PN2 Exam #2 Study Guide

PN2 Exam #2 Study Guide ASTHMA  Characterized by exacerbations of acute airway inflammation  Airway obstruction occurs d/t bronchoconstriction, mucous, or inflammation when exposed to trigger Clinical Manifestations:  High pitched, wheezing lung sounds  Cough  SOB  Chest tightness  Worsens at night or when triggers are present Medications:  Short Acting= Albuterol, Proventil, Ventoli  Long Acting= Serevent  Corticosteroids= Serevent, Advair Education:  Avoid triggers  Stop/avoid smoking  Teach which inhaler is rescue Exacerbation Interventions:  Give short-acting beta agonist  IV corticosteroids depending on severity  O2 via nasal cannula  High-fowler’s position  Calm atmosphere Questions: If a pt. is having an asthma attack how would you expect it to affect their VS?  At first RR increased then decreased as attack progresses  Tachycardia 120  Decreased BP If you give a pt. Albuterol, what type of side effects would you expect to see?  Increased HR  Tremors What are rescue medications for Asthma?  Short-acting beta agonists (Albuterol) EPITAXIS  Nose bleed – d/t trauma, allergies, drug use  Most frequent ED complaint Interventions & Treatment:  Anterior portion of nose = apply direct pressure for 5-10 while leaning forward  Apply silver nitrate  Apply lidocaine/ep with cotton pledge for 5-10 minutes  Nasal packing for 2-5 days  Educate on prevention – Vaseline, humidifiers COPD  Chronic obstructive pulmonary disease – emphysema & chronic bronchitis  Causes= air pollution, occupation, smoking Primary Symptoms:  Cough  Sputum production  DOE – Dyspnea On Exertion Clinical Manifestations:  Wheezes or crackles heard in lungs  Prolonged expiratory phase  Distant heart sounds  Orthopneic position  Barrel chest  Use of accessory muscles  Weight loss (dyspnea with eating)  Late phase= clubbing to nails, right-sided HF, chronic cyanosis Medications:  Avoid frequent use of cough suppressants (antitussives) because coughing is a protective mechanism  Limit narcotic use d/t respiratory depression can worsen hypercapnia  Beta-Adrenergic Agonists: Albuterol, formoterol  Anticholinergics: Atrovent, Spiriva  Corticosteroids: short course only  Methylxanthines: Theophylline (limited) Interventions & Education:  Pursed lipped breathing  Controlled coughing  Controlled O2 therapy (1-2 L)  Low sodium diet  Diaphragmic breathing  Conserve energy  Small frequent meals  Increase fluids  BiPAP RAYNAUD’S DISEASE  Bilateral vasospasms; peripheral artery occlusive disease triggered by cold & stress Clinical Manifestations:  Pain & cyanosis followed by redness and pain (when warmed up)  Pain is intermittent, extremities are numb & cold & may have swelling/ulcerations Education:  Stop smoking  Exercise  Control stress  Avoid extreme temperatures ALLERGIC RHINITIS