NURS 160 FINAL EXAM | with complete solution

NURS 160 FINAL EXAM | with complete solution What the the first line agents of TB? - Isoniazide (INH) Rifampin *GIVEN TOGETHER FOR 6-12 MONTHS* Nursing considerations and patient teaching for: INH - (First line for active TB tx, used prophylactically) Admin on empty stomach Monitor for: -numbness and tingling of the extremities -hepatotoxicity -anemia Take pyridoxine to prevent peripheral neuropathy Avoid ETOH Notify MD if allergic rxn occurs Nursing considerations and patient teaching for: Rifampin - (used for TB in combo with other antiTB meds to tx) Admin on empty stomach Additive effects when used with INH Causes body fluids to turn RED-ORANGE (*think RIPIN ORANGE= RiFAPIN) Decreases effectiveness of PO contraceptives Observe for interactions: decreased therapeutic effects of theophylline, steroids, opioids, PO hypoglycemics, PO anticoags, beta blockers, benzos Nursing considerations and patient teaching for: Pyrazinamide - (TB med that may be added during first 2 months of tx; if implement PZA into therapy=less therapy needed) Admin with meals (*think PZA= pizza=food) Maintain high fluids Monitor liver function tests, CBC, uric acid levels Avoid ETOH Monitor for: Hepatotoxicity Hyperuricemia Nursing considerations and patient teaching for: Ethambutol - (TB med that may be used with other anti-TB meds for active TB) (bacteriostatic drug that reduces development of resistance to first line agents) Monitor for: optic neuritis -Be sure to obtain a baseline visual exam and color discrimination test before and during tx -monitor CBC, renal function (BUN & CRE), liver function tests Nursing considerations and patient teaching for: Streptomycin - (TB med for active TB that may be used in combo with other anti-TB meds) Monitor for: -nephrotoxicity -ototoxicity -renal function studies Assess hearing and balance frequently Have audiometric testing Admin via IM into large muscle mass Maintain 2-3L fluid/day Use TB meds cautiously in patients that... - -have liver dysfuntion -renal dysfunction -pregnancy or lactation -gouty arthritis -ETOH intake -optic neuritis What are the bronchodilators for COPD AND ASTHMA? - Beta 2 Adrenergic Agonists -SABA: Albuterol -LABA: Sameterol Asthma and COPD Route, Action and Nursing Implication of: SABA - (albuterol) Neb or MDI SHORT ACTING rescue inhaler to gain rapid control of symptoms of wheeze and bronchospasm Onset= 1-3 min ACTION: bronchodilation= relaxes smooth muscle NURSING IMPLICATION: ^BP, ^HR CNS stimulation/excitation dysrhythmias, palpitations, tremors, HA, nausea, anxiety NOT FOR LONG TERM CONTROL DO NOT USE ALONE; add to overall tx regime for asthma Frequent use= poor asthma control Be careful with patients with HTN and CVD Route, Action and Nursing Implication of: LABA - (Salmeterol) MDI or DPI LONG TERM control and NOT for rapid relief of symptoms SIDE EFFECTS: ^BP, HR, CNS stimulation, dysrhythmias, HA, throat dryness Route, Action and Nursing Implication of: Fluticasone COMBO agent - (some used in combo with inhaled corticosteroids & LABA for COPD/asthma) *Fluticasone and salmeterol (Advair) *Fluticasone vilanterol (Breo Ellipta) ACTION: brochodilator and steroid (anti-inflammatory) added for better control over symptoms NURSING IMPLICATION: combo therapy used with caution in patients with diabetes, ^ blood glucose Rinse mouth with water or mouthwash after LABA and steroids to prevent PO candidiasis Route, Action and Nursing Implication of: Methylxanthines - (combo used for COPD and asthma) ROUTE: po, elixir, IV NURSING IMPLICATIONS: Used typically when other long term bronchodilators not available/affordable Not used as frequently bc inhaler use Narrow margin of safety & ^ potential for toxicity-monitor for N/V, dysrhythmias and SZ MONITOR: serum blood lvls AVOID CAFFEINE TO PREVENT ADVERSE EFFECTS Route, Action and Nursing Implication of: Leukotrine Modifiers - (Montelukast/Singulair for COPD and asthma) ROUTE: po Can be long term tx for children and adults with asthma ACTION: prevent leukotrine effect of inflammation. Anti-inflammatory and bronchodilator effects NOT USED FOR ACUTE ASTHMA ATTACKS NURSING IMPLICATIONS: well tolerated admin at least 1 hour BEFORE or 2 hours BEFORE meals Monitor liver enzymes; can be hepatotoxic to the liver (*think Leuk= Liver tox; L/L) Route, Action and Nursing Implication of: Anticholinergics -Short Acting -Long Acting - (for COPD and asthma) -Short: ipratropium (Atrovent) ACTION: Blocks bronchoconstriction of the parasympathetic nervous system NURSING IMPLICATIONS: dry mouth, so have patient sip on fluids and suck sugar free candy ; usually given in combo with other bronchodilators -Long: tiotropium (Spiriva HandiHaler) ACTION: Blocks bronchoconstriction of the parasympathetic nervous system -long term control; 1x daily for COPD NURSING IMPLICATIONS: DO NOT SWALLOW THE SPIRIVA CAPSULES... ONLY TO BE USED IN THE HANDIHALER DEVICE AND INHALED PO Route, Action and Nursing Implication of: Corticosteroids for COPD and asthma - Flovent Pulmicort ROUTE: IV, PO, inhaled ACTION: suppress inflammatory response by decreasing the synthesis and release of inflammatory mediators; reduces bronchial hyper-responsiveness NURSING IMPLICATIONS: -hyperglycemia, weight gain, moonface, mood swings, osteoporosis -MUST BE GRADUALLY DISCONTINUED -inhaled corticosteroids MUST be given for 1-2 weeks before therapeutic effects are seen -to reduce risk of fungal infection= RINSE MOUTH after using inhaler and practice good oral hygiene -if using MDI= use spacer to decrease risk ABG values of: pH pCO2 HCO3 pAO2 - pH= 7.35-7.45 pCO2= 35-45 HCO3= 22-26 pAO2= 80-100 What is the Mantoux test used for? Significant values? - TB EXPOSURE!!! (not diagnostic or latent/active) -Induration 48-72h after test indicates pt has been exposed to TB and developed antibodies; positive if raised area present