1F RESPIRATORY

Question 1

Insert the medication canister into the plastic holder.

If a spacer is used, insert the MDI into the end of the spacer.

Shake the inhaler vigorously five or six times before using. Remove the cap from the mouthpiece.

Have the patient breathe in through the mouth and exhale.

With the inhaler properly positioned, have the patient hold the inhaler with the thumb at the mouthpiece and the index finger and middle finger at the top

Instruct the patient to take a slow, deep breath through the mouth and during inspiration, to push the top of the medication canister once.

Have patient hold the breath for 10 seconds and then exhale slowly through pursed lips

If a second dose is required, wait 1 to 2 minutes, and repeat the procedure by first shaking the canister in the plastic holder with the cap on.

When it is first used or if it has not been used recently, test the inhaler by spraying it into the air before administering the metered dose.

If a glucocorticoid inhalant is to be used with a bronchodilator, wait 5 minutes before using an inhaler that contains a steroid

Teach patients to self-monitor their pulse rate.

Caution against overuse because side effects and tolerance may result.

Teach patient to monitor the amount of medication remaining in the can-ister. Advise patient to ask a health care provider or pharmacist to estimate when a new inhaler will be needed based on the dosing schedule.

Teach patient to rinse their mouth after using an MDI. This is especially important when using a steroid drug. Rinsing the mouth helps prevent irritation and secondary infection to oral mucosa.

Avoid Smoking

Teach patient to do daily cleaning of equipment; this should include (1) washing the hands; (2) taking apart all the washable parts of the equipment and washing them with warm water; (3) rinsing: (4) placing the parts on a clean towel and covering them with another clean towel to air dry; and (5) storing the parts in a clean plastic bag once completely dry.
Alternate two sets of washable equipment to make this process easier.

Answer 1

Correct use of a Metered-Dose Inhaler

Question 2

H1 Blockers of H1 Antagonists

Answer 2

Antihistamines

Question 3

competes with histamine for receptor sites and prevent histamine response

Answer 3

Antihistamines

Question 4

Act by blocking H1 receptors

Decreases nasopharyngeal secretions by blocking H1 receptor

Answer 4

Antihistamines

Question 5

when stimulated, extravascular smooth muscles constrict

Answer 5

H1

Question 6

when stimulated, gastric secretions occur

Answer 6

H2

Question 7

Cold

Allergic rhinitis

Urticaria

Not used for anaphylaxis

Answer 7

Indications for Antihistamines

Question 8

T/F: Most antihistamines are rapidly absorbed in 15 minutes, but they are not potent enough to combat anaphylaxis

Answer 8

TRUE

Question 9

Mostly can cause drowsiness, dry mouth, decreased secretions and other anticholinergic symptoms

contained in many OTC cold remedies

Answer 9

1st Generation Antihistamines

Question 10

Drowsiness

Dizziness

Fatigue

Disturbed coordination

Skin rashes

Anticholinergic symptoms

Answer 10

Side Effects of Antihistamines

Question 11

Most prevalent type of upper respiratory infection

Answer 11

Common Cold

Question 12

Caused by rhinovirus

Answer 12

Common Cold

Question 13

Acute inflammation of the mucus membrane of the nose

Answer 13

Acute Rhinitis

Question 14

Hay Fever; Caused by pollen or a foreign substance such as animal dander

Answer 14

Allergic Rhinitis

Question 15

blocks the effects of histamine by competing for and occupying H1 receptor sites

Answer 15

Diphenhydramine

Question 16

Primarily used to treat rhinitis

Answer 16

Diphenhydramine

Question 17

closed angle glaucoma

urinary retention

peptic ulcer

small bowel obstruction

Answer 17

Contraindications of Diphenhydramine

Question 18

can cause central nervous system depression if taken with alcohol, narcotics, hypnotics, or barbiturates

Answer 18

Diphenhydramine

Question 19

Advise patients to avoid alcohol and other CNS depressants

Answer 19

Nursing Interventions of Diphenhydramine

Question 20

Have fewer anticholinergic effects and a lower incidence of drowsiness

Answer 20

2nd Generation Antihistamines

Question 21

Nonsedating Antihistamines

Answer 21

2nd Generation Antihistamines

Question 22

Results from dilation of the nasal blood vessels caused by infection, inflammation, or allergy

Answer 22

Nasal Congestion

Question 23

medications used to treat nasal congestion

Answer 23

Nasal Decongestant

Question 24

stimulate the alpha-adrenergic receptors leading to vascular constriction of the capillaries within the nasal mucosa

Answer 24

Nasal Decongestant

Question 25

Frequent use results to tolerance and rebound nasal congestion

Answer 25

Nasal Decongestants

Question 26

used primarily for allergic rhinitis including hay fever and acute coryza

Answer 26

Systemic Decongestants

Question 27

May decrease beta blocker effect

Answer 27

Pseudoephedrine + Beta blockers

Question 28

increased possibility of hypertension or cardiac dysrhythmia

Answer 28

Decongestant + MAOIs

Question 29

Increased restlessness and palpitations

Answer 29

Decongestant + Caffeine

Question 30

Effective for treating allergic rhinitis

Answer 30

Intranasal Glucocorticoid

Question 31

with anti-inflammatory action — allergic rhinitis symptoms of rhinorrhea sneezing and congestion

Answer 31

Intranasal Glucocorticoid

Question 32

Continuous use = dryness of the nasal mucosa may occur

Answer 32

Intranasal Glucocorticoid

Question 33

Nervous Restless Rebound nasal congestion

Answer 33

Side Effects of Decongestant

Question 34

Hypertension Cardiac Disease Hyperthyroidism Diabetes Mellitus

Answer 34

Contraindications of Decongestant

Question 35

Headache Nasal Irritation Pharyngitis Fatigue Insomnia Candidiasis

Answer 35

Side Effects of Intranasal Glucocorticoid

Question 36

Act on the cough control center in the medulla to suppress the cough reflex

Answer 36

Antitussives

Question 37

for nonproductive and irritating cough

Answer 37

Antitussives

Question 38

Nonopioid Opioid Combination Preparations

Answer 38

Types of Antitussives

Question 39

Benzonatate

Answer 39

Nonopioid

Question 40

Codeine Dextromenthorphan Guaifenesin Homatropine 1.5mg & Hydrocodone 5mg

Answer 40

Opioid

Question 41

Guaifenesin Dextromethorphan

Answer 41

Combination Preparations (with expectorant)

Question 42

provides temporary cough relief due to non-productive cough

Answer 42

Dextromethorphan

Question 43

Acts by decreasing the excitability of the cough center in the medulla

Answer 43

Dextromethorphan

Question 44

Loosen bronchial secretions so they can be eliminated by coughing Used for productive cough with or without nonpharmacologic agents

Answer 44

Expectorants

Question 45

inflammation of the mucous membrane of one or more of the maxillary, frontal, ethmoid or sphenoid sinuses

Answer 45

Sinusitis

Question 46

Antibiotic may be prescribed for acute or severe sinusitis acetaminophen fluids and rest may be helpful

Answer 46

Sinusitis

Question 47

Inflammation of the throat or sore throat

Answer 47

Acute Pharyngitis

Question 48

can be caused by a virus, beta-hemolytic streptococci or other bacteria

Answer 48

Acute Pharyngitis

Question 49

can occur alone or with common cold and rhinitis or acute sinusitis Elevated temperature cough

Answer 49

Acute Pharyngitis

Question 50

Throat culture first (should be obtained to rule out beta-hemolytic streptococci infection)

Answer 50

Acute Pharyngitis

Question 51

Chemoreceptors are sensors that are stimulated by changes in these gases and ions. Chemoreceptors are located centrally and peripherally The central chemoreceptors, which are located in the medulla near the respiratory center and the cerebrospinal fluid, respond to an increase in carbon dioxide and a decrease in pH by increasing ventilation. However, if the carbon dioxide level remains elevated, the stimulus to increase ventilation is lost. Peripheral chemoreceptors are in the carotid and aortic bodies. It responds to changes in oxygen levels. A low blood oxygen level stimulates the peripheral chemoreceptors which in turn stimulate the respiratory center in the medulla, and ventilation is increased. If oxygen therapy increases the oxygen level in the blood, the oxygen may be too high to stimulate the peripheral chemoreceptors, and the ventilation will be depressed. Take Note: the tracheo-bronchial tube consists of smooth muscles whose fibers spiral around the trachea-bronchial tube. Contraction of these muscles constrict the airway. The sympathetic and the parasympathetic nervous system affects the bronchial smooth muscles in opposite ways.

Answer 51

Respiration

Question 52

The vagus nerve releases acetylcholine, which causes Bronchoconstriction The sympathetic nervous system releases epinephrine which stimulates beta 2 receptors in the bronchial smooth muscle, resulting in Bronchodilation These two nervous systems counterbalance each other to maintain homeostasis.

Answer 52

Respiration

Question 53

Increase bronchodilation by bronchial smooth muscles. Phosphodiesterase enzyme can inactivate cAMP

Answer 53

Cyclic Adenosine Monophosphate (cAMP)

Question 54

Chronic Obstructive Pulmonary Disease Restrictive Pulmonary Disease

Answer 54

Lower Respiratory Infections

Question 55

Caused by airway obstruction with increased airway resistance of airflow to lung tissues Chronic bronchitis Bronchiectasis Emphysema Asthma

Answer 55

Chronic Obstructive Pulmonary Disease

Question 56

Results in irreversible lung tissue damage

Answer 56

Chronic Obstructive Pulmonary Disease

Question 57

Results to the decrease in total lung capacity as a result of fluid accumulation or the loss of elasticity of the lungs

Answer 57

Restrictive Pulmonary Disease

Question 58

Pulmonary edema Pulmonary fibrosis Pneumonitis Lung tumors Thoracic deformities (scoliosis) Disorders affecting thoracic muscular wall

Answer 58

Restrictive Pulmonary Disease

Question 59

Characterized by periods of bronchospasm

Answer 59

Bronchial Asthma

Question 60

results when the lung tissue is exposed to extrinsic or intrinsic factors that stimulate broncho constrictive response

Answer 60

Bronchospasm

Question 61

Progressive lung disease Caused by smoking or chronic lung infections Bronchial inflammation and excessive mucous secretion > airway obstruction

Answer 61

Chronic Bronchitis

Question 62

Hypercapnia and Hypoxemia > respiratory acidosis

Answer 62

Chronic Bronchitis

Question 63

Abnormal dilation of the bronchi and bronchioles due to frequent infection and inflammation

Answer 63

Bronchiectasis

Question 64

Bronchioles become obstructed by the breakdown of the epithelium of the bronchial mucosa and tissue fibrosis may result

Answer 64

Bronchiectasis

Question 65

Progressive lung disease caused by smoking, atmospheric contaminants, or lack of alpha-antitrypsin protein that inhibits proteolytic enzymes that destroy alveoli

Answer 65

Emphysema

Question 66

Terminal bronchioles become plugged with mucous, causing a loss in the fiber and elastin network in the alveoli Alveoli enlargement as many of the alveolar walls are destroyed

Answer 66

Emphysema

Question 67

Airway obstruction Dyspnea Decreased gas exchange Fatigue

Answer 67

Patient Problems on Chronic Pulmonary Disease

Question 68

Bronchodilators (sympathomimetics, parasympatholytic, and methylxanthines to assist in opening narrow airways) Glucocorticoids (decreases inflammation) Leukotriene Modifiers (used to reduce inflammation in lung tissue) Expectorants (assist in loosening the mucus from the airways) Antibiotics (to prevent serious complications from bacterial infections)

Answer 68

Medications for Chronic Obstructive Pulmonary Disease

Question 69

used to manage COPD.

Answer 69

Sympathomimetics or Alpha and Beta 2 Adrenergic Agonists

Question 70

Acts on Alpha 1, Beta 1, Beta 2 Adrenergic Receptor Sites Promotes bronchodilation and elevates blood pressure Used during anaphylaxis reaction through Subcutaneous route

Answer 70

Sympathomimetics: Epinephrine

Question 71

Beta 2 adrenergic agonist Stimulates beta 2-adrenergic receptor in the lungs which relaxes the bronchial smooth muscle > bronchodilation High dose or overuse may cause some degree of beta 1 response > nervousness, tremor, and increased PR

Answer 71

Albuterol

Question 72

Asthma Bronchospasm

Answer 72

Indications of Albuterol