asthma
S/S of asthma?
BONUS!! Can you name what RAT BED stands for?
hypoxia: tightness in chest, cough w/w/o sputum, bronchoconstriction
RAT BED - early and late s/s of hypoxia
Early – Restlessness, Anxiety, Tachycardia/tachypnea
Late – Bradycardia, Extreme restlessness, Dyspnea),
risk factors for COPD? Are any specific to emphysema or chronic bronchitis?
smoking, age, pollution, occupational/env exposure, SES
lack of AAT gene (emphysema)
diagnostics for bacterial pneumonia?
sputum c&S, gram stain, CXR, increased WBC, blood C&S
how do you dx atelectasis?
chest XR shows whitening
what are some contraindications for cough suppressants? (i.e. dextromethorphan)
pneumonia, productive coughs, chronic bronchitis
we want them to get their secretions out! without coughing it makes it harder to do that.
unless cough is affecting their sleep, these pts. should not get cough suppressants
Patho of asthma?
extrinsic or intrinsic stimuli induces a hypersensitivity reaction and inflammatory response (mast cell destabilization) = vasoconstriction, vascular permeability, WBC attraction, mucus secretion, bronchoconstriction, stimulation of alpha-adrenergic receptors
common S/S for COPD
Bonus: Can you name at least 3 specific features of chronic bronchitis or emphysema in terms of S/S?
cough, sputum, dyspnea, decreased ventilation, orthopnea, low O2, high CO2, cyanosis, malnutrition,
risk factors for bacterial pneumonia?
long term care facility, smoking, chronic illness/other comorbidities, travel, old age, immobilization
how do you treat atelectasis?
ICOUGH, mobilization, oxygen, percussive drainage, analgesics, hydration
How would you educate a patient about to start albuterol use?
rebound bronchospasm/bronchoconstriction may occur with frequent use, how to use an inhaler, always keep it with you, when to admin, can take prophylactically, avoid admin in PM to avoid insomnia
What are some risk factors for asthma?
chronic irritant exposure, allergies, genetics, SES
Pathophysiologically, what is the difference between emphysema and chronic bronchitis?
Chronic bronchitis – irritants cause inflammation which narrow airways over time with scar tissue and increase size and number of goblet cells and mucus glands = increased airflow resistance and WOB = hypoventilation and CO2 retention
Emphysema – damage to alveoli and air sacs = decreased SA for O2 to enter blood stream, enlargement of air sacs, and collapsed small airways
how do you tx bacterial pneumonia?
Abx, bronchodilators, analgesics, ICOUGH, hydration, O2
what are some s/s of atelectasis? what does s/s presentation depend on?
depends on how much lung is involved: dyspnea, cough, cyanosis, sputum production, decreased SaO2, high CO2 low O2 ABG, high HR, crackles, increased WOB
What's the difference between Heparin and Warfarin?
Antidotes for both!
Which would someone who's pregnant take?
both prevent blood clots, but by different mechanisms
Heparin:inhibits conversion of prothrombin to thrombin and clotting factors IX-XII, uses PTT to monitor
Antidote: protamine
Warfarin: inhibits Vit K dependent clotting factors II, VII, IX, and X, takes several days to take effect, monitor with PT/INR, contraindicated in pregnancy
Antidote: Vitamin K
NAME ALL 4 MEDS YOU CAN USE WITH ASTHMA
bonus: can you name what they all do???
Albuterol (Proventil) - rescue inhaler (bronchodilator)
Ipratropium (Atrovent) - maintenance inhaler (prevent bronchoconstriction and decrease mucus)
Beclomethasone - reduce asthma exacerbations
Montelukast (singulair) - oral maintenance for decreased bronchoconstriction, mucus, and inflammation
how do you tx COPD, chronic bronchitis, or emphysema?
BONUSSSS 100 points: what is the criteria for chronic bronchitis?
S/S management, low flow O2, prevention of irritants, remove secretions (expectorants), bronchodilators, abx (if infection), steroids, NO COUGH SUPPRESSANTS, pneumectomy or bullae removal, ICOUGH, hydration!!!!
BONUS: 3 months/yr exacerbations for 2 consecutive years
S/S of bacterial pneumonia
sudden onset, fever, chills, malaise, increase pulse and RR, productive cough with rusty sputum, pleuritic pain, wheezing/crackles, cyanosis, HA, orthopnea, diaphoresis, anorexia
nursing interventions??
encourage hydration, humidifiers, encourage ICOUGH, turn patient often, suction secretions PRN, early mobilization
Adverse effects to monitor for and considerations with digoxin
You have a patient with asthma, what are you monitoring for? any nursing interventions?
monitor for worsening ventilation and hypoxia s/s, respiratory sounds, LOC changes, encourage hydration, increased HOB
Your patient has a severe COPD exacerbation, what interventions/monitoring should you be doing?
give O2 with caution, monitor RR, assess for malnutrition and deterioration, high protein high calorie low carb diet with small meals, Cyanosis, airway clearance, have suction available, orthopneic with shoulders forward or high fowlers, assess peak expiratory flowmeter, teach pursed lip and diaphragmatic breathing
nursing interventions for bacterial pneumonia?
Rx for pneumonia? name min. 2
250 for each!
interventions: semi-high fowlers positioning or prone with severe, lying on unaffected side to improve V/Q, turn every 2 hours, encourage vaccine, smoking cessation
Rx: penicillan, cephalosporin, albuterol, acetaminophen
Furosemide:
indications, MOA, adverse effects, monitoring, contraindications