Respiratory Flashcards

Question

Pulmonary Embolism

Answer 1

Dehydration, venous stasis from prolonged immobility or surgery or birth control pills Clotting disorders or heart arrthymias like Afib ``` S/S Hypoxemia PaO2 is down SOB, cough, Increased RR INcreased D-Dimer Positive VQ scan ( looks at perfusion in the lungs, dye is not used, remove jewlellery) Positive CT or CT angiography Hemoptysis Increased pulse because hypoxic Sharp stabbing chest pain CXR will show right sided failure Pulmonary HTN ``` ``` PREVENT - ambulate and hydrate! Oxygen ABG's Decrease Pain Heparin + anticoagulants While on warfarin, limit green leafy veggies/ high in vitamin k Bleeding precautions Surgery ```

Answer 2

TUberculosis ``` PO/IV Rapid Interactions: Acetaminophen, chloramphenicol, cyclosporine, digoxin, diltiazem, antacids ``` MoA: Prevents the replication of tubercle bacilli by inhibiting DNA dependent polymerase. Bactericidal against the following organisms: staphylococcus aureus, Haemophilus influenza, Neisseria meningitis, legionella pneumophila ``` Side Effects: Headache Vertigo Dyspepsia Hepatotoxicity Nausea/vomiting Red-brown discoloration to sweat, urine and sputum ``` Adverse: Pseudomembranous colitis Pancreatitis Acute renal failure ``` Intervention: Monitor liver function test every month Monitor renal status Observe for diarrhea, abdominal pain, fever associated with pseudomembranous colitis. Culture before treatment started ``` Education: This medication is best taken on an empty stomach with a full glass of water (8 ounces or 240 milliliters) 1 hour before or 2 hours after meals Do not take antacids with rifampin since it will lessen the effectiveness of this drug. Keep MD appointments to prevent relapse. Many tuberculosis medications can cause toxic effects such as hepatotoxicity, nephrotoxicity, neurotoxicity , optic neuritis or ototoxicity. Teach client about the signs of toxicity and inform the client that the HCP needs to be notified if any signs arise.

Answer 3

Prophylactic treatment of chronic bronchial Asthma PO ``` Interactions: Barbiturates decrease montelukast levels; black and green tea increase stimulation. When administered with inhaled glucosteroids, increases risk of upper resp infection. ``` MoA: Inhibits leukotriene formation which prevents smooth muscle contraction of the bronchial airways, decreased mucus secretion and reduced vascular permeability (which reduces edema). Advantages: Stops asthma symptoms that are caused by the immune system at the cellular level. Side Effects: Headache Dizziness GI upset Insomnia Drowsiness Adverse Effects: Thrombocytopenia Suicide thoughts Seizures Interventions: Monitor liver enzymes, can be hepatotoxic. Not indicated for acute episodes, improvement usually seen after one week of administration. Monitor CBC and blood chemistry during treatment. Assess for suicidal thoughts. Assess respiratory rate, rhythm, depth and auscultate fields bilaterally. Education: Avoid hazardous activities dizziness may occur Teach not to be used for acute attacks Increase fluid intake.

Answer 4

``` Common uses: Asthma Bronchitis Emphysema COPD ``` ``` Contraindications: Hypersensitivity Tachy-arrhythmias Severe cardiac disease or heart block Hyperthyroidism Peptic ulcer disease ``` PO/aerosol/nebulizer Interactions: Adrenergic drugs increase action of albuterol so don’t use together. B- adrenergic blockers MoA: These drugs are usually used during the acute phase of an asthma attack to quickly reduce airway constriction and restore airflow to normal. They are agonist or stimulators of the adrenergic receptors in the sympathetic nervous system. They imitate the effects of norepinephrine and cause bronchodilation Side Effects: Muscle tremor Anxiety Nervousness Insomnia Tachycardia Adverse Effects: Hypertension Hallucinations Dysrhythmias Interventions: Assess heart rate and rhythm, assess respiratory function, ABGs, lung sounds Watch for evidence of allergic reactions. Notify prescriber if bronchospasms occur. EDucation: Do not use other bronchodilators or OTC medications with Terbutaline, as they may cause additive cardiovascular effects. Do not break, crush or chew extended release tablets Give inhaler instructions. Limit caffeine products such as chocolate, coffee, tea and cola

Answer 5

``` Common uses: Acetaminophen toxicity Bronchitis/ COPD Cystic Fibrosis Atelectasis ``` Contraindications: Increased ICP, Status asthmatics PO/IV/Neb ``` Interactions: Nitrates: increased effects, Iron, copper, nickel or rubber – Interacts with acetylcysteine ``` MoA: Decreases the viscosity of secretions in respiratory tract by breaking disulfide links of mucoproteins. Inactivates acetaminophen toxic metabolites in acetaminophen overdose. ``` Side Effects: Stomatitis Fever Nausea/vomiting Rhinorrhea Drowsiness Diaphoresis Chest tightness ``` Adverse Efects: Hepatotoxicity Anaphylaxis Bronchospasms Interventions: Assess cough type, frequency, character including sputum. Assess character, rate, rhythm of respirations. Assess liver function test May be given in nebulizer or instilled intratracheally If the patient vomits within one hour of administration, repeat the dose. Give gum, hard candy, frequent rinsing of mouth for dryness of oral cavity EDucation: Teach patient that unpleasant odor will decrease after repeated use. Tell client to avoid alcohol and other CNS depressants as they will enhance the sedating properties of this product

Answer 6

5 or >5 is positive in HIV infected, recent contact of TB person, person with fibrotic changes on CXR consistent with prior TB, organ transplants and immunosuppressed peeps 10 or >10= recent immigrants in high prevalence countries, Injection drug users, Residents and employees in high risk congregate settings, mycobacteriology lab personal, persons with clinical conditions that place them at high risk, children <4 years, infants children and adolescents exposed to adults in high risk categories 15 or >15 = any person including persons with no known risk factors for TB An individual who has received a BCG vaccine will have a positive tuberculin test result and should be evaluated for tuberculosis with a CXR

Answer 7

Highly communicable disease. usually upper lobes of lung affected, but can affect brain intestines peritoneum kidney joints and liver. There is an exudative response causes a nonspecific pneumonitis and development of granulomas in lung tissue Spread through the air by droplets. Put these patients in a negative pressure and monitored room. ROOM TO REMAIN CLOSED. Fatigue, Lethargy, Anorexia, Weight loss, Low grade fever, Chills, Night sweats, Persistent cough and the production of mucoid and mucopurulent sputum, which is occasionally streaked with blood, chest tightness and a dull aching chest pain may accompany the cough.

Answer 8

Methylxanthine stimulate the CNS and respiratoin, dilate coronary and pulmonary vessels, cause diuresis and relax smooth muscle ``` Contraindications: Hypersensitivity Tachy-arrhythmias Severe cardiac disease or heart block Hyperthyroidism Peptic ulcer disease ``` Interactions: Theophylline increases the risk of digoxin toxicity and decreases the effects of lithium and phenytonin. If B2 adrenergic agonists are used together, cardiac dysrhthmias can result beta blockers, cimetidine and erythromycin increase effects. Barbituates and carbamazepine decrease effects. Theophylline toxicity is likely to occur when the serum level is 20 mcg/ml or 111 mcmol/L. Early signs of toxicity include restlessness, nervousness, tremors, palpitations and tachycardia

Answer 9

Inhaled medications that improve lung function by blocking muscarinic receptors in the bronchi, which results in bronchodilation. COPD, Allergy induced asthma and excercise induce bronchospasmn Side effects: Dry mouth and irritation of the pharynx Adverse: Increased intraoccular pressure, blurred vision, tachycardia, cV events, urinary retention and constipation If client has a peanut allergy, dont take certain ipratropium products because they contain soy lecthin

Answer 10

Loosen bronchial secretions so that they can be eliminated with coughing; they are used for dry unproductive cough and to stimulate bronchial secretions

Answer 11

Act on the cough control center in the medulla to supress the cough reflex ; used for a cough that is nonproductive and irritating

Answer 12

is the most common type of breathing disorder during sleep and is characterized periods of apnea (>10 seconds) and diminished airflow (hypopnea). A partial or complete obstruction occurs due to upper airway narrowing that results from relaxation of the pharyngeal muscles or from the tongue falling back on the posterior pharynx due to gravity. During periods of apnea, desaturation (hypoxemia) and hypercapnia occur; these stimulate the client to arouse and breathe momentarily to restore airflow. These cycles of apnea and restored airflow can occur several hundred times per night, resulting in restless and fragmented sleep. Partners of clients with OSA witness loud snoring, apnea episodes, and waking with gasping or a choking sensation (Options 5 and 6). During the day, clients experience morning headaches, irritability, and excessive sleepiness. Excessive daytime sleepiness can lead to poor work performance, motor vehicle crashes, and increased mortality (Options 2 and 3). At night, clients with obstructive sleep apnea experience repeated periods of apnea, loud snoring, and interrupted sleep. During the day, morning headaches, irritability, and excessive sleepiness are common.