CHRONIC RESPIRATORY SYSTEM DISORDERS (approx. 15-20 questions): CHAPTER 24
Nursing assessment concerns and considerations when planning care for clients with:
COPD:
● Characterized by airflow limitation that is not fully reversible
● Causes airflow obstruction in the airways or obstruction in the parenchyma of the lung, or
a combination of both
● Can coexist with Asthma, which is characterized by abnormal airways characterized
primarily by reversible inflammation
● Oxygen can improve tissue hypoxia, exercise induced hypoxemia, sleep induced
hypoxemia
○ Airflow limitation is progressive, associated with abnormal inflammatory response
to noxious particles or gases
○ Chronic inflammation damages tissue
○ Scar tissue in pulmonary vasculature causes thickened vessel lining and
hypertrophy of smooth muscle (pulmonary hypertension)
● Risk factors
○ Exposure to tobacco smoke
○ Passive smoking
○ Increased age
○ Occupational exposure
○ CF
● Assessment:
○ Health history (smoking, exposure to smoke)
○ May walk slouched over, sitting forward leaning over TRIPOD position when
SOB and anxious
○ Diagnosis: PFTs, Spirometry, ABGs, CXR to rule out other causes, Screening
for alpha1-antitrypsin deficiency
○ Complications: respiratory insufficiency, respiratory failure, infection,
pneumonia, chronic atelectasis, pneumothorax and pulmonary artery
hypertension
○ Management: smoking cessation ( nicotine replacement), antidepressants),
corticosteroids, (for short term use only)
○ Other medications: antibiotics, mucolytics, antitussives, narcotics, vasodilators
○ Pulmonary rehabilitation: reduces symptoms improve quality of life.
● Surgical Management:
○ Bullectomy; Bullae(enlarged air spaces that don’t contribute to ventilation).
Removing them reduces dyspnea and improves lung function
○ Lung Transplant: expensive, limited number of donors
Emphysema:
● Abnormal distention of air spaces beyond the terminal bronchioles with destruction of the walls of
the alveoli
● Hypoxemia results
● It has more to do with surface area and CO2
● Thoracic cavity becomes enlarged (barrel chest) 1:1 ratio
,Chronic bronchitis
● Diagnosed by cough and sputum production for at least 3 months in each of 2 consecutive years
● Ciliary function is reduced, bronchial walls thicken, bronchial airways
narrow, and mucous may plug airways
● The patient is more susceptible to respiratory infections, especially in
winter months
● Inflammation of the bronchioles
Bronchiectasis - chronic, irreversible dilation of the bronchi and bronchioles
● Caused by:
○ Airway obstruction, pulmonary infections
○ Diffuse airway injury
○ Genetic disorders
○ Abnormal host defenses
○ Idiopathic causes
● Clinical Manifestations and Medical Management:
○ Chronic cough
○ Smoking cessation
○ Antimicrobial therapy
● Nursing Management:
○ Focus is on alleviating symptoms and clearing pulmonary secretions (smoking cessation,
postural drainage)
○ Patient teaching:
○ Monitor for early signs of respiratory infection
○ Pace activities
○ Adequate diet
○ Encourage vaccinations
Asthma :
● Chronic inflammatory disease of the airways that causes hyperresponsiveness, mucosal edema,
and mucus production
● Inflammation leads to cough, chest tightness, wheezing, and dyspnea
● Complication of Asthma:
○ Respiratory failure
○ Pneumonia
○ Atelectasis
○ Airway obstruction
○ Hypoxemia
● Patient Teaching:
○ ID and avoid triggers
○ Inhalation techniques, rinse mouth
○ How to perform peak flow monitoring
○ Implement action plan
○ When and how to seek help.
● Management:
○ Quick-relief medications
○ Incentive Spirometry- deep breathe in and out
○ Long-acting medications
Cystic Fibrosis *NO cure, a bilateral lung transplant may be needed*
Common diagnostic tests, risk factors, anticipated medical management for each disorder Nursing
considerations pre and post diagnostic tests and procedures
● Genetic screening to detect carriers ;Genetic counseling for couples at risk
● Diagnosis: Sweat chloride analysis, GI enzyme evaluation
, CIRCULATION (approx. 25-35 questions): CHAPTER 25
Normal flow of blood through the heart
● Superior and inferior vena cava – bring deoxygenated blood from the body to the heart
● Pulmonary artery - carries deoxygenated blood from RV to lungs where it will become
oxygenated
● Pulmonary veins – bring the oxygenated blood from lungs to the LV
● Aorta – takes oxygenated blood from LV to bodyst
● Stroke Volume- amount of blood ejected from LV with each heartbeat.
■ (normal range (60-130ml)
○ Control of stroke volume(depends on 3 things: preload, afterload and contractility)
○ Preload: degree of stretch of cardiac muscle fibers at end of diastole
○ Afterload: resistance to ejection of blood from ventricle
○ Contractility: ability of cardiac muscle to shorten in response to electrical impulse
● Cardiac Output- amount of blood pumped by ventricle in liters per minute.
○ (normal range is 4-6L/min)
■ CO = SV × HR
● Ejection fraction- percent of end diastolic volume ejected from LV with each heartbeat.
○ (normal range is 55%-65%) / 60-70% (she stated this) want the ventricles to empty out at
least ½.
● Modifiable and non-modifiable risk factors for cardiovascular disease
○ Modifiable (hyperlipidemia, cigarette smoking, hypertension, diabetes, metabolic
syndrome, obesity, physical inactivity)
○ Nonmodifiable (family history (especially sudden death r/t) CAD- increasing age; gender,
race and ethnicity( african american higher risk)
○ #1 Cause of death- CAD #2 Cancer #3 med errors
● Cardiac changes with aging
○ Slower heart rate *it is normal to have a HR of 50 *
○ Increase in size of heart (hypertrophy)- the heart gets bigger but doesnt mean its more
efficient
○ Reduced strength of contraction
○ Lower cardiac output
○ Stiffening of valves (increased murmurs) *the valves start sticking/clogging*
○ Decreased baroreceptor response (increase in orthostatic BP changes) dangle legs
● Clinical Manifestation
○ Chest pain
○ Dyspnea
○ Peripheral edema, weight gain *daily weights is key intervention*
○ Fatigue
○ Dizziness, syncope, changes in level of consciousness
Possible causes of chest pain and management of them:
Always rule out heart attack first**
● Angina Pectoris (stable angina): short duration (5-15 minutes)
○ uncomfortable pressure, squeezing or fullness in substernal chest area (commonly L)
○ precipitated by exertion, stress, eating large meal, exposure to extreme temperature
○ relieved with rest, nitroglycerine (don't touch with hands, sensitive to light), oxygen
● ACS (acute coronary syndrome, unstable angina, MI):
○ same symptoms as angina duration longer than 15min
■ relieved with morphine, cardiac interventions
● Pericarditis: sharp, severe substernal or epigastric pain, sudden onset,
○ can radiate to neck, arms and back
○ may have nausea, fever, dyspnea, palpitations, dizziness
○ Pain increases with movement
○ Treatment: analgesia, non-inflammatory medications, sitting semi- high fowlers
Nursing assessment concerns and considerations when planning care for clients with:
COPD:
● Characterized by airflow limitation that is not fully reversible
● Causes airflow obstruction in the airways or obstruction in the parenchyma of the lung, or
a combination of both
● Can coexist with Asthma, which is characterized by abnormal airways characterized
primarily by reversible inflammation
● Oxygen can improve tissue hypoxia, exercise induced hypoxemia, sleep induced
hypoxemia
○ Airflow limitation is progressive, associated with abnormal inflammatory response
to noxious particles or gases
○ Chronic inflammation damages tissue
○ Scar tissue in pulmonary vasculature causes thickened vessel lining and
hypertrophy of smooth muscle (pulmonary hypertension)
● Risk factors
○ Exposure to tobacco smoke
○ Passive smoking
○ Increased age
○ Occupational exposure
○ CF
● Assessment:
○ Health history (smoking, exposure to smoke)
○ May walk slouched over, sitting forward leaning over TRIPOD position when
SOB and anxious
○ Diagnosis: PFTs, Spirometry, ABGs, CXR to rule out other causes, Screening
for alpha1-antitrypsin deficiency
○ Complications: respiratory insufficiency, respiratory failure, infection,
pneumonia, chronic atelectasis, pneumothorax and pulmonary artery
hypertension
○ Management: smoking cessation ( nicotine replacement), antidepressants),
corticosteroids, (for short term use only)
○ Other medications: antibiotics, mucolytics, antitussives, narcotics, vasodilators
○ Pulmonary rehabilitation: reduces symptoms improve quality of life.
● Surgical Management:
○ Bullectomy; Bullae(enlarged air spaces that don’t contribute to ventilation).
Removing them reduces dyspnea and improves lung function
○ Lung Transplant: expensive, limited number of donors
Emphysema:
● Abnormal distention of air spaces beyond the terminal bronchioles with destruction of the walls of
the alveoli
● Hypoxemia results
● It has more to do with surface area and CO2
● Thoracic cavity becomes enlarged (barrel chest) 1:1 ratio
,Chronic bronchitis
● Diagnosed by cough and sputum production for at least 3 months in each of 2 consecutive years
● Ciliary function is reduced, bronchial walls thicken, bronchial airways
narrow, and mucous may plug airways
● The patient is more susceptible to respiratory infections, especially in
winter months
● Inflammation of the bronchioles
Bronchiectasis - chronic, irreversible dilation of the bronchi and bronchioles
● Caused by:
○ Airway obstruction, pulmonary infections
○ Diffuse airway injury
○ Genetic disorders
○ Abnormal host defenses
○ Idiopathic causes
● Clinical Manifestations and Medical Management:
○ Chronic cough
○ Smoking cessation
○ Antimicrobial therapy
● Nursing Management:
○ Focus is on alleviating symptoms and clearing pulmonary secretions (smoking cessation,
postural drainage)
○ Patient teaching:
○ Monitor for early signs of respiratory infection
○ Pace activities
○ Adequate diet
○ Encourage vaccinations
Asthma :
● Chronic inflammatory disease of the airways that causes hyperresponsiveness, mucosal edema,
and mucus production
● Inflammation leads to cough, chest tightness, wheezing, and dyspnea
● Complication of Asthma:
○ Respiratory failure
○ Pneumonia
○ Atelectasis
○ Airway obstruction
○ Hypoxemia
● Patient Teaching:
○ ID and avoid triggers
○ Inhalation techniques, rinse mouth
○ How to perform peak flow monitoring
○ Implement action plan
○ When and how to seek help.
● Management:
○ Quick-relief medications
○ Incentive Spirometry- deep breathe in and out
○ Long-acting medications
Cystic Fibrosis *NO cure, a bilateral lung transplant may be needed*
Common diagnostic tests, risk factors, anticipated medical management for each disorder Nursing
considerations pre and post diagnostic tests and procedures
● Genetic screening to detect carriers ;Genetic counseling for couples at risk
● Diagnosis: Sweat chloride analysis, GI enzyme evaluation
, CIRCULATION (approx. 25-35 questions): CHAPTER 25
Normal flow of blood through the heart
● Superior and inferior vena cava – bring deoxygenated blood from the body to the heart
● Pulmonary artery - carries deoxygenated blood from RV to lungs where it will become
oxygenated
● Pulmonary veins – bring the oxygenated blood from lungs to the LV
● Aorta – takes oxygenated blood from LV to bodyst
● Stroke Volume- amount of blood ejected from LV with each heartbeat.
■ (normal range (60-130ml)
○ Control of stroke volume(depends on 3 things: preload, afterload and contractility)
○ Preload: degree of stretch of cardiac muscle fibers at end of diastole
○ Afterload: resistance to ejection of blood from ventricle
○ Contractility: ability of cardiac muscle to shorten in response to electrical impulse
● Cardiac Output- amount of blood pumped by ventricle in liters per minute.
○ (normal range is 4-6L/min)
■ CO = SV × HR
● Ejection fraction- percent of end diastolic volume ejected from LV with each heartbeat.
○ (normal range is 55%-65%) / 60-70% (she stated this) want the ventricles to empty out at
least ½.
● Modifiable and non-modifiable risk factors for cardiovascular disease
○ Modifiable (hyperlipidemia, cigarette smoking, hypertension, diabetes, metabolic
syndrome, obesity, physical inactivity)
○ Nonmodifiable (family history (especially sudden death r/t) CAD- increasing age; gender,
race and ethnicity( african american higher risk)
○ #1 Cause of death- CAD #2 Cancer #3 med errors
● Cardiac changes with aging
○ Slower heart rate *it is normal to have a HR of 50 *
○ Increase in size of heart (hypertrophy)- the heart gets bigger but doesnt mean its more
efficient
○ Reduced strength of contraction
○ Lower cardiac output
○ Stiffening of valves (increased murmurs) *the valves start sticking/clogging*
○ Decreased baroreceptor response (increase in orthostatic BP changes) dangle legs
● Clinical Manifestation
○ Chest pain
○ Dyspnea
○ Peripheral edema, weight gain *daily weights is key intervention*
○ Fatigue
○ Dizziness, syncope, changes in level of consciousness
Possible causes of chest pain and management of them:
Always rule out heart attack first**
● Angina Pectoris (stable angina): short duration (5-15 minutes)
○ uncomfortable pressure, squeezing or fullness in substernal chest area (commonly L)
○ precipitated by exertion, stress, eating large meal, exposure to extreme temperature
○ relieved with rest, nitroglycerine (don't touch with hands, sensitive to light), oxygen
● ACS (acute coronary syndrome, unstable angina, MI):
○ same symptoms as angina duration longer than 15min
■ relieved with morphine, cardiac interventions
● Pericarditis: sharp, severe substernal or epigastric pain, sudden onset,
○ can radiate to neck, arms and back
○ may have nausea, fever, dyspnea, palpitations, dizziness
○ Pain increases with movement
○ Treatment: analgesia, non-inflammatory medications, sitting semi- high fowlers
