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NURSING 2NN3 Study Guide - Winter 2019, Comprehensive Midterm Notes - Zirconium Hydride, Zinc Deficiency, Wheat


Department
Nursing
Course Code
NURSING 2NN3
Professor
Tracey Jewiss
Study Guide
Midterm

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NURSING 2NN3

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Copyright © 2019 Elsevier Canada, a division of Reed Elsevier Canada, Ltd.
Lewis: Medical-Surgical Nursing in Canada, 4th Edition
Chapter 31: Nursing Management: Obstructive Pulmonary Diseases
Key Points
ASTHMA
Asthma is a chronic inflammatory lung disorder of the airways that results in
recurrent episodes of airflow obstruction, but is usually reversible. Inflammation
causes varying degrees of obstruction in the airways, which leads to recurrent
episodes of wheezing, breathlessness, sensation of chest tightness, and cough,
particularly at night and in the early morning.
Although the exact mechanisms that cause asthma remain unknown, multiple triggers
are involved.
o Allergic asthma may be related to allergens, such as dust, pollen, grasses, mites,
roaches, moulds, animal dander, or latex.
o Asthma that is induced or exacerbated during physical exertion is called exercise-
induced asthma (EIA) or exercise-induced bronchospasm (EIB). Typically, this
type of asthma occurs after vigorous exercise, not during it.
o Respiratory infections (particularly viral) are the major precipitating factor of an
acute asthma attack.
o Some patients with asthma have chronic sinus and nasal problems. Nasal
problems include allergic rhinitis, either seasonal or perennial, and nasal polyps.
o Sensitivity to specific drugs (e.g., Aspirin and other NSAIDS) may occur in some
asthmatic persons, especially those with nasal polyps and sinusitis, resulting in an
asthma episode.
o Tartrazine (yellow dye no. 5, found in many foods) and sulphites (e.g., sodium
metabisulphite), widely used in the food and pharmaceutical industries as
preservatives and sanitizing agents can precipitate asthma symptoms. Sulphites
are commonly found in fruits, beer, and wine and are used extensively in salad
bars to protect vegetables from oxidation.
o Gastroesophageal reflux disease (GERD) can also trigger asthma.
o Various air pollutants, cigarette or wood smoke, vehicle exhaust, diesel
particulate, elevated ozone levels, sulphur dioxide, and nitrogen dioxide can
trigger asthma attacks.
o Physiological stress that elicits emotional responses such as crying, laughing,
anger, and fear can lead to hyperventilation and hypocapnia, which can cause
airway narrowing.
o Occupational asthma occurs after exposure to agents of the workplace. These
agents are diverse and include wood dusts, laundry detergents, metal salts,
chemicals, paints, solvents, and plastics.
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Key Points
Copyright © 2019 Elsevier Canada, a division of Reed Elsevier Canada, Ltd.
31-2
The hallmarks of asthma are airway inflammation and airway hyper-responsiveness.
The degree of bronchoconstriction is related to the degrees of airway inflammation,
airway hyper-responsiveness, and exposure to endogenous and exogenous triggers
(e.g., infections, allergens, histamine, and other cell mediators).
Exposure to allergens or irritants initiates an inflammatory cascade involving multiple
cell types, mediators, and chemokines. Typically, there are two possible types of
asthmatic responses to stimuli: an early-phase response and a late-phase response.
The characteristic clinical manifestations of asthma are wheezing, cough, dyspnea,
and chest tightness after exposure to a precipitating factor or trigger. Expiration may
be prolonged.
In some patients with asthma, cough is the only symptom, which is termed cough
variant asthma.
The severity of asthma is determined from the frequency and duration of symptoms,
the presence of persistent airflow limitation, and the medication required to maintain
control.
Severe acute asthma can result in complications such as pneumothorax,
pneumomediastinum, acute cor pulmonale with right ventricular failure, and severe
respiratory muscle fatigue that leads to respiratory arrest (which can be fatal).
Two main features must be considered in the diagnosis of asthma: symptoms and
variable airflow obstruction. A detailed history is important in determining whether a
person has had previous attacks of a similar nature, often precipitated by a known
cause or trigger.
In all patients who are able to perform pulmonary testing, clinically suspected asthma
should be confirmed with objective lung measurements that demonstrate post-
bronchodilator reversible obstruction, variable airflow limitation over time, or airway
hyper-responsiveness. Spirometry is the preferred test for diagnosing asthma;
alternative lung testing includes variations in PEFR and bronchoprovocative
challenge testing.
Patient education remains the cornerstone of asthma management and should be
carried out by health care providers providing asthma care. Several components
enable successful management of asthma: (1) establishment of a confirmed diagnosis
through the use of objective measures; (2) development of a partnership between
health care providers and the patients and families affected by asthma; (3) limited
exposure to triggers; (4) education of patients; (5) appropriate pharmacotherapy; (6)
continuous assessment and monitoring of asthma control and severity; (7)
implementation of a written action plan; and (8) ensuring regular follow-up.
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Key Points
Copyright © 2019 Elsevier Canada, a division of Reed Elsevier Canada, Ltd.
31-3
Medications are divided into two general classifications: (1) relievers (“rescue”
medications used intermittently as required to ease asthma symptoms) and (2)
controllers (maintenance therapy used on a daily basis, typically twice a day).
o Because chronic inflammation is a primary component of asthma, corticosteroids,
which suppress the inflammatory response, are the most potent and effective anti-
inflammatory medication currently available to treat asthma.
o Mast cell stabilizers are nonsteroidal anti-inflammatory drugs that inhibit the IgE-
mediated release of inflammatory mediators from mast cells and suppress other
inflammatory cells (e.g., eosinophils).
o The use of leukotriene modifiers can successfully be used as add-on therapy to
reduce (not substitute for) the doses of inhaled corticosteroids.
o Short-acting inhaled β2-adrenergic agonists are the most effective drugs for
relieving acute bronchospasm. They are also used for acute exacerbations of
asthma.
o Methylxanthine (theophylline) preparations are less effective long-term control
bronchodilators than β2-adrenergic agonists.
o Anticholinergic agents (e.g., ipratropium [Atrovent], tiotropium [Spiriva]) block
the bronchoconstricting influence of the parasympathetic nervous system.
One of the major factors for determining success in asthma management is the correct
administration of drugs.
Inhalation devices include metered-dose inhalers (with or without spacers), dry
powder inhalers, and wet nebulizers.
A goal in asthma care is to maximize the ability of the patient to safely manage acute
asthma episodes via an asthma action plan developed in conjunction with the health
care provider. An important nursing goal during an acute attack is to decrease the
patient’s sense of panic.
Written asthma action plans should be developed together with the patient and family,
especially for those with moderate or severe persistent asthma or a history of severe
exacerbations.
CHRONIC OBSTRUCTIVE PULMONARY DISEASE
Chronic obstructive pulmonary disease (COPD) is a preventable and treatable
disease state characterized by airflow limitation that is not fully reversible. The
airflow limitation is usually progressive and associated with an abnormal
inflammatory response of the lungs to noxious particles or gases, primarily caused by
cigarette smoking.
Cardinal symptoms experienced by patients with COPD are dyspnea, difficulty
breathing, or shortness of breath and limitations in activity. Symptoms are usually
insidious in onset and progressive. Dyspnea is the subjective experience of shortness
of breath and is the most disabling symptom in COPD.
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