Block II, Test 2: Respiratory - Iggy chapters 29-33; Kee chapters 40 and 41

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Block II, Test 2: Respiratory - Iggy chapters 29-33; Kee chapters 40 and 41
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Block II Test Respiratory Iggy chapters 29 33 Kee 40 41
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Block II, Test 2: Respiratory - Iggy chapters 29-33; Kee chapters 40 and 41
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  1. What two (2) actions make up ventilation?
    • 1:  Inspiration
    • 2:  Expiration
  2. Explain the Inspiration process
    • This is an Active Process (as opposed to a passive process) which includes the following:
    • 1.) Diaphragm:  Major work of inspiration
    •  - C3 to C5 innervation
    • 2.) External intercostals:  Increases anteroposterior diameter, elevates the ribs
    •  - T1 to T11 innervation
    • 3.) Accessory muscles of neck:  Not used at rest
  3. Explain the Expiration process
    • This is a passive process, which includes the following: 
    • 1.) Abdominals:  Elevate diaphragm
    • 2.) Internal intercostals:  Depress ribs and decrease anterposterior diameter
  4. Define compliance, in relation to ventilations
    Elasticity of the lung
  5. What two types of compliance issues you can have with ventilation?
    • 1.) Increased compliance:  Alveoli are not stiff enough (caused by aging, COPD, etc.)
    • EXAMPLE: COPD Patients can take in a lot of air, but the problem is getting the air out. They have a barrel chest from the retention of the CO2, which equals an increased compliance.
    • 2.) Decreased compliance:  Stiff lung (ARDS)
    • EXAMPLE: Pneumothorax - decreased compliance.
  6. Define perfusion
    • Blood supply available to the lungs; The ability of the blood to flow and supply O2.
    • NOTE: When the alveoli are stretched out and engorged with CO2, as with a COPD patient, they press on the capillary bed, which can occlude perfusion.
  7. Is the pulmonary system a low or high pressure system, when comparing it to the rest of the body?
    Low
  8. What does the pulmonary system do, in response to hypoxia?
    It constricts (long term constriction is known as pulmonary hypertension).
  9. What is the most common cause for hypoxemia?
    VQ (ventilation-perfusion) mismatch!
  10. Define diffusion
    Exchange of gases at the cellular level
  11. What are some factors that affect diffusion?
    • 1: Amount of surface area available
    • 2: Integrity of alveolar-capillary membrane
    • 3: Amount of hemoglobin in the blood
    • 4: Pressure differences between alveoli and capillaries
  12. In relation to diffusion, what is the Gas Transport?
    • 1:  Oxygen dissolved in plasma - PaO2 (Normal reading is 80-100 mm Hg)
    • NOTE:  PaO2 is an arterial measure of the amount of O2 in the blood, this should be high, since arterial blood is oxygenated.
    • 2:  Oxygen bound to hemoglobin - SaO2 expressed as a percentage (Normal reading is 95% or greater) and is measured by a pulse oximeter (SpO2)
    • NOTE:  SpO2 is a venous measure, this would be less, since the blood is deoxygenated.
  13. What issues can occur, if there is a problem in the pulmonary blood flow?
    • 1: Altered gas exchange 
    • 2: Tissue perfusion
  14. What issues can occur, if there are alterations in ventilation?
    • 1:  Impaired respiratory effort
    • 2:  Impaired gas exchange
  15. What issues can occur, if a person has infectious and inflammatory lung disorders?
    • 1:  Infection
    • 2:  Altered airway clearance
  16. What issues can occur, if a person has an obstructive and restrictive airway?
    • 1:  Altered gas exchange
    • 2:  Altered airway clearance
  17. Define atelectasis
    An alveoli that has collapsed
  18. What is INTERNAL respiration?
    The gas exchange between tissue cells and blood in the systemic capillaries.
  19. What is EXTERNAL respiration?
    The gas exchange between air in alveoli and blood in the pulmonary capillaries.
  20. When assessing a patient with lung issues, what type of information, regarding their history, would you like to know?
    • 1: Smoker?
    • 2: Workplace environment?
    • 3: History of asthma?
    • 4: Chronic respiratory illness?
    • 5: Cough? Productive or nonproductive? Color of sputum?
    • 6: Weight changes?
    • 7: Dyspnea? Nocturnal paroxysmal dyspnea? 
    • NOTE: Only take the time to gather this information, if it is NOT an emergency!
  21. What is Nocturnal paroxysmal dyspnea?
    When the blood returns to the heart at night, the preload is higher and it causes pain. Will most likely have nocturia and the patient may prefer to sleep in a recliner, because it reduces the pain.
  22. When there are lung problems, how would you assess the chest?
    • 1.) Inspect: Look for symmetry, changes in skin color, respiratory rate and effort, bruising and/or abnormalities like "clubbing" in the fingernails.
    • 2.) Auscultate: Listen to breath sounds. Ensure you listen from side to side, to ensure sounds are equal bi-laterally. Do not forget to roll your patient on their side and listen to the posterior lung sounds, this is where you will hear the sounds in the base of the lungs!!

    NOTE: Be sure to do this UNDER the clothing, otherwise you will not be able to hear crackles or friction, due to the movement of the clothes.

    • Watch:
    • http://www.youtube.com/watchv=5JA6D1Mguh0
  23. What are the six (6) P's of Dyspnea?
    • 1: Pneumonia
    • 2: Pneumo-thorax
    • 3: Possible Foreign Body = blood flow disruption and diffusion problems
    • 4: Pulmonary Bronchial Constriction = Asthma and/or COPD
    • 5: Pulmonary Embolus
    • 6: Pump Failure
  24. Name the five (5) abnormal respiratory patterns.
    • 1: Biots = slow shallow . . . fast deep . . . stop . . . slow shallow . . . fast deep . . . stop . . . 
    •  - A neuro issue (cerebral edema)
    • 2: Bradypnea = slow breathing
    •  - Drugs, medications, dying, etc.
    • 3: Cheyne - stokes = fast/racing breaths . . . stop . . . fast/racing breaths . . . stop
    •  - A near death breathing pattern
    • 4: Kussmaul = fast shallow . . . fast deep . . . fast shallow . . . fast deep . . . 
    •  - Fruity acetone breath
    • 5: Tachypnea = Fast/rapid breathing
  25. What are some symptoms of hypoxia?
    • Early: 
    • Restless
    • Anxiety
    • Tachycardia/Tachypnea
    • Late: 
    • Bradycardia
    • Extreme Restlessness
    • Dyspnea (Severe)
  26. What are the symptoms of hypoxia in pediatric patients?
    • Feeding difficulty
    • Inspiratory stridor
    • Nares flare
    • Expiratory grunting
    • Sternal retractions
  27. What happens during respiratory failure?
    • 1:  Deterioration of the gas exchange function of the lung
    • 2:  Exists when the exchange of oxygen for carbon dioxide in the lungs cannot keep up with the rate of oxygen consumption and carbon dioxide production by the cells of the body
    • Presents: PO2 < 50; CO2>50 mmHg and pH<7.35
  28. What are the early signs of Respiratory Failure?
    • Early signs:
    • 1: Restlessness
    • 2: Fatigue
    • 3: Head Ache
    • 4: Dyspnea
    • 5: Air hunger
    • 6: Tachycardia
    • 7: Increased BP
  29. What are the late signs of Respiratory Failure?
    • Late signs:
    • 1: Confusion
    • 2: Lethargy
    • 3: Tachycardia
    • 4: Tachypnea
    • 5: Cyanosis
    • 6: Diaphoresis
    • 7: Respiratory arrest
  30. What is the Orthopneic or Tripod Position?
    • Leaning over a table or elbows resting on the knees.
    • 1:  Increases lung expansion
    • 2:  Allows for intake of more air with each breath

    NOTE: This position allows the airway to expand and it feels like the weight is taken off of their chest.
  31. What diagnostic tests would be requested for respiratory issues?
    • 1: CBC
    • 2: ABG
    • 3: Sputum
    • 4: Chest XR
    • 5: CT/MRI
    • 6: Ventilation/Perfusion: VQ
    • 7: Pulmonary function test: PFT
    • 8: Bronchoscopy
  32. If you client is on antibiotics, what would you write on the sputum culture?
    The name of the antibiotic
  33. 1:  What time of the day should you collect a sputum culture, when testing for TB?

    2:  When should sputum cultures be taken, when TB is NOT suspected?
    • 1:  First thing in the morning
    • 2:  As soon as possible
  34. When gaining a sputum culture, what should it not contain?
    Saliva or sinus drainage
  35. Should a sputum culture be collected before or after starting antibiotics?
    BEFORE
  36. Describe how a VQ Scan works
  37. What is a bronchoscope and how does it work?
    • 1:  Small scope with a light and camera, through the nose or the mouth, down into the
    • airway, via the trachea and into the bronchus.
    • 2:  NPO for at least a few hours.
    • 3:  Coming out of the surgery, watch for a gag reflex, just using the tongue depressor.
    • 4:  Should never see bright red bleeding, but may see a red tinge, if a biopsy was taken. (Similar to a colonoscopy, but just the
    • other end.)
    • 5:  Conscious sedation is used.
  38. What are some of the Nursing Diagnosis that can be used for respiratory issues?
    • 1:  Pulmonary Blood Flow
    •  - Altered gas exchange    
    •  - Tissue perfusion
    • 2:  Alterations in ventilation
    •  - Impaired respiratory effort
    •  - Impaired gas exchange
    • 3:  Infectious and Inflammatory Lung Disorders
    •  - Infection
    •  - Altered airway clearance
    • 4:  Obstructive and Restrictive Airway
    •  - Altered gas exchange
    •  - Altered airway clearance
  39. When can you list "Altered Gas Exchange" as the etiology?
    • The patient must have a history of COPD and the O2sats support the altered gas exchange claim.
    • NOTE: Dyspnea, is NOT an indicator, as it does not SHOW altered gas exchange.
  40. Define Oxygen toxicity
    Too much O2
  41. What are the signs and symptoms of oxygen toxicity?
    Substernal distress, paresthesias, dyspnea, restlessness, fatigue, malaise, progressive respiratory difficulty.
  42. How can we prevent oxygen toxicity?
    Use oxygen as prescribed. If high concentrations are required, duration should be kept to a minimum.
  43. What are some of the oxygen delivery systems?
    • 1:  Simple Face Mask
    • 2:  Nasal Cannula
    • 3:  Face Mask with Reservoir Bag
    • 4:  Venturi Mask
  44. What are the advantages, disadvantages, and avenue of delivery for a Simple Face Mask?
    • Advantages: Easy to use, inexpensive
    • Disadvantages: Variable FiO2, poor fitting; Used for short term
    • Delivers: 40-60% at 5-8 L/m

    (FiO2 = % of inspired O2 concentration)
  45. What are the advantages, disadvantages, and avenue of delivery for a Nasal Cannula?
    • Advantages: Lightweight, comfortable, inexpensive, can use while eating & activity
    • Disadvantages: Nasal mucosal drying, variable FiO2
    • Delivers:  24-44% at 1-6 L/m

    (FiO2 = % of inspired O2 concentration)
  46. What are the advantages, disadvantages, and avenue of delivery for a Face Mask with a Reservoir Bag?
    • Advantages:  High concentration of O2
    • Disadvantages:  Warm, poor fitting, must remove to eat
    • Delivers:  
    • 1:  Rebreather 6-10 L/m up to 70%
    • 2:  Nonrebreather 10-15 L/m 85-95%
  47. What are the advantages, disadvantages, and avenue of delivery for a Venturi Mask?
    • Advantages: Provides low levels of O2, precise FiO2, most reliable and accurate method of delivering precise O2 concentration
    • Disadvantages: Must remove to eat
    • Delivers: 2-14 L/m 24-55%

    (FiO2 = % of inspired O2 concentration)
  48. What is COPD?
    • Literally: Chronic Obstructive Pulmonary Disease
    • It means there is a chronic airflow limitation.
  49. What are the two diseases commonly associated with COPD?
    • 1:  Emphysema
    • 2:  Chronic Bronchitis
  50. In general, if a patient needs O2, what will be the most common level administered?
    1-2 Liters, via nasal cannula

    NOTE: In an emergency situation, you may see higher, but not for an extended period of time.
  51. What are some of the signs and symptoms of COPD?
    • 1: Easily fatigued
    • 2: Frequent respiratory infections
    • 3: Use of accessory muscles to breathe
    • 4: Orthopneic
    • 5: Cor Pulmonale (Late in the disease)
    • 6: Thin in appearance
    • 7: Wheezing
    • 8: Pursed-lip breathing
    • 9: Chronic cough
    • 10: Barrel chest
    • 11: Dyspnea
    • 12: Prolonged expiratory time
    • 13: Digital clubbing
  52. What are some of the signs and symptoms that are specific to Emphysema?
    • 1: Decreased CO2 retention
    • 2: Minimal cyanosis
    • 3: Purse lip breathing
    • 4: Dyspnea
    • 5: Minimum cough
    • 6: Orthopneic
    • 7: Hyperresonance on chest percussion
    • 8: Orthopneic
    • 9: Barrel chest
    • 10: Exertional dyspnea
    • 11: Prolonged expiratory time
    • 12: Speaks in short jerky sentences (be concerned if fewer than three words can be spoken at a time)
    • 13: Use of accessory muscles to breathe
    • 14: Thin appearance

    NOTE: Used to be referred to as the "Pink Puffer", but not any longer.
  53. Define Cor Pulmonale
    • End Stage Emphysema
    • 1: Decreased pulmonary capillary bed =
    • 2: Increased resistance to pulmonary blood flow=
    • 3: Increased pulmonary artery pressure
    • 4: Increased R ventricular pressure
    • 5: Can lead to R sided heart failure
  54. What are the signs and symptoms specific to Chronic Bronchitis?
    • 1: Color dusky to cyanotic
    • 2: Recurrent cough and increased sputum production
    • 3: Hypoxia
    • 4: Hypercapnia (increased PCO2)
    • 5: Respiratory acidosis
    • 6: Increased hemoglobin
    • 7: Increased respiratory rate
    • 8: Exertional dyspnea
    • 9: Increased incidence in heavy cigarette smokers
    • 10: Digital clubbing
    • 11: Cardiac enlargement
    • 12: Use of accessory muscles to breathe
    • 13:  Leads to right-sided failure

    NOTE: Referred to as the "Blue Bloater"
  55. What are a few facts about chronic bronchitis?
    • 1.) Risk Factor: Smoker or environmental
    • 2.) Increased mucus: Increased inflammation
    • 3.) Action: Mucus plugs clog and damage alveoli
    • 4.) Diagnosed: When cough with sputum for three (3) months in each of two (2) consecutive years
  56. What are some of the Nursing Diagnoses for COPD?
    • Fatigue
    • Activity Intolerance
    • Risk for Infection
    • Impaired Gas Exchange
    • Ineffective Coping
    • Knowledge Deficit
    • Ineffective airway clearance
    • Poor Nutrition (burning more calories than taking in, working to breath

    NOTE: These patients usually want all of their items in specific places, because of the energy it takes to get to them, if they are placed too far away.
  57. What is Asthma referred to?
    A reactive airway disease.
  58. Why is asthma referred to as a Reactive Airway Disease, instead of COPD?
    Because it can be reversed.
  59. What is Asthma related to?
    • Allergies, such as food, grass, etc. 
    • May hear wheezing upon inspiration or expiration. 

    URI = Upper respiratory infection
  60. What are some of the signs and symptoms of Asthma?
    • Triggered by:
    • 1: Hypersensitivity
    • 2: URI
    • 3: Exercise

    • Hypoxemia:
    • 1: Tachycardia
    • 2: Increased restlessness
    • 3: Tachypnea

    • Familial Tendency
    • Increased occurrence in males
    • Onset before age 12 years
  61. How do you manage ASTHMA?
    (HINT: Use the acronym)
    • A: Adrenergics (Beta 2 Agonists = Albuterol)
    • S: Steroids
    • T: Theophylline
    • H: Hydration (IV)
    • M: Mask O2
    • A: Anticholinergics
  62. What are the three types of Pneumothorax?
    • 1. Simple: Rupture of a bleb or fistula; more common in COPD conditions
    • EXAMPLE: Lungs are unable to expand, due to changes in the chest.Thin, male, smokers can get a “bleb” on the lung, a weak spot that POPS and changes the pressure in the lungs.
    • 2. Traumatic: Air escape with laceration of lung (may be blunt or penetrating or diaphragmatic tears)
    • EXAMPLES: Injuries (stabs, gun shot, etc.) 
    • 3. Tension: Air trapping in pleural space creating a one-way valve. Things shift!
    • EXAMPLE: Tension pneumothorax (air is pressing against the lung, thus outside of the lungs, and there will not be any lung sounds) = Tracheal deviation.
  63. What is the assessment for pneumothorax?
    • 1: Respiratory distress: what do you see?
    • 2: Pain - sudden and pleuritic
    • 3: Tachypnea
    • 4: Absence of breath sounds
    • 5: Air hunger
    • 6: Agitation
    • 7: Hypoxemia, cyanosis, ↓BP,
    • 8: ↑HR with tension pneumothorax

    NOTE: Severity depends on size and cause of the pneumothorax.
  64. What are the types of interventions for pneumothorax?
    • Nursing 
    • Medical
  65. Define pneumothorax
    • Partial or complete collapse of the lung due to positive pressure in the pleural space; Air in the pleural cavity, resulting in lung collapse.
    • NOTE: This can cause tracheal deviation
  66. What are the signs of pneumothorax?
    • 1: Dyspnea
    • 2: Anxiety
    • 3: Pleural pain
    • 4: Asymmetrical chest wall expansion
    • 5: Decreased breath sounds
  67. What can cause a pneumothorax?
    • 1: Ruptured bleb (COPD)
    • 2: Thoracentesis
    • 3: Trauma (knife, gun, etc. wounds)
    • 4: Secondary infection
  68. How do you diagnose a pneumothorax?
    • 1: Chest x-ray
    • 2: ABGs
  69. How is the pneumothorax treated?
    Chest tube
  70. What is a pleural effusion?
    • 1: Collection of fluid in the pleural space
    • 2: Rarely a primary disease
    • 3: Normal pleural fluid is 5-15 mL
    • NOTE: Decreased breath sounds on affected side
  71. What can cause a pleural effusion?
    • Result of:
    • 1: Heart failure
    • 2: TB
    • 3: Pneumonia
    • 4: Viral lung infections
    • 5: Nephrotic syndrome
    • 6: Connective tissue disease
    • 7: PE
    • 8: Tumors
  72. How would you assess for a Pleural effusion?
    • Assessment:
    • 1: S/S of infection (fluid may be clear, cloudy, purulent, or bloody)
    • 2: Chest pain
    • 3: Dyspnea
    • 4: Coughing
    • 5: Respiratory distress
    • 6: Absent breath sounds over affected area
  73. What is a medical management for pleural effusion?
    Thoracentesis
  74. What is a nursing management for pleural effusion?
    • MONITOR!!
    • 1: Chest tube
    • 2: Breath sounds
    • 3: S/S of infection
  75. What is a thoracentesis?
    This is to relieve pressure on the lungs. this is a sterile technique. We must keep the area clean and dry and use foam tape (occlusive dressing).
  76. What is pulmonary edema?
    • 1: Abnormal accumulation of fluid in the lung tissues and/or alveolar space
    • 2: Severe and life threatening
  77. What can cause pulmonary edema?
    This can be caused by L. heart pressure = increased blood in pulmonary vessels = fluid leaking into alveoli.
  78. What causes "flash pulmonary edema"?
    R/T infection, renal failure, too fast of IV fluid infusion!
  79. What are the signs and symptoms of Pulmonary Edema?
    • Severe and sudden respiratory distress
    • Crackles
    • Infiltrates on CXR
    • Tachycardia
    • Tachypnea
    • Hypoxia (air hunger = like fish out of water)
    • Foamy, blood-tinged sputum (Fluid shift = capillaries leaking into the pleural tissue)
  80. What is the purpose of the medical management of pulmonary edema?
    • To correct the cause!
    •  - Cardiac Meds
    •  - Diuretics
    •  - O2
    •  - Morphine (reduces the workload of the heart, as the vasodialation increases the available O2)
  81. What are some of the interventions that a nurse can take while managing pulmonary edema?
    • Monitor effectiveness of treatment
    • Positioning (head of bed up!)
    • Focused assessment!
    • I & O
    • Daily weight
  82. What kind of problem is a pulmonary embolism?
    Profusion or Ventilation?
    Profusion - The embolism occludes a blood vessel in the lung, so blood does not flow freely, allowing for respiration exchange.

    NOTE: This is a mismatch!
  83. What type of tests can find a pulmonary embolism?
    • VQ Scan
    • D-Dimer Test
    • CT Scan
  84. What are some of the causes of a pulmonary embolism?
    • 1: Thrombus
    • 2: Air
    • 3: Fat
    • 4: Amniotic fluid
    • 5: Septic (bacterial invasion of thrombus)
  85. What are some of the assessment findings for a pulmonary embolism?
    • 1: Dyspnea (most severe)
    • 2: Impending doom
    • 3: Tachypnea
    • 4: Chest pain
    • 5: Anxiety (fear)
    • 6: Tachycardia
    • 7: Hemoptysis with cough
    • 8: Syncope
  86. Where does a fat emboli come from?
    • Long Bone injury
    • Usually young people are prone to these = they are the ones breaking their bones?
  87. How does hemoptysis come about?
    Due to the blockage, blood is backing up and hydrostatic pressure is building.
  88. What are some of the risk factors for a pulmonary embolism?
    • 1: Immobility
    • 2: Tumor (breast, lung, GI)
    • 3: Pregnancy
    • 4: Obesity
    • 5: Postop/Postpartum
    • 6: Heart failure
    • 7: Hypercoagulability
  89. What is the medical management for a pulmonary embolism?
    • 1: O2
    • 2: Cardiac monitoring
    • 3: Anticoagulation
    • 4: ABGs
  90. What is the nursing management of a pulmonary embolism?
    • 1: Elevate legs
    • 2: SCD or Ted Hose
    • 3: O2
    • 4: Focused assessment!!
  91. What are some of the statistics on Lung Cancer?
    • 1: #1 cancer killer among men and women in the US
    • 2: Mostly in 6th and 7th decade of life
    • 3: 70% of time, patient present with lymph and other mets
    • 4: 85%of lung CA are caused by smoking
  92. What are some of the cell types for Lung Cancer?
    • Non-small cell (70-75%)
    • 1: Squamous cell (30%)
    • 2: Large cell (10-16%)
    • 3: Adenocarcinoma and bronchioalveolar (31-34%)
    • Small cell (15-20%)
    • 1: Arise in major bronchi and spread by infiltration along the bronchial wall

    NOTE: Oat cell CA of the lung causes 80% of SIADH (syndrome of inappropriate diuretic hormone, which in turn causes hyponatremia and hypervolemia)
  93. Define Lung Cancer staging and explain the stages.
    • Staging refers to the tumor size, location and whether lymph nodes are involved.
    • Non-small cell: I = Good; IV = Bad
    • Small cell: Limited = good; Extensive = bad
  94. What are soem of the risk factors of Lung Cancer?
    • 1: Smoke
    • 2: Environmental
    • 3: Genetic predisposition
    • 4: COPD
    • 5: TB
  95. What might a nurse find, during an assessment of a Lung Cancer patient?
    • Most frequent: cough or change in chronic cough
    • 1: Wheezing
    • 2: Dyspnea
    • 3: Hemoptysis; blood tinged sputum
    • 4: Chest wall pain (may indicate metastasis)
    • 5: Their breath may have a bad or strong order
  96. What type of interventions might be done on a patient with lung cancer?
    • 1: Nursing interventions
    • 2: Medical interventions

    NOTE: Radiation may be done on this patient
  97. Define Antihistamines
    What are the drugs that fall into the two generations and what should be part of the teaching for patients?
    • 1: Antihistamines, H1 Blockers or H1 Antagonists, compete with histamine for receptor sites which prevents histamine release.
    • 2: Useful in non-emergent situations but commonly used for rhinitis

    • 1st generation: Diphenhydramine (Benedryl)
    •  - Side effects: drowsiness, dry mouth, anticholinergic effects

    • 2nd generation: Fexofenadine (Allegra)
    •  - Side effects: non-sedating, fewer anticholinergic symptoms

    Teaching: avoid alcohol, narcotics, avoid driving with 1st generation, use gum or candy for dry mouth
  98. What is an anticholinergic effect?
    • Anticholinergic: Decreases the parasympathetic effect = Vasoconstriction, tachycardia, bronchodilation, etc.
    • 1) Will dry out your mouth and cause
    • urinary retention
    • – Do not give to Renal patients
    • 2) Impacts pressure in the eyes and makes you very sleepy
    • – Do not use on glaucoma patients
  99. Define Decongestants
    Give an example of a decongestant, its side effects, and the teaching for patients?
    • 1: Stimulate the alpha adrenergic receptors, producing vascular constriction of the capillaries within the nasal mucosa, thus reducing fluid secretion.
    • 2: May be spray, drops, tablet, capsule, or liquid

    Prototype: Pseudoephedrine (Sudafed)

    Side Effects: jittery and nervousness which decreases with it’s use; rebound nasal congestion; BP and glucose (alpha-adrenergic effect) can elevate-use with caution

    Teaching: avoid use longer than 5 days; monitor BP and glucose
  100. Give additional information regarding decongestants.
    • 1: Stimulates the sympathetic response (alpha adrenergic receptors = epinephrine and norepinephrine)
    • 2: Do not give to hypertension, glaucoma patients.
    • 3: Give to renal patients CAUTIOUSLY.
    • 4: Do not use longer than 5 days, due to the possibility of rebound effect.
  101. Define Intranasal Glucocorticoids
    • 1: Prototype Flonase, Nasacort
    • 2: Can treat allergic rhinitis, but used mainly now for bronchospasms
    • 3: Systemic effects rare
    • 4: Short term use
    • 5: May cause dryness of nasal mucosa
  102. Define Bronchodilators - Beta 2-adrenergics, give an example, and list the side effects.
    • 1: Selective for Beta 2; High doses creates a beta 1 effect (nervousness, tremor, ↑HR)
    • 2: Bronchodilation can decrease with continued use, tolerance can develop

    • Prototype: Albuterol (Proventil, Ventolin)
    • Side effects: tremors, HA, nervousness, palpitations, may increase glucose level
  103. Define Xanthines (bronchodilator), give an example, and list the side effects.
    • TURNS INTO CAFFEINE IN THE BODY:
    • Stimulates CNS and respiration, dilate coronary and pulmonary vessels and cause diuresis (aminophylline, theophylline and caffeine)

    • Prototype: Theophylline (Theo-Dur): 
    • 1: Relaxes smooth muscles of the bronchi, bronchioles, and pulmonary vessels which leads to bronchodilation
    • 2: Narrow therapeutic range of 10-20 mcg/mL.  Toxic effects include dysrhyhmias, convulsions, cardiorespiratory collapse
    • 3: Beta-blockers, cimetidine (Tagamet), and erythromycin increase theophylline effects
    • 4: Theophylline increases the risk of digitalis toxicity
    • 5: Synergistic effect occurs with beta-adrenergic agonist, can cause dysrhythmias

    • Teaching: avoid caffeine, get blood draws,
    • increase fluid intake
  104. Define Anticholinergic (bronchodilators), give an example, and list the teaching that should take place.
    Used for asthmatic bronchodilation

    Prototype: Ipratropium bromide (Atrovent)

    Teaching: Order of delivery for best effect should be as follows:

    • 1: First take the Beta-agonist
    • 2: After 5 minutes, give Anticholinergic
    • 3: After 5 minutes, give Inhaled steroid 
  105. What is the delivery method for respiratory medications?
    • 1: Oral
    • 2: IV
    • 3: SQ
    • 4: Inhaled (inhaler/puffer/meter dosed inhaler or SVN)
    • Watch: Abcnews.go.com/Video/playerIndexid=5780299
  106. Define the Antiinflammatory Drugs - Glucocorticoids (Steroids), give an example,  the side effects, and teaching.
    • 1: Strong, fast antiinflammatory action
    • 2: Synergistic effect when given with beta 2 agonist
    • 3: Given as MDI inhaler, tablet, Intravenous

    • Prototype: Beclomethasone (Vanceril—MDI route)
    • Side effects: GI ulcers,

    Teaching: oral dose must be tapered, fungal infections (rinse mouth after use), fluid retention with long term use, increase blood glucose (think hyper-adrenal!)
  107. Define a Leukotriene receptor antagonist (antiinflammatory), give an example, and side effects.
    • 1: Reduce inflammatory symptoms of asthma triggered by allergic and environmental stimuli
    • 2: Not recommended for acute events, but considered a maintenance medication
    • 3: Short half life, and used in children

    Prototype: Montelukast sodium (Singulair)

    Side effects: Headache, fatigue, nasal congestion, sore throat
  108. Define the Mucolytics, give an example, and the side effects.
    • 1: Act like detergents by liquefying and loosening thick mucous secretions so they can be more easily expectorated
    • 2: Should not be mixed with other drugs in nebulizer

    • Prototype:  Acetylcysteine (Mucomyst—by
    • SVN)

    Deliver: Give bronchodilator 5 minutes before mucolytic

    Side effects: nausea, vomiting, stomatitis and “runny nose”

    NOTE: Also used as Tylenol antidote for overdose
  109. What are some of the RESPIRATORY HERBS?
    • Violet and Ginger PaC3 a Wild Thyme
    • Violet: Expectorant
    • Ginger: Decreases phlegm, use for colds
    • Plaintain: Decreases phlegm
    • Chickweed: Decreases lung inflammation
    • Cinnamon: Use for "chesty" colds
    • Coltsfoot: Expectorant
    • Wild Cherry Bark: Cough suppressant
    • Thyme: Reduces symptoms of asthma

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