advice Timmy's mother to stay calm.