Medsurg Respiratory Questions With Complete Answers

MEDSURG RESPIRATORY QUESTIONS WITH COMPLETE ANSWERS BRONCHODILATORS -Answer--Cause relaxation of bronchial smooth muscle -NO effect on inflammation 1. Short-Acting Beta2 Agonists: Tx of acute asthma attack Albuterol (Proventil) 2. Long-Acting Beta2 Agonists: Long-term prevention of asthma Salmeterol and formoterol 3. Anticholinergics: Tx of acute asthma attack Ipratropium (Atrovent) Beta2 agonists: What do they do? Two types -Answer-Bind to the beta2 adrenergic receptors and cause an increase in smooth muscle relaxation. Short acting beta2 agonists (SABAs) and long acting beta2 agonists Short-acting beta2 agonists vs. long-acting beta2 agonists Used for? Examples? -Answer-Short acting beta2 agonists (SABAs) provide rapid but short-term relief. Used for acute asthma attacks. Ex. albuterol, levalbuterol Long acting beta2 agonists (LABAs) take time to take effect but the effects are longer. Used for asthma attack prevention. Ex. formoterol and salmeterol Anticholinergics: What do they do? Used for? Examples? -Answer-Block the parasympathetic nervous system Used to relieve and to prevent asthma Ex. ipratropium (atrovent), tiotropium (spiriva) Xanthines: Used for? Examples? -Answer-Used only when other types of management are ineffective. Ex. theophylline and aminophylline ANTI-INFLAMMATORY AGENTS -Answer--Cause reduction in inflammation -NO effect on bronchodilation 1. Corticosteroids: Long-term prevention of asthma Prednisone (Deltasone, Predone), Fluticasone (Flovent) 2. Cromones: Long-term prevention of asthma Nedocromil 3. Leukotriene Modifier: Long-term prevention of asthma Montekulast (Singulair) Corticosteroids: What do they do? Used for? Examples? -Answer-Decrease inflammation Used to prevent an asthma attack Ex. fluticasone (flovent), prednisone (deltasone, predone) Cromones: What do they do? Used for? Example? -Answer-Decrease inflammation Used to prevent an asthma attack Ex. nedocromil Leukotriene modifier: What do they do? Used for? Example? -Answer-Decrease inflammation by blocking leukotriene receptor Used to prevent an asthma attack Ex. montelukast (singulair) Asthma Management: 1st line ongoing Rx 1st line for asthma attack -Answer-Inhaled corticosteroid Short acting inhaled beta2 agonist Asthma special concerns: Surgery Drugs to avoid Highest asthma related deaths population -Answer-Increased surgery risk from intubation ASA and NSAID 55+ ASTHMA MEDICATIONS: Control vs. relief -Answer-1. Long Term Control Medications are used to prevention of asthma attacks: -Long-Acting Beta Agonists, i.e. Salmeterol, Formoterol -Corticosteroids, i.e. Fluticasone (Flovent), Prednisone (Deltasone, Predone) -Cromones, i.e. Nedocromil -Leukotriene Modifiers, i.e. Montekulast (Singulair) 2. Quick Relief Medications are used as needed for rapid, short-term symptom relief during an asthma attack: -Short-Acting Beta Agonists, i.e. Albuterol (Proventil) -Anticholinergics, i.e. Ipratropium (Atrovent) Acute Severe Asthma Therapy: 1. 2. 3. 4. 5. 6. -Answer-1. Short acting beta2 agonists (SABA) inhalers 2. O2 therapy to keep SpO2 90% 3. Anticholinergics for more bronchodilatioin 4. Corticosteroids within 1st hr in ER 5. Heliox (helium and O2) to help carry bronchodilators deeper into lungs - used if condition does not improve within 1 hr of Rx 6. Non-invasive positive pressure ventilation; AVOID intubation TYPES OF INHALERS: -Answer-1. Aerosol vs. Dry powder 2. Metered dose inhaler or MDI (indicates # of doses left in inhaler) vs. non-MDI *Preferred method of administration is using a spacer, which increases the amount of medication delivered to the lungs. COPD: Characterized by Risk factors -Answer-Airflow limitation that is not fully reversible Cigarette smoking, occupational dust and chemicals, environmental tobacco smoke, and indoor/outdoor air pollution COPD S/S -Answer-Increase in anterior/posterior diameter (barrel chest) Use of accessory muscles SOB ABG changes -- hypoxemia and hypercapnia Decrease in breath sounds, rales, expiratory wheezes Frequent pulmonary infections Unplanned weight loss Physical exam findings for COPD -Answer-Tachypnea Tachycardia Hypoxia Dyspnea w/ speaking/eating Accessory muscle use Intercostal chest retractions Abnormal breath sounds Barrel chest Cyanosis Hepatomegaly (enlarged liver) Jugular vein distention Muscle wasting Pathophysiology of COPD: Airflow limitation is __________ and associated w/ ____________. ___________ and ___________ occurs in airways. Inflammatory response causes __________. -Answer-Airflow limitation is progressive and associated w/ abnormal inflammatory response of the lungs to noxious agents. Scar tissue and narrowing occurs in airways. Inflammatory response causes changes in pulmonary vasculature. COPD Comorbidities -Answer-Cardiac failure, esp. cor pulmonale Cardiac dysrhythmias, result from hypoxemia (decreased O2 to heart muscle) Osteoporosis Resp. infections Anxiety Depression DM Lung ca COPD MEDICATIONS AND TX -Answer--O2 via nasal cannula at 2-4 L/min; SpO2 of at least 88% -Drugs to manage COPD are the same as asthma -Long-acting drugs, such as arformoterol (Brovana), indacaterol (Arcapta Neohaler), tiotropium (Spiriva), and fluticasone furoate/vilanterol (BREO ELLIPTA) -Mucolytics to thin thick secretions, such as acetylcysteine (Mucosil) or dorase alfa (Pulmozyme) -Diaphragmatic or abdominal pursed-lip breathing -High Fowlers position -Effective coughing -Exercise conditioning and pulmonary rehabilitation -Suctioning PRN -Maintaining hydration -Vibratory positive expiratory pressure device to loosen secretions and allow them to be coughed more easily