N316A Exam 2

Explain emphysema’s effect on alveoli in COPD

Alveoli lose their elasticity, making it harder for the patient to get air out of their lungs. This causes air trapping, which increases the residual volume and carbon dioxide levels in lungs.

Explain chronic bronchitis’s effect on alveoli

Chronic bronchitis causes atelectasis, where alveoli are shrunken

Chronic Bronchitis 7 signs

Mucus and edema

Cannot get air in

Cyanosis

Cough

Chronic hypoxia

Clubbing

Pulmonary arterial vasoconstriction

“Blue bloater”

Emphysema 6 signs

AIr trapping

Cannot get air out

Chronic hypercapnia

Prolonged exhalation

Barrel chest

Diaphragm pushed downward

“Pink puffer”

Bronchodilators (MOA, indications, common drugs, adverse effects, interactions, nursing implications)

MOA - stimulate B2-adrenergic receptors in smooth muscles of airways, leading to relaxation adn bronchodilation

Indications - COPD symptoms, acute bronchospasm (asthma)

Common Drugs - Albuterol, levalbuterol

Adverse effects - Tachycardia, tremors, anxiety, hypokalemia

Interactions - may interact w/ beta blockers and diuretics

Implications - monitor for tachy, proper inhaler technique, assess for overuse, which can indicate poor asthma control

Anticholinergics

MOA - Relaxation of smooth muscle in bronchi

Indications - Bronchospasm in COPD, can provide maintenance treatment with fewer side effects, but not as fast acting as sympathomimetics

Common Drugs - ends in “-ium” and glycopyrrolate, revefenacin

Adverse effects - dry mouth, blurred vision, urinary retention, constipation, tachycardia

Corticosteroids

MOA - Reduce inflammation in the airways by inhibiting the release of inflammatory mediators

Indications - Chronic asthma, COPD management, prevention of exacerbations

Common Drugs - Fluticasone, Budesonide, Prednisone (oral)

Adverse effects - oral thrush, hoarseness, pneumonia risk, bone loss

Interactions - fungal infxn, NSAIDS - ulcer risk

Implications - mouth rinsing for thrush, signs of infection b/c decreased immunity

Antitussives

MOA - act on medullary cough center

Indications - uncomfortable cough

Common Drugs - Codeine, hydrocodone, dextromethorphan

Adverse effects - drowsiness, dizziness, nausea, sedation, N/V

CI - opiod dependency, respiratory depression

Implications - monitor misuse or dependence, avoid children under 8, assess if cough is dry

Steroid Nasal Decongestants

MOA - anti-inflammatory in nasal passages

Indications - chronic sinusitis or allergic rhinitis

Common Drugs - fluticasone (flonaze), budesonide (rhinocort_, mometasone (nasonax)

Adverse effects - nasal irritation, dryness, systemic effects

Interactions -

Implications - side effects, long-term use, proper administration

Acute rhinitis viral and allergies (dischrage and turbinate colors, lymphocytes or eosinphils?)

Viral - rhinovirus, red turbinates, yellow or green discharge, high lymphocyte levels

Allergies - grey turbinates, clear discharge, eosinophils increase

Acute sinusitis (acute vs. chronic, symptoms)

Acute - URI or allergy, viral 5-7 days, bacterial up to 4 weeks

Chronic - More than 12 weeks

Symptoms - headache, sinus pain, fatigue, nasal obstruction, purulent nasal discharge

Asthma chronic changes

Chronic inflammation can lead to thickening of the airway wall and altered epithelial integrity; why it must be controlled

3 diagnostic sounds of pneumonia

Bronchophony - words clearer over areas of consolidation ex/ “99'“

Egophony - “e” sounds like “ay”

Whispered pectoriloquy - whispered sounds become clear and distinctive

Isoniazid (INH) info and CI

TB drug used alone or in combination with other drugs

CI w/ liver disease and may cause peripheral neuropathy or hepatotoxicity

Rifamycin antibiotic

RibabuTIN, RifamPIN, RiapenTINE

Oral only

Turns feces, urine, feces, saliva, skin, sputum, sweat, tears a red-orange-brown color
Can cause liver dysfunction

Type I Hypersensitivity

IgE mediated

IgE binds to Fc receptors on mast cells and becomes sensitized

Histamiine release from mast cell degranulation

Antihistamines used in treatment

Type II Hypersensitivity

Tissue specific - response depends on tissue or organ involved

Five mechanisms

Cell is destroyed by antibodies and complement

Cell destruction through phagocytosis

Tissues damaged by products of neutrophils

Antibody-dependent cell-mediated cytotoxicity

Target cell malfunction - Graves disease targets thyroid

Type III Hypersensitivity

Immune complex mediated

Antigen-antibody complexees are formed in the circulation and are later deposited in vessel wallss or extravascular tissues

Antibodies bind to soluble antigens in blood or body fluids
Large number of lysosomal enzymes released

Not organ specific

Type IV Hypersensitivity

T-cell mediated hypersensitivity reactions

Does not involve antibody

Ex/ graft rejectioon, TB skin test, allergic rxns from poison ivy or metals

Systemic effects of anaphylaxis

•Subsequent exposures causes IgE antibodies trigger release of

anaphylatoxins

•Platelet activating factor initiates inflammatory response

•Leukotrienes & prostaglandins causing bronchoconstriction

•Prostaglandins cause vasodilation causing hypotension

•Histamine ⬆ vascular permeability of smooth muscle

contraction & tachycardia

•Kinins cause angioedema

•Serotonin causes pupil dilation

• Additional systemic effects

Immunomodulators in Lupus treatment

Drugs that regulate the immune system to treat autoimmune diseases or prevent organ rejection

Indications: Reduce inflammation and tissue damage affected by lupus, prevent flare ups + relapses

MOA: Immunosuppression, cytokine modulation, inhibit B and T cells and the production of autoantibodies

4 Immunomodulators and their adverse effects

Hydroxychloroquine - Retinal damage, GI upset

Methotrexate - Hepatotoxicity, bone marrow suppression, naursea

Azathioprine - Bone marrow suppression, infxn risk

Belimumab - infusion rxns, infxns, depression

CBC, liver fxn tests, avoid live vaccines, sun protection

Vitamin A fxns and sources

Good vision, tissues, skin, reproduction and growth

Diary, liver, egg yolks, carrots, sweet potato, broccoli, dark green leafy veggies

Vitamin D

Works with calcium and phosphorus to ensure bone growth

Fortified dairy products, egg yolks, higher-fat fish, fortified breakfast cereals

Vitamin E

Powerful antioxidant, oxidation damage, reduce risk of heart disease and some cancers

Nuts, seeds, green leafy veggies, wheat germ, vegetable oil, soyben oil

Vitamin K

Helps blood to clot so wounds stop bleeding, bone health

Green leafy veggies, dairy pproducts, fruits

7 Common minerals and purpose

Ca: Bones, muscles, nerves

Mg: Nerve, muscle, cardiovascular health

Fe: Oxygen transport

K: Heart and muscle

Na: FLuid balance, nerves

Zn: Immune, wound healing, DNA synthesis

Phos: bone, energy production, cell fxn

Hiatal Hernia

Stomach pushes up through opening in diaphragm

May be asymptomatic

Risk factors obesity/pregnancy

S/S - dysphagia, epigastric discomfort

Treatment - PPI, histamine-2 blockers, surgery

GERD

Regurgitation of stomach acid into esophagus

Problem with tone of LES

Metaplasia of cells may occur

Gastroparesis

Delayed stomach emptying - cause of GERD

Barret’s esophagus

PRecancerous change of esophageal tissue

Crohn’s Disease

Chronic transmural inflammatory process

Can affect from mouth to anus - usually terminal ileum and ascending colon

Skip lesions - areas of disease separated by healthy areas

Cobblestone granulomas form

s/s - diarrhea, can be bloody, weight loss, fatigue, fever

Toxic megacolon: extreme dilation of disease colon - can cause complete obstruction or life-threatening perforation

Peptic Ulcer Disease (causes, diagnosis, treatmnet)

Duodenal most common, H pylori or NSAIDS

Intermittent pain in epigastric area, relieved by food or antacids

Reduce acid levels, antibiotics, lifestyle changes, surgical intervention

Appendicitis two intiiating events

Narrowing causes obstruction that results in ischemia

Bacterial growth in trapped secretions

Appendicitis treatment

Antibiotics

Avoid laxatives

Pain management

Surgery

Appendicitis pain locations

Epigastric or periumbilical pain

RLQ rebound tenderness

Cholesystitis 4 risk factors

Fat

Forty

Fertile

Female

Empyema

Infection of bladder leading to purulent effusion

Acute or chronic inflammation of the gallbladder

Due to gallstones

RUQ pain that spread to shoulder or back

Antihistamine (Class, mechanism, example, key uses, nursing considerations)

Blocks H1 receptors

Meclizine, dimenhydrinate

Motion sickness

Sedation, caution glaucoma/BPH

Antidopaminergic (Class, mechanism, example, key uses, nursing considerations)

Blocks D2 in CTZ

Prochlorperazine, promethazine

Severe n/v

Extrapyramidial symptoms risk, tissue necrosis IV

Prokinetic (Class, mechanism, example, key uses, nursing considerations)

D2 block and increase gastric motility

Metaclopramide

Gastroparesis, GERD

tardive dyskinesia black box

5-HT3 Antagonist (Class, mechanism, example, key uses, nursing considerations)

Blocks serotonin receptors

Ondansetron

Chemo/post-p n/v

QT prolongation

H2 blockers (Mechanism, example, key points)

Block histamine receptors on parietal cells

Famotidine

Less potent than PPIs

PPIs (Mechanism, example, key points)

Block proton pump (H/K+ ATPase)

Omeprazole, pantoprazole

Most effective; llong-term risks

Antacids (Mechanism, example, key points)

Neutralize acid

Tums, maalox

Drug interactions, renal caution

Mucosal protectant (Mechanism, example, key points)

Coats ulcer

Sucralfate

Give on empty stomach

Prostaglandin Analog (Mechanism, example, key points)

Protects mucosa

Misoprostol
Prevents NSAID ulcers

Bulk laxative (Mechanism, example, key points)

Fiber absorbs water

Psyllium

Obstruction if low fluid

Stool softener (Mechanism, example, key points)

Softens stool

Docusate

Mild effect

Hyperosmotic (Mechanism, example, key points)

Pulls water in

PEG, lactulose

Electrolyte imbalance

Saline (Mechanism, example, key points)

Osmatic salt effect

Magnesium citrate

Avoid renal failure

Stimulant (Mechanism, example, key points)

Nerve stimulation

Senna, bisacodyl

Dependency