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Ch. 11 - Nursing Management: Patients With Chest and Lower R
TEST 1
22
Nursing
Undergraduate 4
09/12/2014

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Term
What is a d-dimer test?
Definition
D-dimer (fibrin degradation fragment)- is a marker of blood clotting activity
Disseminated intravascular coagulation and effectiveness of treatment
Normal or negative means it is probable the patient doesn’t have an acute condition that is causing abnormal clot formation and breakdown
Elevated can be caused by recent surgery, trauma, infection, heart disease, and some conditions in which fibrin is not normally cleared (liver disease for example). Can also be caused by hyperlipidemia
Term
What are the most common manifestations of COPD?
Definition
Dyspnea
Chronic cough
Sputum production
Term
What is the diagnosis of COPD depend on?
Definition
based on lung function testing:
Diagnostic criteria are FEV1 of less than 80% and an FEV1/FVC ratio of less than 70%
Term
How is COPD managed?
Definition
-Smoking cessation
-Bronchodilators by metered dose inhaler (MDI) and spacer:
-Anticholinergics
-Sympathomimetics
-Corticosteroids
-Oxygen therapy
-Surgery
Term
The nurse is teaching a COPD patient about his newly prescribed corticosteroid. The nurse should explain that the drug is used for:

Relieving bronchospasm in an emergency
Curing underlying systemic infections
Preventing recurrent pulmonary infections
Achieving longer-term control of COPD symptoms
Definition
D. Achieving longer-term control of COPD symptoms
Rationale: Corticosteroids are integrated in the medication regimen of a patient with COPD in order to minimize the frequency of exacerbations and achieve long-term symptom control. Corticosteroids are not normally used as an emergency medication, and they do not address infections.
Term
What are the goals of management of COPD?
Definition
Promoting smoking cessation
Managing chronic dyspnea
Managing impaired gas exchange
Managing cough
Improving exercise tolerance, self-care, and coping
Promoting nutrition
Preventing complications
Term
What is asthma?
Definition
Characterized by recurring and variable symptoms, airflow obstruction, and bronchial hyper-responsiveness
Inflammation is the key underlying feature
Term
What is the pathophysiolgy of asthma?
Definition
Acute inflammation leads to airflow limitation, hyperresponsiveness, airway edema, and mucus hypersecretion:
Mast cells, neutrophils, eosinophils, and lymphocytes are involved
Term
What are risk factors for asthma?
Definition
Risk factors include genetic predisposition, exposure to environmental factors, airborne allergens, and viral respiratory infections
Term
What are the goals of asthma management?
Definition
Symptom control
Maintenance of pulmonary function and activity
Prevention of recurrent exacerbations
Provision of optimal pharmacotherapy
Patient education
Term
What is used to as a fast-acting treatment of an asthma attack?
Definition
Short acting beta-agonists (SABA)
Albuterol, Xopenex, Atrovent*
Term
What are used for long-term management of asthma?
Definition
Long acting beta-agonists (LABA)
Current guidelines recommend using LABAs only in combination with inhaled corticosteriods
Term
What are inhaled corticosteroids?
Definition
Considered the most effective long term usage medication for control and management
Flovent
Term
What is a leukotriene modifier?
Definition
Used to treat allergy symptoms and prevent asthma
Singulair
Methylxanthines (sustained released theophylline)
Term
What is COPD?
Definition
Chronic airflow limitation that is not fully reversible. Associated w/ inflammatory response of the lungs
Term
What is emphysema?
Definition
An abnormal enlargement of the air spaces beyond the terminal bronchioles, with destruction of the walls of the alveoli.
Term
What is chronic bronchitis?
Definition
Defined as the presence of cough and sputum production for at least 3 months in each of two consecutive years.

Chronic mucus secretion causes lung fxn to decline, exacerbations, and infections.
Term
Who is at risk for COPD?
Definition
-tobacco users
-environmental tobacco exposure
-occupational dust and chemcials
-indoor/outdoor air pollution
-infection
Term
What are the clinical manifestations of COPD?
Definition
Dyspnea, chronic cough, sputum broduction.
Term
How is COPD diagnosed?
Definition
pulmonary fxn studies, spirometry ABG
Term
How is COPD medically managed?
Definition
Goal is to stabalize, managem and monitor the disease, reduce the symptoms, reduce exacerbation risk and rate, promote maximal functional ability, prevent premature disability, assist the ind. to adapt to handicap and limited prognosis as the disease progresses.

-SMOKING CESSATION
-BRONCHODILATORS
-CORTICOSTERIODS
-MEDICATION DELIVERY SYSTEMS
-OXYGEN THERAPY
-SURGERY
-PULMONARY REHABILITATION
-PREVENTING/MANAGING EXACERBATIONS AND COMPLICATIONS
Term
What is the nursing management involved with COPD?
Definition
-Assessing the patient
-Promoting smoking cessation
-Managing chronic dyspnea
-Managing impaired gas exchange
-Managing cough and ineffective airway clearance
-Improving exercise intolerance
-Promoting nutrition
-Managing exacerbtions/complications
-Enhancing individual coping strategies
-Enhancing self-care strategies
-Continuing care
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