Contraindications
Name this medication that is contraindicated during an acute bronchospasm.
What is salmeterol?
Scenario: A 72-year-old patient is having a preoperative assessment. Patient started smoking in their 20s but "can't really remember" how much or when they quit. Patient states, "It was a while ago, maybe 15 years."
Calculate the age when the patient stopped smoking.
Calculate pack-years.
What is 72 current age - 15 years ago quit = 57?
What is 32 pack-years? The client smoked one pack a day for 32 years.
Pack-years = (Packs per day) x (Years of smoking)
What are allergens, weather, illness, pollution, irritants, and exercise?
Scenario: A prescriber orders Levothyroxine 0.1 mg orally once daily. The pharmacy provides Levothyroxine 25 mcg tablets. Calculate tablets per day.
What are 4 tablets/day?
1. 0.1 mg x 1000 mcg/mg = 100 mcg
Formula: (Desired dose / Dose on hand) x Quantity per tablet
2. (100 mcg / 25 mcg) x 1 tablet = 4 tablets
3. Tablets per day: 4 tablets/dose x 1 dose/day = 4 tablets/day
Name this SABA that is approved for use during pregnancy to treat and prevent bronchospasm.
What is terbutaline?
What are xanthines?
Scenario: A 68-year-old patient is admitted to the hospital for pneumonia. During the nursing admission assessment, they stated they have smoked about one pack of cigarettes every day since they were 18 years old.
Calculate pack-years.
What is 50 pack-years?
68 - 18 = 50 years
50 = 1x50
Pack-years = (Packs per day) x (Years of smoking)
Name this priority nursing diagnosis related to feelings of breathlessness.
What is anxiety?
Scenario: A pediatrician orders Ibuprofen for a child weighing 44 pounds at 10 mg/kg per dose, every 6 hours. The available medication is Ibuprofen 200 mg chewable tablets. Calculate tablets per day.
What is 4 tablets per day?
1. 44 lbs / 2.2 lbs/kg = 20 kg
2. 10 mg/kg x 20 kg = 200 mg
Formula: (Desired dose / Dose on hand) x Quantity per tablet
3. (200 mg / 200 mg) x 1 tablet = 1 tablet
4. 24 hours / 6 hours = 4
Name this SABA commonly used during emergency codes.
What is epinephrine?
Name this class of medications that are contraindicated in clients with hypersensitivity to corticosteroids, acute bronchospasm, status asthmaticus, or other acute episodes of asthma.
What are inhaled corticosteroids (ICS)?
Scenario: A 55-year-old patient sees their primary care provider. They disclose that they smoked one and a half packs of cigarettes per day from age 15 to 30, then quit. They started smoking again at age 45, smoking half a pack per day until the present.
Calculate pack-years.
What is the total pack years: 22.5 + 5 = 27.5 pack-years?
Segment 1 (Age 15–30): 1.5 packs/day x 30 - 15 = 22.5 pack-years.
Segment 2 (Age 45–55): 0.5 packs/day x 45 - 55 = 5 years.
Total: 22.5 + 10 = 27.5 pack-years.
Instructing/teaching the patient to use their SABA bronchodilator medication, up to three times at 20-minute intervals, is an example of this.
What is quick relief for acute symptom intervention?
Scenario: A doctor orders Vancomycin 1 gram in 250 mL of NS to infuse over 90 minutes. The nurse selects IV tubing with a drop factor of 20 gtts/mL. Calculate drops per minute. Round to the nearest whole number.
What is 56 gtts/min?
gtts/min = 250mL x 20gtts/mL / 90min
gtts/min = 5000/90 = 55.55...
gtts/min = 56
Name this xanthine medication taken by mouth.
What is theophylline?
Name the medication contraindicated for a patient with a history of narrow-angle glaucoma who presents with a new onset of asthma.
What is an adrenergic bronchodilator?
Scenario: A 68-year-old patient has been smoking since they were 18. They smoked a half-pack per day from age 18 to 38, then increased to one and a half packs per day from age 38 to 68. They are in the hospital now for pneumonia.
Calculate pack-years.
What is 55 pack-years?
Segment 1 (Age 18–38): 0.5 packs/day x 20 years = 10 pack-years.
Segment 2 (Age 38–68): 1.5 packs/day x 30 years = 45 pack-years.
Total: 10 + 45 = 55 pack-years.
This three-level tool helps patients play a role in their health maintenance.
What is an asthma action plan?
Scenario: You are starting your shift and notice a gravity IV infusion is running low. The order is for 500 mL of Lactated Ringer's to be infused over 4 hours. The tubing has a drop factor of 10 gtts/mL. You observe the infusion and count 30 drops over 15 seconds. Calculate drops per minute. Round to the nearest whole number.
What is 120 gtts/min?
Convert time to minutes:
4 hours×60 min/hour=240 minutes
Calculate gtts/min:
gtts/min=500 mL×10 gtts/mL /240 min
gtts/min=5000/240
gtts/min=20.83 gtts/min
Round to the nearest whole number: 21 gtts/min.
Determine actual rate:
Counted drops: 30 drops over 15 seconds.
Calculate gtts/min:
30 drops×4=120 gtts/min
Name this inhaled corticosteroid that comes packaged as a purple disk, and patients should rinse their mouth out after use to prevent thrush.
What is Flovent diskus?
Name the medication contraindicated for a patient who is currently experiencing status asthmaticus.
What are inhaled corticosteroids (ICS)?
Scenario:
Initial health history (age 65): A 65-year-old patient admitted for a heart attack. Their health history reveals they started smoking at age 17, but their smoking pattern is inconsistent. They smoked one pack per day until age 30, quit for 5 years, then resumed at 1.5 packs per day until age 50, when they quit again. At age 60, after the death of the patient's spouse, the patient started smoking a half-pack per day as a coping mechanism.
Follow-up care (age 70): The patient is undergoing a lung cancer screening and is diagnosed with non-small cell lung cancer.
End-of-life care (age 72): The patient has progressed to stage IV lung cancer and is receiving palliative chemotherapy. The patient passed away two years later.
Calculate total lifetime pack-year history.
What is the total of 49 pack-years?
Segment 1: 1 pack/day x (30-17) = 13 pack-years.
Segment 2: 1.5 packs/day x (50-30) = 30 pack-years.
Segment 3: 0.5 packs/day x (72-60) = 6 pack-years.
Total pack-years at death (age 72): 13 + 30 + 6 = 49 pack-years.
This condition may result from adrenal insufficiency during or after transfer from systemic corticosteroids to inhaled corticosteroids (ICS).
What is death?
Scenario: A physician orders a weight-based dose of Tobramycin for an 8 kg infant at a dose of 2 mg/kg. The pharmacy dispenses the medication in a 20 mL syringe to be infused over 30 minutes using a microdrip set (drop factor of 60). Calculate the drops per minute. Round to the nearest whole number.
What is 40 gtts/min?
Calculate the total dose:
8 kg×2 mg/kg=16 mg
gtts/min = 20mL x 60gtts/mL / 30min
gtts/min = 1200/30 = 40
Name this leukotriene modifier/immunomodulator that is administered primarily in the evening by mouth for chronic asthma in both adults and children 12 months and older.
What is Singulair?