COPD
Primary cause of COPD
smoking
Symptoms of asthma, name a few.
dry, nonproductive cough
wheezing
SOB
apprehension
anxiety
prolonged expiration
First manifestation of cystic fibrosis
Meconium ileus
What is a common trigger for sickle cell crises?
infection --> often pneumonia as most common
Others: blood loss, stress, acidosis,
Interpret this ABG:
pH 7.28
CO2: 84
HCO3: 28
Respiratory acidosis
What is the defining feature of a COPD exacerbation?
airflow limitation during forced EXPiration
What is the most effective drug for relieving a BRONCHOSPASM?
B2 adrenergic agonists i.e. albuterol
What is the diagnostic test for cf?
PCA
Transfusion
tx underyling cause i.e. fever
What is the major cause of respiratory acidosis?
What about respiratory alkalosis?
Hypoventilation
Alk: hyperventilation
Name four S/S of COPD exacerbation
INC wheezing, acue change in usual patterns of dyspnea, cough or sputum, malaise, fatigue, confusion, depression, anxiety
SEVERE:
use of accessory muscles, central cyanosis, AMS, edema in LE/signs of RSHF, unstable BP
what is the most effective anti-asthmatic drug?
A child diagnosed with CF is experiencing an acute exacerbation. What is a nursing intervention that will help with this exacerbation?
Ambulate pt
What is the role of hydroxyurea for sickle cell patients?
Inc hgb conc, dec sickled cells, reduces destruction of RBC
NOT used in acute SC crisis
pH: 7.5
CO2: 60
HCO3: 48
Compensated?
Interpretation: Metabolic alkalosis
(HCO3 and pH are alkalotic)
Compensated: Partial;
pH, bicarb and co2 are all abnormal.
You have a COPD patient who is on 2L NC w SpO2 98%. Is this okay/expected SpO2?
No; COPD pt target spo2 is 88-92. Higher Spo2 places pt at risk for hypercapnia
tx for asthma exacerbation list a few
Humidified O2
Hydration
Pt positioning
Quiet environment, rest, support
Medication
Dietary modifications for CF patients
decrease fat soluble vitamins (ADEK)
high protein, high calorie
- fluids : inc w exercise, warm weather, stress, do not limit fluids at night --> maybe try inc bathroom visits overnight instead.
- reproductive risks (1/4 chance of children acquiring
- avoid high altitude, immunize
- retinopahty assessments beginning at 10
Name some causes of metabolic acidosis
renal failure
diarrhea
DKA
starvation/malnutrition
Explain pulmonary htn and cor pulmonae.
Pulmonary hypertension: hypoxia --> constricted pulmonary vessels + viscous blood --> inc pulmonary pressure
Cor pulmonae: inc pulm pressure = inc pressure in R side of heart --> RSHF sx
Is dec wheezing a goos sign for asthma exac? Why or why not?
BAD! Means airway is constricting more
A 12-year-old female with cystic fibrosis presents to the clinic for a routine check-up. Her mother reports that the patient has been experiencing frequent greasy stools, poor weight gain, and fatigue. The patient’s BMI is in the 5th percentile, and her recent sputum culture shows colonization with Staphylococcus aureus. The healthcare provider suspects that her pancreatic enzyme replacement therapy (PERT) may be insufficient.
Which of the following is the most appropriate nursing intervention for managing the patient’s symptoms?
a. Increase the dosage of pancreatic enzymes and educate the patient on taking them with all meals and snacks.
b. Initiate a low-fat diet to reduce fat malabsorption and help with stool consistency.
c. Discontinue pancreatic enzyme therapy and switch to a protein-rich, low-carbohydrate diet.
d. Begin a course of corticosteroids to reduce inflammation and improve nutrient absorption.
A) Increase the dosage of pancreatic enzymes and educate the patient on taking them with all meals and snacks.
A 24-year-old female with a history of sickle cell disease is admitted to the emergency department with severe generalized pain, especially in her chest and lower back. Her vital signs show a heart rate of 118 bpm, respiratory rate of 28 breaths per minute, blood pressure of 96/58 mmHg, and oxygen saturation of 91% on room air. She reports that she has not urinated much in the last 12 hours, despite drinking fluids. Laboratory results reveal an elevated white blood cell count, decreased hemoglobin, and elevated reticulocyte count. The healthcare team suspects an acute vaso-occlusive crisis (VOC).
Which of the following is the priority nursing intervention for this patient?
a. Administer IV fluids to promote hydration and reduce blood viscosity.
b. Administer oxygen to improve tissue perfusion and prevent further sickling.
c. Administer a blood transfusion to increase hemoglobin and alleviate anemia.
d. Initiate intravenous opioids to manage pain and reduce stress on the body.
B: Admin O2
Interpret this ABG
pH: 7.38
CO2: 48
HCO3: 30
Compensation?
Fully compensated BC pH WNL but still leaning towards acidosis.