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PathopharmA 2

Chapter 76-ASTHMA+COPD

QuestionAnswer
CHAPTER 76 COPD +ASTHMA
short acting beta agonist-albuterol BETA-ADRENERGIC RECEPTOR AGONIST(HELP) LON ACTING-IPRATROPIUM+GLUCOCORTICOID acute asthma exacerbation ALBUTEROL FOR EXERCISE INDUCED-OPEN AIRWAY FOR IMPROVED OXYGENATION-USE SPACER S/E-INCREASED HR+JITTERY-DIFFICULTY FALLING ASLEEP (ALL OTHER ASTHMA MEDICATION ARE USED PROPHYLACTICALLY )
CHRONIC LUNG ISSUE BURN THEIR CO2 RECEPTOR DRIVE-CHANGE IT TO LOW 02 WHICH MAKES THEM BREATH ONLY WHEN THEY FEEL THAT THEIR O2 IS LOW NORMAL O2 SAT=90-92% ASSESSMENT IS KEY
NOSE TO TOE NO SNIFFING LEAN FORWARD-SQUEEZE 2 PUFF IN EACH NOSTRIL
TIPS TO DECREASE ALLERGEN CLEAN VENT=REPLACE AIR FILTER PREFERABLE HARDWOOD GRASS POLLEN AVOIDED ALLERGEN IGE AND BASOPHILS
CROMOLYN PROPHYLASIS-PREVENT ASTHMA ATTACK-LESSEN SEVERITY AND LIKELIHOOD DOESN'T DILATE AIRWAYS WORK ON HISTAMINE-MACROPHAGES
NEBULIZER CRYING BABY INHALE MORE MEDICATION ACUTE FLARES UP USED IN HOSPITAL
ALBUTEROL AND IPRATROPIUM VESSEL DILATOR AND LONG ACTING
CHILD ABUSE BRUISING-BUTTOCK-PULLING-FINGERS PRINT MARKS ON UPPER ARMS MONGOLIAN SPOT-BUTTOCKS-LOWER BACK
ASTHMA- BRONCHODILATOR BETA 2-ALBUTEROL ANTICHOLENERGIC-IPRATROPIUM METHYLXNTHINE-THEOPHYLLINE ANTI-INFLAMMATORY STEROID-PREDNISONE LEUKOTRIENE-MONTLUKAST MAST CELL STABILIZERS-CROMYLIN CHRONIC INFLAMMATORY DISORDER OF THE AIRWAY S/S-BREATHLESSNESS TIGHTENING OF CHEST, COUGH DYPNEA AND WHEEZING-CAN'T TAKE DEEP BREATH DUE TO IMMUNE MEDIATED AIRWAYS
PATHOPHYSIOLOGY INFLAMMATION AND BRONCHOCONSTRICTION ALLERGEN TRIGGER-HOUSE DUST MITES FECES ACTIVATING IGE ON MAST CELL(RELEASE HISTAMINE-LEUKOTRIENES-PROSTAGLANDINSI-INTERLEUKINS(IMMEDIATE BRONCHOCONSTRICTION+INFILTRATION AND ACTIVATION OF INFLAMMATORY CELLS
PATHOPHYSIOLOGY INFLAMMATORY CELLS (EOSINOPHILS, LEUKOCYTES AND MACROPHAGES)=INFLAMMATION=EDEMA, MUCUS PLUGGING SMF SMOOTH MUSCLE HYPERTHROPHY=OBSTRUCT AIRWAYS BRONCHIAL HYPERRACTIVITY- MILD TRIGGER(COLD AIR, EXERCISE, TOBACCO SMOKE)=BRONCHOCONSTRICTION
NURSING HOW OFTEN USING SAB, IAB , GETTING UP IN NIGHT, AFFECTING DAILY ACTIVITIES? LUNG FUNCTION TEST-HOW MUCH AIRFLOW IS BLOWN OUT AFTER TAKING DEEP BREATHE IMMEDIATLY, SECONDS, MINUTES, TOTAL VOLUME OF AIR? IS INTERMITTENT,MILD,MODERATE,SEVERE?
NURSING REDUCE IMPAIRENMENT-PREVENT SYMPTIOMS-MAINTAIN NORMAL PULMONARY FUNCTION AND ACTIVITY LEVEL REDUE RISK-PREVENT RECURRENT EXACERBATION, MINIMIZE ED VISIT, PREVENT PROGRESSIVE LOSS OF LUNG FUNCTION, REDUCE LUNG GROWTH IN KIDS,
TEACHING AIM SHORT ACTING BETA-AGONIST-ALBUTEROL-WAIT 1 MIN BETWEEN PUFF -LONG-ACTING BETA-AGONIST=IPRATROPIUM GLUCOCORTICOIDS=PREDNISONE
TEACHING BRONCHODIALTORS-BETA2 ADREGERNIC AGONISTS PROVIDE SYMPTOMATIC + LONGTERM SUPPRESSION OF INFLAMMATIION THROUGH ACTIVATION OF BETA2 IN THE SMOOH MUSCLE, MEDS PROVIDE BRONCHODILATION DOESN'T SUPRESS HISTAMINE RELEASE THAT WELL
TEACHING PRN EIB-TAKE BEFORE EXERCISE-PUFF ACUTE SEVER TTACK-NEBULIZED SABA MDI-OUTPATIENT SETTING
TEACHING Avoid sleeping or lying on upholstered furniture Keep indoor humidity below 50% DON'T ALLERGENS: pets, cockroaches, mold STAY AWAY FROM: Tobacco smoke, wood smoke, household sprays DO: Encase the patient’s pillow, mattress, Wash all bedding and stuffed animals weekly in a hot-water wash cycle (130F) NO carpeting or rug IN HOUSE
CHRONIC OBSTRUCTIVE-PULMONARY DISEASE PATHOPHYSIOLOGY RESPIRATORY ACIDOSIS CHRONIC-PROGRESSIVE-IRREVERSIBLE AIRFLOW RESTRICTION-NFLAMMATION S/S-CHRONIC COUGH, EXCESSIVE SPUTUM PRODUCTION-WHEEZING, POOR EXERCISE TOLERANCE CAUSED BY SMOKING, OR POLLUTION
CHRONIC BRONCHITIS-BLUE BLOATER BIG AND BLUE SKIN-CYNOSIS-HYPOXIA LONG TERM CHRONIC COUGH SPUTUM UNUSUAL LONG SOUNG(CRACKLE-WHEEZING) EDEMA PERIPHERALLY =CORE PULMONALE CHRONIC SPUTUM PRODUCTION-HYPERTHROPY(ENLARGEMENT OF AN ORGAN TISSUE) OF MUCUS-SECRETING GLAND IN THE EPITHELIUM OF LARGER AIRWAYS -RECURRENT INFECTION RIGHT SIDE HEART FAILURE S/SJVD-EDEMA-WEIGHT(H2O) GAIN
EMPHYSEMA-PINK PUFFER P-INK SKIN, PURSED LIPS INCREASED CHEST-BARREL CHEST NO CHRONIC COUGH KEEP TRIPODING-H ENLARGEMENT OF AIRSPACE W/IN BRONCHIOLES AND ALVEOLI DUE TO DAMAGE TO THEIR WALLS INABILITY TO PROPER EXCHANGE AIR COUGH-NO ELASTICITY IN LUNG TISSUE=AIR TRAPPING-HYPERRESONANCE S/S-CLUBBING FINGERS(CHRONIC HYPOXIA) HIGH RBC LEVEL
NURSING AIRWAY OBSTRUCTION AIR TRAPPING LOSS OF SURFACE AREA FOR GAS EXCHANGE FREQUENT EXACERBATION (IFECTION AND BRONCHOSPAM) LEADING TO: DYSPNEA-COUGH-HYPOXEMIA(LOW BLOOD O2)-HYPERCAPNIA(HIGH CO2)-CORE PULMONALE
NURSING MEASURE LUNG FUNCTION =SPIROMETRY MILD, MODERATE, SEVERE, AND VERY SEVER TREATMENT GOAL- REDUCE S/S, IMPROVE HEALTH STATUS INCREASE EXERCISE TOLERANCE,REDUCE RISK & MORTALITY -PREVENT PROGRESSING(SMOKNG CESSATION) PREVENTING A ND MANAGING EXACERBATION
NURSING INHALED THERAPY: QUICK THERAPEUTIC EFFECT-RELIEVE OFACUTE EPISODE-MINIMIZE SYSTEMIC EFFECT TYPES METERED-DOSE IHALER(MDIs) RESPIMATS DRY- POWDER INHALER(DPIs) NEBULIZERS
TEACHING-GLUCOCORTICOIDS PRIMARILY INHALED-MOST EFFECTIVE SUPPRESS INFLAMMATION REDUCE BONCHIAL HYPERREACTIVITY- SWELLING DECREASE AIRWAY MUCUS PRODUCTION GLUCOCORTICOID-INHALED DAILY FOR LONGTERM I,E BECLOMETHASONE, PREDNISONE
TEACHING INHALE USED PROPHYLACTICALLY FIXED SCHEDULE FIRST LINE MANAGEMENT OF INFLAMMAORY COMPONENT OF ASTHMA- PT W/ PERSISTENT ASTHMA USE DAILY RINSE MOUH AFTER TO PREVENT DYSPHONIA AND OROPHARYNGEAL CANDIDIASIS OR USE SPACER TO DECREASE THE RISK...
TEACHING INCREASE DOSE INTIME OF STRESS-TAPER TO DSCONTINUE MEDS ORAL- MODERATE/SEVERE PERSISTENT COPD/ASTHMA ACUTE EXACERBATION OF COPD/ASTHMA BRIEFLY US, ONLY WHEN OTHER METHODS AREN'T EFFECTIVE ORALLY-HIGHER EFFECT OFADRENAL SUPPRESSION SLOW GROWTH OF CILDRESS-BONE LOSS-INCREASE RISK OF GLUCOMA-INFECTION-PEP.UD
TEACHING-LEUKOTRIENES 2ND LINE SUPPRESS EFFECT OF LEUKOTRIENE (LEUKOTRIENE-PROMOTE SMOOTH MUSCLE CONSTRICTION-BLOOD VESSEL PERMEABILITY- INFLMMATORY RESPONSE-DIRECT ACTION W/EOSINOPHILS) REDUCE BROCONSTRICTION AND SWELLING AND MUCUS SECRETION MONTLUKAST-DEPRESSION-SUICIDAL THOUGHTS
TEACHING-CROMYLIN PROPHYLASIS STABILIZE MAST CELLS- INFLAMMATORY MEDIATORS SUPRESS INFLAMMATION USED IN NEBULIZERS TREAT -ASTHMA-EXERCISE INDUCE BRONCHOSPASM ALLERGIC RHINITIS ADR-COUGH, BRONCHOSPASM
TEACHING-BONCHODILATOR-LONG ACTING-BETA AGONIST FREQUENT ATTACK FIXED SCHEDULED STABLE COPD ASTHMA+GLUCOCORTICOID SALMETEROL ADR -INHALED=TACHYCARDIA, TREMOR,ANGINA ORAL=ANGINA PECTORS, TACHYDSYRYTHMIAS, TREMOR
TEACHING-METHYXANLTINES THEOPHYLINE RELEASE SMOOTH MUSCLE BRONCHODILATOR-ORAL-MAINTENANCE-CHRONIC STABLE ASTHMA 10-20MCG/ML NORMAL 20-25MCG/ML -N/V/D INSOMINIA RESTLESNESS ABOVE 30MCG/ML-SEVER DYSRYTHMIAS(VENTRICULAR FIB,) CONVULSION DEATH FROM CARDIORESPIRATORY COLLAPSE
TEACHING-THEOPHYLLINE TOXICITY-STOP-ACTIVATED CHARCOAL DYSRYTHMIAS=LIDOCAINE SEIZURE=IV DIAZEPAM INTERACTION CAFFEINE, TOBACCO, FLUROQUINILONE, MARIJUANA AND CIMETIDINE
TEACHING-ANTICHOLENERGIC-IPRATROPRIUM BLOCK MUSCARANIC RECEPTOR IN BRONCHI ONSELT 30 SECONDS, LAST 6HRS USE WITH SABA IN ACUTE ATTACK I.E IPROTROPIUM AND ATROPENT-DUONEB ADR-DRYMOUTH-IRRITATION OF PHARYNX GLACUMA, CARDIOVASCULAR EVENT
GLUCOCORTICOID+IPRATROPIUM LONGTERM MAINTENANCE IN ADULTS AND CHILDREN NOT FOR INITIAL THERAPY I.E FLUTICASONE + SALMETEROL (ADVAIR) MOMETASONE+FORMETEROL (DULERA) BUDESONINDE+FORMETEROL(SYMBICORT)
DRUGS FOR SEVERE ACUTE EXACERBATION IMMEDIATELY TO HOSPITAL OPEN AIRWAY-REVERSE HYPOXEMA-NORMALIZING LUNG FUNCTION O2-RELIEVE HYPOXMIA SYSTEMIC GLUCOCORTICOID IV- AIRWAYS INFLAMMATION NEBULIZED HIGH DOSE SABA-BRONCHODIALTE AIRFLOW NEBULIZED IPRATRPIUM-DILATE AIRWAY-LAST LONGER
EXERCISE-INDUCED ASTHMA PEAK 5-10 MINS DURATION 30MINS CROMYLIN 15-30 MINS B4 EXERCISE BRONCHOSPASM-DUE TO LOSS OF HEAT AND H20 IN LUNGS
PHOSPHODIESTERAS-4 INHIBITOR REDUCE INFLAMMATION, COUGH AND EXCESSIVE MUCUS PRODUCTION I.E ROFLUMILAST(DALIRESP)
COPD EXACERBATION MANAGEMENT BL. PH ACIDIC <7.35-7.45 PACO2 7.35-7.45> ACIDIC PAO2 ACIDIC<80-100 UPPER RESP.INFECTION SABA(INHALED ALONE OR W/ IPROTROPIUM) SYSTEMIC GLUCOCORTICOIDS ANTBIOTICS MAINTAIN=O2 SAT 88-92% ALTERED LEVEL OF CONSCIOUSNESS-LOW O2 BIPAP-TO EXPELL HIGH CO2(HYPERCAPNIC) NO OPIOID-BENZO-ORAL HYGIENE-SMALL MEALS-NO GASSY FOOD
Created by: Seka_nurse
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