NURS 201 PALS Tutoring

NURS 201 PALS Tutoring Quiz 3 • Asthma o Intermittent obstructive airways o Reversible, not progressive o Risk Factors: ▪ Tobacco use ▪ GERD ▪ Air Pollutants • Smog • Dust • Pollen ▪ Smoking ▪ Allergies ▪ Genetics is the most common • The more risk factors, the more likely they will develop asthma o Signs and Symptoms: ▪ Wheezes ▪ Chest tightness ▪ Persistent cough ▪ Dyspnea o Early Symptoms: ▪ Increase pH • Respiratory alkalosis ▪ Restlessness ▪ Agitation ▪ Tachycardia ▪ Tachypnea ▪ Anxiety o Late Symptoms: ▪ Bradycardia ▪ Cyanosis ▪ Stupor ▪ Body gets tired when the body is undergoing respiratory alkalosis-> respiratory acidosis -> respiratory failure o If pt has chest tightness and coughing, what are some nursing interventions? ▪ Give O2 in a hospital setting ▪ Use a rescue inhaler if not in a hospital o Patient Teaching: ▪ Prevention • Ways to prevent developing an asthma attack • Avoid triggers o ABG Interpretation/Analysis ▪ pH 7.35-7.45 • Below: Acidosis • Above: Alkalosis ▪ HCO3 22-26 • Below: Acidosis • Above: Alkalosis ▪ CO2 35-45 • Below: Alkalosis • Above: Acidosis ▪ Uncompensated • pH is out of range ▪ Compensated • pH is normal • CO2 and HCO3 out of range ▪ Partially Compensated • Everything is out of range o Best way to diagnose asthma ▪ Pulmonary function test • Uses incentive spirometry ->take the levels of bronchodilators -> retake incentive spirometry -> of the levels increased = pt has asthma ▪ Patient Teaching: • No bronchodilators and no smoking o 6-12 hours before o Medications for Asthma ▪ Beta 2 adrenergic agonists (bronchodilators) • First-line drug therapy • Administered through a nebulizer or meter-dosed inhaler • Short-acting agonists o Albuterol (rescue inhaler) ▪ Can be administered through meter dose or dry powder ▪ S/E • Tachycardia • Angina • Tremors • Nervousness • Restlessness ▪ Pt should avoid caffeine • Stimulants will make the symptoms worse • Long-acting agonists o Salmeterol ▪ S/E • Headache • Tremors • Cough • Dizziness o Prevents asthma attacks DOES NOT treat asthma ▪ Methylxanthines/theophylline • 3rd line drug therapy • Theophylline o Normal range: 10-20 o S/E ▪ Restlessness ▪ Insomnia ▪ Nausea ▪ Vomiting ▪ Diarrhea ▪ Tachycardia IF it reaches toxic levels o Pt should avoid caffeine ▪ Inhaled Corticosteroids • Beclomethasone/Fluticasone o S/E ▪ Hoarseness ▪ Throat irritation ▪ Oral candidiasis o Patient Teaching: ▪ Rinse mouth after each use ▪ Use a spacer to prevent oral candidiasis ▪ Mast Cell Stabilizers • Cromolyn sodium o If prescribed with a bronchodilator take bronchodilator first o Only administered through metered dose inhaler ▪ S/E • Cough • Dry mouth • Throat irritation • Bad taste in their mouth o Pt should take inhaler 15 mins before the workout to prevent developing a bronchospasm ▪ Leukotriene Modifiers • Montelukast o Administered by mouth o Take once a day at night o Take an hour before food or 2 hours after food o Pt should take 2 hours before a workout to prevent developing a bronchospasm ▪ Pt should not take it at night, because they can only take the medication once a day ▪ Metered dose inhaler • Use a spacer to allow the medication to reach its end site o Decrease the deposit left in the mouth or throat ▪ If there is a deposit AKA oral candidiasis • Deliver a measured amount of medication into the lungs ▪ Dry powdered inhaler • Delivers more medication into the lungs • Does not need a spacer ▪ If a doctor orders multiple puffs, wait 1 minute in between puffs • After they inhale, the pt should hold their breath for 10 secs • If pt is using two types of inhalers o Pt should wait 5 mins between the two different inhalers ▪ If pt is taking a glucocorticoid/corticosteroids and bronchodilators, pt should take bronchodilators FIRST ▪ Pt should taper corticosteroids • Ex) Prednisone • May lead to adrenal insufficiency ▪ Nursing Interventions for Asthma Attacks • SaO2> 90%