Respiratory Part 3 Flashcards
what is considered part of the lower respiratory tract?
trachea, bronchi, lungs
what would be considered a bronchoconstrictive disorder?
-airway hyperresponse
-bronchoconstriction
-inflammation, mucosal edema
-excessive mucous production
-asthma, bronchitis, emphysema
what is the etiology of asthma?
genetic IgE hypersensitivity (type 1)
can happen at any age
more common in African Americans and Hispanics
what are some stimuli for asthma?
-viral infections
-environmental irritants (ex. cleaning products)
-stress/emotion
-strenuous activity
-temp/weather change
-medications
what is the pathophysiology of asthma?
muscle constriction and inflammatory response (cytokines released)
how does long-term asthma look like, mild-severe?
mild: recurrent-reversible, chronic/flareups
severe: less reversible, chronic inflammation, structural changes – scar tissue
what are some manifestations of asthma?
dyspnea (shortness of breath)
wheezing (musical)
chronic cough
Peak expiratory flow rate (PEFR) decrease (force of blowing out and amount)
what is status asthmaticus?
acute severe asthma, no response to treatment, severe respiratory distress and life-threatening
what is chronic bronchitis?
frequent productive cough of more than 3 months per year for 2 years.
-increased mucus causes narrowed airway and chronic changes
what is emphysema?
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
what are the key differences between chronic bronchitis and emphysema?
B: cyanotic, cough and increased sputum, hypoxia, hypercapnia, respiratory acidosis, clubbing, increased hgb
E: CO2 retention, pink color, pursed lip breathing, barrel chest
what is COPD and its symptoms?
chronic bronchitis and emphysema (in that order)
-caused by exposure to airway irritants = smoking
S: dyspnea, activity intolerance, air trapping (constant, nonreversible)
true or false, there are no long-term side effects from asthma?
false
Patients with bronchoconstrictive disorders will report difficulty with what?
exhaling
what is the main goal of drug therapy and what are the main treatment options?
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)
what are the two main types of beta2 adrenergic agonists and their function?
used for asthma – stimulate production of cyclic AMP=broncodilation
rescue: albuterol
maintenance: salmeterol
what are the uses of beta2 adrenergic agonists, adverse effects, and contraindications?
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
whar are some nursing implications and patient teaching for beta2 adrenergic agonists?
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)
what is a common anticholinergic, its function and use?
ipratropium
-block acetylcholine, stopping constriction and mucus secretion – normally used with bronchodilator
-nebulizer and MDI
U: maintenance for asthma, bronchitis and emphysema
what are the adverse effects of anticholinergics and their contraindications?
cough, dry mouth, GI upset
C: glaucoma, BPH
what is a common xanthine, its function and when it is used?
theophylline
relaxes smooth muscle, causing bronchodilation and depressing airway responsiveness
-only used in severe cases of chronic bronchoconstriction do to toxic effects
what are the adverse effects, contraindications, nursing implications, and teaching for xanthines?
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
which inhaler should be used first, an albuterol inhaler or steroid inhaler?
albuterol, wait 5 minutes then steroid
what is the example of a corticosteroid and its MOA and effects?
beclomethasone ONE=steriod
-suppresses airway inflammation by blocking cytokines
-decreased mucus, decreased edema, repaired epithelium damage, reduced airway reactivity
what are the uses for corticosteroids, adverse effects, and contraindications?
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
what are some nursing implications and patient teaching for corticosteroids?
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
what is an example of a leukotriene modifier, its MOA, how it is administered, and its use?
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
what are some adverse effects of a leukotriene modifier?
HA, D/V/D
Black box: neuropsychotic events — vivid dreams, agitation, hallucinations
what is an example of a mast cell stabilizer, its MOA, and when it is used?
cromolyn (inhaled)
-prevent release of substances from mast cells (bronchoconstriction and inflammation)
-Second-line treatment for mild persistent asthma, not for acute attacks
what is an example of a monoclonal antibody med, its MOA, use, and black box warning?
omalizumab (new)
binds with IgE blocking receptors so less IgE
-for severe allergic asthma not well-controlled
BB: life-threatening anaphylaxis
what are the benefits of combo meds, and what is normally in them?
can be less expensive, increased compliance
-bronchodilators and steroids
-ex: ipratropium and albuterol (fast/short acting seen in a hospital setting)
what are the relievers, controllers, and preventers?
R: acute=albuterol
C: maintence=salmeterol, ipratropium
P: theophylline, beclomethasone, montelukast, cromolyn, omalizumab
