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(4) Chronic Bronchitis, emphysema, bronciectasis_PPT..pptx

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(4) Chronic Bronchitis, emphysema, bronciectasis_PPT..pptx

  1. 1. COPD Characterized by: ⚫progressive airflow ⚫limitations into & out of the lungs ⚫Elevated AWresistance ⚫IRREVERSIBLE LUNG DISTENTION ⚫ABG IMBALANCE
  2. 2. Causes of COPD ⚫SMOKING(80 – 90%), 2nd hand smoke ⚫3 E’s
  3. 3. Most Common S/sx: ⚫1. ⚫2. ⚫3. ⚫4. ⚫5.
  4. 4. 3 Primary symptoms and other manifestations: ⚫1. Sputum production ⚫2. chronic cough ⚫3. dyspnea (on exertion) ⚫4. weight loss ⚫5. use of accessory muscles
  5. 5. Laboratory Data ⚫1. ABG analysis ⚫2. chest x-ray: ⚫CONGESTION (in bronchitis) ⚫HYPERINFLATION (in emphysema)
  6. 6. Nursing Diagnoses ⚫ Impaired gas exchange rt airflow obstruction from collapsed alveoli & narrow bronchioles ⚫ Ineffective breathing pattern RT increased mucous & air trapping ⚫ Activity intolerance RT fatigue & hypoxemia ⚫ Nutrition imbalance less than body requirements RT increased energy expenditures from breathing difficulties
  7. 7. INTERVENTIONS ⚫AIRWAY!!! 1.Position 2.Admin Bronchodilators 3.Breathing & blowing exercises Ex. Incentive spirometry (deep inhalation & prolonged expiration)
  8. 8. OVERVIEW ⚫CHRONIC BRONCHITIS 🡪inflammed bronchioles ⚫Aka “blue bloater” ⚫🡪obese, cyanotic
  9. 9. OVERVIEW ⚫EMPHYSEMA ⚫🡪 overdistented alveoli ⚫Aka “PINK PUFFER” ⚫🡪thin, ruddy, barrel chest
  10. 10. OVERVIEW ⚫ASTHMA ⚫🡪inflammed air passages ⚫🡪whitish sputum ⚫🡪 wheezing
  11. 11. GENERAL INTERVENTIONS (A-F) ⚫A – minophylline (Methylxantines – CNS & smooth muscles) ⚫Theophylline Signs of Toxicity: 1.Vomiting 2.hyperactivity 3.Insomnia 4.Agitation 5.Tachycardia (> 200 bpm)
  12. 12. B - ronchodilators (beta-adrenergics – Airway & smooth muscles) Types: (oral, inhaled, per neb) Metered-Dose Inhaler Dry powder inhaler Nebule Assignment: at least 5 pictures of different types of Bronchodilators ( long bond paper)
  13. 13. MDI ⚫Shake ⚫Tilt head back & breathe out slowly ⚫Press – inhale slowly & deeply (3 – 5 secs) ⚫Hold breath ( 8 – 10 secs) ⚫1 – 2 mins for the 2nd dose ⚫w/out spacer: 1 – 2” away (mouth) ⚫w/ spacer/ holding chamber: lips around the mouth piece ⚫Admin bronchodilator then corticosteroids ( wait for 5 mins)
  14. 14. SIDE EFFECTS ⚫Tachycardia ⚫Palpitations ⚫Dysrrhythmias ⚫Hyperglycemia ⚫h/a ⚫dizziness
  15. 15. Contraindications: (caution) ⚫HPN ⚫DM ⚫Cardiac arrythmias
  16. 16. C-hest physiotherapy ⚫Percussion & vibration over the thorax 🡪 loosen secretions BEST TIME: ⚫AM ⚫1 HR Before, 2 hrs after eating STOP: PAIN Post care: ______
  17. 17. D- elivery of OXYGEN ⚫@ 1 – 3 ⚫LPM (1 – 2 LPM) ⚫Stimulus to breathe is a low arterial P02 ⚫🡪 RESPIRATORY DISTRESS ⚫pH= 7.35-7.45 ⚫P02 = 85 – 100 mmHg ⚫PC02= 35 – 45 mmHg ⚫HC03= 22-26mEqs/L
  18. 18. Evaluation of Oxygen (P02) ⮚100 = more than adequate 02 ⮚85 – 100 = adequate 02 ⮚78 – 84 = mild hypoxemia ⮚60 – 77 = moderate hypoxemia ⮚40 – 59 = severe ⮚< 40 = very sever hypoxemia
  19. 19. Venturi mask
  20. 20. E- xpectorants ⚫Water - expectorant of choice ⚫Mucus secreting drugs 🡪Symptom relief only ⚫AVOID – ANTITUSSIVE (to depress cough)
  21. 21. F-ORCED FLUIDS
  22. 22. CHRONIC BRONCHITIS
  23. 23. Chronic bronchitis involves inflammation and swelling of the lining of the airways that leads to narrowing and obstruction of the airways.
  24. 24. The inflammation also stimulates production of mucus (sputum) by GOBLET CELLS, which can cause further obstruction of the airways.
  25. 25. Chronic bronchitis usually is defined clinically as a daily cough with production of sputum for three months, two years in a row.
  26. 26. ⚫Obstruction of the airways, especially with mucus, increases the likelihood of bacterial lung infections.
  27. 27. PATHOPHYSIOLOGY SMOKING Irritation of AW Hypersecretion of mucus mucus – secreting glands & goblets cells (increase in number) mucus production mucus plug persistent cough
  28. 28. (Chronic) Inflammation bronchial walls thickened bronchial lumen narrows Adjacent alveoli may be damaged & fibrosed altered alveoli (macrophage function) Susceptible to respiratory infection
  29. 29. Inflammation Release of chemical mediators (BRADYKININ, HISTAMINE, PROSTAGLANDIN) Increased capillary permeability fluid/ cellular exudation edema of mucous membrane hypersecretion of mucus Persistent cough
  30. 30. S/Sx: ⚫Persistent bout of cough ⚫Thick, gelatinous sputum ⚫Wheeze & dyspnea ⚫Cyanotic nailbed ⚫SOB ⚫Tachypnea ⚫Acidosis ⚫Hypercapnia
  31. 31. Diagnostic Tests ⚫Chest roentgenography ⚫PFT- via SPIROMETRY – to evaluate airflow obstruction ⚫ABG analysis ⚫TIDAL VOLUME - the volume of air moved into and out of the lungs during quiet breathing
  32. 32. PFT
  33. 33. Exacerbation ⚫RETAINED SECRETIONS: 1. Chronic bronchial obstruction 2. Air trapping 3. Hypoxemia 4. CO2 retention 5. Localized infection 🡪EMPHYSEMA 🡪RSHF or COR PULMONALE
  34. 34. What treatment is available for COPD? The goals of COPD treatment are: 1. to prevent further deterioration in lung function; 2. to alleviate symptoms; 3. to improve performance of daily activities and quality of life.
  35. 35. The treatment strategies include: ⚫ 1.quitting cigarette smoking; 2. bronchodilators 3.vaccination against flu influenza3.vaccination against flu influenza and pneumonia; 4.regular oxygen supplementation; and 5. pulmonary rehabilitation
  36. 36. EMPHYSEMA
  37. 37. EMPHYSEMA
  38. 38. PATHOPHYSIOLOGY SMOKING/ HEREDITY/AGING DISEQUILIBRIUM (ELASTASE & ANTI ELASTASE) DESTRUCTION OF ELASTIC RECOIL RETENTION OF CO2 OVERDISTENTION OF THE ALVEOLI
  39. 39. Hypercapnia Impaired diffusion of 02 Hypoxemia
  40. 40. alveolar walls maybe destroyed ____ dead space ___ pulmonary bed size ___Pulmonary capillary bed size🡪 ___ blood pressure in pulmonary artery
  41. 41. TYPES OF EMPHYSEMA 1.PAN LOBULAR (PANACINAR)- destruction of respiratory bronchiole, alveolar duct, alveoli 🡪 Typically – HYPERINFLATED (HYPEREXTENDED CHEST) 🡪 s/sx: 🡪 1. barrel chest 🡪 2. marked dyspnea on exertion 🡪 3. weight loss
  42. 42. 2. CENTRILOBULAR (CENTROACINAR)- center of the secondary lobule, preserving the peripheral of the acinus s/sx: V/Q mismatch
  43. 43. Late s/sx: 1. chronic hypoxemia 2. hypercapnia 3. Polycythemia Others: weight loss, easy fatigability, pursed-lip breathing, digital clubbing “PINK PUFFERS”
  44. 44. VENTILATION-PERFUSION PERFUSION- PULMONARY VEIN ALVEOLI O2 O2 O2 O2 CO2 CO2 O2 O2 O2 O2 VENTILATION- PULMONARY ARTERY O2 O2 O2 O2 O2 CO2 CO2 CO2 O2 O2 CO2 CO2 CO2
  45. 45. V/Q MISMATCH ⚫ALVEOLI O2 cO2 O2 O2 CO2 CO2 CO2 CO2 cO2 O2 O2 O2 CO2 CO2 CO2 CO2 O2 O2 CO2 CO2 CO2 CO2 VENTILATION- PULMONARY ARTERY PERFUSION- PULMONARY VEIN
  46. 46. V/Q = 4L/5L/MIN ⚫VENTILATION= REFERS TO THE AMT OF AIR IN THE ALVEOLI ⚫Q- PERFUSION=REFERS TO THE AMT OF BLD IN THE CAPILLARIES ⚫V = ALVEOLI RECEIVES AIR @ THE RATE OF 4L/MIN ⚫Q = CAPILLARIES SUPPLY THE RATE OF 5L/MIN
  47. 47. EMPHYSEMA
  48. 48. Diagnostic tests ⚫1. PFT 2. chest x-ray ⚫3. ABG analysis ⚫4. Alpha antitrypsin assay - ___
  49. 49. Management ⚫Bronchodilator ⚫Avoid narcotics, sedatives, tranquilizers ⚫Fluids ⚫Postural drainage ⚫Pursed-lip breathing ⚫Corticosteroids
  50. 50. GENERAL MANAGEMENT FOR COPD CASES ⚫1. exacerbation ⚫2. oxygen therapy ⚫3. surgical management ⚫Bullectomy ⚫Lung volume reduction surgery (LVRS)
  51. 51. BULLECTOMY
  52. 52. VIDEO-ASSISTED THORACOSCOPY
  53. 53. LUNG VOLUME REDUCTION SURGERY (LVRS)
  54. 54. ⚫4. pulmonary rehabilitation – educational, psychosocial, behavioral, physical
  55. 55. ⚫5. patient education ⚫A. Breathing exercises ⚫Diaphragmatic ⚫Pursed-lip ⚫B. inspiratory muscle training ⚫C. activity pacing ⚫D. physical conditioning ⚫E. 02 ⚫F. Nutritional ⚫G. Coping Measures
  56. 56. ASTHMA ( Page 1116) ⚫Is a chronic inflammatory disease of the airways characterized by episodic exacerbations of acute inflammation of the airways ⚫- symptom free periods & acute exacerbation
  57. 57. 3 MAIN PROBLEMS ⚫1. BRONCHOSPASM ⚫2. EDEMA OF THE MUCOUS MEMBRANES ⚫3. HYPERSECRETION OF MUCUS
  58. 58. etiology ⚫Triggers – cause the release of inflammatory mediators from the bronchial mast cells, macrophages, & epithelial cells ⚫- can be allergenic, pharmacological, environmental, air pollution – related, occupational, infectious, exercise – related
  59. 59. Allergens ⚫Animal dander (from the skin, hair, or feathers of animals) ⚫Dust mites (contained in house dust) ⚫Cockroaches ⚫Pollen from trees and grass ⚫Mold (indoor and outdoor)
  60. 60. Irritants ⚫Cigarette smoke ⚫Air pollution ⚫Cold air or changes in weather ⚫Strong odors from painting or cooking ⚫Scented products ⚫Strong emotional expression (including crying or laughing hard) and stress
  61. 61. Others ⚫ Medicines such as aspirin and beta-blockers, penicillin ⚫ Sulfites in food (dried fruit) or beverages (wine) ⚫ A condition called gastroesophageal reflux disease that causes heartburn and can worsen asthma symptoms, especially at night ⚫ Irritants or allergens that you may be exposed to at your work, such as special chemicals or dusts ⚫ Infections
  62. 62. Cyclic adenosine monophosphate (CAMP) -maintains balance between ALPHA- ADRENERGIC RECEPTORS & BETA- ADRENERGIC RECEPTORS ____________ receptors 🡪bronchoconstriction ______ receptors 🡪bronchodilation -- for relaxation of smooth muscles cAMP - __________
  63. 63. ⚫ Allergy (Extrinsic) ⚫ Inflammation (Intrinsic) ⚫ Release of chemical mediators by mast cells ⚫ ⚫ Histamine, Bradykinin, ⚫ Prostaglandin,Leukotrienes ⚫ ⚫ Bronchospasm/Broncoconstriction ⚫ Edema of mucous membrane ⚫ Hypersecretion of mucus
  64. 64. ⚫Narrowing of airways ⚫Increased work in breathing ⚫ Tends to sit up ⚫Restlessness ⚫Tachypnea/dyspnea ⚫Tachycardia ⚫Chest pain ⚫Flaring of alae nasi
  65. 65. ⚫Diaphoresis ⚫Cold clammy skin ⚫Wheezing ⚫Retractions Pallor, cyanosis
  66. 66. ⚫Exhaustion ⚫Slow, shallow respiration (hypoventilation) ⚫Retention of carbon dioxide (air trapping) Hypoxia ⚫Respiratory acidosis
  67. 67. SIGNS AND SYMPTOMS: ⚫ Dyspnea ⚫ coughing ⚫ wheezing ⚫ chest tightness possible mucus production ⚫ Signs of progressing exacerbation ⚫ Diaphoresis ⚫ Tachycardia ⚫ Widened pulse pressure ⚫ Hypoxemia ⚫ Cyanosis
  68. 68. Exercise induced astma
  69. 69. Classification of Severity of Asthma (Adult) table 33 -7, page 1119 ⚫I. MILD INTERMITTENT ⚫Symptoms <2 days/ wk ⚫< 2 nights/ mo ⚫2. MILD PERSISTENT ⚫> 2 wks but < 1 x in a day ⚫> 2 nights/ mo
  70. 70. ⚫3. MODERATE PERSISTENT – Daily ⚫> 1 night/ wk ⚫4. SEVERE PERSISTENT ⚫Continual ⚫Frequent (night)
  71. 71. DIAGNOSTIC TESTS: ⚫History (Family, environmental, occupational) ⚫Sputum and blood tests ⚫ABG and Pulse oximertry ⚫Chest x-ray
  72. 72. Levels of Asthma I. Mild intermittent <2 days/wk;<2nights/mo II. Mild Persistent >2 wks but <1/day; >2 nights/ mo III. Moderate Persistent Daily; > 1 night/wk IV. Severe Persistent Continuous; freq @ night
  73. 73. COMPLICATIONS: ● Status asthmaticus ● Respiratory failure ● Pneumonia ● Atelectasis
  74. 74. Treatment ⚫A. LONG ACTING CONTROL MEDICATIONS B. QUICK RELIEF MEDICATIONS
  75. 75. A. LONG ACTING CONTROL MEDICATIONS 1. Corticosteroids-for mild, moderate, severe asthma 2. Mast cell stabilizers-as prophylaxis 3. Long acting beta2-adrenergic agonist- inhibit release of chemical mediators & increase CAMP 4. Methylxantines- may anti-inflammatory effect 5. Leukotriene modifiers 6. Combination Agent
  76. 76. B. QUICK RELIEF MEDICATIONS – “RESCUE MEDS” 1. Short acting beta-adrenergic bronchodilators 2. Anticholinergics
  77. 77. A typical breathing treatment for cystic fibrosis, using a mask nebulizer and the ThAIRapy Vest
  78. 78. PEAK FLOW METER
  79. 79. PEAK FLOW METER PG. 1123 ⚫- measures the highest airflow during a forced expiration(3 times & record the highest reading) ⚫Monitors severity of asthma & how it is controlled ⚫ REFER: PATIENT PLAYBOOK – USE OF PEF (PEAK EXPIRATORY FLOW)
  80. 80. PEF (PEAK EXPIRATORY FLOW) ⚫- LEVEL INTERPRETATIO N GREEN YELLOW RED
  81. 81. ⚫GREEN ZONE: DOING WELL (GOOD ASTHMA CONTROL) ⚫ No cough, wheeze, chest tightness, or SOB during the day/night ⚫ Can do usual activities ⚫ Peak flow: more than - (80% or more of my best peak flow) My best peak flow is: __ ⚫Take these long – term control medicines each day
  82. 82. ⚫ YELLOW ZONE: ASTHMA IS GETTING WORSE/ CAUTION ⚫ Cough, wheeze, chest tightness, or SOB or ⚫ Waking at night due to asthma, or ⚫ Can do some, but not all usual activities ⚫ Peak flow: __ to __ (50% - 80% of my best peak flow) ⚫Add quick- relief medicine and your green- zone medicines (Goal: Return to Green Zone)
  83. 83. ⚫RED ZONE: MEDICAL ALERT/ HEALTH CARE ALERT! ⚫ Very SOB or ⚫ Quick relief meds have not helped, or ⚫ Cannot do usual activities, or ⚫ Symptoms are same or get worse after 24 hours in Yellow zone ⚫ Peak Flow: Less than __ (50% or less of my best peak flow) ⚫ Take this medicine: ⚫ ______________ ⚫ ______________ ⚫ Then call your Doctor NOW
  84. 84. ⚫DANGER SIGNS: ⚫Trouble walking & talking due to SOB ⚫Lips or fingernails are blue ⚫Take 4 or 6 puff of your quick relief meds AND ⚫Go to to the hospital NOW!
  85. 85. Teachings ⚫ Allergen control ⚫ Avoid extreme temperature ⚫ Avoid crowds ⚫ Instruct to identify early s/sx of acute asthma attack ⚫ Adequate rest, sleep & diet ⚫ Encourage cough effectively ⚫ Immunization-_____&____
  86. 86. Ventilator Alarms HIGH PRESSURE ALARM -secretions in AW -ET is displaced -ET is obstructed- KINK 🡪Pt. coughs, gags or bites the ET 🡪Is anxious or fights the ventilation
  87. 87. Low Pressure Alarm 🡪Disconnection or Leak in ventilator 🡪Pt. stops spontaneous breathing
  88. 88. STATUS ASTHMATICUS ⚫LIFE THREATENING! ⚫Severe persistent asthma that does not respond to conventional therapy ⚫Attacks can last > 24 hours ⚫Can occur quickly 🡪 ASPHYXIATION
  89. 89. factors ⚫Infection ⚫Nebulizer abuse ⚫DHN ⚫Anxiety
  90. 90. Signs & symptoms ⚫SOB, cough, wheeze ⚫Cannot do usual activities ⚫Unable to speak in full sentences ⚫Change in LOC ⚫Quick relief meds have not helped
  91. 91. ⚫DOC: Epinephrine ⚫Others: Corticosteroids ⚫Mg S04
  92. 92. Risk of Death pg 1120 ⚫ With hx of severe exacerbations ⚫ Intubated ⚫ Admission to ICU ⚫ 2 or more hosp/yr ⚫ 3 or more emergency ⚫ Consume 2 or more MDI/mo ⚫ Urban Residency ⚫ Comorbid ⚫ LOW SOCIOECONOMIC
  93. 93. BRONCHIOLECTASIS
  94. 94. BRONCHIECTASIS
  95. 95. BRONCHIOLECTASIS ⚫🡪 characterized by increased mucus formation & difficulty of breathing
  96. 96. May be: ⚫ Localized or diffused ❑3 TYPES: 1. c________- mildest, slight widening of the respi passages; reversible 2. v_______- air sacs fail in portions of the passages 3. c______- most severe type involving ballooning or expansion of the air sacs
  97. 97. pathophysiology ⚫ Etiology (viscious cycle of bacterial colonization) ⚫ Inflammatory change ⚫ Increased mucus production ⚫ Scaring ⚫ More bacterial colonization
  98. 98. ⚫Damage of mucociliary mechanism ⚫Damage bacterial clearance ⚫ ⚫Stretching & enlargement of respiratory passages ⚫Scaring ⚫Bacteria build up (cycle)
  99. 99. ⚫(Notes) ⚫Etiology ⚫Impairment of bronchial clearance ⚫Bronchial secretions ⚫Stasis ⚫infection
  100. 100. ⚫ Weakening & further destruction of bronchial walls ⚫ Increased dilation ⚫ atelectasis ⚫ Inflammatory scarring ⚫ Fibrosis ⚫ Respiratory insufficiency ⚫ V/Q mismatch ⚫ Hypoxemia
  101. 101. ❑ S/SX: ⚫Chronic cough ⚫Purulent sputum - ______ to _____ white fluid (infection) ⚫Hemoptysis ⚫Clubbing ⚫Repeated respiratory infections ⚫Hypoxemia, weight loss, dyspnea ⚫Definitive sign: ________
  102. 102. ❑ DIAGNOSTIC TESTS 1. CT SCAN - _______ 2. X-RAY - 3. BRONCHOGRAM/ BRONCOSCOPY - 4. SPUTUM CULTURE 5. Auscultation -
  103. 103. Nsg diagnosis ⚫1. ⚫2. ⚫3. ⚫4.
  104. 104. TREATMENT/ GOALS: ⚫1. To promote effective airway clearance and remove secretions (bronchial drainage) ⚫2. To prevent or control infections ⚫3. to minimize further damage (complications)
  105. 105. ❑ MEDICAL MANAGEMENT: 1. Postural drainage & CPT 2. Anti microbial therapy 3. Bronchodilators, steroid therapy 4. Vaccination 5. Surgical interventions/ lung resections A.Lobectomy B.Segmental Resection/ segmenectomy C.Pneumonectomy
  106. 106. NURSING MANAGEMENT Stop smoking! 1. Alleviate symptoms 2. Assist in secretion clearance 3. Balance rest and activity 4. Watch out for sx of infection – AVOID _____! 5. Nutritional support
  107. 107. CYSTIC FIBROSIS
  108. 108. CFTR ⚫CYSTIC FIRBOSIS TRANSMEMBRANCE CONDUCTANCE REGULATOR GENE
  109. 109. ❑ S/SX: ⚫1. RESPI S/SX: A. Coughing, wheezing,respiratory obstruction B. barrel chest, cyanosis, digital clubbing ⚫II. GI S/SX: A. Steatorrhea B. In newborns: MECONIUM ILEUS
  110. 110. ❑ Other s/sx: ⚫Coughing with thick, sticky phlegm ⚫Freq. pneumonia, bronchitis ⚫Salty skin ⚫DHN (due to fluid shifting) ⚫Infertility
  111. 111. ❑ DIAGNOSTIC 1. Sweat chloride test/ pilocarpine test NORMAL: A. Na:< 50 mq/l B. Cl: < 50 meq/l ABNORMAL: A. Na:> 90 meq/l B. Cl: > 60 meq/l Suggestive: Confirmatory:
  112. 112. ⚫2. x-ray, PFT ⚫3. sputum exam ⚫4. abdominal exam, stool analysis and Pancreatic function test - to asses GI involvement & presence of fats
  113. 113. ❑ MANAGEMENT ⚫1. Control & prevent infection ⚫2. bronchodilators ⚫3. CPT ⚫4. mucolytic ⚫5. corticosteroids ⚫6. O2 ⚫7. lung transplant ⚫8. gene therapy
  114. 114. ❑ HEALTH TEACHINGS ⚫Avoid crowds ⚫Assess s/sx of respiratory infection ⚫Fluid intake – prevent DHN ⚫Exercise freq ⚫Healthy diet ⚫end of life issue
  115. 115. ACTIVITY ⚫¼ - USE 1 PAPER PER PAIR ⚫19 – 20 = +3 ⚫17 – 18 = +2 ⚫14 - 16 = +1 ⚫11 – 13 = + 1 ⚫0 – 10 = NONE
  116. 116. 1. YPTAAHYNCE 11. LPAILMHEININO 2. BOLEYMECTOM 12. AXNERPTOCTE 3. IFLLA TCESH 13. STAANASETIEL 4. OMPNRESOICS 14. GROVEAPNHY 5. OCPNREPIALI 15. MHYXEIAPO 6. LMIYCEOBN 16. PXENTHORAUMO 7. PIRASRERYTO IAIDSCOS 17. OARCNETLBRIUL 8. TETCHORASIENS 18. RAUPLEL UFFOENSI 9. ORIONESSTIOPH 19. CHOBNTSIRI 10.SMEPIRRYOT 20. CMUISIOVSSIDO
  117. 117. END OF QUIZ!!! ☺
  118. 118. 1. TACHYPNEA 11. AMINOPHILLINE 2. EMBOLECTOMY 12. EXPECTORANT 3. FLAIL CHEST 13. ANTIELASTASE 4. COMPRESSION 14. VENOGRAPHY 5. PILOCARPINE 15. HYPOXEMIA 6. BLEOMYCIN 16. PNEUMOTHORAX 7. RESPIRATORY ACIDOSIS 17. CENTRILOBULAR 8. THORACENTESIS 18. PLEURAL EFFUSION 9. IONTOPHORESIS 19. BRONCHITIS 10.SPIROMETRY 20. MUCOVISIDOSIS
  119. 119. QUIZ – BLOCK A
  120. 120. ⚫1. this is the enzyme that destroys the lung tissue during the inflammatory process
  121. 121. ⚫2. this is the enzyme that inhibits the action of proteolytic enzymes
  122. 122. ⚫3. Type of emphysema that affects the respiratory bronchiole, alveolar duct, & alveoli
  123. 123. ⚫4. The normal V/Q ratio
  124. 124. ⚫5. refers to the abnormal increase in the immature erythrocytes
  125. 125. ⚫6. medication in asthma which is commonly used as prophylaxis
  126. 126. ⚫7. – 9. what are the 3 main problems in asthma
  127. 127. ⚫10. type of asthma when the patient’s night attack is more than twice per month.
  128. 128. QUIZ
  129. 129. ⚫1. What is the major problem in emphysema
  130. 130. ⚫2. this is the enzyme that destroys the lung tissue
  131. 131. ⚫3. type of emphysema that affects the secondary lobule but not the peripheral acinus/ air sac
  132. 132. 4. This refers to the amount of blood in the cappilaries
  133. 133. 5. This refers to the abnormal increase in the number of immature erytrocytes
  134. 134. 6. This is a surgical procedure to treat COPD that involves removal of a portion of a diseased lung parenchyma allowing the functional lung to expand
  135. 135. ⚫7. ENZYME THAT PROTECTS THE LUNG TISSUE FROM INJURY
  136. 136. ⚫8. What is the ideal position of patients with COPD
  137. 137. 9. This is a management in COPD that involves vibration & percussion
  138. 138. ⚫10. EMPHYSEMA IS ALSO KNOWN AS
  139. 139. 11. What is normal therapeutic range of theophylline?
  140. 140. ⚫12. The patient’s heart rate is 130 bpm after taking salbutamol. What must the nurse do? ⚫A. Do nothing, it is expected ⚫B. Report to the physician, it is abnormal
  141. 141. ⚫13. The doctor orders a bronchodilator and steroids to be given at the hour. What must be given first?
  142. 142. ⚫14. This is the enzyme that facilitates the stretchability of the lung tissue
  143. 143. ⚫15. Hypertrophy of the right ventricle is AKA __________, which could lead to RSHF.
  144. 144. ⚫16-20. 5points ⚫Write a brief pathophysiology of chronic bronchitis.
  145. 145. QUIZ (ASTHMA)
  146. 146. ⚫1. RINSING THE MOUTH AFTER INHALING PREDDNISONE IS TO PREVENT WHAT CONDITION
  147. 147. ⚫2. TYPE OF BRONCHODILATOR GIVEN AS PROPHYLAXIS
  148. 148. ⚫3. THE PERSONAL BEST OF THE PT. IS 62% . WHAT COLOR ZONE IS THIS?
  149. 149. ⚫4. INTERPRET THE FINDINGS
  150. 150. ⚫5. IF THE PATIENT HAS NO COUGH, NO SOB, CAN DO ACTIVITIES. HE IS IN WHAT ZONE
  151. 151. ⚫6. EXAMPLE OF LEUOTRIENE MODIFIERS
  152. 152. ⚫HIGH OR LOW PRESSURE ALARM ⚫7. DISCONNECTION ⚫8. LEAK ⚫9. SECRETIONS IN THE ET
  153. 153. ⚫10. ONE RECOMMENDED VACCINE GIVEN IN ASTHMA
  154. 154. ⚫11. DOC OF STATUS ASTHMATICUS
  155. 155. ⚫12. ONE MANIFESTATION OF STAUS ASTHMATICUS
  156. 156. ⚫13 – 15: ENUMERATE RISK OF DEATH IN ASTHMA

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