Respiratory Part 3

Question 1

what is considered part of the lower respiratory tract?

Answer 1

trachea, bronchi, lungs

Question 2

what would be considered a bronchoconstrictive disorder?

Answer 2

-airway hyperresponse
-bronchoconstriction
-inflammation, mucosal edema
-excessive mucous production
-asthma, bronchitis, emphysema

Question 3

what is the etiology of asthma?

Answer 3

genetic IgE hypersensitivity (type 1)
can happen at any age
more common in African Americans and Hispanics

Question 4

what are some stimuli for asthma?

Answer 4

-viral infections
-environmental irritants (ex. cleaning products)
-stress/emotion
-strenuous activity
-temp/weather change
-medications

Question 5

what is the pathophysiology of asthma?

Answer 5

muscle constriction and inflammatory response (cytokines released)

Question 6

how does long-term asthma look like, mild-severe?

Answer 6

mild: recurrent-reversible, chronic/flareups
severe: less reversible, chronic inflammation, structural changes – scar tissue

Question 7

what are some manifestations of asthma?

Answer 7

dyspnea (shortness of breath)
wheezing (musical)
chronic cough
Peak expiratory flow rate (PEFR) decrease (force of blowing out and amount)

Question 8

what is status asthmaticus?

Answer 8

acute severe asthma, no response to treatment, severe respiratory distress and life-threatening

Question 9

what is chronic bronchitis?

Answer 9

frequent productive cough of more than 3 months per year for 2 years.
-increased mucus causes narrowed airway and chronic changes

Question 10

what is emphysema?

Answer 10

effects exchange of o2 and co2 = trapped co2
-enlargement and destruction of alveoli caused by long term damage
-lost elasticity and surface area
-common in smokers

Question 11

what are the key differences between chronic bronchitis and emphysema?

Answer 11

B: cyanotic, cough and increased sputum, hypoxia, hypercapnia, respiratory acidosis, clubbing, increased hgb
E: CO2 retention, pink color, pursed lip breathing, barrel chest

Question 12

what is COPD and its symptoms?

Answer 12

chronic bronchitis and emphysema (in that order)
-caused by exposure to airway irritants = smoking
S: dyspnea, activity intolerance, air trapping (constant, nonreversible)

Question 13

true or false, there are no long-term side effects from asthma?

Answer 13

false

Question 14

Patients with bronchoconstrictive disorders will report difficulty with what?

Answer 14

exhaling

Question 15

what is the main goal of drug therapy and what are the main treatment options?

Answer 15

prevent inflammation and minimize need for rescue meds
T: bronchodilators (adrenergic, anticholinergic, xanthines) NORMALLY INHALE and anti-inflammatories (corticosteroids, leukotriene modifiers, mast cell stabilizer, immunosuppressants)

Question 16

what are the two main types of beta2 adrenergic agonists and their function?

Answer 16

used for asthma – stimulate production of cyclic AMP=broncodilation
rescue: albuterol
maintenance: salmeterol

Question 17

what are the uses of beta2 adrenergic agonists, adverse effects, and contraindications?

Answer 17

treat/prevent constriction, used in adults and peds, large doses can be used if needed, available as nebulizer, MDI, and oral

A: muscle tremor, cardiac stimulation, CNS stimulation

C: dysrhythmias, CAD, HTN

Question 18

whar are some nursing implications and patient teaching for beta2 adrenergic agonists?

Answer 18

beta blockers=spasm
thyroid, theophylline, cold meds, and caffeine will increase strength

T: use a bronchodilator first (wait 5 minutes), do not overuse rescue, do not skip doses, proper use (2 fingers/spacer)

Question 19

what is a common anticholinergic, its function and use?

Answer 19

ipratropium
-block acetylcholine, stopping constriction and mucus secretion – normally used with bronchodilator
-nebulizer and MDI
U: maintenance for asthma, bronchitis and emphysema

Question 20

what are the adverse effects of anticholinergics and their contraindications?

Answer 20

cough, dry mouth, GI upset
C: glaucoma, BPH

Question 21

what is a common xanthine, its function and when it is used?

Answer 21

theophylline
relaxes smooth muscle, causing bronchodilation and depressing airway responsiveness
-only used in severe cases of chronic bronchoconstriction do to toxic effects

Question 22

what are the adverse effects, contraindications, nursing implications, and teaching for xanthines?

Answer 22

toxicity= anorexia, N/V, agitation, tachycardia, convulsions
C: gastritis, PUD, seizures
N: drug to drug interactions! cigarette smoking increases metabolism
T: do not OD, alert if stop/start smoking

Question 23

which inhaler should be used first, an albuterol inhaler or steroid inhaler?

Answer 23

albuterol, wait 5 minutes then steroid

Question 24

what is the example of a corticosteroid and its MOA and effects?

Answer 24

beclomethasone ONE=steriod
-suppresses airway inflammation by blocking cytokines
-decreased mucus, decreased edema, repaired epithelium damage, reduced airway reactivity

Question 25

what are the uses for corticosteroids, adverse effects, and contraindications?

Answer 25

lower dose to prevent, higher dose to treat
-asthma, COPD
-inhaled to only effect the lungs, and can be given long-term
A: HA, dry mouth, cough, thrush
C: nasal/oral surgery

Question 26

what are some nursing implications and patient teaching for corticosteroids?

Answer 26

rinse mouth after use, and use the smallest dose possible
-can be given IV in hospital
T: take on schedule, not for rescue, use bronchodilator first, rinse mouth

Question 27

what is an example of a leukotriene modifier, its MOA, how it is administered, and its use?

Answer 27

not common, Montelukast
-prevents leukotrienes from binding, reducing bronchoconstriction and inflammation
-long-term treatment of asthma, not for attacks, can be given with bronchodilators and corticosteroids
A: GIVEN PO

Question 28

what are some adverse effects of a leukotriene modifier?

Answer 28

HA, D/V/D
Black box: neuropsychotic events — vivid dreams, agitation, hallucinations

Question 29

what is an example of a mast cell stabilizer, its MOA, and when it is used?

Answer 29

cromolyn (inhaled)
-prevent release of substances from mast cells (bronchoconstriction and inflammation)
-Second-line treatment for mild persistent asthma, not for acute attacks

Question 30

what is an example of a monoclonal antibody med, its MOA, use, and black box warning?

Answer 30

omalizumab (new)
binds with IgE blocking receptors so less IgE
-for severe allergic asthma not well-controlled
BB: life-threatening anaphylaxis

Question 31

what are the benefits of combo meds, and what is normally in them?

Answer 31

can be less expensive, increased compliance
-bronchodilators and steroids
-ex: ipratropium and albuterol (fast/short acting seen in a hospital setting)

Question 32

what are the relievers, controllers, and preventers?

Answer 32

R: acute=albuterol
C: maintence=salmeterol, ipratropium
P: theophylline, beclomethasone, montelukast, cromolyn, omalizumab