Ch. Respiratory Pt. 4

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RNSG1940 MED-SURG Mr. Foutch

FI02

Fraction Inspired Oxygen, room air is 21%

nasal cannula

6 L

bradykenine

...

lisiopril, anthing pril- ace inhibtor or ARB

causes cough

dry cough

s/E

ace inhibitor # adverse event

angioedema, but not a common thing you see in ace inhibitors

why would you not smoke with o2 therapy?

blow up

bronchodialators

albuteral
zopenex
theophylline
caffiene

broncholiation

Heart rate will increase
biggest reason you could see flushing- blood volume to increase
NOT ON TEST

beta 2 receptors

found in lung

leukotriene

mediator released from mast cells upon contact with allergens. COPD. asthma
nasonex- stops 8 of those 12
singular- main one

corticosteriod

effects all 12 mediators, "steroids", are powerful drugs that can quickly reduce inflammation and pain. To maximize benefits, but minimize potential side effects, corticosteroids are usually prescribed in low doses or for short durations.

status asthmaticus

the nurse has4 pt.
20 yo f ns kvo
post static asthmatic is at discharge
lady screaming out in pain
Answer: post static asthmatic is at discharge
****you will hear nothing when you auscultate.
reg brochodialtors will not work
50/50% chance of survival- anoxia

COPD

chronic disease
you can stop from getting worse but you can reverse
BUT NO CURE

3 major patho's that result into a person have COPD:

asthma
emphysema
chronic bronchitis

uncontrolled chronic asthma

will lead to COPD from scar tissue

atrovent

ICS- an inhaled bronchodilator (trade name Atrovent), Ipratropium bromide
Anticholinergic
Asthma, COPD , Allergic rhinitis

symbicort

combo of budesonide (inhaled corticosteroid) and formoterol (long acting B2 agonist)

why can't take formoterol?

outside the scope of practice of an RN?
Like albuteral.... can sudden cardiac death.

formoterol

Adrenergic agonoist, B2 selective agonist, similar to salmeterol, more rapid onset of action
foradil- long acting albuterol.... an ER drug.

why give atrovent and not just a pill?

chronic inflammation, sends fluid, need something now

hyperinflation

giving the client breaths that are 1 to 1.5 times the tidal volume through the ventilator circuit or via a manual resuscitation bag. quick breath

why wld a person with emphysema have hyperinflation?

increased pressure. you can blow out your aveoli

air trapping

incomplete emptying of alveoli during expiration due to loss of lung tissue elasticity (emphysema), bronchospasm (asthma), or airway obstruction; cant perfuse appropriately. acid base. like tieing off a ballon. blowing it up and deflated. over stretching. body gets pissed off and sends fluid.

emphysema

an abnormal condition of the lungs marked by decreased respiratory function. Risk factor: SMOKING, chronic bronchotis, age (smoking is modified risk factory)

rhonchi

lower-pitched sounds like snoring or rattling, secretions in larger airways (pneumonia, bronchitis, aspiration) larger airways. sounds like a train--- a bunch of air trapped off. lower trachea starts to become inflammed.

What two, generally smoking related diseases, are commonly associated with each other and form COPD?

chronic bronchitis and emphysema

chronic bronchitis and emphysema

****NTK MAJOR DIFFERENCE• Pulmonary Emphysema: Loss of elasticity and hyperinflation of the lungs. Aveloli collapse and air becomes trapped in lungs.
• Chronic Bronchitis: Inflammation of the bronchi and bronchioles caused by exposure to irritants, especially smoke. (vasodilation of airways and increased mucous)
• Consider age, gender, occupational history, and race
S&S
• Hypoxia, hypoxemia, fatigue, weakness
• Warm cyanotic extremities/lips, bounding pulse, distended neck veins
• Nausea or anorexia, chronic cough, acidosis

Large amount of thick mucus, what would we give?

exportant- mucinex, robotussin ac

What are the three major things treat COPD?

ISC
anticholenergics
beta agonists

taking a beta agonist? what can it do it to your heart?

Bronchodilation - given to COPD and asthma patients. Beta antagonists contraindicated in these patients., increased myo. contraction, rate via av node
tx of clinical heart failure
Side effects:htn, angina prctoris, fatal cardiac arrhythmias

1 nebulizer treatment of short acting albuterol is equal =

7 puffs of rescue inhaler

risk is higher with a long acting

beta agonists

long acting beta agonists

important for asthma control but should not be used for rescue drugs, They have a slower onset and will not rapidly relieve bronchoconstriction, Patients have "gotten into trouble" ie developed life-threatening bronchodilatation from trying to use long acting B2s for acute symptoms.

enviromental health risk? are we able to modify?

smoking? yes

black lung disease

lung disease caused by inhaling coal dust

sick building syndrome

a set of symptoms, such as headache, fatigue, eye irritation, and dizziness, that may affect workers in modern, airtight office buildings; believed to be caused by indoor pollutants

major risk factor for asbestos?

MC risk factor for mesothelioma

cor pulmonale

NTK: respiratory failure that results in cardiac failure or ominous of uncontrolled COPD.. lots of fluids on heart. can give viagra.
enlargement of the right ventricle of the heart due to disease of the lungs or of the pulmonary blood vessels.

tripod position

An upright position in which the patient leans forward onto two arms stretched forward and thrusts the head and chin forward.

COPD

is it an inflammatory process

what can trigger asthma?

dander, reflux, smoking or an NSAID

electolytes are monitored in COPD because

if lungs are taking a hit then your kidneys are in overdrive. Complete metabolic panel.

N/I

impaired gas exchange
ineffective breathing pattern
ineffective airway clearance
imbalanced nutrition: < body req.
anxiety
activity intolerance

pulmonary hypertension

NOT ON TEST....elevated pulmonary pressure resulting from an increase in pulmonary vascular resistance to blood flow through small arteries and arterioles., mean pulmonary artery pressure 5-10 mmHg above normal or >20 mmHg (normal value = 15-18 mmHg). TX viagra 5HT2- dialates pulm arteries and veins

drug classification

Classified by:
- Effects on body systems
- Therapeutic uses
- Chemical characteristics
Example - Morphine
- CNS depressant
- narcotic analgesic
- opiate

Schedule 1 drugs

Cocaine. prescription or legend drugs, schedule 1: high potential for abuse, no current medical use, lack of safety for use of drug under medical supervision (heroin, peyote, mescaline, hash, psilocybin, etc.

Schedule 2 drugs

ritalin, adderal, percocet, morphine, diladid

Schedule 3 drugs

Codeine, Empirin with codeine, Lortab, Fiorinal, Tylenol with codeine, hydrocodone

Schedule 4 drugs

phenobarbital, Valium, xanex, ativan

Schedule 5 drugs

Lomotil, dimetane, Expectorant DC, Robitussin DAC

Sarcoidosis

CAN look like TB and lung carcinoma; generally benign flinding; excess growth of grandular tissue. a chronic disease of unknown cause marked by the formation of nodules in the lungs and liver and lymph glands and salivary glands

idiopathic

(of diseases) arising from an unknown cause

atelectasis and pneumothorax difference

pneumothorax will have air in sac- collasped lung
atelectasis-collapse alveoli; acute condition like pneumonia; rarely will it be chronic except for Marfan syndrome
atelectasis can lead to pnemothorax

Marfan syndrome

FYI: Genetic Disease: abnormal gene on chromosome 15. Abnormalities in fibrillin, collagen, and elastin. Causes skeletal, vision, cardio, and connective tissue abnormalities. TALL, THIN with long legs, arms, finger and toes. Typically die by age 50 because of heart weakness

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