Bronchodilators
This short-acting beta-agonist is commonly used as a rescue inhaler for asthma.
Albuterol
Explain why corticosteroids may increase risk for infection.
Immunosuppression.
Corticosteroids suppress the immune system, so the body is less able to fight off bacteria, viruses, and other germs, which increases the risk of infection.
What is a teaching point for all antibiotics in order to eliminate the infection completely?
Finish the entire course. Do not stop once you feel better.
pH 7.30
PaCO2 68 mm Hg
HCO3 28 mmol/L
PaO2 60 mm Hg
Interpret the ABG. What can commonly cause this?
Respiratory Acidosis, Partially Compensated
Causes: Hypoventilation, COPD, Asthma, ARF, Drug overdose (opioids)
This prophylactic nasal spray is safe and well-tolerated but must be used consistently for several weeks; it does not relieve acute allergy symptoms.
Hint: it is not a steroid...
What is Cromolyn?
What are some common side effects of Tiotropium?
Serious adverse effect??
Anticholinergic common side effects: Dry mouth, constipation, urinary retention, blurry vision
Serious adverse effect: Hypersensitivity reactions including angioedema
What are risks associated with steroids when used long term? Select all that apply.
A. Osteoporosis
B. Dry mouth
C. Adrenal insufficiency
D. Depression
E. Constipation
F. Hyperglycemia
A. Osteoporosis – Steroids decrease bone density, increasing fracture risk.
C. Adrenal insufficiency – Long-term steroids suppress the adrenal glands, which can lead to adrenal crisis if stopped abruptly.
D. Depression – Mood changes, anxiety, and depression can occur with prolonged steroid use.
F. Hyperglycemia – Steroids increase blood sugar by promoting gluconeogenesis and decreasing insulin sensitivity.
What is the treatment for Viral pharyngitis vs Bacterial pharyngitis?
Bacterial - Penicillin (most common)
Viral - Tylenol, Ibuprofen, Throat Lozenges, Fluids, Rest, Supportive care
pH 7.0
PaO2 90 mm Hg
PaCO2 23 mm Hg
HCO3 12 mmol/L
Interpret the ABG. What clinical manifestations may cause this?
Metabolic Acidosis, Partially, Compensated
Causes: Diabetic ketoacidosis, Lactic acidosis (sepsis, shock), Renal failure
Explain why an expectorant may be useful for a client with COPD and provide an example of one.
Guaifenesin is an expectorant that helps with COPD, especially chronic bronchitis, by thinning and loosening mucus in the airways. This makes it easier to cough up phlegm.
Name a different medication for each:
SABA
LABA
Anticholinergic (short acting)
Anticholinergic (long acting)
SABA - Albuterol, Levalbuterol
LABA - Salmeterol
Anticholinergic (short acting) - Ipratropium
Anticholinergic (long acting) - Tiotropium
To prevent oral candidiasis, the nurse should educate the patient on the importance of what ____?
Rinsing mouth after using steroid inhaler.
A client taking doxycycline develops a painful blistering rash. The nurse notes this is likely ___?
Adverse effect - Steven's Johnson Syndrome
pH 7.60
PaO2 120 mm Hg
PaCO2 31 mm Hg
HCO3 25 mmol/L
Interpret the ABG. What clinical manifestations may cause this?
Respiratory Alkalosis, Uncompensated
Main Causes: Hyperventilation (anxiety, pain, fever), sx: numbness or tingling of fingers
A child was recently prescribed Montelukast. What clinical manifestation should be reported to the HCP right away?
A. Nausea and vomiting
B. Reduced emotional response
C. Headache in the morning
D. Abdominal tenderness
Correct answer:
B. Reduced emotional response
Used for maintenance, not acute attacks. Monitor for mood changes/suicidal thoughts (esp. in children).
SABA's like Albuterol should be used cautiously in patient's with a history of ___?
List 3 conditions.
SABA's stimulate the SNS. Use cautiously for clients with Cardiac Disease, Hypertension, Diabetes, Hyperthyroidism, Seizures, Glaucoma
What medication may cause the patient's urine to turn orange in color?
(hint: not an ABX)
Rifampin (used for TB)
This antibiotic class should never be given to pregnant women or children under 8 years old due to permanent teeth discoloration.
What are Tetracyclines (Ex. Doxycycline)?
pH 7.50
PaO2 85 mm Hg
PaCO2 40 mm Hg
HCO3 34 mmol/L
Interpret the ABG. What clinical manifestations may cause this?
Metabolic Alkalosis, Uncompensated
Causes: Vomiting (loss of gastric acid), Excessive bicarbonate intake (antacids),Diuretics (loss of potassium-AKA Furosemide)
A client recently admitted for a COPD exacerbation is taking Warfarin for A-fib and recently had an INR checked: 4.8 (normal 2 - 3).
The nurse knows this is most likely an adverse effect of which medication?
A. Ipratropium
B. Albuterol
C. Dexamethasone
D. Theophylline
Correct answer:
C. Dexamethasone
Dexamethasone is a Corticosteroid; can interact with Warfarin and increase INR in some patients.
This type of inhaled bronchodilator blocks acetylcholine, causing bronchodilation but can also lead to dry mouth and blurred vision.
What is Ipratropium (SAMA) or Tiotropium (LAMA)?
This inhaled corticosteroid(s) should be used for maintenance rather than for acute symptoms.
What is budesonide or fluticasone?
A patient receiving IV antibiotics develops wheezing, swelling of the lips, and a drop in blood pressure. What is the nurse’s priority action?
What is stop the infusion immediately and administer epinephrine for suspected anaphylaxis?
pH 7.39
PaCO2 27 mmHg
HCO3 19 mEq/L
Interpret the ABG. What is a classic clinical manifestation associated with this acid base disorder? (hint: Resp)
Metabolic Acidosis, Fully Compensated
Kussmaul breathing is a specific type of deep, rapid breathing that occurs in response to metabolic acidosis, particularly in conditions like diabetic ketoacidosis. This is the our bodies attempt to compensate for acidosis by increasing RR to expel more CO2.
Explain how the body tries to compensate in respiratory acidosis and respiratory alkalosis
Respiratory acidosis- Too acidic from retained CO2, Kidneys try to retain HCO3- (bicarb AKA base)
Respiratory alkalosis- Alkalotic from blowing off too much CO2/hyperventilating. Kidneys try to excrete HCO3- (to help lower blood pH)