Pulmonary / Respiratory (prt 3)

Pneumothorax

Air or gas in the pleural space

Impaired oxygenation and ventilation

Spontaneous or traumatic

Primary or Secondary

Treatment for Pneumothorax

Chest tube

Pleural effusion

Fluid in the pleural space (inflammation)

5 categories based on mechanism

Aspiration

Eating and then the food goes in trachea instead of esophagus leading to inflammation and infection leading to pneumonia

Atelectasis

Collapse of lung tissue such as starting at our alveoli

Treatment for Atelectasis

Bronchodilators, coughing and deep breathing exercises

Pulmonary Fibrosis

Excessive amount of fibrous connective tissue damage in the lung

Caused by scarred tissue, COPD disorders

Pulmonary edema

Buildup of fluid in the lung

Happens when protective mechanisms are disrupted, heart disease, lung capillary injury, damaged or blocked lymphatic vessels, left sided heart failure

Treatment for Pulmonary edema

Strengthening the heart, improving hemodynamic exchange, ventilator for Diffusion

Asthma

Most common, heterogenous, familial, inflammation, triggered bronchoconstriction/spasms, wheezing

Treatment for Asthma

Bronchodilation, decreasing inflammation and secretions

COPD

Chronic bronchitis

Emphysema

Dyspnea and wheezing

Treatment for COPD

Bronchodilation, lowering inflammation and secretions

Chronic bronchitis

Hypersecretion of mucous & productive cough that continues for more then 3 months

two years consecutively

Emphysema

Abnormal permanent enlargement of gas exchange air way accompanied with the

destruction of alveolar walls poor diffusion & poor perfusion

Pneumonia

Inhalation of pathogens

Treatment for Pneumonia

Take care of inflammation first then, antibiotic

Pulmonary Embolism

Blood clots in lungs

Pulmonary hypertension

Constriction of pulmonary artery

Bronchodilator agents

Beta2-adrenergic agonists (SABAs and LABAs)

Short-Acting Beta2 Agonists (SABAs)

Long-Acting Beta2 Agonists (LABAs)

Short-Acting Beta2 Agonists (SABAs)

Albuterol

Ephedrine

Epinephrine

Levalbuterol

Metaproterenol

Terbutaline

Action/Use of Short-Acting Beta2 Agonists (SABAs)

Activate B2 adrenergic receptors and cause bronchodilation

Acute symptom relief “Rescue”

Long-Acting Beta2 Agonists (LABAs)

Aformoterol

Formoterol

Idacaterol

Action/Use of Long-Acting Beta2 Agonists (LABAs)

Activate B2 adrenergic receptors and cause bronchodilation

Long term relief “management”

Action of Bronchodilator agents

Bronchospasm is relieved.

Histamine release is inhibited.

Ciliary motility is increased.

Therapeutic Uses of Bronchodilator agents

Inhaled, short-acting prevention of asthma episode (exercise-induced)

Inhaled, short-acting treatment for bronchospasm and asthma

Oral, long-acting, long-term control of asthma

Side Effects/ Complications of Bronchodilator agents

Tachycardia

Chest pain/ Angina

Nursing Considerations of Bronchodilator agents

Avoid stimulants (caffeine)

Bronchodilators before inhaled steroids

SABAs for acute symptoms

LABAs need to be taken daily

Methylxanthines

Theophylline

Action of Methylxanthines

Relaxes smooth muscle of bronchi and bronchioles promoting bronchodilation

Therapeutic Uses of Methylxanthines

Asthma (No longer first-line)

Oral route used for long-term control of COPD or chronic asthma

Therapeutic range of Methylxanthines

5-15 mcg/mL

Toxicity greater than 20

Side effects/adverse effects of Methylxanthines

Dysrhythmias

Dizziness / Headache

Irritability / Nervousness,

Hyperreflexia

GI distress / Intestinal bleeding

Seizure

Insomnia

Hyperglycemia

Tachycardia / Palpitations

Hypotension

Inhaled anticholinergics

Ipratropium bromide (Short-acting), Tiotropium (Long-acting)

Action of Inhaled anticholinergics

Maintenance treatment of bronchospasms associated with COPD

Dilating the Bronchioles

Allergen-induced and exercise-induced bronchospasm

Administered by inhalation only with the HandiHaler device

(dry-powder capsule inhaler)

Common side effects of Inhaled anticholinergics

Anticholinergic effects

Nursing Considerations of Inhaled anticholinergics

Sugarless candy for dry mouth, rinse mouth after inhalation

Do not swallow

Anti-inflammatory agents

Glucocorticoids

Leukotriene modifiers

Antibiotics

Glucocorticoids

Beclomethasone

Budesonide

Formoterol (Inhaled)

Prednisone (oral)

Hydrocortisone

Methylprednisone (IV)

Actions of Glucocorticoids

Prevent inflammation, suppress airway mucus production, and reduction in airway mucosa edema

Administration of Glucocorticoids

MDI inhaler, tablet, intravenous

Side effects of Glucocorticoids

Oral- hyperglycemia, suppression of adrenal gland (cortisol)

Inhaled- hoarseness, candidiasis, osteoporosis, bleeding,

Fluid and Electrolyte imbalance

Nursing Considerations of Glucocorticoids

Rinse mouth after inhalation, use spacer, monitor

Taper dose to avoid adrenal imbalance

Weight-bearing exercises, monitor glucose, avoid NSAIDS, monitor stools

Monitor I&O, Potassium levels

Leukotriene modifiers

Zafirlukast

Montelukast

Zileuton

Action of Leukotriene modifiers

Reduce inflammatory process and decrease bronchoconstriction

Therapeutic Use of Leukotriene modifiers

Not for treatment of acute asthmatic attacks

Long-term therapy of asthma in adults and children

Maintenance therapy for chronic asthma

Used for Prophylaxis of exercise-induced bronchospasm

Common side effects of Leukotriene modifiers

Dizziness

Headache

Confusion

GI distress

Depression

Weakness

Infection

Hepatotoxicity

Nursing Considerations of Leukotriene modifiers

Monitor liver function, monitor behavior changes

Monitor for interactions with other drugs (potentiates warfarin and theophylline)

Take on an empty stomach, once daily

Antibiotics

Trimethoprim-sulfamethoxazole

Action / Use of Antibiotics

Mild to moderate acute exacerbations of chronic bronchitis from infectious causes

Give for symptoms that last more than 7 days and/or fever

Collect sputum first