Medical Surgical Nursing 2023 EXAM
Which of the following statements indicate that the client with PUD understands how to
effectively adjust the response to work related stress?
1) I will have to improve my ability to cope with stress
2) I don't have any control over my stressors at work. My c...
COPD - inhalation of irritants triggers what?
An inflammatory response
COPD - what leukocyte is triggered during the inflammatory response caused by
pathogens, or irritants?
Neutrophils are triggered when inflammation occurs.
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COPD - How do neutrophils respond to reduce inflammation cause by pathogens or
irritants?
By releasing proteolytic enzymes
COPD- Neutrophils release proteolytic enzymes, what else do they release to destroy
proteolytic enzymes (which destroy elastin fibres if not removed)?
Elastase, (alpha-1 antitrypsin)
COPD- If elastin fibres are destroyed how does this effect homeostasis?
Reduces the lungs recoil causing an inability to release CO2 into atmosphere.
COPD - What causes the lungs to have reduced elasticity?
The presence of neutrophils and macrophages, causes lung damage, reoccurring
pathogens or irritants causes neutrophils and macrophages to be continuously
activated.
COPD - What are possible patient presentations with respiratory diseases?
- Decreased lung compliance
- Impaired gas exchange
Aetiology of COPD?
Irritants - pollution, gases, smoke, occupational dusts.
Genes - Alpha1 antitrypsin deficiency
History - frequent LRI during childhood
What are Nursing based assessments used to help determine impaired lung function or
airway disease?
- Visual assessment
- Vital signs
- Pt Hx & medications
- Pulmonary function tests
- Sputum specimen to lab
, - Chest x-ray
- Arterial blood gas tests
What to look for visually when assessing for COPD?
- Blueness of the lips or fingernail beds (cyanosis)
- Swelling in ankles, feet or legs
- Wheezing
- A chronic cough that may produce mucus (sputum) that may be clear, white, yellow or
greenish
- Barrel chest in late stages due to inability to exhale air, therefore leaves lungs bloated.
COPD is a primary pulmonary condition, but it is recognised as...
...a multi-system disease associated with systemic consequences including systemic
inflammation and complex chronic comorbidities.
Can respiratory disease, impact mental health?
People whom have shortness of breath will slowly have deconditioning (a subsequent
muscle wastage), engage less in social situations, therefore become socially isolated,
as lung function decreases there is a risk of clinical depression.
+ 1 more side
What would be reg flags in vital signs that may indicate COPD?
- Increased respiratory rate (21-35+).
- Aterial oxygen saturation (spO2) below 88%, (O2 should be titrated to 88-92% spO2).
- HR above 94bpm
- Decrease in temperature, however fevers and increased temp are common as viral
and bacterial infection (acute bronchitis, pneumonia, cold and flu)
- Loss of consciousness (LOC)
- Unrelieved pain
What are signs and symptoms of COPD?
- SOBE
- Chronic cough
- Chronic septum production
- Progressive dyspnoea
- Wheeze
- Chest tightness
- Hypoxemia & hypercapnia (low oxygen in blood & high arterial CO2)
What would you look for with Pt Hx and medication?
- Hx of lung infection, breathing problems such as asthma. Also Hx of smoking or
occupational irritants.
- Medications: bronchodilator.
What are pulmonary function tests for assessment of respiratory symptoms?
- Spirometry measures the rate of air flow and estimates lung size
- Lung volume tests are the most accurate way to measure how much air your lungs
can hold.
- Lung diffusion capacity assesses how well oxygen gets into the blood from the air you
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