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Class notes NUR 601 Class notes NUR 601 PFTs/Gold criteria NUR 601
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Test content 1-4Week 1: aging (chapter 1 – Kennedy)
The major impact of all of these physiological changes can be highlighted with three primary
points. First, there is a reduced physiological reserve of most body systems, particularly cardiac,
respiratory, and renal. Second, there are reduced homeostatic mechanisms that fail to adjust
regulatory systems such as temperature control and fluid and electrolyte balance. Third, there is
impaired immunological function: infection risk is greater, and autoimmune diseases are more
prevalent
Exercise (Kennedy, ch 3)
The preferred amount of exercise is 30 minutes per day for 5 days a week of moderate exercise;
if weight management is part of this, 60 minutes per day is advised. This can be broken up into
as little as 10-minute intervals throughout the day; any increase in physical activity is desirable
and has some value over sedentary behavior
PFTs/Gold criteria
PFT is a group of test that provide quantifiable measurement of lung function and used to
diagnose respiratory abnormalities or assess the progression or resolution of lung disease.
FEV1 (1st second Forced Expiratory Volume) and FVC (Forced Vital Capactiy)80% -120%
Patient criteria: FEV1/FVC <0.70 (ratio is the percentage of maximum inspiration expired in
1 second)
FEV1 ≥80% predicted GOLD 1: Mild
50% ≤FEV1 <80% predicted GOLD 2: Moderate
30% ≤FEV1 <50% predicted GOLD 3: Severe
FEV1 <30% predicted GOLD 4: Very Severe
Chest disorders = 8 and gorroll
COPD
Signal symptoms: Dyspnea, chronic cough with sputum production, decreased activity
tolerance, wheezing.
Description: COPD (also called chronic obstructive lung disease [COLD]) encompasses a
group of conditions distinguished by ongoing expiratory airflow limitation
leading cause of death, it is a common, preventable, treatable disease that is characterized
by persistent airflow limitation that is usually progressive and associated with an
enhanced chronic inflammatory response in the airways and the lung to noxious particles
, or gases. You will have airway fibrosis, luminal plugs, airway inflammation, increased
airway resistance, small airway disease. There is a decreased elastic recoil of the alveoli.
Risk factors for COPD- smoking and increases with the number of pack years smoked.
Second hand smoke as well. Environmental pollution-endotoxins, coal dust, and mineral
dust. Nonmodifiable risk factors are gender.
Dyspnea get progressively worse and is an increased effort to breathe. The issue is getting
air out, not in.
Physical exam- The physical exam be normal in early disease states. So as severity of the
airway obstruction increases, the physical exam they rebuild hyperinflation of the lung,
decreased breath sounds, wheezes at the lung bases, and then you begin to hear distant
heart tones because of the hyperinflation, So S1 and S2 sounds kind of way off in the
distance. You will also see use of accessory muscles, pursed-lip breathing increased
expiratory phase, neck vein distension.
Diagnosing- Spirometry is the gold standard for diagnosing COPD- pre and
postbronchodilator. Irreversible airflow limitation is a hallmark of COPD.
Treatment: bronchodilators- beta e agaonists. And you've got a long acting and short
acting, and then your anticholingeric, which are long acting and short acting, and then a
combination of those. And so the beta agonists, the mechanisms of action of these is that
it stimulates the beta-2-adrenergic receptors, increasing cyclic AMP with the resulting
relaxing airways with muscles, so they can breathe better. anticholinergics, these block
the effect of acetylcholine on the muscarinic-type 3 receptors, which results in
bronchodilation. long-acting bronchodilators for moderate air flow limitation, you
schedule long-acting bronchodilators because they relieve the symptoms, increases
exercise tolerance, reduces the number of exacerbations, and improves your quality of
life.
NON-pulmonary diagnosis are CHF, hyperventilation syndrome, panic attacks, vocal
cord dysfunction, obstructive sleep anea, aspergillosis and chronic fatigue syndrome.
CORONARY HEART DISEASE
Primary prevention- Framingham Risk Score Control HTN, hypercholesterolemia,
smoking and obesity. Family history
HYPERTENSION
High levels of homocysteine are thought to be injurious to arterial walls, and initial
epidemiologic study suggested a strong independent relationship, perhaps accounting for
risk in persons with otherwise unexplained coronary events.
ASTHMA
Signal symptoms: Wheezing, shortness of breath, cough (especially at night), chest
tightness. Seen every one to 6 months for evaluation.
CHRONIC BRONHCITIS
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