Upper respiratory, infectiond and Meds

Where does gas exchange occur

the alveoli

Inhalation

diaphragm contracts (moves down)

exhalation

diaphragms relaxes( moves up)

Breathing is considered voluntary or involuntary or both?

Both because you don’t have to think about breathing but take a breath

alveolar ventilation (V)

• air

• amount of air reaching the alveolar

• should be equal to the perfusion

Perfusion (Q)

• the amount of blood that reaches the alveolar

• should be equal to the ventilation

To check for VQ ratio

• scans to check if there’s imbalance

• shunt: area that isn’t getting any ventilation(air)

• Dead space: an area that is not getting any perfusion

What causes VQ imbalance

for perfusion (Q): pulmonary embolism

Central chemoreceptors

• sense an increase of CO2 or decrease in pH

• causes an increase in respirations

• gives us the control and stimulus for humans to breath

Peripheral chemoreceptors

• the respond to decrease in arterial oxygen

• Also called the hypoxic drive (seen in COPD patients)

• the backup of central chemoreceptors ( not ideal but is there, that’s why it happens in COPD patients, hence is why we cannot over oxygenate them because it will knock out their drive to breath, 88% is ideal )

dyspnea

shortness of breath

orthopnea

Shortness of breath when laying flat

hemoptysis

coughing up blood

Atelectasis

collapse of the alveoli

• common after surgery and why the incentive spirometer is used

• coughing and deep breathing is also common

hypoxia

oxygen levels in the blood are too low

hypercapnia

when there’s buildup of carbon dioxide in the blood

• caused from breathing too slow

impending respiratory failure

when the respiratory system isn’t able to oxygenate the blood and eliminate the carbon dioxide

Arterial blood gases

• arterial puncture at the radial pulse site and puncture an artery

• allows us to see alterations of acid base imbalances

culture and sensitive testing

• sputum sample

• allows us to see what is causing the infecting and what the infection is sensitive to give the right antibiotics

pulse oximetry

• monitors oxygen saturation

• expected finding is 95%-100%

imaging studies

• chest x-rays

• CT MRI’s

Bronchoscopy

• allows for visual of the larynx, trachea, and bronchi

thoraconcentesis

• removal of pleural fluid using a big needle

• through the chest wall into the chest space

Pulmonary function test

used to:

• diagnose inflammatory respiratory disorders

• evaluate the lung volumes

• can help differentiate between obstructive and restrictive diseases

Upper respiratory tract disorders

• acute rhinitis

• acute pharyngitis

• acute sinusitis

• acute tonsillitis

• epiglottis

• laryngitis and tracheitis

acute rhinitis

• irritation and inflammation of the nasal passage

• caused from viruses that are airborne

• patient complaint: nasal discharge( clear, yellow, green), nasal congestion, sneezing, and throat irritation

• nasal mucosa are red

• treatment: antihistamines, analgesics, antipyrectics (anti fever)

• not hospital, treats on its own or primary care appointment or urgent care

acute pharyngitis

• inflammation of the pharynx

• viral in nature

• can be bacterial which would be Group A beta-hemolytic streptococcus

• assessment : red, swollen pharyngeal membranes and tonsils , maybe white exudate, cervial lymph nodes swollen

• symptoms: fever, malaise, sore throat

• diagnosis: visual inspection and identification of causative organism ( rapid strep test)

• treatment: penicillin, erythromycin, or cephalosporins if bacterial

• at home: salt water gargles, analgesics for main management

• can spread and cause sinusitis

acute tonsils

• infection and inflammation of tonsils

• may be GABHS (bacterial) or EBV (viral)

• signs: sore throat, fever, difficult swallowing

• assessment: red inflamed pharynx, tonsils inflamed and swollen, white exudate on tonsils

• if cervical lymphphadenopathy test for heterophile antibody because it can indicate mono

• diagnostics: heterophile antibody test, throat culture and sensitivity

• treatment: antibiotic if GABS, tonsillectomy if recurrent

acute sinusitis

• infection of the facial maxillary and frontal sinuses, causing inflammation and obstruction of the sinus cavity

• signs: headaches, malaise, fever, stuffy and runny nose, sore throat, earache

• assessment: pain over sinus area( worse when leaning forward), nasal obstruction/discharge, fever, decrease sense of smell

• diagnosis: visual inspection and palpation of frontal and maxillary sinuses, can get x-ray

• treatment: antibiotics if bacterial, decongestants, antihistamines, saline spray, humidifaction, mucolygic agents, analgesics

epiglottitis

• the epiglottis: keeps from from entering the respiratory tract

• this is an inflection and inflammation of the epiglottis

• can obstruct the trachea; emergency ; requires hospitalization and trachcheotomy

• symptoms: severe sore throat with inability to speak and difficult breathing, drooling because saliva cannot be swallowed

• assessment: swollen epiglottis

• diagnostics: laryngoscope examination, neck x-ray (show steeple sign which is means swelling) , increase WBC count, culture and sensitivity

• Tx: antibiotics, humidified oxygen, IV guilds, maintenance of airway

laryngitis and tracheitis

• infection and inflammation of the larynx or trachea

• S/S: sore throat, difficulty speaking (hoarseness or complete loss of voice)

• assessment: stridor may be heard, high pitched brassy cough, yellow/green sputum, wheezing on exertion

• diagnostic: throat culture and sensitivity

• tx: rest voice, bronchodilators, antibiotics, symptom management

meds used for upper respiratory tract

• antitussives

• decongestants

• antihistamines

• mucolytics

Antitussives

• traditional ( codeine, hydrocodone, dextromethorphan)

  • act directly on the medullary cough center of the brain to depress the cough reflex

• local acting: benzonatate

  • acts as local anesthetic on the respiratory passages, lungs, pleurae, blocking effectiveness of stretch receptors

• indication: treat uncomfortable, unproductive cough ( we want patient to cough things out) give cough medicine if its a dry cough

• contraindications: patients who need to cough to maintain airway, head injury or impaired CNS, pregnancy and lactation due to narcotics that will suppress respiratory drive

• cautions: asthma, emphysema, history or narcotic addiction

• Drug to drug interaction: MAOI’s which are psych meds

• adverse affects:

  • traditional: drying effect on mucous membranes. CNS adverse affects ( respiratory depression, sedation, and drowsiness)

  • Bensonatate: GI upset

Topical nasal decongestants

• Drugs: Naphazoline (province), oxymetazoline (farina & others), phenylephrine (coricidin and others), Tetrahydrozoline(tyzine), xylometalozine (otrivin)

• therapeutic actions: sympathomimetics cause vasoconstriction leading to decreased edema and inflammation of the nasal membranes

• route: nasal sprays

• indications: relieve discomfort of nasal congestions that accompanies the common cold, sinusitis, and allergic rhinitis

• pharmacokinetics: onset of action is almost immediate

• cautions: lesion or erosion of mucous membranes, pregnancy/lactation, any condition that might be exacerbated by sympathetic activity ( diabetes ,hypertension)

• adverse affects: local stinging and bring, rebound congestion, sympathomimetic affect

• drug to drug interactions: other drugs affecting the sympathetic nervous system

Oral decongestants

• drugs: Pseudoephedrine and phenylephine ( sudafed)

• therapeutic actions: shrink the nasal mucous membranes by stimulating the alpha adrenergic receptors indication the nasal mucous membranes

  results in decrease in membrane size; promoting drainage in the sinuses and providing air flow

• indications: decrease nasal congestion related to common cold, sinusitis, allergic rhinitis and relieve pain and nasal congestion of otitis media

• pharmacokemetics: well absorbed, widely distributed in the body;metabolized in the liver, exceed in urine

• cautions: any condition that might be exacerbated by the sympathetic activity, pregnancy and lactation due

• adverse affects: rebound congestion, sympathomimetics effects, care must be rake to avoid accidental overdose

• drug to drug interactions: concurrent use of OTC cold medication products that contraindicate these drugs

Steroid decongestants

• drugs: Beclomethasone, budesonide, flunisolide, fluticasone, triamcinoline

• Therapeutic actions: unknown,

  • ant inflammatory result from direct local effect blocking reactions responsible for inflammatory response

• indications: allergic rhinitis, relieve inflammation after removal of nasal polyps, first line medication for nasal congestion

• pharmacokinetics: 1 week to cause changes, not absorbed systematically

• contraindications: if patient has acute infection

• adverse affects: local burning, irritation, stinging, dryness of mucosa, headache; suppression of healing can occur in a patient who has had nasal surgery or trauma

• drug to drug interaction: concurrent nasal medications should not be administer without consulting provider

Antihistamines

• drugs:

  • first generation: diphenhydramine(benadryl), brompheniramine, clemastine, cyproheptadine

  • second generation: azelastine, cetirizine (zyrtec), desloratadine, loratadine (claritin)

• therapeutic actions: selectively blocks effects of histamine at the histamine-1 receptor sites, decreasing allergic response

  • results in anticholinergic and antipruritic effects ( itching effects)

• indications: relief of symptoms associated with seasonal and perennial allergic rhinitis, allergic conjunctivitis, uncomplicated urticaria, and angioedema

• pharmacokinetics: absorbed orally, metabolized in the liver; excreted in the urine and feces

• cautions: renal or hepatic impairment

  • with first generation use with caution for patients with hx of arrhythmia or prolonged QT intervals

• drug to drug interactions varies on specific drug

anticholinergic side effects

• can’t see ( blind, dilated pupils, confused)

• can’t pee (urinary retention)

• can’t spit (dry mouth )

• can’t shit (absent bowel sounds)

Expectorants

• drugs: guaifenesin(mucinex) can be purchased OTC

• therapeutic actions: enhances output of respiratory tract fluids by reading their adhesiveness and surface tension, allowing for easier movement of the less viscous secretions

• results in more productive cough and enhanced airway protection

• indications: relief of symptoms and respiratory conditions

• pharmacokinetics: pregnancy and lactation, persistent cough

• adverse affects: GI symptoms, HA, dizziness, prolonged use may result in masking symptoms of a serious underlying condition

• drug to drug interactions no significant interactions

• educate patient to take with a full glass of water

Mucolytics

• drugs: acetylcysteine and donate alfa

• therapeutic actions: acetylcysteeine: spilts apart disulfide bonds responsible for holding together mucous material

  • Dornase alpha: selective breaks down respiratory tract mucous by separating extracellular DNA from proteins

• indications: liquefaction and cleaning of secretions and treatment of atelectasis from thick mucous secretions as in cystic fibrosis

• pharmacokinetics: aceetylcysteine: metabolized in liver;excreted in some urine

  • dornase alfa: metabolized by proteases

• caution: asthma and pregnancy/lactation

• adverse effects: GI upsets,stomatitis, rhinorrhea, bronchospams, rash

• drug to drug interaction: none known

expected findings after albuterol nebulizer treatment

• mild tachycardia

Albuterol

• rescue medication