1F RESPIRATORY Flashcards
Insert the medication canister into the plastic holder.
If a spacer is used, insert the MDI into the end of the spacer.
Shake the inhaler vigorously five or six times before using. Remove the cap from the mouthpiece.
Have the patient breathe in through the mouth and exhale.
With the inhaler properly positioned, have the patient hold the inhaler with the thumb at the mouthpiece and the index finger and middle finger at the top
Instruct the patient to take a slow, deep breath through the mouth and during inspiration, to push the top of the medication canister once.
Have patient hold the breath for 10 seconds and then exhale slowly through pursed lips
If a second dose is required, wait 1 to 2 minutes, and repeat the procedure by first shaking the canister in the plastic holder with the cap on.
When it is first used or if it has not been used recently, test the inhaler by spraying it into the air before administering the metered dose.
If a glucocorticoid inhalant is to be used with a bronchodilator, wait 5 minutes before using an inhaler that contains a steroid
Teach patients to self-monitor their pulse rate.
Caution against overuse because side effects and tolerance may result.
Teach patient to monitor the amount of medication remaining in the can-ister. Advise patient to ask a health care provider or pharmacist to estimate when a new inhaler will be needed based on the dosing schedule.
Teach patient to rinse their mouth after using an MDI. This is especially important when using a steroid drug. Rinsing the mouth helps prevent irritation and secondary infection to oral mucosa.
Avoid Smoking
Teach patient to do daily cleaning of equipment; this should include (1) washing the hands; (2) taking apart all the washable parts of the equipment and washing them with warm water; (3) rinsing: (4) placing the parts on a clean towel and covering them with another clean towel to air dry; and (5) storing the parts in a clean plastic bag once completely dry.
Alternate two sets of washable equipment to make this process easier.
Correct use of a Metered-Dose Inhaler
H1 Blockers of H1 Antagonists
Antihistamines
competes with histamine for receptor sites and prevent histamine response
Antihistamines
Act by blocking H1 receptors
Decreases nasopharyngeal secretions by blocking H1 receptor
Antihistamines
when stimulated, extravascular smooth muscles constrict
H1
when stimulated, gastric secretions occur
H2
Cold
Allergic rhinitis
Urticaria
Not used for anaphylaxis
Indications for Antihistamines
T/F: Most antihistamines are rapidly absorbed in 15 minutes, but they are not potent enough to combat anaphylaxis
TRUE
Mostly can cause drowsiness, dry mouth, decreased secretions and other anticholinergic symptoms
contained in many OTC cold remedies
1st Generation Antihistamines
Drowsiness
Dizziness
Fatigue
Disturbed coordination
Skin rashes
Anticholinergic symptoms
Side Effects of Antihistamines
Most prevalent type of upper respiratory infection
Common Cold
Caused by rhinovirus
Common Cold
Acute inflammation of the mucus membrane of the nose
Acute Rhinitis
Hay Fever; Caused by pollen or a foreign substance such as animal dander
Allergic Rhinitis
blocks the effects of histamine by competing for and occupying H1 receptor sites
Diphenhydramine
Primarily used to treat rhinitis
Diphenhydramine
closed angle glaucoma
urinary retention
peptic ulcer
small bowel obstruction
Contraindications of Diphenhydramine
can cause central nervous system depression if taken with alcohol, narcotics, hypnotics, or barbiturates
Diphenhydramine
Advise patients to avoid alcohol and other CNS depressants
Nursing Interventions of Diphenhydramine
Have fewer anticholinergic effects and a lower incidence of drowsiness
2nd Generation Antihistamines
Nonsedating Antihistamines
2nd Generation Antihistamines
Results from dilation of the nasal blood vessels caused by infection, inflammation, or allergy
Nasal Congestion
medications used to treat nasal congestion
Nasal Decongestant
stimulate the alpha-adrenergic receptors leading to vascular constriction of the capillaries within the nasal mucosa
Nasal Decongestant
Frequent use results to tolerance and rebound nasal congestion
Nasal Decongestants
used primarily for allergic rhinitis including hay fever and acute coryza
Systemic Decongestants
May decrease beta blocker effect
Pseudoephedrine + Beta blockers
increased possibility of hypertension or cardiac dysrhythmia
Decongestant + MAOIs
Increased restlessness and palpitations
Decongestant + Caffeine
Effective for treating allergic rhinitis
Intranasal Glucocorticoid
with anti-inflammatory action — allergic rhinitis symptoms of rhinorrhea sneezing and congestion
Intranasal Glucocorticoid
Continuous use = dryness of the nasal mucosa may occur
Intranasal Glucocorticoid
Nervous
Restless
Rebound nasal congestion
Side Effects of Decongestant
Hypertension
Cardiac Disease
Hyperthyroidism
Diabetes Mellitus
Contraindications of Decongestant
Headache
Nasal Irritation
Pharyngitis
Fatigue
Insomnia
Candidiasis
Side Effects of Intranasal Glucocorticoid
Act on the cough control center in the medulla to suppress the cough reflex
Antitussives
for nonproductive and irritating cough
Antitussives
Nonopioid
Opioid
Combination Preparations
Types of Antitussives
Benzonatate
Nonopioid
Codeine
Dextromenthorphan
Guaifenesin
Homatropine 1.5mg & Hydrocodone 5mg
Opioid
Guaifenesin
Dextromethorphan
Combination Preparations (with expectorant)
provides temporary cough relief due to non-productive cough
Dextromethorphan
Acts by decreasing the excitability of the cough center in the medulla
Dextromethorphan
Loosen bronchial secretions so they can be eliminated by coughing
Used for productive cough
with or without nonpharmacologic agents
Expectorants
inflammation of the mucous membrane of one or more of the maxillary, frontal, ethmoid or sphenoid sinuses
Sinusitis
Antibiotic may be prescribed for acute or severe sinusitis
acetaminophen fluids and rest may be helpful
Sinusitis
Inflammation of the throat or sore throat
Acute Pharyngitis
can be caused by a virus, beta-hemolytic streptococci or other bacteria
Acute Pharyngitis
can occur alone or with common cold and rhinitis or acute sinusitis
Elevated temperature
cough
Acute Pharyngitis
Throat culture first (should be obtained to rule out beta-hemolytic streptococci infection)
Acute Pharyngitis
Chemoreceptors are sensors that are stimulated by changes in these gases and ions.
Chemoreceptors are located centrally and peripherally
The central chemoreceptors, which are located in the medulla near the respiratory center and the cerebrospinal fluid, respond to an increase in carbon dioxide and a decrease in pH by increasing ventilation.
However, if the carbon dioxide level remains elevated, the stimulus to increase ventilation is lost.
Peripheral chemoreceptors are in the carotid and aortic bodies. It responds to changes in oxygen levels.
A low blood oxygen level stimulates the peripheral chemoreceptors which in turn stimulate the respiratory center in the medulla, and ventilation is increased.
If oxygen therapy increases the oxygen level in the blood, the oxygen may be too high to stimulate the peripheral chemoreceptors, and the ventilation will be depressed.
Take Note: the tracheo-bronchial tube consists of smooth muscles whose fibers spiral around the trachea-bronchial tube.
Contraction of these muscles constrict the airway.
The sympathetic and the parasympathetic nervous system affects the bronchial smooth muscles in opposite ways.
Respiration
The vagus nerve releases acetylcholine, which causes Bronchoconstriction
The sympathetic nervous system releases epinephrine which stimulates beta 2 receptors in the bronchial smooth muscle, resulting in Bronchodilation
These two nervous systems counterbalance each other to maintain homeostasis.
Respiration
Increase bronchodilation by bronchial smooth muscles.
Phosphodiesterase enzyme can inactivate cAMP
Cyclic Adenosine Monophosphate (cAMP)
Chronic Obstructive Pulmonary Disease
Restrictive Pulmonary Disease
Lower Respiratory Infections
Caused by airway obstruction with increased airway resistance of airflow to lung tissues
Chronic bronchitis
Bronchiectasis
Emphysema
Asthma
Chronic Obstructive Pulmonary Disease
Results in irreversible lung tissue damage
Chronic Obstructive Pulmonary Disease
Results to the decrease in total lung capacity as a result of fluid accumulation or the loss of elasticity of the lungs
Restrictive Pulmonary Disease
Pulmonary edema
Pulmonary fibrosis
Pneumonitis
Lung tumors
Thoracic deformities (scoliosis)
Disorders affecting thoracic muscular wall
Restrictive Pulmonary Disease
Characterized by periods of bronchospasm
Bronchial Asthma
results when the lung tissue is exposed to extrinsic or intrinsic factors that stimulate broncho constrictive response
Bronchospasm
Progressive lung disease
Caused by smoking or chronic lung infections
Bronchial inflammation and excessive mucous secretion > airway obstruction
Chronic Bronchitis
Hypercapnia and Hypoxemia > respiratory acidosis
Chronic Bronchitis
Abnormal dilation of the bronchi and bronchioles due to frequent infection and inflammation
Bronchiectasis
Bronchioles become obstructed by the breakdown of the epithelium of the bronchial mucosa and tissue fibrosis may result
Bronchiectasis
Progressive lung disease caused by smoking, atmospheric contaminants, or lack of alpha-antitrypsin protein that inhibits proteolytic enzymes that destroy alveoli
Emphysema
Terminal bronchioles become plugged with mucous, causing a loss in the fiber and elastin network in the alveoli
Alveoli enlargement as many of the alveolar walls are destroyed
Emphysema
Airway obstruction
Dyspnea
Decreased gas exchange
Fatigue
Patient Problems on Chronic Pulmonary Disease
Bronchodilators (sympathomimetics, parasympatholytic, and methylxanthines to assist in opening narrow airways)
Glucocorticoids (decreases inflammation)
Leukotriene Modifiers (used to reduce inflammation in lung tissue)
Expectorants (assist in loosening the mucus from the airways)
Antibiotics (to prevent serious complications from bacterial infections)
Medications for Chronic Obstructive Pulmonary Disease
used to manage COPD.
Sympathomimetics or Alpha and Beta 2 Adrenergic Agonists
Acts on Alpha 1, Beta 1, Beta 2 Adrenergic Receptor Sites
Promotes bronchodilation and elevates blood pressure
Used during anaphylaxis reaction through Subcutaneous route
Sympathomimetics: Epinephrine
Beta 2 adrenergic agonist
Stimulates beta 2-adrenergic receptor in the lungs which relaxes the bronchial smooth muscle > bronchodilation
High dose or overuse may cause some degree of beta 1 response > nervousness, tremor, and increased PR
Albuterol
Asthma
Bronchospasm
Indications of Albuterol
