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NRS 340 - Final Exam Questions and Answers
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NRS 340 - Final Exam
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NRS 340 - Final Examminor alcohol withdrawal begins - answer6-12 hrs after last drink
s/s of minor withdrawal - answer nervousness, tremulousness, increased BP and pulse,
GI upset, mild anxiety
single or flurry of generalized, tonic-clinic seizures - answer6-48 hrs after last drink
alcoholic hallucinations - answer intact orientation with normal vital signs
12-48 hrs after last drink
delirium tremors (DTs) - answer delirium, agitation, tachycardia, HTN, febrile,
diaphoresis
48-96 hrs after last drink
medical emergency: ICU, ventilator, fatal
goal for tx of alcohol withdrawal - answerto prevent DTs
alcohol withdrawal: benzos - answerprevent seizures
COPD - answerairflow limitation not fully reversible
generally progressive
abnormal inflammatory response of lungs to noxious particles or gases
3rd leading cause of death in the US
in order to prevent -> educate
COPD includes - answerchronic bronchitis
emphysema
chronic bronchitis - answerinflammation of the airways
3 months out of a year; could be consecutive
,emphysema - answeralveoli do not recoil
retain CO2, can't expel air
risk factors for COPD - answercigarette smoke: second hand smoking
occupational chemicals and dust
air pollution
infection: chronic
heredity: A1 antitrypsin
aging
effects of nicotine - answerstimulates SNS:
-increases HR
-causes peripheral vasoconstriction
-increases BP and cardiac workload
-decreases amount of functional hemoglobin
-increases platelet aggregation -> clots
-compounds problems in CAD
effects of smoking on respiratory tract - answerincreased production of mucus
hyperplasia of goblet cells: increased production of mucus
lost or decreased ciliary activity: paralyzed
chronic, enhanced inflammation: risk for hyperplasia
effects of smoking on carbon monoxide - answerdecreased O2 carrying capacity
-increased HR
-impaired psychomotor performance and judgement
passive smoking (second-hand smoke) - answerdecreases pulmonary fxn
increases risk for lung cancer
increases respiratory symptoms
COPD: occupational and environmental - answerCOPD can develop with intense or
prolonged exposure to
-dust, vapor, irritants, or fumes
-high levels of air pollution
,-fumes from indoor heating or cooking with fossil fuels
COPD: heredity - answeralpha-antitrypsin (AAT) deficiency
-genetic risk factor for COPD
-accounts for 3% of COPD
-AAT is an autosomal recessive disorder
COPD: pathophysiology - answerirreversible airflow limitations during forced exhalation
due to loss of elastic recoil
airflow obstruction due to mucus hypersecretion, mucosal edema, and bronchospasm
primary process = inflammation
-inhalation of noxious particles
-mediators released cause damage to lung tissue
-airways inflamed
-parenchyma destroyed
supporting structures of lungs are destroyed
-air goes in easily, but remains in the lungs
-bronchioles tend to collapse
-causes barrel-chest look
pulmonary vascular changes
-blood vessels thicken
-surface area for diffusion of O2 decreases
results in pulmonary HTN
pulmonary HTN - answerpulmonary vessels change -> increased pressure
s/s of distress - answerfatigue, tripod, blue lips, agitated, increased respiratory rate
s/s of COPD - answer-develops slowly
-dx is considered with cough, sputum production, dyspnea, exposure to risk factors
-causes chest breathing: use of accessory and intercostal muscles; inefficient breathing
-may experience chest tightness with activity
-underweight with adequate caloric intake
-chronic fatigue
-prolonged expiratory phase, wheezes
-decreased breath sounds, tripod position
-pursed lip breathing
-barrel chest
-bluish-red color of skin: cyanosis/polycythemia
classification of COPD - answermild: >80%
, moderate: 50-80%
severe: 30-50%
very severe: <30%
based on forced expiratory volume
COPD exacerbations - answersignaled by change in usual:
-dyspnea, cough, sputum
associated with poorer outcomes
primary causes: bacterial and viral infections
signs of severity:
-use of accessory muscles
-central cyanosis
tx: short-acting bronchodilators, corticosteroids, antibiotics, or supplemental oxygen
therapy
COPD: depression and anxiety - answerpts experience many losses
if pt becomes anxious bc of dyspnea, teach pursed lip breathing
diagnostic studies: COPD - answerspirometry: reduced FEV/FVC ratio; increased
residual volume
chest x-ray; hx and physical examination
COPD assessment tool (CAT)
modified medical research council (mMRC) dyspnea scale
ABGs
typical findings for ABG in later stages of COPD - answerlow PaO2, high PaCO2
low pH, high bicarbonate level
collaborative care: COPD - answer-evaluate for environmental or occupational irritants
-determine ways to control or avoid
-influenza virus vaccine
-pneumococcal vaccine (pneumovax)
-exacerbations txed promptly
-smoking cessation
-drug therapy
drug therapy: COPD - answerbronchodilators: relax smooth muscle in the airway;
improve ventilation of the lungs; decrease dyspnea and increase FEV1; inhaled route is
preferred
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