Presenter: Brent Evans, MSN, RN, CNE
Key Components of Assessment:
History
Lung Sounds
Respiratory Effort
Respiratory Rate
Pulse Oximetry
Arterial Blood Gas (ABG) Analysis
Diagnostics (Bronchoscopy, X-ray, CT, MRI, Biopsy)
Pneumonia: Fluid buildup and infection (can be bacterial or viral)
Pulmonary Edema: Fluid in the alveoli; often a result of heart failure, treated with medications such as Lasix, Morphine, and Nitrates.
Pleural Effusion: Fluid in pleural spaces, reduces lung volume, leads to shortness of breath (shob), may occur due to infection; treated with chest tubes or catheter for fluid removal.
Pulmonary Embolus: Blood clot in the lungs, typically from DVT in legs or arms; treatment includes Heparin drip and oxygen; challenging to treat once lodged in the lung.
Asthma: Constricted airways and airway inflammation, decreases air movement and gas exchange.
COPD: Involves chronic bronchitis (airway inflammation) and emphysema (consolidated lung space).
Key Structures Involved:
Airways (Trachea, Bronchial tubes)
Alveoli (Oxygen exchange occurs here)
Impact of excess mucus compared to healthy bronchiole and alveoli.
Two Basic Classes:
Bronchodilators
Anti-inflammatory Agents
Xanthines (Older Class): Caffeine, Theophylline
Sympathomimetics (Most Common):
Uses: Class of choice for acute shortness of breath, dilates bronchial passages, increases respiratory rate (RR) and depth.
Examples:
Albuterol (first option, sympathetic agonist, intended for short-term use)
Epinephrine (non-selective, used in emergencies)
Long-Acting Beta Agonists (LABA): Salmeterol, Formoterol
Short-Acting Beta Agonist (SABA): Levalbuterol
Physiological Responses:
Sympathetic stimulation
Increased heart rate
Increased blood pressure
Decreased renal and GI perfusion
Bronchodilation
Increased RR
Sweating
Ipratropium: Less effective than Albuterol, commonly used with it for chronic conditions, does not cause sympathetic stimulation.
Mechanism: Disrupts vagal enervation, acts as a parasympathetic antagonist for bronchial dilation.
Reduced systemic effects when using inhalers:
Smooth muscle dilation of bronchi
Side effects: Dry mouth, urinary retention
Glucocorticoids:
Budesonide for long-term prophylaxis.
Inhalation reduces systemic side effects; all steroids must be weaned off after prolonged use.
Inhaled steroids for daily maintenance to avoid systemic side effects.
To note: Not for acute exacerbations; takes 2-3 weeks to reach effective levels.
Post-use recommendation: Rinse mouth with water post inhalation to prevent thrush.
Common Side Effects:
Hyperglycemia
Thrush
Osteoporosis
Immunocompromise
Increased risk of glaucoma (particularly with long-term use).
Three Key Advantages:
Increased therapeutic effect at the site of action.
Decreased systemic side effects.
Rapid onset of action; works quickly.
Administration Tips:
Requires coordination: inhale before activation.
Only 10% reaches the lungs; spacers can increase this to about 20%.
Steps for MDI Use:
Prime 4 times before first use.
Shake inhaler.
Inhale deeply before activation, hold breath, and rinse mouth after use.
Advantages:
Less coordination needed, activated by inhalation.
Approximately 20% of medication reaches the lungs; do not breathe it back out.
How It Works: Drug is mistified and inhaled over several minutes, uses equipment.
Benefit: More drug reaches the lungs compared to other forms of inhalation.
Open floor for any inquiries regarding inhaled medications and related treatments.