NUR 255
EXAM 1 STUDY GUIDE
(Covers Units 1 & 2)
Concepts of Aging, Chronic Illness & Mental Health
Nursing - Galen College of Nursing
, Exam 1 Chronic
Asthma Meds:
Bronchodilators- smooth muscle relaxation. Albuterol
Beta 2 Agonist- bind to beta 2 adrenergic receptors. Increase cAMP to trigger smooth muscle
relaxation. Bitolterol
Short-acting beta 2 agonists- rapid short term relief. Use at start of or before attack.
Terbutaline
Long acting Beta 2 agonist- requires time to build effect, but useful as preventative and have
value during acute attack. Formoterol, Salmeterol
Cholinergic antagonists- only pts who dislike S/E of beta 2 agonists- not as effective.
anticholinergics allow SNS to dominate, increase bronchodilation, decreased secretions.
Ipratropium (Atrovent- short acting), Tiotropium (Spiriva- long acting)
Methylxanthines- only when other med management is ineffective. Monitor blood levels closely
to ensure therapeutic effect at 10-15 μg/mL. Theophylline, Aminophylline
Anti-Inflammatories- decrease inflammation.
Corticosteroids- decrease inflammatory, immune response. Inhaled.May be used daily as
preventative, not during acute attack. Fluticasone (Flovent), Budesonide (Pulmicort)
Leukotriene antagonists- PO prevention on scheduled basis, not during acute attack.
Montelukast (Singulair), Zafirlukast (Accolade), Zileuton (Zyflo)
Immunomodulators- anti- IgE drugs that bind to molecules w/ attached allergens. Prevent
atopic asthma, not acute attacks. In use of pt with high IgE levels. May cause anaphylaxis- only
use where management is possible. Omalizumab (Xolair)
These drugs may be metered dose inhalers, powder inhalers, nebulizers.
Teaching: Include info about meds, name, purpose, dosage, method of administration,
appropriate management of side effects, how to clean and use devices, consequences for
breathing if not taken appropriately.
, Chronic Respiratory
What aging does to respiratory system w/ chronic illness: decrease in alveoli surface area and
elasticity, decreased lung capacity and increased residual volume, pharynx and larynx muscle
atrophy, slack vocal chords, decrease lung capillary volume ( increased vascular resistance can
lead to right sided heart failure), decreased exercise tolerance and decreased response to hypoxia,
increased susceptibility to infection, decreased cilia function in lungs, decreased muscle strength
that may alter AP diameter and cause osteoporosis, lordosis (sway back), kyphosis(humpback).
Care for aging chronically ill respiratory system: vigorous pulmonary hygiene, upright
position, lung and respirations assessment, actively maintain health and fitness, frequent oral
hygiene (dry mouth, dentures, etc), face to face conversations with pt, assess LOC and cognitive
function, assess manifestations of hypoxia, discuss normal changes of aging, discuss increased
need for rest periods during tasks- they need to pace themselves, encourage calcium intake.
Pack years = packs per day x numbers of years smoked.
Obstructive Sleep Apnea
Breathing disruption during sleep at least 10 seconds, 5 times an hour.
Symptoms: excessive daytime sleepiness, inability to concentrate, irritability
Neurological origin/upper airway obstruction (obesity, short neck, smoking, enlarged uvula-
tonsils, adenoids)
Nonsurgical management—change of sleep position, weight loss, positive-pressure ventilation
(BiPAP, APAP, CPAP)
Surgical management—adenoidectomy, uvulectomy or uvulopalatopharyngoplasty, remodel
posterior oropharynx
Other Upper airway obstruction:
- This is life threatening emergency in which airflow through the nose, mouth, pharynx or
larynx is interrupted and gas exchange is impaired. Early detection is key to prevent
complications which can include respiratory arrest.
- Causes for upper airway obstruction include:
- Tongue edema
- Tongue occlusion
, - Laryngeal edema
- Peritonsillar or pharyngeal abscess
- Head and neck cancer
- Thick secretions
- Stroke and cerebral edema
- Facial, tracheal, or laryngeal trauma
- Foreign-body aspiration
- Burns on the head or neck area
- Anaphylaxis
- ONe preventable cause of airway obstruction leading to asphyxiation is inspissared
*thickly crusted* oral and nasopharyngeal secretions. Poor oral hygiene leads to the
thickening and hardening of secretions that can completely block the airway and lead to
death.
- INterventions would be suctioning to remove secretions, perform abdominal thrusts of a
foreign body is lodged. It may also require a emergency trach, ET tube intubation, or
cricothyroidotomy.
Defining terms with Chronic Airflow Limitations:
Asthma: The airways overreact to common stimuli with bronchospasm, edematous swelling of
the mucous membranes, and copious production of thick, tenacious mucus by abundant
hypertrophied mucous glands. Airway obstruction is usually intermittent.
Chronic Bronchitis: Infection or bronchial irritants cause increased secretions, edema,
bronchospasm, and impaired mucociliary clearance. Inflammation of the bronchial walls causes
them to thicken. This thickening, together with excessive mucus, blocks the airways and hinders
gas exchange.
Centriacinar or Centrilobular Emphysema: This affects the respiratory bronchioles most
severely. It is usually more severe in the upper lung.
Emphysema: Lung proteases collapse the walls of the bronchioles and alveolar air sacs. As these
walls collapse, the bronchioles and alveoli transform from a number of small elastic structures
with great air exchanging surface area into fewer, larger, inelastic structures with little surface
area. Air is trapped in these distal structures, especially during forced expiration such as
coughing, and the lungs hyperinflate. The trapped air stagnates and can no longer supply needed
O2 to the nearby capillaries.
Panacinar or Panlobular: Emphysema affects the entire acinar unit. It is usually more severe in
the lower lung.
Asthma
Chronic inflammatory disorder that leads to airway obstruction by either inflammation or
airway hyperresponsiveness leading to bronchoconstriction. Only effects airways, not alveoli.
Inflammation: response to presence of specific allergens, general irritants, microorganisms,
aspirin.
EXAM 1 STUDY GUIDE
(Covers Units 1 & 2)
Concepts of Aging, Chronic Illness & Mental Health
Nursing - Galen College of Nursing
, Exam 1 Chronic
Asthma Meds:
Bronchodilators- smooth muscle relaxation. Albuterol
Beta 2 Agonist- bind to beta 2 adrenergic receptors. Increase cAMP to trigger smooth muscle
relaxation. Bitolterol
Short-acting beta 2 agonists- rapid short term relief. Use at start of or before attack.
Terbutaline
Long acting Beta 2 agonist- requires time to build effect, but useful as preventative and have
value during acute attack. Formoterol, Salmeterol
Cholinergic antagonists- only pts who dislike S/E of beta 2 agonists- not as effective.
anticholinergics allow SNS to dominate, increase bronchodilation, decreased secretions.
Ipratropium (Atrovent- short acting), Tiotropium (Spiriva- long acting)
Methylxanthines- only when other med management is ineffective. Monitor blood levels closely
to ensure therapeutic effect at 10-15 μg/mL. Theophylline, Aminophylline
Anti-Inflammatories- decrease inflammation.
Corticosteroids- decrease inflammatory, immune response. Inhaled.May be used daily as
preventative, not during acute attack. Fluticasone (Flovent), Budesonide (Pulmicort)
Leukotriene antagonists- PO prevention on scheduled basis, not during acute attack.
Montelukast (Singulair), Zafirlukast (Accolade), Zileuton (Zyflo)
Immunomodulators- anti- IgE drugs that bind to molecules w/ attached allergens. Prevent
atopic asthma, not acute attacks. In use of pt with high IgE levels. May cause anaphylaxis- only
use where management is possible. Omalizumab (Xolair)
These drugs may be metered dose inhalers, powder inhalers, nebulizers.
Teaching: Include info about meds, name, purpose, dosage, method of administration,
appropriate management of side effects, how to clean and use devices, consequences for
breathing if not taken appropriately.
, Chronic Respiratory
What aging does to respiratory system w/ chronic illness: decrease in alveoli surface area and
elasticity, decreased lung capacity and increased residual volume, pharynx and larynx muscle
atrophy, slack vocal chords, decrease lung capillary volume ( increased vascular resistance can
lead to right sided heart failure), decreased exercise tolerance and decreased response to hypoxia,
increased susceptibility to infection, decreased cilia function in lungs, decreased muscle strength
that may alter AP diameter and cause osteoporosis, lordosis (sway back), kyphosis(humpback).
Care for aging chronically ill respiratory system: vigorous pulmonary hygiene, upright
position, lung and respirations assessment, actively maintain health and fitness, frequent oral
hygiene (dry mouth, dentures, etc), face to face conversations with pt, assess LOC and cognitive
function, assess manifestations of hypoxia, discuss normal changes of aging, discuss increased
need for rest periods during tasks- they need to pace themselves, encourage calcium intake.
Pack years = packs per day x numbers of years smoked.
Obstructive Sleep Apnea
Breathing disruption during sleep at least 10 seconds, 5 times an hour.
Symptoms: excessive daytime sleepiness, inability to concentrate, irritability
Neurological origin/upper airway obstruction (obesity, short neck, smoking, enlarged uvula-
tonsils, adenoids)
Nonsurgical management—change of sleep position, weight loss, positive-pressure ventilation
(BiPAP, APAP, CPAP)
Surgical management—adenoidectomy, uvulectomy or uvulopalatopharyngoplasty, remodel
posterior oropharynx
Other Upper airway obstruction:
- This is life threatening emergency in which airflow through the nose, mouth, pharynx or
larynx is interrupted and gas exchange is impaired. Early detection is key to prevent
complications which can include respiratory arrest.
- Causes for upper airway obstruction include:
- Tongue edema
- Tongue occlusion
, - Laryngeal edema
- Peritonsillar or pharyngeal abscess
- Head and neck cancer
- Thick secretions
- Stroke and cerebral edema
- Facial, tracheal, or laryngeal trauma
- Foreign-body aspiration
- Burns on the head or neck area
- Anaphylaxis
- ONe preventable cause of airway obstruction leading to asphyxiation is inspissared
*thickly crusted* oral and nasopharyngeal secretions. Poor oral hygiene leads to the
thickening and hardening of secretions that can completely block the airway and lead to
death.
- INterventions would be suctioning to remove secretions, perform abdominal thrusts of a
foreign body is lodged. It may also require a emergency trach, ET tube intubation, or
cricothyroidotomy.
Defining terms with Chronic Airflow Limitations:
Asthma: The airways overreact to common stimuli with bronchospasm, edematous swelling of
the mucous membranes, and copious production of thick, tenacious mucus by abundant
hypertrophied mucous glands. Airway obstruction is usually intermittent.
Chronic Bronchitis: Infection or bronchial irritants cause increased secretions, edema,
bronchospasm, and impaired mucociliary clearance. Inflammation of the bronchial walls causes
them to thicken. This thickening, together with excessive mucus, blocks the airways and hinders
gas exchange.
Centriacinar or Centrilobular Emphysema: This affects the respiratory bronchioles most
severely. It is usually more severe in the upper lung.
Emphysema: Lung proteases collapse the walls of the bronchioles and alveolar air sacs. As these
walls collapse, the bronchioles and alveoli transform from a number of small elastic structures
with great air exchanging surface area into fewer, larger, inelastic structures with little surface
area. Air is trapped in these distal structures, especially during forced expiration such as
coughing, and the lungs hyperinflate. The trapped air stagnates and can no longer supply needed
O2 to the nearby capillaries.
Panacinar or Panlobular: Emphysema affects the entire acinar unit. It is usually more severe in
the lower lung.
Asthma
Chronic inflammatory disorder that leads to airway obstruction by either inflammation or
airway hyperresponsiveness leading to bronchoconstriction. Only effects airways, not alveoli.
Inflammation: response to presence of specific allergens, general irritants, microorganisms,
aspirin.
