Whittney Shared "BreathingProblems" - 22 Picmonics

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BreathingProblems

COPD Overview (Chronic Obstructive Pulmonary Disease Overview)
Causes
Inhaled Toxins
Smoking
AAT Deficiency
Assessment
Emphysema
Chronic Bronchitis
Asthma
Considerations
Spirometry
Slow Progression
2 mins
COPD gradation and treatment
Mild - short acting bronchodilator PRN
Moderate - long acting bronchodilator + short acting PRN
Severe - INHALED corticosteroid + long acting + short acting
very severe - O2 therapy, lung TP
CHRONIC COPD Treatment
Treatment for Prevention of Exacerbations
Vaccines
Influenza
Pneumococcal
Quit smoking
Bronchodilators
Beta-2 agonists
Anti-cholinergics (e.g. ipratropium)
LONG-acting bronchodilators
anti-cholinergics (tiotropium)
Beta-2 agonists (salmeterol)
Inhaled corticosteroids
Oxygen
PaO2 < 55
SpO2 < 88
COPD Exacerbation
SYSTEMIC steroids
Antibiotics
Chronic Bronchitis Assessment
Clinical Findings
Chronic Productive Cough
> 3 Months for 2 Years
Increased Mucus Production
Dyspnea
Cyanosis
Wheezes
Complications
Right Side Heart Failure
Jugular Venous Distention (JVD)
Peripheral Edema
2 mins
Emphysema
Mechanism
Hyperinflation and Loss of Elasticity
Assessment
Pursed Lip Breathing
Barrel Chest
Dyspnea on Exertion
Clubbing
Depression and Anxiety
Thin Appearance
Nursing Considerations
CO2 Retention
Low Concentration of O2
High Fowler's Position
High Calorie, High Protein Diet
2 mins
Chronic Bronchitis Interventions
Tripod Position
Humidified Oxygen
Pursed Lip Breathing
Increase Fluid Intake
ABGs
Early Detection of Exacerbation
Considerations
Lowest O2 Therapy
Assisted Ventilation
Increased Infection Risk
2 mins
Respiratory Acidosis Interventions
Improve Respiration
Pharmacologic Interventions
Bronchodilators
Respiratory Stimulants
Drug Antagonists
Nonpharmacologic Interventions
Oxygen
Assisted Ventilation
Prevent Complications
1 min
Respiratory Acidosis
Hypoventilation
Increased PaCO2 > 45
Barbiturates Depress Central Respiratory Center of Brain
Opioids Depress Central Respiratory Center of the Brain
Airway Obstruction
Respiratory Muscle Weakness/Paralysis
3 mins
Beta-2 Agonists
Short-term Treatment
Terbutaline
Asthma
Tocolysis
Albuterol
Asthma
Long-term Treatment
Salmeterol
Asthma
Chronic Obstructive Pulmonary Disease (COPD)
3 mins
Acute Respiratory Distress Syndrome (ARDS) Assessment
Cause
Damaged Alveolar-Capillary Membrane
Assessment
Restlessness
Dyspnea
Refractory Hypoxemia
Decreased PaO2
Diffuse Pulmonary Infiltrates
Atelectasis
Pulmonary Hypertension
2 mins
Restrictive vs. Obstructive Lung Diseases
Restrictive Lung Disease
Decreased Lung Volume
FEV1/FVC Ratio Normal to Increased
Obstructive Lung Disease
Increased Lung Volume
Decreased FEV1/FVC Ratio
2 mins
Acute Bronchitis
Cough and Sputum Production
Viral upper respiratory infection
Hemoptysis
Fever is NOT typical
Antibiotics not beneficial
Self limiting- just treat symptoms
procalcitonin to distinguish between bacterial and viral
Lung Sounds - Wheezes
Location
Throughout Lung
Description
High Pitched
Sounds Like
Musical
Cause
Air Moving through Narrowed Airways
37 secs
Lung Sounds - Crackles
Location
Lower Lobes
Description
Fine/Coarse
Sounds Like
Fine: Twisting Hair through Fingers
Coarse: Velcro
Cause
Collapsed Small Airways and Alveoli "Popping Open"
1 min
Lung Sounds - Rhonchi
Location
Trachea and Bronchi
Description
Low Pitched Rumbling
Sounds Like
Gurgling
Cause
Narrowed Airway
Secretions or Bronchospasm
48 secs
Inhaled Corticosteroids
Inhaled Corticosteroid
Budesonide
Budesonide
Ages 12 +
Beclomethasone
Fluticasone
MOA: Anti-Inflammatory through Gluc. Response Elements
Side Effects
Fx: Candidiasis
Fx: Bone Resorption
Fx: Osteonecrosis
Fx: Psychosis
Candida albicans (Oral Thrush)
Fx: Cushing Syndrome Characteristics
Inhaled corticosteroids for asthma
Fluticasone
Budesonide
Ciclesonide
Beclomethasone
Prodrug activates by airway esterase
Less SEs than other corticosteriods
Chronic asthma 1st Line Therapy (I)
Inhibits synthesis of virtually all cytokines (MOA)
Inactivates NF-Kappa-B the TF responsible for making TNF-Alpha (MOA)
Oral thrush (SE)
Limited role in COPD (I)
Beneficial combination with beta-2-agonists
Corticosteroids
Inhibit NF-κB. Suppress both B- and T-cell function by  transcription of many cytokines. Induce apoptosis of T lymphocytes.
Transplant rejection prophylaxis, many autoimmune and inflammatory disorders
Hyperglycemia, osteoporosis, central obesity, muscle breakdown, psychosis, acne, hypertension, cataracts, avascular necrosis (femoral head).Cushing syndrome
Anticholinergics
B.O.AT.S Acronym
Benztropine
Parkinson's Disease
Oxybutynin
Decrease bladder spasms
Atropine
Mydriasis and Cycloplegia
Scopolamine
Motion Sickness
1 min
Anticholinergics Continued
Drugs
Glycopyrrolate
Reduces Airway Secretions
Ulcer Treatment
Ipratropium
Asthma and C.O.P.D
Dicyclomine
Hyoscyamine
Irritable Bowel Syndrome
1 min

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