Therapeutic interventions for wounds, fungal, protozoan infections Flashcards
fiO2
Fraction of inspired O2
O2 of RA
21%
Asthma characterized by
Bronchconstriction and inflamm
Sudden contraction of smooth muscle that causes acute dyspnea
Thick, viscous secretions
Edema
Caused by engorgement of pulmonary blood vessels
Drugs are given for asthma with the goal of
Terminanting or preventing an epidsodes
Systemic side effects and inhalation
Less common
Beta 2 receptor stimulation =
Bronchodialtion
Duration of action for asthma drug
Ultra short-acting – work almost immediately but only last 2 to 3 hours. (Ventolin)
Short acting- act quickly last 5-6 hours (terbutaline)
Intermediate-acting – slower onset, 8 hr duration (
Long-acting – lasts up to 12 hours
Salmeterol
Long-acting beta2 agonist indicated for prevention of asthma episodes in patients with severe persistent asthma
or Chronic bronchitis
causing bronchodialaiton
Not great in acute attack (15-20 mins onset)
Prophlactic use with exercise
Adverse effects of Salmeterol
Nervousness
Restlessness
Serious adverse effects
- Tachycardia, chest pain, arythmias
Salbutamol (Ventolin)
a short-actingβ2adrenergic receptor agonistwhich works by causing relaxation of airwaysmooth muscle
Treats asthma and related, COPD, onset in 15 minutes
Methylxanthines
long-term management of asthma when beta agonists, anticholinergics do not work
Chemically similar to caffeine
Nausea, vomiting, CNS stimulation are common adverse effect
Avoid caffeine
Inhaled anticholinergics
Promote bronchodilation by blocking muscarinic Ach receptors
alternative to short-acting beta2 agonists
Can be combined with beta2 agonists
Atrovent, Spiriva
Ipratropium (Atrovent)
Relieving and preventing bronchospasm of asthma and chronic bronchitis
Can relieve acute bronchospasm in minutes, peaks in 1-2 hours and continues for up to 6 hours.
Intransal admin blocks parasymp receptors, reduces nasal hypersecretion
Adverse effects of Ipratropium
Dry mouth
Urinary retention
Tachycardia
Caution with BPH
Nursing interventions for asthma
Maintain an environment as free from triggers
FLuids
VIts and minerals
Beclomethasone
Therapeutic effects and uses
Asthma
Allergic rhinitis
Mech of action
Glucocoriticoid that reduces
Durgs used to preventa asthma episodes
Focus is on reducing inflammation
Glucocorticoids Inhaled or PO
Most effective and commonly used
Mast Cell Stabilizers
Leukotriene Modifiers
Monoclonal antibodies
Must be taken a certain amount of time (weeks) to be effective
Adverese effects of Beclomethasone
Dry mouth, hoarseness, change to sense of taste, masks infection
Can cause fungal infections
How to avoid fungal infections from Beclomethasone
Wait a bit and then rinse out mouth
Common inhaled steroids
Flovent (fluticasone) a steroid
Pulmicort (budesonide)- a steroid
Advair ( fluticasone and salmeterol- a long-acting beta agonist) must be taken twice per day to be effective.
Symbicort ( budesonide a steroid and formoterol a long-acting beta agonist LABA)
Solu-Medrol
Sterioid injection
used to treat a number of different conditions, such as inflammation (swelling), severe allergies, adrenal problems, arthritis, asthma,
Steroids important to know
Serious side effects if taken long term
Less concerned about inhaled
Rinse out mouth after inhaled
Taper dose for PO meds (For adrenal system)
Monitor ss of infection
Increase blood glucose in diabetics
Cause peptic ulcers
Mast cell stabalizer
Used in PREVENTION of attacks
Not helpful in treatment
cells respond to environmental triggers (allergens) by releasing histamine which causes inflammation of bronchi
Leukotrienes
promote inflammation and recruit WBCs to sites of injury
Reduce inflammation through two mechanisms
Monoclonal antibodies
Prevent release of histamine by mast cells through a different mechanism from mast cell stabilizers
Last resort medications for severe perssistant asthma
For any inhaler prescribed, ensure that the patient is able to ?
Provide demonstration and return demonstration
Ensure the patient knows the correct time intervals for inhalers
Provide a spacer if the patient has difficulty coordinating breathing with inhaler activation
Expiration,
Slow, deep inspiration
Avoid harmonica sound! (slow down intake breathe)
Metered dose inhalers
Pressurized devices that deliver a measured dose of drug with each activation
Hold breath for 10 seconds after each puff.
When 2 or more puffs are needed, wait 2 minutes between puffs
Spacers
Used with MDIs
Increase delivery of drug to the lungs & decrease deposition of drug on the oropharyngeal mucosa
Especially important for inhaled coricosteriods - decreases risk of aquiring fungal infection
Dry powder inhalers
Include Turbuhalers & Accuhalers
Drugs are in the form of dry, micronized powder
No propellant is employed
Breath activated, much easier to use
Nebulizer
Include Turbuhalers & Accuhalers
Drugs are in the form of dry, micronized powder
No propellant is employed
Breath activated, much easier to use
Droplets in the mist are much finer than those produced by inhalers
Take several minutes to deliver the same amount of drug contained in 1 puff from an inhaler
Remember it should be gentle mist flow
Antitussives
Antitussives are used to manage non-productive coughs (we don;t supress a productive cough)
Opiod or Non-opiodi
Opioid Antitussives
Raise the cough threshold in CNS
More effective than non-opioids; used for severe coughs
Codeine
Doses are low so less likely to cause dependance.
Non-opioid antitussives
Dextromethorphan
Benzonate
Robitussin
Raises threshold of non-producive cough
Adverse effects
CNS: Ataxia, slurred speech etc.
Drugs to treat COPD
Mucolytics and expectorants
Bronchodilators
Anti-inflammatory agents
Similar to those used to treat asthma
Normally ____________ is the main stimulus to breathe.
accumulation of carbon dioxide
Carbon diozide necrosis
What increases the metabolism in people with COPD
Increased inflammation
Nutritional therapy for COPD pts
Eat 5 to 6 small meals
Rest 30 min. before eating
Use a bronchodilator before meals
Foods that are easy to prep
Fluid 2-3L per day between meals unless they have heart failure.
Fluids should be taken between meals
Cold foods /decreased feeling of fullness
Avoid foods that cause gas
Late stage increased calories. High calorie, high protein
Pulmonary Formulas- enteral formulas designed for use in COPD with higher fat lower carb content because carbon dioxide production is lower when fat is consumed.
Sx therapy for COPD
Lung volume reduction
Lung transplant
