COPD
What are Some Physical Characteristic of COPD?
chest breathing - Use of accessory and intercostal muscles.
Barrel Chest
Virchow's triad-3 factors of etiology of venous thrombosis:
venous stasis
damage of the endothelium (inner lining of the vein)
hypercoagulability of the blood
Dyspnea, Tachypnea, Cough, Chest Pain, Hemoptysis, Crackles, Wheezing, Fever, Tachycardia, Syncope, Change in level of consciousness
Explain the differences between Neoplasia and Neoplasm
Neoplasia: Abnormal and progressive multiplications of cells
Neoplasm: New but abnormal tissue growth that is uncontrolled and progressive
Main Purpose of the Respiratory System?
Transfer of oxygen and carbon dioxide between the atmosphere and blood
What is the Max amount of O2 that should be given to a COPD patient: Bonus, what is the normal Sa02 for a patient with COPD. Finally, what is the Main drive for a COPD to breath?
2L
88-89%
Low O2
Atrial fibrillation
Bed rest, Prolonged immobility
Fractured leg or hip
Long trips without adequate exercise
Obesity
Orthopedic surgery (especially hip or lower extremity)
Pregnancy and postpartum period
Spinal cord injury or limb paralysis
Define Heparin and its antidote
Bonus: Define Warfarin (Coumadin) and its antidote
Low-molecular weight Heparin-weight heparin (LMWH) - Enoxaparin (Lovenox) has been found to be safer and more effective than unfractionated heparin.weight heparin (LMWH) - Enoxaparin (Lovenox) has been found to be safer and more effective than unfractionated heparin.
protemine sulfate
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Should also be initiated at time of diagnosis. Warfarin should be administered for at least 3 months, and then reevaluated. (antidote-VItamin K)
Name 4 of the 6 risk factors for Cancer
1. Smoking
2. Poor Nutrition
3. Excess weight
4. Sedentary Lifestyle
5. Exposure to Carcinogens
6. Genetics
Define Fine and Coarse Crackles
Bonus Define Wheezing
Fine Crackles: short high pitched, end of inspiration, Mostly on Inspiration.
Coarse Crackles: long, low pitched, air moving through mucus, bubbly sound, Mostly on Inspiration.
Wheezing: continuous & high pitched, heard on expiration first.
Explain some of the Nutritional Goals for COPD patients
Encourage fluids to promote adequate hydration and thin secretions
Encourage the client to drink 2 to 3 L/day to liquefy mucus.
Malnutrition in COPD clients is multifactorial
Increased metabolic rate
Lack of appetite
Monitor for weight and not changes
To decrease dyspnea and conserve energy for eating
Rest at least 30 minutes before eating
Avoid exercise for 1 hour before and after eating
Use bronchodilator 3o minutes before eating
Supplemental O2 may be helpful
High-calorie, high-protein diet is recommended
Eat five to six small meals to avoid bloating and early satiety (fullness
Avoid
Foods that require a great deal of chewing
No exercises 1 hour before and after eating
Gas-forming foods
What are the clinical Manifestations of DVT?
unilateral leg edema
pain
tenderness with palpation
dilated superficial veins
a sense of fullness in the thigh or the calf, paresthesias (tingling, prickling)
warm skin, erythema, or a systemic temperature greater than 100.4° F
If the superior vena cava is involved, similar symptoms may occur in the arms, neck, back, and face.
List Some Nursing Interventions for PE
Semi-High Fowler’s position -to facilitate breathing
Oxygen therapy - administer as ordered
Frequent assessments - careful monitoring of vitals signs, cardiac rhythm, pulse oximetry, ABGs, and lung sounds
IV access -maintain IV line Avoid giving IM injections to prevent localized bleeding
IV Therapy-Heparin
Monitor laboratory results - to endure therapeutic range INR (for warfarin) aPTT for IV Heparin
Emotional support and reassurance
Primary Prevention of Cancer
Bonus: Secondary Prevention of Cancer
Primary Prevention: Healthy Diet and weight, Regular Physical activity, Have regular health examinations, Avoidance of excessive exposure to sunlight, Get adequate rest, limit alcohol use, smoking cessation, cope with stress.
Secondary stress: Practice recommended cancer screenings, Practice self-examination, Know “7 Warning Signs of Cancer”, Seek medical care if cancer is suspected, Prophylactic surgery for genetic risks Lifestyle habits to reduce risks
Three ways organisms reach lungs
Aspiration from nasopharynx or oropharynx
Inhalation of microbes present in air
Hematogenous spread from primary infection elsewhere in body
Describe Pursed Lip Breathing
Pursed lip breathing
Prolongs exhalation and prevents bronchiolar collapse and air trapping
Teach clients to use “just enough” positive pressure
What is the most serious Complications of DVT?
Pulmonary embolism (PE)
What is a potential cause of deep vein thrombosis (DVT) That is women specific?
Oral contraceptives
Cancer Treatment and Management Goals
Curative
Control of Disease
Palliative
Name four of the five Clinical Manifestations of Pneumonia
Cough
Fever, chills
Dyspnea, tachypnea
Pleuritic chest pain
Green, yellow, or rust-colored sputum
What are some of the Prioritize client problems
Ineffective breathing pattern
Ineffective airway clearance
Impaired gas exchange
Imbalanced nutrition: Less than body requirements
Risk for infection
How can we as nurses gauge the effectiveness of treatment?
No evidence of PE
Pain relief
Decreased edema
Increased knowledge of disorder
Treatment plan
No skin ulceration
No bleeding complications
What is the name of the Main Diagnostic Study for PE
Bonus: If a patient cannot have contrast, Then what Diagnostic Studies do Medical teams do.
Spiral (helical) CT scan (Requires IV contrast)
Bonus: Ventilation-perfusion (V/Q) scan
What is Myelosupression? What are some side effects of Myelosupression?
Bone marrow suppression (myelosuppression) 🡪 Low WBC, RBC, and platelets 🡪 risk for infection, anemia, bleeding, fatigue.
Thrombocytopenia: increased risk of spontaneous bleeding or major hemorrhage (when platelets are <50,000)
SAFETY is critical, minimize procedures, may get platelet transfusion for <20,000
Anemia: later onset, can cause extreme fatigue
May administer growth factors (e.g. Epoetin) to stimulate RBC growth.
Only give RBCs in extreme cases/when patient symptomatic
Name Four Different ways to Diagnosis Pneumonia
History & Physical – events leading to diagnosis, lung sounds, RR
Chest x-ray – shows pattern, can show atelectasis and pleural effusions
Blood cultures & Sputum analysis – culture and gram stain (obtain before antibiotics if possible)
CBC with differential – WBC >15k
Pulse oximetry – less than 90%
ABGs – look for hypoxia, PaO2 <80 & acidosis
Thoracentesis – drain plural fluid
Bronchoscopy with washings