Chapter 76-ASTHMA+COPD
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| CHAPTER 76 | COPD +ASTHMA
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| 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 )
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| 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
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| NOSE TO TOE | NO SNIFFING
LEAN FORWARD-SQUEEZE 2 PUFF IN EACH NOSTRIL
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| TIPS TO DECREASE ALLERGEN | CLEAN VENT=REPLACE AIR FILTER
PREFERABLE HARDWOOD
GRASS POLLEN AVOIDED
ALLERGEN IGE AND BASOPHILS
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| CROMOLYN | PROPHYLASIS-PREVENT ASTHMA ATTACK-LESSEN SEVERITY AND LIKELIHOOD
DOESN'T DILATE AIRWAYS
WORK ON HISTAMINE-MACROPHAGES
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| NEBULIZER | CRYING BABY
INHALE MORE MEDICATION
ACUTE FLARES UP
USED IN HOSPITAL
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| ALBUTEROL AND IPRATROPIUM | VESSEL DILATOR AND LONG ACTING
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| CHILD ABUSE | BRUISING-BUTTOCK-PULLING-FINGERS PRINT MARKS ON UPPER ARMS
MONGOLIAN SPOT-BUTTOCKS-LOWER BACK
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| 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
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| 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
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| 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
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| 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?
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| 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,
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| TEACHING | AIM
SHORT ACTING BETA-AGONIST-ALBUTEROL-WAIT 1 MIN BETWEEN PUFF
-LONG-ACTING BETA-AGONIST=IPRATROPIUM
GLUCOCORTICOIDS=PREDNISONE
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| 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
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| TEACHING | PRN
EIB-TAKE BEFORE EXERCISE-PUFF
ACUTE SEVER TTACK-NEBULIZED SABA
MDI-OUTPATIENT SETTING
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| 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 (130F)
NO carpeting or rug IN HOUSE
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| 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
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| 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
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| 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
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| 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
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| 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
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| NURSING | INHALED THERAPY:
QUICK THERAPEUTIC EFFECT-RELIEVE OFACUTE EPISODE-MINIMIZE SYSTEMIC EFFECT
TYPES
METERED-DOSE IHALER(MDIs)
RESPIMATS
DRY- POWDER INHALER(DPIs)
NEBULIZERS
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| 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
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| 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...
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| 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
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| 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
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| TEACHING-CROMYLIN | PROPHYLASIS
STABILIZE MAST CELLS- INFLAMMATORY MEDIATORS
SUPRESS INFLAMMATION
USED IN NEBULIZERS
TREAT
-ASTHMA-EXERCISE INDUCE BRONCHOSPASM
ALLERGIC RHINITIS
ADR-COUGH, BRONCHOSPASM
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| 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
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| 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
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| TEACHING-THEOPHYLLINE | TOXICITY-STOP-ACTIVATED CHARCOAL
DYSRYTHMIAS=LIDOCAINE
SEIZURE=IV DIAZEPAM
INTERACTION
CAFFEINE, TOBACCO, FLUROQUINILONE, MARIJUANA AND CIMETIDINE
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| 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
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| GLUCOCORTICOID+IPRATROPIUM | LONGTERM MAINTENANCE IN ADULTS AND CHILDREN
NOT FOR INITIAL THERAPY
I.E FLUTICASONE + SALMETEROL (ADVAIR)
MOMETASONE+FORMETEROL (DULERA)
BUDESONINDE+FORMETEROL(SYMBICORT)
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| 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
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| 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
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| PHOSPHODIESTERAS-4 INHIBITOR | REDUCE INFLAMMATION, COUGH AND EXCESSIVE MUCUS PRODUCTION
I.E ROFLUMILAST(DALIRESP)
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| 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
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