2580621
| Question | Answer |
| ICS | Inhaled Corticosteroid |
| What's the next approach after a bronchodilator if it's not working? | Inhaled coricosteroid |
| salmeterol (Servent) | long-acting beta agonist for maintenance – shake MDI before using – daily use (another one is Advair) |
| albuterol (Proventil, Ventolin) | short-acting beta agonist for rescue –– have pt carry MDI at all times; can inc. HR, cause jitteriness and excitement |
| Ipatropium (Atrovent) | cholinergic antagonist – can be used for maintenance or rescue – carry at all times, shake before use, causes dry mouth, report visual changes/palpitations/ tremors ( another one is Spiriva and Combivent) |
| Theophylline (Theo-Dur, Theolair) | smooth muscle relaxant – maintenance - taken po – check serum drug levels – do not use with caffeine or other stimulants, can cause inc. HR, cause jitteriness and excitement which may mean level is too high (can be used IV as aminophylline for a severe, persistent attack) |
| Fluticasone (Flovent) | steroid – maintenance – rinse mouth after using MDI – use daily – do not d/c abruptly |
| Prednisone (Deltasone) | steroid – maintenance or after an attack – only used of other meds fail – taken po - side effects (wt gain, hyperglycemia, BP changes, ulcers) – take with food, do not d/c abruptly |
| Nedocromil (Tilade) | prevents inflammation – maintenance – use MDI daily |
| cromolyn sodium (NasalCrom) | anti-inflammatory by mast cell stabilization |
| Montelukast (Singular) | prevents inflammation – maintenance – taken po – take daily in the evening |
| Omalizumab (Xolair) | antibody – maintenance – given every 2-3 weeks in facility, watch closely for allergic reaction with first 30-60 min., may not be effective for months |
| status asthmaticus | life-threatening emergency where patient's airway becomes obstructed. may need epi or intubation. |
| Which diseases comprise COPD? | Emphysema – a lung tissue issue Chronic Bronchitis – an airway issue |
| Proteases (enzymes) in emphysema | in higher levels can damage alveoli and small airways by breaking down elastin→ alveoli lose elasticity and small airways collapse → less areas for gas exchange |
| Why are emphsema patient's referred to as pink puffers? | Pink= pink, frothy sputum Puffer= peripheral edema from right sided HF |
| What happens to emphysema patients? | Floppy alveoli leads to air trapping in lungs → flattening of diaphragm Results in hypercarbia and resp. acidosis – often can get O2 in but not CO2 out |
| What does chronic bronchitis do? | Due to the increase in inflammation in airway, there is an increase in # of mucus glands so more thick mucus is made Bronchial walls eventually thicken adding to impaired airflow. Mucus and thickening will block some smaller airways. Can lead to cor pulmonale with resultant edema – thus “blue bloater” |
| List the ways COPD can be diagnosed | Physical assessment & report of s/s CXR & pulmonary function tests - PFTs will be decreased with both - CXR will show hyperinflation with emphysema Bronchoscopy – chronic bronchitis will have thickened airways Sputum evaluation – may have infection Lung scan – r/o cancer |
| Which medications are commonly used for COPD patients? | Asthma meds, acetylcysteine (Mucomyst), and guiafenesin (Mucinex, Robitussin) |
| Cor pulmonale | right sided heart failure – with increased lung pressure → blood flow from lungs back up to the right side of heart eventually weakening it |
| What is a complication of emphysema? | blebs or bullae can form on the lung surface, if they burst the pt will have a pneumothorax |
| What are the 3 types of pneumonia? | - Lobar- confined to one area - Bronchopneumonia- scattered throughout - Hypostatic- R/T hypoventilation (prolonged bedrest) |
| What can pneumonia cause? | Atelectasis, exudates, consolidation, necrosis Can lead to heart failure, empyema, pleurisy, septicemia even shock and death |
| Levofloxacin (Levoquin) | given po/IV, do not take with mag and aluminum antacids, may incr. effect of warfarin, w/steroid use may ↑ risk of tendon rupture, w/antidiabetic meds can ↓ blood sugar |
| ceftriaxone (Rocephin) | given IM or IV, often used in ER to start tx, poss. nausea/vomiting, inject deep into muscle and massage after, may add lidocaine to decrease pain, IV over 10-30 minutes |
| azithromycin (Zithromax) | given po or IV, watch for nausea / diarrhea/ pseudomembranous colitis, don’t take with mag and aluminum antacids, take on empty stomach, may affect blood levels of digoxin, theophylline, carbamazepine, phenytoin – pt needs to take full prescription until complete |
| What precaution should be taken when TB infection is suspected? | pt needs to be in a negative airflow room on resp. isolation until the test results come back !!!!! |
| What is the combination RIPE therapy? | R-- rifampin I – isoniazid P – pyrazinamide E – ethambutol |
| Rifampin (RIF) | given po on empty stomach reddish brown discoloration of the skin, saliva, urine, feces, sweat, and tears If on oral contraceptives, need to change to an alternate method of birth control No alcohol while on med (liver damage) Teach signs of liver damage (jaundice, bleeding) Monitor hepatic function May get N/V/D |
| Isoniazid (INH) | given po (can be with food) No alcohol while on med (liver damage) Teach signs of liver damage (jaundice, bleeding) Monitor hepatic function May get peripheral neuropathy (take B6) Avoid tyramine foods (aged cheeses, red wine, chocolate, etc.) |
| What is hypoxic drive? | The drive to breathe in order to increase oxygen rather than breathe off CO2 |
| How saturated is arterial hemoglobin with oxygen versus venous? | Arterial Hgb is 97.4% saturated Venous blood is 75% saturated |
| Tidal Volume | the amount of air inhaled or exhaled during normal breathing. |
| Total Lung Capacity | the total volume of lungs when maximally inflated. |
| Forced expiratory volume | the volume of air expired during the first, second, and third seconds of the forced vital capacity (FVC) test |
| Peak Expiratory Flow Rate (PEFR) | the maximum volume during forced expiration |
| Why might a patient need a bronchoscopy? | visualize, take a sputum culture, obtain a biopsy, or clean out mucus |
| What is a thoracentesis? | Fluid or air is removed from the pleural space with a needle and syringe and possibly suction |
| Ventilation Perfusion (VQ) Scan | Follows air and blood flow in and out of the lungs While pt is breathing, a radioactive substance is either inhaled, injected, or both Body is non-radioactive after about 8 hours |
| What percentage of room air is oxygen? | 21% |
| What is the proper technique for using an MDI? | After pressing down on the canister the client should breathe in slowly over 3 to 5 seconds and then hold her breath for 10 seconds to let the medication reach deep into the lungs |
| How is sleep apnea diagnosed? | Breathing disruption during sleep that lasts at least 10 seconds and occurs a min of 5 times in an hour |
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