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488 > Class 3 Respiratory system: Asthma > Flashcards

Class 3 Respiratory system: Asthma Flashcards

1
Q

Long-term drugs used to treat asthma

A

-Leukotriene receptor antagonists, theophylline, mast cell stabilizers, anticholinergics
-Inhaled/PO glucocorticosteroids, long-acting β2-agonists (LABAs)
-Combination of glucocorticoid OR corticosteroid AND LABA

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2
Q

Rapid relief asthma drugs

A

-SAβA
-Corticosteroid and LABA; budesonide and formoterol combination (>=12 years old)
-Ipratropium (rarely used)

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3
Q

Asthma management step 1 (mild, intermittent)

A

-SABA PRN and low dosage glucocorticoids

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4
Q

Asthma management step 2 (moderate; persistent)

A

-SABA PRN and medium-dosage of corticosteroid
-LABA & corticosteroid combination (>=12 years old)
-Leukotriene receptor antagonist

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5
Q

Asthma management step 3-4 (severe; uncontrolled)

A

-Step 1&2 + PO prednisone if FEV<60%
-Anti-IgE antagonist if >=12 years old

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6
Q

Antiasthmatics

A

-Leukotriene receptor antagonist, anticholinergics, corticosteroids
-B-agonist & xanthine derivatives
-Mast cell stabilizers (Na+ cromoglycate & nedocromil)

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7
Q

Anticholinergic MOA

A

Block cholinergic receptors, thus preventing the binding of cholinergic substances that cause constriction and increase secretions

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8
Q

Leukotriene receptor antagonist MOA

A

Disrupt leukotrienes, which decreases arachidonic acid-induced inflammation and allergen-induced bronchoconstriction

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9
Q

B-agonists & xanthine derivatives MOA

A

Raise intracellular levels of cyclic adenosine monophosphate, which promotes smooth muscle relaxation and dilates bronchi & bronchioles

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10
Q

Corticosteroids MOA

A

Prevent the inflammation commonly provoked by the substances released from mast cells

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11
Q

Mast cell stabilizers (Na+ cromoglycate & nedocromil) MOA

A

Stabilize mast cells membranes in which the antigen–antibody reactions take place, thereby preventing the release of substances such as histamine

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12
Q

Bronchodilators

A

-Beta-adrenergic agonists
-Anticholinergics
-Xanthine derivatives

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13
Q

Non-bronchodilating respiratory drugs

A

-Leukotriene Receptor Antagonists
-Corticosteroids

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14
Q

Bronchodilators: B-agonists

A

-AKA sympathomimetic bronchodilators
-Stimulate β2-adrenergic receptors, used in acute asthma attacks

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15
Q

Types of bronchodilators

A

-Nonselective adrenergics
-Nonselective β-adrenergics
-Selective β2 drugs

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16
Q

-Nonselective adrenergic bronchodilators

A

-Stimulate α, β1 (cardiac), and β2 (respiratory) receptors
-Include epinephrine (Adrenalin)

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17
Q

Nonselective β-adrenergics bronchodilators

A

-Stimulate both β1 and β2 receptors
-Include isoproterenol

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18
Q

Selective β2 drugs: Bronchodilators

A

-Stimulate only β2 receptors
-Include salbutamol (Airomir, Ventolin)

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19
Q

B-agonist MOA

A

-Begins at the specific receptor stimulated & ends with the dilation of the airways
-Activation of β2 receptors activates cyclic adenosine monophosphate (cAMP)

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20
Q

B-agonist indications

A

-Relief of bronchospasm related to asthma, bronchitis, and other pulmonary diseases
-Treatment and prevention of acute attacks, hypotension & shock
-To produce uterine relaxation to prevent premature labor
-Treatment of hyperkalemia (stimulates potassium to shift into the cell)

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21
Q

Adrenergic receptor responses to stimulation: A1

A

-Vasoconstriction

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22
Q

Adrenergic receptor responses to stimulation: B2

A

-Vasodilation

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23
Q

Adrenergic receptor responses to stimulation: Heart muscle B1

A

-Increased contractility

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24
Q

Adrenergic receptor responses to stimulation: AV&SA node B1

A

Increased HR

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25
Q

Adrenergic receptor responses to stimulation: Pupillary muscles of iris a1

A

-Mydriasis (dilated pupils)

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26
Q

Adrenergic receptor responses to stimulation: Kidney B1

A

-Increased renin secretion

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27
Q

Adrenergic receptor responses to stimulation: Liver B2

A

Glycogenolysis

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28
Q

Adrenergic receptor responses to stimulation: Muscle a2&B2

A

Decreased motility

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29
Q

Adrenergic receptor responses to stimulation: Bladder sphincter a1

A

Constriction

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30
Q

Adrenergic receptor responses to stimulation: Penis a2

A

Ejaculation

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31
Q

Adrenergic receptor responses to stimulation: Uterus a2

A

Contraction

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32
Q

Adrenergic receptor responses to stimulation: Uterus B2

A

Relaxation

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33
Q

Adrenergic receptor responses to stimulation: Bronchial muscles B2

A

Dilation

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34
Q

B-agonist contraindications

A

-Uncontrolled cardiac dysrhythmias
-High risk of stroke (because of the vasoconstrictive drug actions)

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35
Q

B-agonist adverse effects a-B

A

-Epinephrine: anorexia, insomnia, vascular headache, cardiac stimulation, tremor, restlessness, hyperglycemia

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36
Q

B-agonist adverse effects B1&B2

A

-Isoproterenol: Cardiac stimulation, anginal pain, vascular headache, hypotension & tremor

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37
Q

B-agonist adverse effects B2

A

-Salbutamol: aBP, vascular headache, tremor

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38
Q

B-agonist interactions

A

-Require an adjustment to antihyperglycemic drugs
-Increase risk for HTN & cardiac toxicity

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39
Q

B-agonist derivatives: Nursing implications

A

-Avoid excessive fatigue, extremes in temperature, caffeine, take in adequate fluids
-Salbutamol can lose its β2-specific actions at larger doses… As a result, β1 receptors are stimulated, causing nausea, anxiety, palpitations, tremors, and increased HR

40
Q

B-agonist derivatives: Nursing implications (things to report)

A

-Insomnia, restlessness, palpitations, chest pain, or any change in symptoms

41
Q

Inhalers: Pt education

A

-Teach time-intervals for inhalers
-Provide spacer if coordination of breathing is impaired
-Teach patient how to keep track of the number of doses in the inhaler

42
Q

Anticholinergic mechanism of action

A

-Anticholinergics bind to the ACh receptors, preventing ACh from binding
-Prevents bronchoconstriction and airways dilate

43
Q

About anticholinergics

A

-Include ipratropium bromide (Atrovent) and tiotropium (Spiriva)
-Slow and prolonged action

44
Q

Anticholinergic adverse effects

A

-Dry mouth/throat, congestion, coughing, headache
-Heart palpitations, anxiety, GI distress

45
Q

Bronchodilators: Xanthine derivatives

A

-The natural xanthines are the plant alkaloids caffeine, theobromine, and theophylline (Theolair, Uniphyl)
-Only theophylline is used as a bronchodilator

46
Q

Synthetic xanthines

A

-Aminophylline (Phyllocontin)
-Oxtriphylline

47
Q

Xanthine derivatives: Mechanism of action

A

-Increase levels of cAMP by inhibiting phosphodiesterase, the enzyme that breaks down cAMP
-The result is increased smooth muscle relaxation & bronchodilation

48
Q

Xanthine derivatives: Drug effects (other effects)

A

-Increased contraction & HR resulting in increased CO and blood flow to the kidneys (diuretic effect)
-Stimulate CNS

49
Q

Xanthine derivatives: Indications

A

-Dilation of airways in asthma, chronic bronchitis, and emphysema
-Mild to moderate acute asthma
-Combination drug in COPD management

50
Q

Xanthine derivatives: Contraindications

A

-Uncontrolled cardiac dysrhythmias, seizure disorders
-Hyperthyroidism, peptic ulcers

51
Q

Xanthine derivatives: Adverse effects

A

-N/V, nocturnal GERD, anorexia
-Sinus tachycardia, extrasystole, palpitations, ventricular dysrhythmias
-Transient increased urination

52
Q

Xanthine derivatives: Interactions

A

-Several drugs increase serum levels of xanthine derivatives
-When used with sympathomimetics (e.g., caffeine) additive heart and CNS stimulation
-St. John’s wort (Hypericum perforatum) and cigarette smoking enhance the rate of metabolism
-Charcoal broiling and high-protein and low-carbohydrate foods may reduce serum levels of xanthines

53
Q

Xanthine derivatives: Implications

A

-Report N/V, weakness, dizziness, palpitations, chest pain, & convulsions

54
Q

Antileukotrienes

A

-AKA leukotriene receptor antagonists (LRTAs)
-“lukasts”; montelukast (Singulair) & zafirlukast (Accolate)

55
Q

Antileukotrienes mechanism of action

A

-Leukotrienes cause inflammation, bronchoconstriction, and mucus production
-The result is coughing, wheezing, and SOB
-Antileukotriene drugs prevent leukotrienes from attaching to receptors on circulating immune cells and immune cells within the lungs

56
Q

Antileukotrienes drug effects

A

-Prevent smooth muscle contraction of the bronchial airways, decrease mucus secretion
-Prevent vascular permeability, decrease inflammatory response in the lungs

57
Q

Antileukotrienes indications

A

-Used for asthma if >=12
-NOT for acute asthmatic attacks
-Montelukast: Approved for use in children ages 2 and older and for treatment of allergic rhinitis

58
Q

Antileukotrienes contraindications

A

Allergy to cellulose derivatives, titanium dioxide, povidone, or lactose

59
Q

Antileukotrienes adverse effects: Zafirlukast

A

-Headache, nausea, diarrhea
-Liver dysfunction

60
Q

Antileukotrienes: Nursing implications

A

-For chronic asthma, not acute
-Taken every night even if symptoms improve
-Therapeutic effect ~ 1 week
-High interaction rate
-Assess liver function before beginning therapy

61
Q

Corticosteroids

A

-For chronic asthma, not acute asthmatic attacks
-PO or inhaled forms
-Inhaled forms reduce systemic effects
-May take several weeks before full effects are seen

62
Q

Corticosteroids mechanism of action

A

-Stabilize membranes of leukocytes or WBCs that release broncho-constricting substances
-Increase responsiveness of bronchial smooth muscle to β-adrenergic stimulation

63
Q

Inhaled corticosteroids

A

-Budesonide, triamcinolone acetonide “ides”
-Fluticasone furoate & propionate
-Mometasone furoate monohydrate “ates”

64
Q

Inhaled corticosteroids indications

A

-Bronchospastic disorders that cannot be controlled by conventional bronchodilators

65
Q

Inhaled corticosteroids contraindications

A

-Hypersensitive to glucocorticoids
-Positive for Candida organisms
-Systemic fungal infection

66
Q

Inhaled corticosteroids adverse effects

A

-Pharyngeal irritation, oral fungal infection
-Coughing, dry mouth
-Systemic effects are rare because of the low doses used for inhalation therapy

67
Q

Inhaled corticosteroids nursing implications

A

-Rinse mouth after to prevent fungal infections
-Bronchodilator used before the corticosteroid
-Encourage use of a spacer device to ensure successful inhalations
-Teach patients how to keep inhalers and nebulizer equipment clean after use

68
Q

Care of the respiratory client: Diagnostics

A

-Pulmonary Function Tests, SpO2
-ABG’s, D-Dimer, sputum Cultures
-Chest X-Ray, CT Scan, MRI

69
Q

Care of the respiratory client: Diagnostics cont’d

A

-D-Dimer is a by-product of blood clotting. D-dimer is released when a blood clot begins to break down.
-Fluoroscopy; continuous x ray image
-Bronchoscopy; scope to see interior of airway
-Thoracoscopy; look at the space inside the chest
-Pulmonary Angiogram; shows blood flow through lung
-Thoracentesis; remove fluid or air from around the lungs
-Biopsy; bronch, thoracentesis

70
Q

Common upper airway complications

A

Rhinitis, sinusitis, pharyngitis, tonsillitis, laryngitis

71
Q

Nursing care for common upper airway complications

A

-Fluid & Electrolyte balance
-Promote communication
-Medication management

72
Q

Obstruction & trauma to upper airway

A

Obstructive Sleep Apnea, epistaxis, nasal Obstruction, laryngeal Obstruction

73
Q

Nursing care of obstruction & trauma to upper airway

A

-Fear & Anxiety, sleep, communication
-Nutrition, body Image

74
Q

Lower respiratory tract disorders

A

Atelectasis, pneumonia, tuberculosis, abscess

75
Q

Lower respiratory tract disorders: Nursing care

A

-Rest
-Fluid balance, nutrition
-Knowledge
-Medication management

76
Q

Lower respiratory tract disorders in pediatrics

A

-Respiratory Syncytial Virus (RSV)

77
Q

-Respiratory Syncytial Virus (RSV)

A

-Acute viral infection causing bronchiolitis
-Most frequent cause of pediatric hospitalization for lower respiratory tract infection

78
Q

RSV presentation

A

SOB, wheezing, tachypnea, nasal secretions, poor feeding, +/- fever

79
Q

RSV nursing care

A

Symptom management, NP suction, I&O, IV fluids

80
Q

Severe RSV may require…

A

PICU admission and intubation

81
Q

Prevention of RSV

A

Monoclonal antibody (palivizumab)

82
Q

Asthma diagnostic tests

A

-Pulmonary function tests (PFTs)
-Peak expiratory flow rate (PEFR)
-Lab tests (CBC + diff) and CXR

83
Q

Status asthmaticus goals of therapy

A

Correct dehydration and acidosis + the obvious goals

84
Q

Status asthmaticus treatment

A

-Humidified O2, SABA, +/- corticosteroids & anticholinergics
-IV Mg+ sulfate
-Admit to PICU

85
Q

Pleural conditions

A

-Pleurisy
-Pleural Effusions
-Empyema

86
Q

Pleural conditions: Nursing care

A

-Effective breathing pattern, gas exchange
-Tube & medication management

87
Q

Respiratory failure

A

-Pulmonary Edema, Pulmonary Embolism; D-dimer
-Acute Respiratory Failure, ARDS
-Pulmonary HTN, Cor Pulmonale

88
Q

Respiratory failure: Nursing care

A

-Medications, weight & fluid balance, nutrition
-Patient teaching, family centered care
-Fear & Anxiety

89
Q

Chest trauma

A

-Blunt Trauma
-Sternal/Rib Fractures
-Penetrating Trauma
-Pneumothorax
-Cardiac Tamponade
-Hemothorax

90
Q

Chest trauma: Nursing care

A

-Emergency…ABC
-Oxygen
-Lines & tubes
-Pain
-Fluid & electrolyte balance
-Medication management
-Family centered care
-Pt education

91
Q

Chest tubes, drains and catheters

A

-1) Drainage of air:
-Pneumothorax
-Primary or secondary
-Spontaneous or traumatic
-2) Drainage of fluid:
-Malignant pleural effusion
-Parapneumonic effusions / Empyema
-Hemothorax
-3) Post operative for recovery

92
Q

Insertion technique: Factors to consider

A

-Percutaneous:
-Simple
-Less painful & traumatic
-Quick
-No inspection of pleural space
-Required if located pleural space
-Surgical:
-More complex & painful
-Allows examination of pleural space
-Allows placement of large bore tubes

93
Q

Large bore chest tubes

A

-Stiff
-Thick fluid (blood, pus)
-Large air leaks
-Pain
-Wound infections

94
Q

Small bore tubes

A

-Pigtails
-Strait “pneumothorax”
-Tubes
-With or w/o image
-Guidance
-More comfortable
-Less traumatic
-Plugs easily, need for flushing
-Good for “lighter” fluids

95
Q

Tunneled pleural catheters (Pleurx)

A

-Malignant effusions
-Long term use, intermittent home
-Low complication rates, soft/comfortable

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