Respiratory (Module 2) Flashcards

Question

Levalbuterol (*Xopenex*) (Asthma)

Answer 1

teach pt to monitor HR because excessive use causes tachycardia use them at least 5 min before other inhaled drugs **teach pt correct technique for using MDI or DPI**

Answer 2

causes bronchodilation through relaxing bronchiolar smooth muscle by binding to and activating pulmonary beta2 receptors; onset of action is slow with long duration **primary use is prevention of an asthma attack**

Answer 3

INHALED DRUGS teach pt to not use these drugs as reliever drugs because slow onset and don’t relieve acute symptoms

Answer 4

causes bronchodilation by inhibiting the parasympathetic nervous system, allowing the sympathetic system to dominate, releasing norepinephrine that activates beta2 receptors **purpose is to both relieve and prevent asthma and improve GAS EXCHANGE**

Answer 5

INHALED DRUG FOR RELIEF AND PREVENTION if pt is to use any of these as a reliever drug, teach them to carry it at all times because it can stop/reduce life threatening bronchoconstriction

Answer 6

INHALED DRUG teach pt to increase daily fluid intake because it can cause mouth dryness teach pt to observe for blurred vision, eye pain, headache, nausea, palpitations, tremors, inability to sleep **same for ipratropium**

Answer 7

don’t cause bronchodilation

Answer 8

main purpose is to prevent an asthma attack caused by inflammation or allergies

Answer 9

MDI INHALED DRUG use drug daily even when no symptoms present, because max effectiveness requires continued use for 48-72 hrs check mouth daily for lesions or drainage; good mouth care

Answer 10

PO avoid anyone who has an upper respiratory infection because **drug reduces all protective inflammatory responses which increases risk for infection** avoid activities that lead to injury because **blood vessels become more fragile leading to bruising and petechiae** take drug with food to help reduce side effects of GI ulceration don’t suddenly stop taking drug for any reason because **drug suppresses adrenal production of corticosteroids**

Answer 11

purpose is to prevent asthma attack triggered by inflammation and allergies

Answer 12

PO (USE DAILY) max effectiveness requires continued use 48-72 hrs

Answer 13

Xanthine drugs (*Theophylline, Aminophylline*) might be used not as common due to toxicity in adults and frequent blood draws for monitoring

Answer 14

severe and life threatening asthma attack that doesn’t respond to treatment (wheezing might diminish, NO AIR MOVEMENT!) *can develop into pneumothorax, cardiac/respiratory arrest and acidosis* **TX:IV fluids, bronchodilators, steroids, epinephrine, O2 therapy, magnesium sulfate (rapid to relax muscles)**

Answer 15

improve airflow and gas exchange self management education/personal asthma action plan (*Peak Flow Meter for monitoring, trigger recognition/avoidance*) exercise/activity planning O2 therapy admin bronchodilator before steroid **INHALER: WAIT AT LEAST 1 MIN BETWEEN PUFFS**

Answer 16

hypersensitivity is overactive immunity with excessive inflammation occurring in response to presence of antigen to which pt usually has been previously exposed **1st exposure: patient is “sensitized” and future exposures cause immune reaction; T’s tell Bs to create IgE specific to allergen, mast cells basophiks have IgE receptors with lots of IgE attached, allergen binds to IgE, causes degranulation**

Answer 17

excessive production of IgE antibodies allergens across body (*inhalation, ingestion, injection*) contraction (*latex, food, pollens, environmental proteins*)

Answer 18

sneezing runny nose red itchy watery eyes **genetic and environmental risk factors**

Answer 19

ABGs allergic asthma (*inc serum eosinophil and IgE levels*)

Answer 20

take history and physical (*upper airway, skin testing*) skin prick test (*allergen prick, symptoms within 15 min*) intradermal skin testing (*drug, venom or food allergies*) blood tests (IgE, RAST) (*add allergen to blood sample to observe for reaction; high rate of false positives*) physician-supervised challenge test patch test (*contact dermatitis, checked after 48-96 hrs from application*)

Answer 21

supportive therapy (no nasal washing) vitamin C, zinc steroids (*anti inflammatories, reduces edema including airways, reduces mucous production*) leukotriene inhibitors (Montelukast) antihistamines (Benadryl; diphenhydramine) eye decongestants decongestants (nasal (can cause rebound effect), PO); can produce rebound effect with extended use bronchodilators anti-inflammatories antipyretics mast cell stabilizers

Answer 22

immunotherapy (desensitization/allergy shots) or therapy (**SQ injection of low dose allergens increasing the amount slowly; full course=5 yrs**) decreased allergic response d/t competition; allergen in small amounts cannot bind to IgE, leading to IgG production against allergen, allergen attached to IgG instead of mast cell and IgG clears allergen from body

Answer 23

angioedema and anaphylaxis; can be fatal potential for complete airway obstru from mucous swelling and anxiety from hypoxia

Answer 24

chronic inflammation of bronchi and bronchioles **smoke/toxins trigger mucous glands and damage cilia -> reduced secretion clearance -> mucous plugs block airway -> leads to infections, hypoxemia, respiratory acidosis**

Answer 25

decreased lung elasticity and hyperinflation of the lung **smoke/toxins raise proteases -> breaks down elastin in alveoli and small airway -> alveoli become damaged and enlarge into bullae -> air trapping, flattened/weak diaphragm -> increased work of breathing, accessory muscle use -> raised demand for O2 and disorganized breathing (inhalation starts before exhalation)**

Answer 26

easily fatigued frequent respiratory infections use of accessory muscles to breathe orthopneic (*SOB that occurs lying down*) cor pulmonale (*late*) thin wheezing pursed-lip breathing chronic cough barrel chest dyspnea prolonged expiratory time (respiratory acidosis) digital clubbing of fingers (prolonged hypoxia)

Answer 27

genetic/environmental SMOKING!!! asthma -> 12x risk for COPD (Alpha1-antitrypsin (AAT) deficiency, recessive genetic; prevents proteases from breaking down protein **faulty gene + non smoker = no COPD** **faulty gene + smoker = high risk COPD** **2 faulty genes + non smoker = COPD at young age**

Answer 28

ABGs (*could be grossly out of balance depending on severity of condition*) sputum samples CBC (*may show high WBC count, presence of infection*) H&H (*high RBCs and iron levels; compensatory mechanisms for low O2 in blood*) BMP (*serum electrolytes*) Serum AAT

Answer 29

PFTs Chest X-ray (*hyperinflation and FLATTENED diaphragm*)

Answer 30

**similar to asthma** beta-andrenergics cholinergic antagonists mythylxanthines corticosteroids NSAIDs *mucolytics*

Answer 31

lung transplant (rare) lung reduction

Answer 32

hypoxemia and acidosis pneumonia and respiratory infections right sided HF pulmonary HTN pneumothorax skeletal muscle dysfunction depression/anxiety **SMOKING CESSATION!**

Answer 33

lie on back with knees bent or sit in chair place hands or a book on abdomen to create resistance begin breathing from abdomen while keeping chest still; you can tell if you’re breathing correctly if hands/book rises and falls accordingly

Answer 34

close mouth and breathe in through nose purse your lips as you would to whistle; breath out slowly through mouth w/o puffing cheeks; spend at least twice the amount of time took you to breathe in use abdominal muscles to squeeze out every bit of air you can remember to use pursed lipped breathing during physical activity; always inhale before beginning and exhale while performing; never hold it in

Answer 35

21 mg/patch; 4-6 weeks nicotine at night may interfere with sleep, vivid dreams, but may help with morning cravings **remove ashtrays from view, healthy snacks, keep hands busy**

Answer 36

2 and 4 mg; 3-6 mths absorbed through cheeks and gums; chew slowly until tingling is felt, place gum behind the cheek until tingling goes away for about 30 min no coffee, soda or OJ for 15 min. before/during use

Answer 37

similar to gum but no chewing

Answer 38

prescription only nicotine in the throat and mouth; irritation is common

Answer 39

prescription only rapid but safe rise similar to smoking

Answer 40

decrease cravings; taken after eating with full glass of water; high risk with CV history **hallucinations, impaired judgement, nausea, abnormal dreams**

Answer 41

antidepressant; 7-12 weeks; contraindicated in seizure/BPD, head trauma, anorexia, bulimia, excessive alcohol drinkers **dry mouth, difficulty sleeping**

Answer 42

unable to lay flat (orthopnea); sit upright 3 times a day for 1 hr pace yourself to manage fatigue and activity intolerance, assess for issues with activity intolerance pulmonary rehab and energy conservation manage weight

Answer 43

**often productive cough in the am; encourage cough and deep breathing** sit on chair/side of bed with feet on floor turn shoulders in and head slightly down, hugging a pillow against chest (splinting) take few breaths (3-4) trying to exhale fully brace pillow, take a full breath and cough 2-3 times in same breath and repeat at least twice

Answer 44

pt inhaled deeply and then exhaled through device, causing the ball to move and set up vibrations that are transmitted to chest and airways

Answer 45

nasal cannula/40% venti mask (humidification!) O2 sat of 88-92% is acceptable; otherwise, similar therapy to asthma

Answer 46

drug therapy (**teach pt to self monitor the peak expiratory flow rates at home and adjust drugs as needed, manage anxiety with SOB**) suctioning as needed; encourage cough and clearing secretions hydration/nutrition to support healthy weight (**2L per day, high protein and calorie, pulmocare supplements may be needed; no dry/gas forming foods**) nutritionist consult physical appearance (accessory muscle use), tripod positioning, enlarged neck muscle no gas-forming foods assess for activity intolerance; pace activity O2 lvls 88-92%

Answer 47

maintain gas exchange (O2 sat 88%) no cyanosis cognitive integrity/orientation coughing and clearing secretions effectively RR and quality

Answer 48

airborne droplets inhaled bacillus invades and multiplies in bronchi/alveoli primary infection acquired immunity (2-10, +ppd, immune response) exudate lesions in middle/lower lungs (caseous necrosis, calcification, primary lesions) successful control= lesions resolve with little residual bacilli followed by latent TB potential secondary TB infections or necrotic (liquified) lesions active disease

Answer 49

persistent cough, mucopurulent sputum, blood streaks (hemoptysis) progressive fatigue, lethargy nausea anorexia weight loss irregular menses low grade fever night sweats chills

Answer 50

frequent close contact with infected person immunocompromised crowded conditions older, homeless, disadvantaged IVDU and ETOH users lower SES immigrants

Answer 51

Nucleic Acid Amplification Test (NAAT) results in <2 hrs, tests secretions MOST ACCURATE AND RAPID sputum culture typically 3x confirms diagnosis, can take 4 weeks Bacille Calmette-Guerin (BCG) vaccine given in some countries; pts will show +PPD results, requires x-ray or blood analysis follow up Tuberculin skin testing (TST)/Mantoux test (PPD) **read in 48-72 hrs, raised area is measured; >10 mm=TB exposure or latent TB (>5 mm in immunocompromised)** false negative in elderly or severely immunocompromised blood analysis (+ means infected but doesn’t distinguish; QuantiFERON-TB Gold, T-SPOT TB, GeneXpert Omni) + PPD or blood analysis requires chest x-ray; can show active or healed lesions

Answer 52

**combination drug therapy with strict adherence**; TRIPLE ANTIBIOTIC THERAPY ORDERED FOR ACTIVE TB isoniazid rifampin pyrazinamide ethambutol

Answer 53

kills actively growing bacteria outside cell and inhibits growth of dormant bacteria **take drug on empty stomach, avoid drinking and watch for signs of liver toxicity**

Answer 54

kills slower-growing organisms, even those that reside inside macrophages and caseating granulomas **expect orange-reddish staining of skin and urine, and all other secretions to have a reddish-orange tinge and soft contact lenses will become permanently stained** reduces effects of oral contraceptives

Answer 55

can effectively kill organisms residing within the very acidic environment of macrophages, only combo with other TB drugs **ask pt for gout history, will make gout worse** **be careful in sun and causes photosensitivity**

Answer 56

inhibits bacterial RNA synthesis; slow acting and bacteriostatic and used in combo with other TB drugs **can cause optic neuritis and can lead to blindness**

Answer 57

promote airway clearance (increase fluids, IS, TCDB) prevent resistant TB (super TB) airborne precautions (N95) negative air pressure room (until 3 negative sputum cultures, around 3 mths treatment) home (*cover mouth and throw tissues in separate trash can, wear mask when in contact with crowds, can’t work until not infectious*) manage anxiety improve nutrition manage fatigue care coordination/transition of care DOH reporting and follow up **remind pt disease is not contagious after drugs have been taken for 2-3 consecutive weeks and clinical improvement is seen** **DOT where healthcare professional watches pt swallow drugs magma be necessary in some situations. leads to more treatment successes, fewer relapses, less drug resistance**

Answer 58

highly contagious acute viral respiratory infection rapid onset of **severe headache, muscle ache, fever, chills, fatigue, weakness, anorexia** preventable or reduced severity with vaccine HANDWASHING antiviral agents may be effective if started within 24-48 hrs of symptoms

Answer 59

upper respiratory symptoms loss of taste/smell vaccination status exposure overall activity and oxygenation

Answer 60

respiratory symptoms range in severity fever/chills cough SOB fatigue muscle/body aches headache new loss of taste (ageusia) or smell (anosmia) sore throat n/v diarrhea abdominal pain

Answer 61

conjunctivitis prothrombotic state (*venous and arterial disease*) neurologic findings (*encephalopathy with agitated delirium*) dermatologic findings, reddish nodules on distal digits (in YA) trouble breathing persistent pain/pressure in the chest new confusion inability to wake or stay awake bluish lips or face

Answer 62

heightened sense of fear NAAT using RT-PCR home antigen testing antibody (serology) testing chest imaging pulse oximetry

Answer 63

recommended 6 mths or older recommended 3 mths after recovery

Answer 64

pulmonary vessels and often other lung tissues undergo growth changes that greatly increase pressure in lung circulatory system for unknown reasons may lead to right ventricular failure and death **risk factors are collagen vascular disease, congenital heart problems, portal HTN, HIV, toxins, pregnancy**

Answer 65

dyspnea and fatigue exertional intolerance chest pain (late) palpitations dizziness peripheral edema as cites adventitious lung and heart sounds

Answer 66

right sided cardiac catheterization (can measure pressures in lungs and heart) echocardiogram to screen and rule out other causes PFTs, V/Q scan CT blood samples for HIV or autoimmune disease rule out sleep study (OSA)

Answer 67

respiratory/cardiac transplant

Answer 68

pulmonary rehab mobility exercises deep breathing/airway clearance importance of med therapy adherence respiratory infection prevention

Answer 69

1. remove cap 2. connect pieces 3. shake 4. exhale, place in mouth 5. push 6. breathe in slow 7. remove, hold breath and breathe out 8. wait 1 min between puffs