respiratory Flashcards
efficiency of the resp system depends on?
the quality and quantity of air inhaled
- patency of air passageways
- ability of lungs to expand and contract
- and ability of o2 and co2 to cross alveolar capillary membrane
circulatory, nervous and musculoskeletal system have important functions in respiration
after oxygen enters bloodstream, it combines with ___In RBC for transport to body cells, w here it is released
hemoglobin
capillaries are lined with single layer epithelium that ____
forms a barrier and transport of gases
also recreates vasodilation substances
what does the Nervous system has to do with the respiratory system ?
regulates rate and depth of respiration by respiratory centre in medulla oblongata, pneumotaxic centre of pons and apneustic centre in the reticular formation
resp center is stimulated by?
inc co2 rate
depth of breathing inc
excessive co2 exhaled
resp acidosis in reg to blood gases? when does this usually occur?
ph<7.35
inc pCo2 and bicarb
COPD and emphysema
resp alkalosis in reg; blood gases? when does this usually occur?
ph>7.35
dec pCo2 and bicarb
hypeventilation
S&S of resp acidosis?
rapid, shallow rests, dec BP with vasodilation, dyspnea, headache, hyperkalemia, dysrtyhmias (inc K), drowsiness, dizziness, disorientation, muscle weakness, hyperrelexia,
S&S of resp alkalosis?
tacky, dec or normal BP, hypokalmeia, numbers and tingling of extremities, hyperrelexes and muscle cramping, inc anxiety and irritability
how does the musculoskeletal system contribute to respiratory system?
Participates in chest expansion and contraction
Diaphragm and external intercostal muscles expand the chest cavity
Abdominal and internal intercostal muscles are muscles of expiration
what are some hereidatary risk factors of asthma?
genetic predisposition, atopy, male sex ( <10 years), female sex (adults)
what are some acquired factors that are risk factors for asthma?
indoor allergens, outdoor allergens, irritants (low molecular weight sensitizers eg. tobacco smoke, air pollutants), resp infections e.g.. rhinoviruses, high socio-economic status, small family size, higher body mass index
triggers for asthma?
allergens, air pollutants including tobacco, resp viruses, exercise and hyperventilation, weather changes, extreme emotional expressions, drugs, food and additives
drug therapy for asthma?
broncho-dilators, anti-inflammatories and combinations
what are bronchodilators used for? example? (asthma)
used to prevent and treat bronchoconstriction. example: salbutamol
what are anti-inflm for? example? (asthma)
are used to prevent and teat inflammation of the airways. reduced inflm also reduces bronchocontrivtion by decreasing mucosal edam and mucus secretions.
example inhaled corticosteroid.
what are some combination drugs of bronchodilators and anti-inflm?
example?
long acting beta-agonist (LABA and corticosteroid (ICS) for maintenance
example: budenoside/formoterol most effective (symbicort)
nursing implications for drugs for asthma?
differences between <6yo, 6-18, adult asthma
assess proper use of inhaler and spacer
discuss how o use written action plan
how to assess triggers, modify environment
what consists of the asthma action plan for adults?
green zone (asthma is well controlled), yells zone (asthma symp, take action- flair up) red zone- danger zone
how does COPD usually develop?
develops after long-standing exposure to an airway irritant
T or F - chronic bronchitis and emphysema are included in COPD?
T. they are no longer used on their own but included in the diagnosis of COPD
what are some risk factors for COPD?
susceptibility genes
exposure to inhaled particles (tobacco smoke, dusts, indoor air pollution from heating and cooking with biomass in poorly ventilated dwellings, outdoor pollutions)
female gender, age, resp infections, poor lung growth and development, oxidative stress, poor nutrition, low SE status, comorbidites
what is the key risk factor for COPD?
cumulative exposure to noxious particles
what are the 2 major groups of drugs for COPD?
bronchodilators and anti-inflm drugs
what do adrenergic drugs do? what kind of drugs are they?
stimulate beta2 adrenergic receptors in the smooth muscle of bronchi and bronchioles. increased cAMP produces brochodilation
**some adrenergic drugs stimulate beta1 adnergic receptors as well causing an inc heart rate and force of contraction (albuterol for example)
other examples of adrenergics?
epinephrine, albuterol, and formoterol and salmertol, bitoerol, adn pirbuterol, isoproterenol, metaproterenol, and terbutaline
what does epinephrine do? how is it available?
**Stimulates beta1 and beta2 receptors. may be injected SUBq with an acute attack of bronchocsontriction. also available without prescriptive pressurized aerosol form
what does albuterol, bitolterol, and pirbuterol do?
(ventolin) they are short acting beta2- adrenergic agonists. most often taken by inhalation. **Drug of choice to relieve acute asthma
what does formoterol and salmeterol do?
long-acting beta2-sdrenergic agonists **used only for prophylaxis of acute bronchocnostriction. effects last 12 hours
what adrenergic is used to relieve acute asthma?
albuterol (ventolin)
what adrenergic drug is used for prophylaxis?
foromoterol and salmeterol
what does isoproterenol do?
it is a short-acting bronchodilator and cardiac stimulant. may be given in combination or alone
what does metaproterenol do?
it is a selective, intermediate-acting beta2 adrenergic agonist given orally or by MDI. used to treat acute bronchospasm and to prevent exercised-iduced asthma
what does terbutaline do?
it is a selective beta 2 -adrenergic agnostic that is a long-acting bronchodilator. given subQ it loses its selectivity
what do anticholinergics do?
block action of acetylcholine in bronchial smooth muscle when given by inhalation. reduces intracellular GMP, a broncho-constrictive substance
examples of anticholinergics
ipratropium (atrovent) and toptropium (spiriva)
what does ipratropium do?
(anticholinergic) it is used for maintenance therapy for chronic bronchitis and emphysema. acts synergistically with adrenergic bronchodilators and may be used together
T or F tiotropium is superior to ipratropim
T
what is the main zanithine used clinically?
theophylline
what do xanithines do?
In addition to bronchodilation, also inhibits pulmonary edema by decreasing vascular permeability, increases cilia’s ability to clear mucus, strengthens contractions of the diaphragm, and decreases inflammation.
Increases cardiac output, causes peripheral vasodilation, exerts mild diuretic effect and stimulates CNS
what types of foods or drinks inc effects caused by theophylline **?
Drinking or eating foods high in caffeine, like coffee, tea, cocoa, and chocolate, may increase the side effects caused by theophylline. Avoid large amounts of these substances while you are taking theophylline
corticosteroids are used in treatment of what?
acute and chronic asthma and other broncho-constrictive disorders
what do corticosteroids do? ***
suppress inflm by inhibiting movement of fluid and proteins into tissues, migration and function of neutrophils and eosinophils, synthesis of histamine in mast cells and production of pro-inflm substances
inc number and sensitivity of beta-adrenergic receptors
when should corticosteroids be used in caution?
Corticosteroids should be used with caution in patients with peptic ulcer disease, inflammatory bowel disease, hypertension, congestive heart failure, and thromboembolic disorders. However, they cause fewer and less severe adverse effects when taken in short courses or by inhalation than when taken systemically for long periods of time.
some examples of anti-inflm agents that are tropical corticosteroids for inhalation?
Beclomethasone, budesonide, flunisolide, fluticasone* (Flovent) and triamcinolone
why might you choose Beclomethasone, budesonide, flunisolide, fluticasone* (Flovent) and triamcinolone
they are topical corticosteroids for inhalation and minimize systemic absorption and adverse effects ***
what would you take (ant-inflm agent) to get a systemic corticosteroid effect?
hydrocortisone, prednisone and methylprenisolone
what are leukotrienes?
*** are strong chemical mediators of bronchoconstriction and inflammation causing prolonged constriction of bronchioles and immediate hypersensitivity reactions. They also increase mucus secretion and mucosal edema in the respiratory tract.
what do leukotriene modifier drugs do? **
counteract the effects of leukotrienes and are used for long-term treatment of asthma. Also help to prevent acute asthma attacks.
what does zileuton do?
** inhibits lipoxygenase and reduces formation of leukotrienes
what are some examples of leukotriene receptor antagonists?
montelukast and zafirlukast ***
cromoloyn and nedocromil do what?
they are mast cell stabilizers. so they stabilize mast cells and prevent the release of bronchoconstrictive and inflm substances
when do you take mast cell stabilizers?
**for prophylaxis oNLY of acute asthma attacks
how do you take mast cell stabilizers?
taken by inhalation. nasal solution available for allergic rhinitis
when do you use o2 with COPD patients?
how long may it prolong life?
used to reduce the risk of detain COPD patient with hypoxemia or Sao2 <88%
6 or 7 years
what are some natural health products used?
***Caffeine is a xanthine. Caffeine-containing products may produce weak bronchodilating effects.
teaching around relivers?
Relievers are used to quickly alleviate asthma symptoms. They do this by relaxing the bands of muscle that surround the airways. However, they do not reduce inflammation in the airways - to treat inflammation, you will need to take a controller medication.
teaching around controller medications?
controller medications help to treat the underlying inflammation of the airways in a person with asthma. By controlling the inflammation, asthma symptoms will diminish and attacks prevented. When you start taking controller medications, you may not notice a difference right away. It may take a few weeks before the inflammation in your airways is reduced. Even if you do not feel better right away, do not stop taking your controller medication unless your doctor tells you to.
Remember, controllers do not immediately relieve wheezing, coughing or chest tightness, and should not be used to treat a severe asthma attack. Make sure you understand the difference between your reliever medication, which provides quick relief during an asthma episode, and your controller medication, which controls your underlying inflammation so that you’re less likely to experience these symptoms in the first place.
(sorry so long)
T or F theophylline is a short acting bronchodilator?
F it is long acting
what is FEV1?
forced expiratory volume
what possible surgery could you have to manage COPD?
bullectonoy, lung volume reduction surgery, and lung transplantation
what is a bullectomy?
is the surgical removal of a bulla, which is an air pocket in the lung that is greater than one centimeter in diameter (across). Bullae tend to occur as a result of lung tissue destruction and diseases such as cancer and emphysema. Their presence in the lung takes up space, causes pressure and blocks your breathing.
what is lung volume reduction surgery?
is an operation that removes parts of the lungs that are not working properly. By removing the most damaged parts of the lungs that are unable to efficiently process oxygen, the rest of the lungs and the surrounding muscles are able to work more efficiently.
management of bronchodilator overdose?
cardiac and CNS stimulation (angina, tachycardia, agitation, tremors, seizures)
discontinue the causative medications and use general supportive measures.
management of theophylline overdose?
Ventricular dysrhythmias or convulsions may be the first sign of toxicity (anorexia, N&V, agitation, tachycardia), normal range 8-20 micrograms/mL
Watch for delayed increases in serum drug levels with sustained release forms
Gastric lavage if able, otherwise maintain airway, supportive measures
management of LTRA overdose?
These drugs seem relatively devoid of serious toxicity in overdose.
What drug stabilizes mast cells and prevents the release of bronchoconstrictive and inflammatory substances?
a. Ventolin b. Cromolyn c. Foradil d. Berotec
B
Cromolyn and nedocromil stabilize mast cells and prevent the release of bronchoconstrictive and inflammatory substances. Indicated for prophylaxis ONLY of acute asthma attacks. Taken by inhalation. Nasal solution available for allergic rhinitis.
