1
Q
What is COPD and what does it include?
A
A preventable and treatable disease with persistent, progressive airflow limitation, loss of elastic recoil, mucus hypersecretion, mucosal edema, bronchospasm, and air trapping. Includes chronic bronchitis and emphysema.
2
Q
What defines chronic bronchitis (Blue Bloater)?
A
Cough and sputum production for at least 3 months in each of 2 consecutive years.
3
Q
What defines emphysema (Pink Puffer)?
A
Destruction of alveoli, hyperinflation, loss of elasticity, decreased gas exchange, CO2 retention.
4
Q
What are key causes and risk factors for COPD?
A
Smoking, older age, environmental exposures (dust, chemicals, pollution), infections, TB, alpha-1 antitrypsin deficiency, male gender.
5
Q
What are signs and symptoms of COPD?
A
Dyspnea (worse with exertion), low O2 (89–94%), hypercapnia, hypoxia (early = tachycardia, tachypnea, HTN; late = cyanosis, clammy, hypotension, retractions), pallor, barrel chest, wheezing, crackles, cough, clubbing.
6
Q
What does COPD eventually lead to?
A
Right-sided heart failure (cor pulmonale) and edema.
7
Q
What is the diagnostic hallmark of COPD on spirometry?
A
FEV1/FVC ratio <70%. Severity is based on degree of FEV1 reduction.
8
Q
What chest x-ray findings are common in COPD?
A
Flattened diaphragm and hyperinflated lungs (not diagnostic, but supportive).
9
Q
What ABG pattern is expected in late-stage COPD?
A
↓PaO2, ↑PaCO2, low-normal pH, ↑HCO3. Commonly respiratory acidosis.
10
Q
What are the GOLD classifications of COPD severity?
A
GOLD 1: Mild (FEV1 ≥80%). GOLD 2: Moderate (50–79%). GOLD 3: Severe (30–49%). GOLD 4: Very severe (<30%).
11
Q
What is the main oxygen therapy rule in COPD?
A
2–4 L via NC or 40% Venturi mask. NEVER over-oxygenate; maintain O2 sat high 80s–low 90s.
12
Q
Which inhalers/bronchodilators are used in COPD maintenance?
A
SABAs (Albuterol), Anticholinergics (Ipratropium).
13
Q
Which mucolytics are used in COPD?
A
Dornase alfa, Mucomyst, Guaifenesin (Robitussin). Help thin secretions.
14
Q
Which inhaled corticosteroid is used in COPD and what is important teaching?
A
Fluticasone (ICS). Rinse mouth after use to avoid thrush.
15
Q
What is included in COPD exacerbation management?
A
Continue maintenance meds + antibiotics + oral steroids (prednisone). Do NOT increase O2 liters.
16
Q
What breathing technique is taught to COPD patients and why?
A
Pursed-lip breathing: increases expiratory time, reduces trapped air, improves O2 exchange, lowers SOB.
17
Q
What is huff coughing and its purpose?
A
Take a deeper breath and force out in 3 breaths (“ha, ha, ha”). Helps clear mucus with less energy.
18
Q
What exercise teaching is important for COPD?
A
Take albuterol beforehand. Exercise 20 min/day, 2–3 days/week with rest periods.
19
Q
What dietary teaching is important for COPD?
A
High protein, high calorie, moderate carbs/fat. Eat 5–6 small meals. Rest before eating. Use bronchodilator before meals.
20
Q
Why is daily weight important in COPD?
A
A gain of >2 lbs/day may indicate progression to heart failure due to fluid retention.
21
Q
What type of airway disorder is asthma?
A
Chronic, intermittent, and reversible airway obstruction with bronchial hyper-responsiveness and inflammation.
22
Q
What are the major risk factors for asthma?
A
Genetics, IgE immune response, obesity, male gender, allergens (dander, dust mites, pollen, molds), pollutants, smoking, GERD, infections, stress, hormones, certain medications (NSAIDs, aspirin, non-selective beta blockers), food additives (MSG, tartrazine), and cold dry air.
23
Q
Which medications should be avoided in asthma?
A
NSAIDs, aspirin, and non-selective beta blockers (worsen bronchospasm). Cardio-selective beta-1 blockers are safer if needed.
24
Q
What are common signs and symptoms of asthma?
A
Wheezing, breathlessness, chest tightness, cough (night/early morning), mucus, difficulty speaking, tachypnea (>28), tachycardia (>110), accessory muscle use, diaphoresis, hyperresonance, pulsus paradoxus >12 mmHg.
25
What are ominous/dangerous signs of asthma?
Fatigue, absent or decreased breath sounds, cyanosis, inability to lie flat, paradoxical chest-abdomen movement.
26
What complication is a medical emergency in asthma?
Status asthmaticus – failure to respond to conventional treatment, with hypoxemia, hypercapnia, and risk of respiratory failure.
27
What are diagnostic tools for asthma?
History/physical exam, chest x-ray, oximetry, allergy testing, eosinophil/IgE levels, Pulmonary Function Tests (PFT), and peak flow meter.
28
What patient prep is needed before a PFT?
Avoid meals before, avoid bronchodilators 4–6 hrs before, no smoking 6–8 hrs prior.
29
What does a positive bronchodilator response on spirometry look like?
>200 mL or >12% increase in FEV1 between pre- and post-bronchodilator.
30
How should a peak flow meter be used?
Perform 3 times/day, record highest reading, compare to personal best.
31
What are the peak flow meter zones?
Green ≥80% = maintenance; Yellow 50–79% = rescue inhaler + reassess; Red <50% = emergency (status asthmaticus, ER).
32
Which meds are first-line relievers for asthma?
SABAs (Albuterol, Salbutamol, Fenoterol, Levalbuterol). Albuterol causes tremors/tachycardia; Levalbuterol preferred with cardiac history.
33
Which anticholinergic is used in asthma as a rescue med?
Ipratropium (Atrovent) – SAMA.
34
Which corticosteroids are used in acute asthma?
Prednisone, Methylprednisolone, Hydrocortisone. Side effects: hyperglycemia, fluid retention, infection risk.
35
What meds are used in status asthmaticus when SABAs fail?
Methylxanthines (Theophylline, Aminophylline) and IV magnesium sulfate.
36
Why do methylxanthines require monitoring?
Narrow therapeutic range. Side effects: seizures, arrhythmias, respiratory depression. Avoid caffeine.
37
What are long-term controller meds for asthma?
LABAs (Salmeterol, Formoterol), ICS (Fluticasone, Beclomethasone), Leukotriene modifiers (Montelukast), Immunomodulators (Omalizumab).
38
What teaching is essential after ICS use?
Rinse mouth to prevent thrush.
39
What are the 7 steps for proper MDI inhaler use?
Shake → Exhale → Place in mouth → Inhale while pressing → Hold breath 10 sec → Exhale through pursed lips → Wait 60 sec before next puff.
40
What are general nursing interventions for asthma patients?
Monitor respiratory status and O₂ sat, administer meds as ordered, fluid therapy, oxygen delivery (NC, mask, Venturi), patient education (triggers, inhaler technique, symptom monitoring).
41
What is heart failure?
Inability of the heart to pump effectively, leading to decreased cardiac output (CO = SV × HR), tissue perfusion issues, fluid imbalance, and decreased functional ability.
42
What are the main types of heart failure?
Left-sided HF (lungs), Right-sided HF (rest of body), and Biventricular HF (both sides).
43
What is HFrEF and its EF value?
Heart Failure with Reduced Ejection Fraction (systolic failure). EF <40% due to impaired contractility, e.g., MI.
44
What is HFpEF and its EF value?
Heart Failure with Preserved Ejection Fraction (diastolic failure). EF normal but stiff LV prevents filling. Often caused by HTN.
45
What are signs of right-sided HF?
JVD, ascites, dependent edema, hepatomegaly, fatigue.
46
What are signs of left-sided HF?
S3 gallop, dyspnea, crackles, orthopnea, fatigue, frothy blood-tinged sputum, cyanosis, restlessness.
47
What are common causes/risk factors of HF?
HTN, CAD/MI, pulmonary HTN, diabetes, valvular disease, myocarditis, pericardial disease, smoking, metabolic syndrome, age, genetics.
48
What are modifiable vs non-modifiable risk factors for HF?
Modifiable: inactivity, smoking, obesity, cholesterol, HTN, Type II DM, stress. Non-modifiable: age, gender, genetics, race.
49
What are the NYHA HF classification stages?
Class I: No limits; Class II: Symptoms with moderate activity; Class III: Symptoms with minimal activity; Class IV: Symptoms at rest.
50
What diagnostic test confirms HF vs respiratory problem?
BNP (B-type Natriuretic Peptide). <100 no HF, 100-300 HF present, >300 mild, >600 moderate, >900 severe.
51
What is normal EF on echocardiogram?
50-70%. <40% indicates systolic dysfunction.
52
What does chest x-ray show in HF?
Cardiomegaly, pulmonary congestion, pleural effusion.
53
What is UNLOAD FAST in HF management?
Upright, Nitrates, Lasix, Oxygen, ACE inhibitors, Digoxin, Fluids (restrict), Afterload reducers, Sodium restriction, Tests (labs, echo, BNP).
54
What are key side effects of ACE inhibitors?
Hyperkalemia, angioedema, cough (esp. Asians), hypotension, rash, decreased taste.
55
What should be monitored after initial ACE inhibitor dose?
Blood pressure for 2 hours (risk of hypotension).
56
What are signs of digoxin toxicity?
Nausea, vomiting, vision changes (halos), arrhythmias, confusion.
57
What nursing checks are required before giving digoxin?
Check potassium, digoxin level, and apical pulse (hold if HR <60).
58
What are nursing interventions in acute pulmonary edema?
High Fowler's, O2, positive pressure ventilation, IV morphine, rapid-acting loop diuretics, monitor output.
59
Why is IV morphine used in HF with pulmonary edema?
Reduces anxiety, venous return (preload), and respiratory distress.
60
What is orthostatic hypotension and how is it tested?
Drop of ≥20 systolic or ≥10 diastolic within 3 min of standing. Measure supine then standing BP/HR.
61
What are the normal ABG values for pH, PaCO2, HCO3, and PaO2?
pH: 7.35–7.45 | PaCO2: 35–45 mmHg | HCO3: 22–26 mEq/L | PaO2: 80–100 mmHg.
62
What does a pH <7.35 indicate?
Acidosis.
63
What does a pH >7.45 indicate?
Alkalosis.
64
What does PaCO2 <35 indicate?
Respiratory alkalosis (blowing off too much CO2).
65
What does PaCO2 >45 indicate?
Respiratory acidosis (retaining CO2).
66
What does HCO3 <22 indicate?
Metabolic acidosis (too much acid or too little base).
67
What does HCO3 >26 indicate?
Metabolic alkalosis (too much base or acid loss).
68
What does 'Respiratory Opposite' mean in ABG interpretation?
pH and CO2 move in opposite directions in respiratory disorders.
69
What does 'Metabolic Equal' mean in ABG interpretation?
pH and HCO3 move in the same direction in metabolic disorders.
70
What does uncompensated ABG mean?
pH abnormal, one value abnormal, the other normal (no compensation).
71
What does partially compensated ABG mean?
pH abnormal, both PaCO2 and HCO3 abnormal (body trying to compensate).
72
What does fully compensated ABG mean?
pH normal but PaCO2 and HCO3 are abnormal, indicating compensation is complete.
73
What is the ABG pattern for respiratory acidosis?
pH ↓, PaCO2 ↑, HCO3 normal (early) or ↑ (compensated).
74
What are common causes of respiratory acidosis?
COPD, asthma, pneumonia, hypoventilation, head injury, opiates, pulmonary edema.
75
What is the ABG pattern for respiratory alkalosis?
pH ↑, PaCO2 ↓, HCO3 normal (early) or ↓ (compensated).
76
What are common causes of respiratory alkalosis?
Hyperventilation, anxiety, pain, hypoxia, fever, mechanical overventilation.
77
What is the ABG pattern for metabolic acidosis?
pH ↓, HCO3 ↓, PaCO2 normal (early) or ↓ (compensation).
78
What are common causes of metabolic acidosis?
DKA, renal failure, lactic acidosis, malnutrition, severe diarrhea.
79
What is the ABG pattern for metabolic alkalosis?
pH ↑, HCO3 ↑, PaCO2 normal (early) or ↑ (compensation).
80
What are common causes of metabolic alkalosis?
Excessive vomiting, NG suction, diuretics, antacid overuse, hyperaldosteronism.
81
What is hypoxia?
A condition of inadequate tissue oxygenation at the cellular level. Can cause fatal cardiac dysrhythmias if untreated.
82
What are early signs of hypoxia?
Restlessness, tachypnea, dyspnea on exertion, tachycardia, hypertension, diaphoresis, arrhythmias, decreased urine output, unexplained fatigue.
83
Why does diaphoresis occur in early hypoxia?
Catecholamine release (epinephrine, norepinephrine) increases perspiration, making skin cool and moist.
84
Why does restlessness occur in hypoxia?
Catecholamine release stimulates apprehension, irritability, and restlessness.
85
Why does tachypnea occur in hypoxia?
Low oxygen levels stimulate the respiratory center and chemoreceptors to increase respiratory rate.
86
Why does tachycardia occur in early hypoxia?
The body increases cardiac output to circulate oxygenated blood more frequently.
87
Why is hypertension seen in early hypoxia?
Initially due to tachycardia increasing cardiac output; not a reliable late indicator.
88
Why can arrhythmias develop early in hypoxia?
Cardiac muscle has high O2 demand; even slight decreases can cause dysrhythmias.
89
What are late signs of hypoxia?
Cyanosis, hypotension, use of accessory muscles, retractions, cool clammy skin, arrhythmias.
90
What causes cyanosis in hypoxia?
Decreased oxygenated hemoglobin on RBCs, causing bluish discoloration of skin.
91
Why is cool, clammy skin a late sign of hypoxia?
Catecholamine-induced perspiration cools the skin, making it clammy.
92
What is the significance of accessory muscle use in hypoxia?
Indicates increased effort to breathe as dyspnea worsens; seen with retractions.
93
What are retractions and when do they occur?
Muscles pull inward between ribs or in the neck during inspiration; occur as patients try to increase respiratory effort.
94
Why does hypotension occur in late hypoxia?
Compensatory mechanisms fail, tissues cannot meet O2 demand, leading to low blood pressure.
95
Why are arrhythmias common in both early and late hypoxia?
Cardiac tissue is highly sensitive to O2 deprivation; sustained hypoxia can lead to lethal arrhythmias.
96
What FiO2 and flow rate does a nasal cannula deliver?
24%–44% FiO2 at 1–6 L/min. Humidify if ≥4 L/min.
97
What are the advantages of a nasal cannula?
Allows patients to eat, talk, and ambulate. Comfortable and well tolerated.
98
What is a disadvantage of nasal cannula use?
Can dry nasal passages and mucous membranes.
99
What FiO2 and flow rate does a simple face mask deliver?
35%–50% FiO2 at 6–12 L/min.
100
What are disadvantages of a simple face mask?
Not tolerated by anxious/claustrophobic patients; risk of aspiration; must monitor for skin breakdown.
101
What FiO2 and flow rate does a Venturi mask deliver?
24%–50% FiO2 at 4–12 L/min.
102
Why is the Venturi mask the best for COPD patients?
Delivers the most precise FiO2 without risk of over-oxygenating.
103
What FiO2 and flow rate does a partial rebreather mask deliver?
60%–75% FiO2 at 6–11 L/min.
104
What makes a partial rebreather mask unique?
Reservoir bag without valve allows patient to rebreathe some exhaled oxygen.
105
What FiO2 and flow rate does a non-rebreather mask deliver?
80%–95% FiO2 at 10–15 L/min.
106
What is a key nursing action with a non-rebreather mask?
Ensure tight seal over nose and mouth; monitor for skin breakdown; switch to nasal cannula during meals.
107
Which oxygen device delivers the highest concentration of O2?
Non-rebreather mask (80%–95% at 10–15 L/min).
108
Which oxygen device is best tolerated during meals?
Nasal cannula, as it allows eating and drinking while maintaining oxygen therapy.
109
Which mask delivers humidified oxygen and is more comfortable than a nasal cannula?
Simple face mask.
110
What is the mechanism of action of ACE inhibitors in HF?
Reduce afterload and preload by vasodilation and promoting diuresis. Decrease cardiac workload.
111
What are common side effects of ACE inhibitors?
Dry cough, hyperkalemia, angioedema, hypotension, altered taste, skin rash.
112
What is the mechanism of action of ARBs in HF?
Block angiotensin II receptors → reduce afterload. Example: Losartan.
113
What must be monitored with ARBs?
Blood pressure, potassium levels, and renal function.
114
What is the action of beta blockers in HF?
Reduce sympathetic nervous system activity, lower HR, reduce BP, and improve survival.
115
Which beta blockers are safe in asthma/COPD?
Cardio-selective beta-1 blockers (Metoprolol, Atenolol, Bisoprolol, Esmolol).
116
Which beta blockers are unsafe in asthma/COPD?
Non-selective beta blockers (Propranolol, Nadolol) → risk of bronchospasm.
117
What is the mechanism of action of digoxin?
Increases myocardial contractility and slows AV conduction, improving CO.
118
What are signs of digoxin toxicity?
Nausea, vomiting, halos/vision changes, confusion, arrhythmias.
119
What must be checked before administering digoxin?
Apical pulse (hold if HR <60), potassium, and digoxin levels.
120
What is the mechanism of action of loop diuretics in HF?
Inhibit Na+ and Cl- reabsorption in the loop of Henle → promote diuresis, reduce preload.
121
What nursing action is key with IV Furosemide?
Give no faster than 20 mg/min IV to avoid ototoxicity.
122
What electrolyte imbalance is common with loop diuretics?
Hypokalemia and hypocalcemia.
123
Which diuretic is potassium-sparing?
Spironolactone.
124
What are side effects of spironolactone?
Hyperkalemia, gynecomastia, menstrual irregularities.
125
What is the mechanism of nitrates in HF?
Cause venous dilation, reduce preload, decrease myocardial oxygen demand.
126
What is a common side effect of nitrates?
Headache and orthostatic hypotension.
127
What IV drug is used for acute decompensated HF to improve contractility?
Dobutamine (beta-1 agonist).
128
What drug class is used in severe HF to reduce afterload and improve contractility?
Phosphodiesterase inhibitors (Milrinone).
129
When is Warfarin indicated in HF patients?
If history of thrombus formation. Monitor INR/PT and watch for bleeding.
130
What is the first-line rescue medication for asthma?
SABAs: Albuterol, Salbutamol, Fenoterol, Levalbuterol. Relieve acute bronchospasm and prevent exercise-induced asthma.
131
What are common side effects of SABAs like Albuterol?
Tachycardia and tremors.
132
Which SABA is safer in patients with cardiac history?
Levalbuterol (Xopenex) due to fewer cardiac side effects.
133
What is the role of Ipratropium in asthma and COPD?
SAMA (anticholinergic) used as rescue in asthma and maintenance in COPD.
134
Which corticosteroids are used acutely in asthma exacerbations?
Prednisone, Methylprednisolone, Hydrocortisone. Reduce inflammation.
135
What is essential patient teaching after inhaled corticosteroids?
Rinse mouth to prevent oral thrush (candidiasis).
136
What are examples of long-acting beta agonists (LABAs)?
Salmeterol, Formoterol. Used for maintenance therapy in asthma and COPD.
137
What are examples of inhaled corticosteroids (ICS)?
Beclomethasone, Fluticasone, Mometasone.
138
What are leukotriene modifiers and examples?
Controller meds that block inflammatory leukotrienes. Examples: Montelukast, Zafirlukast, Zileuton.
139
Which immunomodulator is used in severe allergic asthma?
Omalizumab (SubQ injection).
140
Which medications are used in status asthmaticus if SABAs/steroids fail?
Methylxanthines (Theophylline, Aminophylline) and IV Magnesium sulfate.
141
Why must methylxanthines be closely monitored?
Narrow therapeutic range; side effects include seizures, arrhythmias, respiratory depression. Avoid caffeine.
142
What is the role of mucolytics in COPD?
Thin secretions for easier clearance. Examples: Dornase alfa, Mucomyst, Guaifenesin (Robitussin).
143
What patient teaching is important with mucolytics?
Encourage 2–3 L of water per day to help liquefy secretions.
144
What is the preferred oxygen device for COPD patients?
Venturi mask: delivers precise FiO2 without risk of over-oxygenation.
145
Which medications are added during COPD exacerbations?
Antibiotics and oral steroids (Prednisone).
146
Which drugs must be avoided in asthmatics?
NSAIDs, aspirin, non-selective beta blockers (bronchospasm risk).
147
Which beta blockers are safer if needed in asthma/COPD?
Cardio-selective beta-1 blockers (Metoprolol, Atenolol, Bisoprolol, Esmolol).
148
What antihistamine can be used for asthma maintenance?
Loratadine (Claritin).
149
What teaching is important for all inhaled respiratory meds?
Proper inhaler technique, rinse mouth after ICS, monitor response to rescue meds, avoid known triggers.
150
What is the priority nursing action for a patient in acute asthma distress?
Administer SABA (Albuterol), place on O2, monitor O2 sat, assess breath sounds, prepare for escalation if no improvement.
151
What is essential teaching for asthma patients using an inhaler?
Proper MDI technique: Shake, exhale, inhale while pressing, hold 10 sec, exhale pursed-lip, wait 60 sec between puffs. Rinse mouth after ICS.
152
What is the peak flow action plan for asthma?
Green ≥80%: maintenance; Yellow 50–79%: rescue inhaler and reassess; Red <50%: emergency, use rescue and go to ER.
153
What breathing techniques are taught for COPD?
Pursed-lip breathing and diaphragmatic breathing to reduce air trapping and improve oxygenation.
154
What position helps COPD patients with dyspnea?
Orthopneic position, semi-Fowler's, or high Fowler's.
155
What daily habit is critical for COPD and HF patients?
Daily weights. A gain of >2 lbs/day indicates fluid retention or worsening HF.
156
What fluid and diet recommendations are given for COPD?
Increase fluids 2–3 L/day, eat high protein/high calorie diet, 5–6 small meals, rest before eating, use bronchodilator before meals.
157
What oxygen safety teaching is required for home use?
No smoking signs, avoid electrical hazards, proper storage of O2 tanks.
158
What are key nursing interventions for HF patients?
Monitor I&Os, daily weights, elevate HOB, sodium restriction, fluid restriction, monitor VS and labs, teach med adherence.
159
What position improves breathing in HF pulmonary edema?
High Fowler's with legs dependent.
160
What interventions are critical in acute pulmonary edema?
Oxygen, IV loop diuretics, IV morphine, monitor urine output, prepare for ventilation if needed.
161
What teaching is important for patients on diuretics?
Monitor daily weights, signs of dehydration, eat potassium-rich foods (if on loop/thiazide), watch for hypokalemia signs.
162
What patient teaching is important with digoxin?
Check pulse before taking, report vision changes or GI upset, know toxicity signs, keep scheduled blood levels.
163
What early signs of hypoxia must nurses recognize?
Restlessness, tachypnea, tachycardia, hypertension, diaphoresis, arrhythmias.
164
What late signs of hypoxia must nurses act on?
Cyanosis, hypotension, retractions, accessory muscle use, cool clammy skin.
165
What nursing intervention is critical when PaO2 is <80 mmHg?
Apply supplemental oxygen, monitor ABGs, escalate care if unresponsive to therapy.
166
What is the purpose of huff coughing in COPD?
Clears mucus with less effort and preserves energy.
167
What emotional support is important for HF and COPD patients?
Encourage energy conservation, assist with ADLs, provide reassurance, manage anxiety and depression.
168
What vital signs and labs must be monitored in HF patients?
ABGs, electrolytes (esp. K+), BNP, digoxin levels, O2 sat, hemodynamic pressures.
169
What patient teaching improves adherence in chronic respiratory disease?
Identify and avoid triggers, use peak flow meters, proper inhaler technique, importance of smoking cessation.
170
What is the purpose of spirometry in asthma?
Evaluates lung function, diagnoses pulmonary disease, monitors progression, and assesses response to bronchodilators.
171
What defines a positive bronchodilator response on spirometry?
FEV1 improvement >200 mL or >12% between pre- and post-bronchodilator.
172
What patient prep is required before spirometry?
No meals right before, avoid bronchodilators 4–6 hrs before, no smoking 6–8 hrs prior.
173
How is a peak flow meter used?
Blow out as hard and fast as possible 3 times daily; record the highest of 3 readings and compare to personal best.
174
What are the peak flow meter zones?
Green ≥80% = good control; Yellow 50–79% = exacerbation; Red <50% = medical emergency.
175
What is the hallmark spirometry finding in COPD?
FEV1/FVC ratio <70%.
176
What does a COPD chest x-ray often show?
Hyperinflated lungs and flattened diaphragm (not diagnostic, but supportive).
177
What is the 6-minute walk test and how is it used in COPD?
Measures oxygen desaturation with exertion; O2 sat ≤88% at rest qualifies for home oxygen.
178
What ABG changes are seen in late COPD?
↓PaO2, ↑PaCO2, low or low-normal pH, ↑HCO3 → respiratory acidosis.
179
What lab test confirms HF over respiratory problems?
BNP (B-type Natriuretic Peptide). Elevated BNP = HF.
180
What BNP ranges indicate HF severity?
<100 = unlikely HF; 100–300 = HF present; >300 mild; >600 moderate; >900 severe.
181
What is normal EF on echocardiogram?
50–70%. <40% indicates systolic dysfunction.
182
What does a chest x-ray show in HF?
Cardiomegaly, pulmonary congestion, pleural effusions.
183
What test provides a detailed view of cardiac structure and function via esophagus?
Transesophageal Echocardiography (TEE).
184
What blood tests are important in HF management?
Electrolytes, cardiac enzymes (CK-MB, Troponin), ABGs, digoxin levels, CBC.
185
What ABG values are considered normal?
pH 7.35–7.45, PaCO2 35–45 mmHg, HCO3 22–26 mEq/L, PaO2 80–100 mmHg.
186
What does PaO2 <80 indicate?
Hypoxemia.
187
What is the classic ABG finding in metabolic acidosis?
pH ↓, HCO3 ↓, PaCO2 normal (early) or ↓ (compensation).
188
Why is echocardiography key in HF?
Measures EF and assesses systolic vs diastolic function.
189
What sputum test may be ordered in COPD exacerbation?
Sputum culture and sensitivity if patient is hospitalized and not improving on antibiotics.
190
What is status asthmaticus?
A severe, life-threatening asthma attack unresponsive to SABA and corticosteroids. Medical emergency requiring hospitalization.
191
What are signs of status asthmaticus?
Extreme dyspnea, silent chest (no wheezing), cyanosis, use of accessory muscles, fatigue, confusion, risk of respiratory failure.
192
What is the immediate treatment for status asthmaticus?
IV corticosteroids, SABA + SAMA nebulizers, IV magnesium sulfate, possible intubation/ventilation.
193
What is cor pulmonale?
Right-sided heart failure caused by chronic pulmonary disease (e.g., COPD).
194
What are signs of cor pulmonale?
Peripheral edema, JVD, hepatomegaly, ascites, weight gain, fatigue.
195
How is cor pulmonale managed?
Oxygen therapy, diuretics, vasodilators, treat underlying lung disease.
196
What is acute pulmonary edema?
Accumulation of fluid in alveoli, usually from left-sided HF. Medical emergency.
197
What are signs of acute pulmonary edema?
Severe dyspnea, orthopnea, frothy pink sputum, crackles, cyanosis, anxiety, diaphoresis.
198
What is the priority treatment for acute pulmonary edema?
High Fowler's, oxygen, IV loop diuretics, IV morphine, vasodilators, prepare for mechanical ventilation if needed.
199
What arrhythmia risk increases with hypoxemia and electrolyte imbalances in HF?
Atrial fibrillation and ventricular dysrhythmias.
200
What complication can occur from diuretic therapy in HF?
Hypokalemia (esp. loop/thiazides), dehydration, hypotension.
201
What is digoxin toxicity and what increases its risk?
Toxic effects of digoxin (N/V, halos, arrhythmias). Increased risk if hypokalemia or renal impairment present.
202
What is the risk of over-oxygenating a COPD patient?
Suppression of hypoxic drive → respiratory failure or apnea.
203
What is pulsus paradoxus and in which condition may it appear?
Drop in systolic BP >10 mmHg during inspiration. Seen in severe asthma or cardiac tamponade.
204
What complication is associated with chronic hypoxia in COPD?
Polycythemia (↑RBC production as compensation). Increases risk of clots.
205
What electrolyte imbalance is common with loop diuretics?
Hypokalemia (may increase digoxin toxicity).
206
What complication can occur with ACE inhibitors in HF?
Life-threatening angioedema (swelling of lips, tongue, airway).
207
What complication can occur from anticoagulation in HF?
Bleeding, bruising, hemorrhage.
208
What emergency sign requires immediate intervention in HF or COPD patients?
Sudden severe dyspnea, cyanosis, inability to speak full sentences, O2 sat <85%, confusion → may indicate respiratory failure.
209
What lifestyle change is most important for COPD management?
Smoking cessation to slow disease progression.
210
What dietary teaching is important for COPD patients?
High protein, high calorie, moderate carbs. Eat 5–6 small meals/day. Rest before meals. Use bronchodilator before eating.
211
What fluid recommendation is given for COPD patients?
Encourage 2–3 L/day to thin secretions (unless contraindicated by HF).
212
What breathing exercises should COPD patients use?
Pursed-lip breathing and diaphragmatic breathing to reduce air trapping.
213
What exercise teaching is important for COPD patients?
Exercise 20 minutes/day, 2–3 days/week with rest breaks. Take albuterol beforehand.
214
What daily monitoring should COPD and HF patients do?
Daily weights. Report >2 lbs/day gain → may indicate fluid overload.
215
What sodium restriction is recommended for HF patients?
Limit sodium intake to <2 g/day.
216
What fluid restriction is common in HF patients?
Limit fluids to ~2 L/day, depending on severity and provider orders.
217
What is important medication teaching for HF patients on diuretics?
Take in the morning, monitor for dehydration, eat potassium-rich foods (if loop/thiazide), monitor electrolytes.
218
What is important medication teaching for patients on digoxin?
Check pulse before taking, report signs of toxicity (N/V, halos, arrhythmias). Do not double dose if missed.
219
What is important medication teaching for patients on inhaled corticosteroids?
Rinse mouth after use to prevent thrush. Use spacer if available.
220
What is the role of a peak flow meter in asthma teaching?
Helps patients monitor control, follow green/yellow/red zone action plans.
221
What teaching should be provided for oxygen therapy at home?
No smoking near oxygen, avoid electrical hazards, secure tanks upright, use proper flow rates as prescribed.
222
What lifestyle change is essential for HF patients?
Adherence to low-sodium diet, fluid restriction, and daily weight monitoring.
223
What activity teaching is important for HF patients?
Balance rest and activity. Avoid overexertion. Report new/worsening fatigue or dyspnea.
224
What vaccinations should COPD patients receive?
Annual influenza vaccine and pneumococcal vaccine to prevent respiratory infections.
225
What patient education is important regarding beta blockers in asthma/COPD?
Avoid non-selective beta blockers. If necessary, use cardio-selective beta-1 blockers only.
226
What emotional support is important in chronic illness teaching?
Encourage support groups, counseling, stress management to improve adherence and quality of life.
227
What teaching should be given about recognizing early hypoxia?
Recognize restlessness, tachypnea, tachycardia, diaphoresis → report to provider immediately.
228
What is the importance of medication adherence in asthma, COPD, and HF?
Prevents exacerbations, improves quality of life, reduces hospitalizations, and prevents disease progression.
Med Surg 2
flashcards
Decks in class (17)
# Cards
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Week 1 Medications71
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week 1 lecture157
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Week 1 Chemo Man20
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week 2 cardiac anatomy and physiology of heart38
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Week 2 Cardiac91
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week 2 cardiac ATI115
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week 2 cardiac drugs120
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week 3 meds61
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week 3 lecture228
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week 3 ati157
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week 3 questions140
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midterm review94
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midterm medications180
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midterm neuro40
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week 6 endocrine135
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week 7177
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Final Exam154
