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68C 2014 P2 Test 5

Chronic Obstructive Pulmonary Disease

Emphysema Characterized by changes in alveolar walls and capillaries. Symptoms develop when a patient is in their 40s progressing to disability in the 50s and 60s.
Emphysema Pathophysiology: Lung elastin, the component of lung connective tissue that provides the elasticity, is destroyed by an enzyme; Results in decreased pulmonary surface area available for gas exchange.
Emphysema Pathophysiology: Bronchi, bronchioles and alveoli become inflamed due to chronic irritation causing bronchiolar narrowing; Results in trapping of air in the alveoli during expiration, causing alveolar distention; The alveoli rupture and scar, losing their elasticity.
Emphysema Pathophysiology: Alveoli walls break down and form enlarged air sacs (called blebs); Capillary beds are replaced with fibrous scarring; Gas exchange is compromised resulting in hypoxia and hypercarbia (increased CO2).
Emphysema Causes: Primarily cigarette smoking - usually about 30 to 35 years between onset of smoking and development of symptoms; Air pollution; Age
Emphysema May lead to cor pulmonale: Right-sided heart failure due to fibrotic changes in the lung and resultant pulmonary hypertension; Results in lower extremity, sacral and perineal edema, distended neck veins and ascites.
Emphysema Clinical Manifestation: Exertional dyspnea is the primary symptom of emphysema; Sputum - minimal at the onset of the disease, but copious in later stages; Use of accessory muscles; Spontaneous pursed-lip breathing;
Emphysema Clinical Manifestation: Development of barrel chest –an increase in anteroposterior diameter caused by over inflation; Wheezing (due to air movement through narrowed bronchioles);Chronic weight loss with emaciation.
Emphysema Subjective: History of onset of symptoms to include intensity of dyspnea, cough and sputum production; Identification of history of smoking or exposure to inhalational irritants; Note family history of respiratory disease.
Emphysema Objective: Tachycardia; Tachypnea; Peripheral cyanosis; Clubbing of fingers; Lung examination will include auscultation, listening for expiratory wheezing, percussion will reveal tympani.
Emphysema Diagnostic test: Diagnostic test the goal of the diagnostic examination is to determine the severity of the disease and its impact on the patient’s quality of life.
Emphysema Diagnostic test: Pulmonary function test (PFT); Arterial blood gas; Chest x-ray; Labs
Emphysema Diagnostic test: Pulmonary function test (PFT) Performed to measure; Total lung capacity- decreased; Residual volume (RV) - increased. (volume remaining in lungs at end expiration); Compliance- increased (distensibility of lung); Airway resistance- increased (due to narrowing of bronchioles)
Emphysema Diagnostic test: Arterial blood gas Decreased PaO2; Increased PaCO2; Normal pH, as a result of compensation (will reveal an elevated HCO3)
Emphysema Diagnostic test: Chest x-ray Reveals hyperinflation of lungs, widened intercostal spaces, and flattened diaphragm; Increased anterior-posterior (AP) diameter (barrel chest)
Emphysema Diagnostic test: Alpha1-antitrypsin assay to determine enzyme deficiency (familial deficiency which causes emphysema, even in nonsmokers
Emphysema Diagnostic test: Complete blood count: Reveals elevated erythrocytes, hemoglobin, and hematocrit; Indicates secondary polycythemia (a compensatory mechanism due to chronic hypoxia)
Emphysema Medical Management: The plan will include long-term management with home oxygen therapy and chest physiotherapy. In acute exacerbations, mechanical ventilation may be required.
Emphysema Medications: Bronchodilators; Antibiotics; Corticosteroids; Diuretics; Oxygen; Anti-anxiety agents
Emphysema Bronchodilators: Enlarges bronchioles for greater oxygenation and ease of secretion clearance; Include terbutaline, isoproterenol, and albuterol inhalers; Patients may also receive PO theophylline
Emphysema Antibiotics: Are frequently ordered to reduce the risk of pulmonary infection during exacerbations
Emphysema Corticosteroids: Usually prescribed only during acute exacerbation because of the long-term side effects associated with systemic steroids; Used to decrease pulmonary inflammation and obstruction
Emphysema Diuretics: May be used for fluid removal
Emphysema Oxygen therapy: To increase oxygenation
Emphysema Anti-anxiety agents: Patients with chronic respiratory disease can experience considerable anxiety, restlessness and irritability during exacerbations; Patients must be carefully monitored to evaluate for respiratory depression with these agents
Emphysema Nursing interventions Directed at attempting to decrease patient’s anxiety and promote optimal air exchange
Emphysema Nursing interventions Oxygenation: Elevate the head of the bed; Low flow oxygen 1-2 liters by nasal cannula
Emphysema: Important for the COPD patient As respiratory drive can be depressed with high flow oxygen (normal drive to breath is CO2 levels; this changes with COPD when the respiratory drive is O2 levels
Airway clearance, ineffective, related to narrowed bronchioles 1) Assist with chest physiotherapy and postural drainage 2) Encourage fluids 2-3 L/day to liquefy secretions
Airway clearance, ineffective, related to narrowed bronchioles 3) Assist with respiratory treatments 4) Auscultate lungs frequently and notify physician of changes 5) Administer medications as ordered
Activity intolerance, related to imbalance between oxygen demand, secondary to inefficient work of breathing 1) Organize care so patient can have periods of uninterrupted rest 2) Advise patient to rest 30 minutes before meals
Activity intolerance, related to imbalance between oxygen demand, secondary to inefficient work of breathing 3) Assist patient with ADLs and exercises to increase stamina 4) Asses patient’s respiratory response to activity
Emphysema: Patient teaching will focus on optimizing nutrition and smoking cessation
Emphysema: Patient teaching: Nutrition Patient with emphysema has an increased protein and caloric requirement; Adequate protein and calories should be divided in five or six small meals per day; Instruct patient to drink fluids between meals.
Emphysema: Patient teaching: Smoking cessation: Probably the most significant factor in slowing disease progression; Nicotine replacement helpful in minimizing nicotine craving; Encourage participation in support groups for behavior modification
Emphysema: Patient teaching: Infection control: Patient should receive flu vaccine each year and pneumovax every 5 years; Teach patient to avoid contact with those with an active respiratory infection; Teach/assess understanding of reasons to contact physician
Emphysema: Patient teaching: Relaxation techniques: critical for the patient and family members to prevent complications of the disease process
Emphysema: Prognosis: COPD is usually irreversible and is the fourth leading cause of death in the US
Chronic bronchitis Etiology: Chronic bronchitis is characterized by a recurrent chronic productive cough for a minimum of three months for at least two years. One of the respiratory diseases that make up COPD
Chronic bronchitis Caused by: physical or chemical irritants or bacterial or viral infection; Smoking is the most common cause of bronchitis
Chronic bronchitis Pathophysiology: The cilia are impaired and can no longer move secretions- mucous gland hypertrophy causes hypersecretion of mucous causing the ciliary dysfunction; Results in an increased susceptibility to infection
Chronic bronchitis Pathophysiology: Chronic infection leads to scarring which causes obstruction; Obstruction leads to increased airway resistance and bronchospasm; Results in hypoxia and hypercapnia
Chronic bronchitis Clinical Manifestations: Primary sign is productive cough which is most pronounced in the morning; Dyspnea and use of accessory muscles; Later signs include cyanosis and right ventricle failure (cor pulmonale)
Chronic bronchitis Clinical Manifestations: Many patients exhibit characteristic reddish-blue skin resulting from polycythemia,cyanosis and dependent edema (from right heart failure)
Chronic bronchitis Subjective: Focused on detailed smoking history exposure to irritants; Identify family history of respiratory disease; Determine patient's disease progression and current treatment regimen.
Chronic bronchitis Objective: Assess cough, including characteristics and amount of sputum; Assess severity of dyspnea; Auscultation for presence of wheezing; Asses patient’s anxiety/restlessness level; Vital signs observing for tachypnea, tachycardia, and hyperthermia
Chronic bronchitis Diagnostic tests: CBC, ABG, Pulse oximetry, PFT reveals, electrolyte
Chronic bronchitis CBC: reveals polycythemia and elevated WBCs
Chronic bronchitis ABG: may reveal respiratory acidosis (although may be normal due to compensation), hypoxia, and hypercapnia
Chronic bronchitis Pulse oximetry: to continuously monitor saturation levels due to potential for hypoxia
Chronic bronchitis PFT: reveals decreased flow on expiration and increased airway resistance and residual volumes
Chronic bronchitis electrolyte: Patients often experience electrolyte abnormalities
Chronic bronchitis Medical management Aimed at minimizing disease progression and facilitating optimal air exchange
Chronic bronchitis Medications: Bronchodilators (same agents as with emphysema); Mucolytics; Antibiotics
Chronic bronchitis Nursing interventions: Provide adequate hydration; Suction as needed
Chronic bronchitis Oxygenation: Maintain on low-flow oxygen; Provide frequent oral hygiene; Provide frequent rest periods
Chronic bronchitis Nutrition patients require high calorie, high protein diet (similar to the requirements for the patient with emphysema)
Chronic bronchitis Prognosis: Irreversible, and with emphysema is the fourth leading cause of death in the US
Breathing pattern, ineffective, related to retained pulmonary secretions 1) Assess degree of dyspnea 2) Teach/assess understanding of effective breathing techniques 3) Suction as needed
Fatigue, related to increased respiratory effort 1) Assess degree of fatigue 2) Provide treatments in a calm, unhurried manner 3) Encourage adequate periods of rest 4) Identify support systems and support if needed
Extrinsic asthma is caused by external factors and occurs in response to allergens, such as pollens, dust spores, feathers, or animal dander, food etc.
Intrinsic asthma is from internal causes. Not fully understood but often triggered by upper respiratory infection and emotional upsets
Causes of asthma: Re-occurrence of attacks is influenced by mental or physical fatigue
Asthma Episodic increased tracheal/bronchial responsiveness to various stimuli. Results in widespread narrowing of the airways which resolves spontaneously or in response to treatment. Classified as intrinsic or extrinsic.
Asthma: Results from an altered immune response or increased airway resistance and altered air exchange
Asthma: Acute attacks are caused by the antigen-antibody reaction in which histamine (causes inflammation) is released
Asthma: primary mechanism Recurrent, reversible obstruction of the airway in the bronchioles and the terminal airway secondary to bronchospasm - the muscles of the airways constrict and narrow the air passages
Asthma: primary mechanism Increased capillary permeability results in edema of mucous membranes- produces increased mucous production and narrowing of the airways
Asthma: primary mechanism Acute inflammatory response in the mast cells of the lungs initiated by an asthma trigger- mast cells release histamine and other inflammatory producing substances that cause
Asthma: Clinical manifestations: Mild asthma dyspnea on exertion and wheezing. Symptoms can be easily controlled with medications
Asthma: An acute asthma attack is most likely to occur at night and includes tachypnea, tachycardia, diaphoresis, expiratory wheezing, accessory muscle use, and nasal flaring
Asthma: acute asthma attack The musical wheezes often audible without a stethoscope are caused by air forcing its way out of narrowed airways The patient experiences anxiety
Asthma: Status asthmaticus Severe, unrelenting form of asthma in which airway obstruction is unresponsive to drug therapy. Symptoms of an acute attack are present and the trapped air and increased work of breathing leads to exhaustion and respiratory failure.
Asthma: Subjective data: Gather information related to quality of life, medications, asthma triggers and anxiety
Asthma: Objective data: Identify s/s suggesting severity of respiratory distress and impending respiratory failure: cyanosis; respiratory effort; vital signs; wheezing, decreased air movement; Check for patient assuming the tripod or hunched position.
Asthma: Diagnostic tests: ABG reveals hypoxia and hypercarbia Ask patient to perform peak flow (peak expiratory flow rate)
Asthma: Diagnostic tests: PFTs used to test airway reversibility during and after an attack (reveals volumes consistent with air trapping) Not particularly helpful during an acute asthma attack, as the patient cannot complete the test
Asthma: Diagnostic tests: Chest x-ray reveals airway trapping and hyperinflation of the airways
Asthma: Diagnostic tests: Sputum culture to rule out secondary infection
Asthma: Diagnostic tests: CBC will reveal increased eosinophil count in the differential, which indicates allergic response
Asthma: Diagnostic tests: Theophylline level must be drawn on patient's taking this medication to ensure drug level is therapeutic
Asthma: Medical management: 2 categories maintenance and rescue (acute) therapy
Asthma: Maintenance therapy used to prevent or minimize symptoms. Medications are taken long-term and on a daily basis
Asthma: Maintenance therapy Bronchodilators- Salmeterol (Serevent) - long acting beta 2 agonist used for prophylaxis and not rescue
Asthma: Maintenance therapy Inhaled corticosteroids- Fluticasone (flovent) - decrease the inflammatory process in the airways
Asthma: Leukotriene inhibitors New medications used to treat chronic asthma ranging from mild to more severe symptoms by antagonizing leukotrienes or inhibiting the synthesis of leukotrienes
Asthma: Leukotriene inhibitors Control both symptoms of asthma: bronchoconstriction and inflammation
Asthma: Leukotriene receptor antagonists zafirlukast (Accolate) and montelukast (Singulair)
Asthma: Leukotriene synthesis inhibitors zileuton (Zyflo)
Asthma: Leukotriene Not indicated as the only therapy for patients with persistent asthma; for use in acute asthma attacks
Asthma: Acute or rescue therapy works Acute or rescue therapy works
Asthma: Acute or rescue therapy Bronchodilators- short acting beta 2-agonist- albuterol which work quickly to relax airway muscles
Asthma: Acute or rescue therapy Corticosteroids: A recent study shows inhaled corticosteroids (Flovent) given with inhaled beta2s may work faster than IV steroids; Intravenous methylprednisolone (Solu-medrol) may be used in an acute attack to decrease inflammation
Asthma: Acute or rescue therapy Epinephrine: Used as a bronchodilator when beta2 agonists have not worked; May be administered SQ or IM
Asthma: Acute or rescue therapy Oxygen should be started immediately in an acute attack and should be monitored with pulse oximetry or serial ABG’s
Asthma: peak flow meter is a helpful tool to assist patient in monitor severity of symptoms. Peak flow can help detect early signs of asthma attacks before they occur .
Asthma: peak flow meter Normal peak flow is between 80%-100% of expected expiratory function and is based on patient’s weight, age, and sex Severe, persistent asthma is less the 60% Severe life-threatening asthma is less than 50%
Asthma: Medical Management: Identification of triggers and education to prevent exposure to these triggers, or medical management of the response
Asthma: Prognosis Death rate for asthma has increased by 50% over the past 10 years-disheartening as this disease can be controlled with medications and trigger avoidance; Status asthmaticus is fatal if not reversed
Breathing pattern, ineffective, related to narrow airway 1) Assess ventilation and respiratory effort 2) Monitor closely for signs/symptoms of increasing dyspnea
Breathing pattern, ineffective, related to narrow airway 3) Maintain position to facilitate optimal ventilation 4) Administer prescribed medications and monitor effects 5) Assist with respiratory treatments 6) Provide
Breathing pattern, ineffective, related to narrow airway 6) Provide care in calm manner 7) Attempt to minimize exposure to triggers 8) Maintain adequate hydration
Health maintenance, ineffective, related to possible allergens in the home 1) Assist patient and family identify allergens and asthma triggers 2) Facilitate allergy testing if necessary 3) Teach/assess understanding of the importance of allergy avoidance
Health maintenance, ineffective, related to possible allergens in the home 4) Teach/assess proper use of medications ie Hold your breath for several seconds then exhale slowly after inhaling the medication
Health maintenance, ineffective, related to possible allergens in the home 5) Teach/assess understanding of use of peak flow meter and goals for individual patient 6) Teach/assess understanding of reasons to call physician
Bronchiectasis A gradual irreversible process of chronic dilation of the bronchi that eventually destroys the elastic and muscular properties of the lung. Follows repeated lung infections in adults and children.
Bronchiectasis Usually secondary to failure of normal lung tissue defenses, as with cystic fibrosis, foreign body, or tumor. d. A complication of many episodes of inflammation that gradually alters the pulmonary structures
Bronchiectasis Subjective note the patient's complaint of dyspnea, weight loss and fever
Bronchiectasis Objective Signs and symptoms of dyspnea, cyanosis and clubbing of fingers; Paroxysmal coughing episodes when lying down and arising in the morning; Copious amounts of foul-smelling sputum;
Bronchiectasis Objective Fatigue, weakness and anorexia; Crackles and wheezing in the lower lobes on auscultation; Prolonged expiratory phase; Hemoptysis seen in 50% of patients; Increased hematocrit
Bronchiectasis Medical Management Low-flow oxygen; Chest physiotherapy; Adequate hydration
Bronchiectasis Medications: Mucolytic agents-Mucomyst; Bronchodilators- theophylline or aminophylline; Antibiotics
Bronchiectasis Medical Management If conservative measure fails, a lobectomy may be necessary to remove damaged portion of lungs
Airway clearance, ineffective, related to retained pulmonary secretions 1) Assess patient’s ability to mobilize secretions 2) Encourage postural drainage, cough, and suction as needed 3) Encourage frequent position changes
Airway clearance, ineffective, related to retained pulmonary secretions 4) Maintain adequate hydration 5) Administer medications as prescribed and monitor effects
Physical mobility, impaired, related to decreased exercise tolerance 1) Asses patient’s activity tolerance and promote adequate rest periods 2) Promote gradual increase of activity 3) Problem solve with patient and family on energy conserving techniques
Asthma edema of respiratory mucosa and excessive mucous production obstruct airways
Antiasthmatics Use Management of acute and chronic episodes of reversible bronchoconstriction. Short Term: treat acute attacks.Long Term: decrease incidence and intensity of future attacks.
Antiasthmatics Action Increases levels of cAMP produce bronchodilation.
Antiasthmatics Adrenergic: Increases production and phosphodiesterase inhibitors by decreasing Breakdown; Example: epinephrine (Adrenalin, Asthma-Haler Mist, Primatene).
Antiasthmatics Anticholinergics: Produces bronchodilation by decreasing intracellular levels of cyclic guanosine monophosphate (cGMP); Example: ipratropium (Atrovent HFA).
Antiasthmatics Bronchodilators: Increases intracellular levels of cyclic-3', 5'-adenosine monophosphate (cAMP). Albuterol (Proventil, Proventil HFA), Salmeterol (Serevent), Terbutaline (Brethaire).
Antiasthmatics Corticosteroids: Corticosteroids: Decreases airway inflammation. Beclomethasone (Beclovent), Flunisolide (Aerobid), Triamcinolone (Azmacort).
Antiasthmatics Leukotriene Receptor Antagonist: Decreases the release of substances that can contribute to bronchospasms. Zileuton (Zyflo), Zafirlukast (Accolate).
Antiasthmatics Mast Cell Stabilizers: Decreases the release of substances that can contribute to bronchospasms. Cromolyn (Intal), Nedocromil (Tilade).
Antiasthmatics Contraindications: Inhaled corticosteroids; Long-acting adrenergic agents; Mast cell stabilizers should not be used during acute attacks of asthma
Antiasthmatics Precautions: Bronchodilators and anticholinergics should be used to cautiously in patients with CV disease.
Antiasthmatics Precautions: Chronic use of systemic corticosteroids should be avoided in children, pregnancy or lactation.
Antiasthmatics Precautions: Diabetic patients may experience loss of glycemic control during corticosteroid therapy. (Corticosteroids should never be abruptly discontinued.)
Antiasthmatics Side Effects: Most Common: Tremors; Anxiety; Nausea; Vomiting; Throat irritation.
Antiasthmatics Side Effects: Serious Adverse Reaction: Bronchospasm; Dyspnea
Antiasthmatics Interactions: Bronchodilators and phosphodiesterase inhibitors may have additive CNS and CV effects with other adrenergic agents.
Antiasthmatics Interactions: Cimetidine increases theophylline levels and the risk of toxicity.
Antiasthmatics Interactions: Corticosteroids: May decrease the effectiveness of antidiabetic agents; May cause hypokalemia (additive with potassium-losing diuretics); May increase risk of digoxin toxicity.
Antiasthmatics Assessment: Assess lung sounds and respiratory function prior to and periodically throughout therapy. (Annotate dyspnea, cough, wheezing, use of accessory breathing muscles, sputum production.)
Antiasthmatics Assessment: Assess CV status of patients taking bronchodilators or anticholinergics. Monitor EKG changes and chest pain.
Antiasthmatics Implementation: Administration: Inhaled- Administer after shaking, Review steps of inhalation medications; PO: with meals to decrease gastric irritation- Gum, small sips of water for dry mouth.
Antiasthmatics Patient Teaching: Take medication as directed. Do not take more than prescribed or discontinue without discussing with health care provider; Avoid smoking. Smoking may make it difficult to adjust the dosage and may worsen breathing problems.
Antiasthmatics Instruct the client on proper technique for using inhalers. Reinforce teaching with a return demonstration. When using a sympathomimetric and corticosteroid inhaler, administer the bronchodilator first, and then wait five minutes before taking the corticosteroid.
Antiasthmatics Patient Teaching: Aerosol inhaler, if more than one inhalation is prescribed, wait 1 full minute between inhalations. When using isoproterenol and epinephrine; wait 3 to 5 minutes between inhalations. For metaproterenol, wait at least 10 minutes between inhalations.
Antiasthmatics Patient Teaching: Instruct the client on use of peak flow meters to monitor effectiveness of the drug regimen. If symptoms become worse, do not increase the dose or frequency of use unless directed to do so by health care provider.
Antiasthmatics Evaluation: prevention and reduction in symptoms of asthma.
Leukotriene Antagonists Use: Zafirlukast (Accolate) long-term control agent in the management of asthma.
Leukotriene Antagonists Use: Montelukast (Singulair) Prevention and chronic treatment of asthma; Management of seasonal allergic rhinitis; Prevention of exercise-induced bronchoconstriction in patients 15 yr and older.
Leukotriene Antagonists Contraindications: Hypersensitivity
Leukotriene Antagonists Side Effects: headache, dizziness, diarrhea, dyspepsia, nausea
Leukotriene Antagonists Assessment: Assess lung sounds and respiratory function before and periodically throughout therapy; Assess allergy symptoms (rhinitis, conjunctivitis, hives) before and periodically throughout therapy.
Leukotriene Antagonists Lab Test: Monitor liver function periodically during therapy; May cause elevated ALT centrations; if liver dysfunction occurs, zafirlukast should be discontinued; May cause ↑AST and ALT concentrations.
Leukotriene Antagonists Implementation (PO): Administer at regular intervals on an empty stomach, 1 hr before or 2 hr after meals; For asthma, administer once daily in the evening; For allergic rhinitis, may be administered at any time of day;
Leukotriene Antagonists Implementation (PO): Administer granules directly into mouth or mixed in a spoonful of cold or room temperature foods (use only applesauce, mashed carrots, rice, or ice cream).
Leukotriene Antagonists Implementation (PO): Granules: Do not open packet until ready to use.; After opening packet, administer full dose within 15 min; Do not store mixture; Discard unused portion; Do not dissolve granules in fluid; Granules may be administered without regard to meals.
Leukotriene Antagonists Patient Teaching: Instruct patient to take medication on an empty stomach as directed, at evenly spaced intervals, even if not experiencing symptoms of asthma. If a dose is missed, take as soon as remembered unless almost time for next dose. Do not double doses.
Leukotriene Antagonists Patient Teaching: Do not discontinue therapy without consulting health care professional. Instruct patient not to discontinue or reduce other asthma medications without consulting health care professional.
Leukotriene Antagonists Patient Teaching: Advise patient that leukotrienes are not used to treat acute asthma attacks but may be continued during an acute exacerbation.
Leukotriene Antagonists Patient Teaching: Advise patient to notify health care professional if symptoms of Churg-Strauss syndrome (generalized flu-like syndrome, fever, muscle aches and pain, weight loss, worsening respiratory symptoms) occur.
Leukotriene Antagonists Patient Teaching: Churg-Strauss syndrome Occurs rarely but may be life-threatening. More likely to occur when weaning from systemic corticosteroids.
Leukotriene Antagonists Evaluation: Prevention of and reduction in symptoms of asthma. Decrease in severity of allergic rhinitis.
Bronchodilator is a drug used to relieve bronchospasms associated with respiratory disorders, such as bronchial asthma, chronic bronchitis, and emphysema.
Bronchodilators Use: Treatment of reversible airway obstruction due to asthma or COPD.
Bronchodilators Use: Revised recommendations for management of asthma recommend that rapid-acting inhaled beta-agonist bronchodilators be reserves as acute relievers of bronchospasm;
Bronchodilators Repeated or chronic use indicates the need for additional long-term control agents, including inhaled corticosteroids, mast cell stabilizers, and long-acting bronchodilators and leukotriene modifiers.
Bronchodilators Action: Adrenergic: produces bronchodilation by stimulating the production of cyclic adenosine monophosphate (cAMP).
Bronchodilators Action: Relaxation of airway smooth muscle with subsequent bronchodilation.
Bronchodilators Action: Onset of action allows use in management of acute attacks except for salmeterol, which has delayed onset.
Bronchodilators Action: Xanthines inhibit the breakdown of cAMP.
Bronchodilators Action: Anticholingerics produces bronchodilation by blocking the action of acetylcholine in the respiratory tract.
Bronchodilators Action: Leukotrienes are components of slow-reacting substance of anaphylaxis A (SRS-A), which may be a cause of bronchospasm.
Bronchodilators Category: Adrenergics: (a) Albuterol (Proventil). (b) Epinephrine (Adrenalin). (c) Salmeterol (Serevent). (d) Terbutaline (Bricanyl).
Bronchodilators Category: Anticholinergics: ipratropium (Atrovent HFA).
Bronchodilators Category: Leuokotriene Antagonists: (a) Montelukast (Singular). (b) Zafirlukast (Accolate).
Bronchodilators Category: Zanthines: (a) Aminophylline (Phyllocontin, Truphylline). (b) Theophylline (Theo-Dur, Uniphyl).
Bronchodilators Contraindications: (1) Hypersensitivity to agents. (2) Avoid use in uncontrolled cardiac arrhythmias.
Bronchodilators Precautions: (1) Diabetes. (2) CV disease. (3) Hyperthyroidism.
Bronchodilators Side Effects: (1) CNS: nervousness, restlessness, tremor. (2) CV: chest pain, palpitations, angina, arrhythmias. (3) GI: nausea, vomiting. (4) Endo: hyperglycemia. (5) F & E: hypokalemia.
Bronchodilators Interactions: Therapeutic effectiveness may be antagonized by concurrent use of beta blockers; Additive sympathomimetic effects with other adrenergic drugs, including vasopressors and decongestants; CV effects may be potentiated by antidepressants and MAO inhibitors
Bronchodilators Assessment: (a) Assess BP, P, R, lung sounds, and character of secretions before and throughout therapy. (b) Patients with a history of CV disease should be monitored for EKG changes and chest pain.
Bronchodilators Implementation: administer around the clock to maintain therapeutic plasma levels.
Bronchodilators Patient Teaching: (a) Take the drug exactly as prescribed. (b) Drink adequate liquids (2000 mL/day) to decrease viscosity of the airway secretions. (c) Avoid OTC cough, cold or breathing preparations without consulting health care professional.
Bronchodilators Patient Teaching: (d) Avoid foods that contain xanthine (e) Avoid smoking and other respiratory irritants. (f) Teach patient on proper use of metered dose inhaler. (g) If symptoms become worse, do not increase the dose or frequency of use unless directed to do so.
Bronchodilators Patient Teaching: Patients using other inhalation medications and bronchodilators should be advised to use bronchodilator first and allow 5 minutes to elapse before administering the other medication, unless otherwise directed.
Bronchodilators Evaluation: (a) Decreased bronchospasm. (b) Increased ease of breathing.
Adrenergics Use: Used as a bronchodilator to control and prevent reversible airway obstruction caused by asthma or COPD.
Adrenergics Use: Inhaln: Used as a quick-relief agent for acute bronchospasm and for prevention of exercise-induced bronchospasm.
Adrenergics Use: PO Used as a long-term control agent in patients with chronic/persistent bronchospasm.
Adrenergics Action: Binds to beta2-adrenergic receptors in airway smooth muscle, leading to activation of adenyl cyclase and increased levels of cyclic-3', 5'-adenosine monophosphate (cAMP).
Adrenergics Action: Increases in cAMP activate kinases, which inhibit the phosphorylation of myosin and decrease intracellular calcium. Decreased intracellular calcium relaxes smooth muscle airways.
Adrenergics Action: Relaxation of airway smooth muscle with subsequent bronchodilation. Relatively selective for beta2 (pulmonary) receptors. Therapeutic Effects: bronchodilation.
Adrenergics Category: Therapeutic: bronchodilators. Pharmacologic: adrenergics.
Adrenergics Examples: (a) Albuterol (Proventil). (b) Epinephrine (Adrenalin). (c) Salmeterol (Serevent). (d) Terbutaline (Bricanyl).
Adrenergics Precautions: Cardiac disease; Hypertension; Hyperthyroidism; Diabetes; Glaucoma; Seizure disorders; Excess inhaler use may lead to tolerance and paradoxical bronchospasm; Lactation. Geriatric: increased risk adverse reactions; may require dosage reduction.
Adrenergics Side Effects: CNS: nervousness, restlessness, tremor, headache, insomnia, hyperactivity in children. CV: chest pain, palpitations, angina, arrhythmias, hypertension. GI: nausea, vomiting. Endo: hyperglycemia. F and E: hypokalemia. Neuro: tremor.
Adrenergics Interactions: Concurrent use with other adrenergic agents will have ↑adrenergic side effects. Use with MAO inhibitors may lead to hypertensive crisis. Beta blockers may negate therapeutic effect. May decrease serum digoxin levels
Adrenergics Interactions: Cardiovascular effects are potentiated in patients receiving tricyclic antidepressants. Risk of hypokalemia ↑concurrent use of potassium-losing diuretics. Hypokalemia ↑the risk of digoxin toxicity. Caffeine-containing herbs ↑stimulant effect
Adrenergics Assessment: Assess lung sounds, pulse, and blood pressure before administration and during peak of medication. Note amount, color, and character of sputum produced.
Adrenergics Assessment: Monitor pulmonary function tests before initiating therapy and periodically during therapy to determine effectiveness of medication.
Adrenergics Assessment: Observe for paradoxical bronchospasm (wheezing). If condition occurs, withhold medication and notify physician or other health care professional immediately.
Adrenergics Assessment: Lab Test: May cause transient ↓in serum potassium concentrations with nebulization or higher-than-recommended doses.
Adrenergics Implementation: PO Administer oral medication with meals to minimize gastric irritation.
Adrenergics Implementation: Inhaln Shake inhaler well, and allow at least 1 min between inhalations of aerosol medication. Prime the inhaler before first use by releasing 4 test sprays into the air away from the face. Pedi: Use spacer for children < 8 years of age.
Adrenergics Implementation: nebulizer compressed air or oxygen flow should be 6-10 L/min; a single treatment of 3 ml lasts about 10 min.
Adrenergics Patient Teaching: Instruct patient to take as directed. If on a scheduled dosing regimen, take missed dose as soon as remembered, spacing remaining doses at regular intervals. Do not double doses or increase the dose or frequency of doses.
Adrenergics Patient Teaching: Caution patient not to exceed recommended dose; may cause adverse effects, paradoxical bronchospasm (more likely with first dose from new canister), or loss of effectiveness of medication.
Adrenergics Patient Teaching: Instruct patient to contact health care professional immediately if shortness of breath is not relieved by medication or is accompanied by diaphoresis, dizziness, palpitations, or chest pain.
Adrenergics Patient Teaching: Instruct patient to prime unit with 4 sprays before using and to discard canister after 200 sprays. Actuators should not be changed among products.
Adrenergics Patient Teaching: Inform patient that these products contain hydrofluoralkane (HFA) and the propellant and are described as non-CFC or CFC-free (contain no chlorofluorocarbons).
Adrenergics Patient Teaching: Advise patient to consult health care professional before taking any OTC medications, natural/herbal products, or alcohol concurrently with this therapy. Caution patient also to avoid smoking and other respiratory irritants.
Adrenergics Patient Teaching: Inhaln: Instruct patient in the proper use of the metered-dose inhaler, Rotahaler, or nebulizer. Advise patient to rinse mouth with water after each inhalation dose to minimize dry mouth.
Adrenergics Patient Teaching: Advise patients to use albuterol first if using other inhalation medications and allow 5 min to elapse before administering other inhalant medications unless otherwise directed
Adrenergics Patient Teaching: Caution adolescents and their parents about overuse of inhalers, which can cause heart damage and life-threatening arrhythmias
Adrenergics Evaluation: prevention or relief of bronchospasm.
Zanthines Use: Long-term control of reversible airway obstruction caused by asthma or COPD. Increases diaphragmatic contractility (aminophylline).
Zanthines Unlabeled Use: respiratory and myocardial stimulant in premature infant apnea (apnea of prematurity) (aminophylline).
Zanthines Action: Inhibit phosphodiesterase, producing increased tissue concentrations of cyclic adenosine monophosphate (cAMP).
Zanthines Increased levels of cAMP result in: bronchodilation, CNS stimulation, positive inotropic and chronotropic effects, diuresis, gastric acid secretion.
Zanthines Therapeutic Effects: bronchodilation.
Zanthines Category: Therapeutic: bronchodilators. Pharmacologic: xanthines.
Zanthines Contraindications: Hypersensitivity to aminophylline or theophylline.
Zanthines Precautions: (1) CHF, liver disease, or hypothyroidism (dosage reduction required). (2) Cardiac arrhythmias. (3) Peptic ulcer disease. (4) Seizure disorder. (5) OB: has been used safely.
Zanthines Precautions: (6) Lactation: safety not established. (7) Pedi: dosage reduction required in children <1 yr. (8) Geri / OB: dosage reduction required due to enhanced potential for adverse reaction.
Zanthines Side Effects: (1) CNS: SEIZURES, anxiety, headache, insomnia, irritability. (2) CV: ARRHYTHMIAS, tachycardia, angina, palpitations. (3) GI: nausea, vomiting, anorexia. (4) Neuro: tremor. (5) Derm: rashes.
Zanthines Interactions: Additive CV and CNS side effects with adrenergics. (2) May decrease the therapeutic effect of lithium and phenytoin.
Zanthines Interactions: Nicotine (cigarettes, gum, and transdermal patches), barbiturates, phenytoin, nevirapine and rifampin may increase metabolism and may decrease effectiveness.
Zanthines Decreases metabolism and may lead to toxicity with the following: erythromycin, beta blockers, clarithromycin, calcium channel blockers, cimetidine, doxycycline, estrogens, hormonal contraceptives, disulfiram,
Zanthines Decreases metabolism and may lead to toxicity with the following: fluvoxamine, isoniazid, ketoconazole, mexiletine, nefazodone, protease inhibitors, quinidine, some fluoroquinolones, and large doses of allopurinol.
Zanthines Interactions: Caffeine-containing herbs (cola nut, guarana, mate, tea, coffee) may ↑serum levels and risk of CNS and cardiovascular side effects. Decreases serum levels and effectiveness with St. John's wort.
Zanthines Interactions: Excessive regular intake of charcoal-broiled foods may ↓effectiveness.
Zanthines Assessment: Assess blood pressure, pulse, respiratory status (rate, lung sounds, use of accessory muscles, number and severity of apnea spells in infants) before and throughout therapy.
Zanthines Nursing Implications: Ensure that oxygen therapy is correctly instituted during acute asthma attacks. Monitor intake and output ratios for an increase in diuresis or fluid overload.
Zanthines Nursing Implications: Patients with a history of cardiovascular problems should be monitored for chest pain and ECG changes (PACs, supraventricular tachycardia, PVCs, ventricular tachycardia). Resuscitative equipment should be readily available.
Zanthines Nursing Implications: Monitor pulmonary function tests before and periodically during therapy to determine therapeutic efficacy in patients with chronic bronchitis or emphysema.
Zanthines Lab Test: monitor ABGs, acid-base, and fluid and electrolyte balance in patients receiving parenteral therapy or whenever required by patient's condition.
Zanthines Toxicity and Overdose: Monitor drug levels routinely, especially in patients requiring high doses or during prolonged intensive therapy. Serum sample should be obtained at time of peak absorption.
Zanthines Toxicity and Overdose: Peak levels should be evaluated 30 min after a 30 min IV loading dose, 12-24 hr after initiation of a continuous infusion and 1-2 hr after rapid-acting oral forms and 4-12 hr after extended-release oral forms
Zanthines Toxicity and Overdose: Therapeutic plasma levels range from 10-15 mcg/ml for asthma and 6-14 mcg/ml for apnea of prematurity. Drug levels in excess of 20 mcg/ml are associated with toxicity. Caffeine ingestion may falsely elevate drug concentration levels.
Zanthines Toxicity and Overdose: Observe patient for symptoms of drug toxicity (anorexia, nausea, vomiting, stomach cramps, diarrhea, confusion, headache, restlessness, flushing, increased urination, insomnia, tachycardia, arrhythmias, seizures).
Zanthines Toxicity and Overdose: Tachycardia, ventricular arrhythmias, or seizures may be the first sign of toxicity.
Zanthines Toxicity and Overdose: Geri: patients over 60 yr have increased risk of toxicity and sensitivity to toxic effects due to age-related pharmacodynamic and pharmacokinetic changes.
Zanthines Toxicity and Overdose: Theophylline doses should not exceed 400 mg/d. Assess frequently.
Zanthines Implementation: Administer around the clock to maintain therapeutic plasma levels. Once-a-day doses should be administered in the morning. Do not refrigerate elixirs; crystals may form. Crystals should dissolve when liquid is warmed to room temperature.
Zanthines Implementation: Wait at least 4-6 hr after stopping IV therapy to begin immediate-release oral dose. For extended-release oral dosage form, give first oral dose at time of IV discontinuation.
Zanthines Implementation: Administer oral preparations with food or a full glass of water to minimize GI irritation. Food slows but does not reduce the extent of absorption. May be administered 1 hr before or 2 hr after meals for more rapid absorption.
Zanthines Implementation: Swallow tablets whole; do not crush, break, or chew enteric-coated or extended-release tablets (extended-release tablets may be broken if scored). Pedi: use calibrated measuring device to ensure accurate dose of liquid preparations.
Zanthines Patient Teaching: Emphasize the importance of taking only the prescribed dose at the prescribed time intervals. Missed doses should be taken as soon as possible or omitted if close to next dose.
Zanthines Patient Teaching: Encourage the patient to drink adequate liquids (2000 ml/day minimum) to decrease the viscosity of the airway secretions.
Zanthines Patient Teaching: Advise patient to avoid OTC cough, cold, or breathing preparations without consulting health care professional. These medications may increase side effects and cause arrhythmias.
Zanthines Patient Teaching: Encourage patients not to smoke. A change in smoking habits may necessitate a change in dosage
Zanthines Patient Teaching: Advise patient to minimize intake of xanthine-containing foods or beverages (colas, coffee, and chocolate) and not to eat charcoal-broiled foods daily.
Zanthines Patient Teaching: Instruct patient not to change brands without consulting health care professional.
Zanthines Patient Teaching: Advise patient to contact health care professional promptly if the usual dose of medication fails to produce the desired results, symptoms worsen after treatment, or toxic effects occur
Zanthines Patient Teaching: Emphasize the importance of having serum levels routinely tested every 6-12 mo.
Zanthines Increased ease in breathing. Clearing of lung fields on auscultation. Respiratory and myocardial stimulation in apnea of infancy (aminophylline).
Created by: 68C2014
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