Bronchodilators

albuterol (Proventil)

salmeterol

levalbuterol (Xopenex)

SE: tachycardia, restless, nervousness, hyperglycemia

Anticholinergics

ipratropium (Atrovent)

tiotropium (Spiriva)

Corticosteroids

budesonide (Pulmicort)

fluticasone (Flovent)

momentasone furoate (Azmanex)

triamcinolone (Azmacort)

Leukotriene Receptor Antagonists

singular

accolate

Nasal Corticosteroids

budesonide (Rhinocort)

fluticasone (Flonase)

mometasone (Nasonex)

TB Meds

isoniazid (INH)

rifampin (Rifadin) (bc ineffective, saliva, urine and orange tears)

ethambutol (Myambutol)

pyrazamide (PZA)

streptomycin

((will be put on the first 4 initially and a selected one once the culture comes back 3-6 wks later))

Flu Meds

amantadine (Symmetrel)

oseltamivir (Tamiflu)

rimantadine (Flumadine)

zanamivir (Relenza)

Pneumonia Meds

intermittent rhinitis

vs

persistent rhinitis

intermittent: <4days/week, <4weeks/year

persistent: >4days/week, >4weeks/year

Laryngitis

cause: smoking, ETOH, overuse of voice

acute: hoarse, dry cough, difficulty swallowing

chronic: persistent hoarseness

mgmt: fluids, rest, throat lozenges

(if persistent hoarseness, get checked to rule out laryngeal cancer)

Laryngeal Edema

Vs

Laryngospasm

Vs

Laryngeal Paralysis

Edema: acute onset of SOB, caused by inflam., injury, anaphylaxsis. Treat with epi, corticosteroids

laryngospasm: acute onset of SOB, caused by general anesthesia, trauma, allergy/anaphyl. treat with oxygen @ 100%, epi.

paralysis: hoarseness. caused by neck surgery, tumors, CVAs.

Sleep Apnea

predisposing factors: obesity, age >65, neck circum >17, craniofacial abn

s/s: frequent awakening, insomnia, daytime fatigue, mood changes, irritable, impotence

diagnosis: polysomnography w/ EEG, >10 episodes/hour with desat. <90%

Complications and

Treatment of Sleep Apnea

Complications: HTN, RSHF from Pulm HTN (caused by nocturnal hypoxia), inability to perfomr ADLs, increased MVA incidence

TX: avoid sedatives/ETOH 3-4 hr prior to sleeping, weight loss, oral appliances, CPAP/BiPAP, surgery

Laryngeal Cancer

Glottic area is majority of cases.

Risk Factors: prolonged smoking/ETOH use, chronic laryngitis, family predisposition

earliest sign: hoarseness >2wks

Dx tests: biopsy

Tracheostomy

complications: obstruction, dislodgement, pneumothorax, subq emphysema, bleeding, infection

dislodged trach: put back in, always have a smaller one extra

Pt is breathing fast and shallow, what would you do?

- deep breathing exercises (deep breath in, hold, exhale slowly)

- buddy breathing

- coughing

Breath sounds

rails

crackles: fluid in alveoli (impedes gas exchange), heard on inspiration not expiration

wheezes: d/t narrowing/constricting, high/low pitch (depending on size of airway), inspiratory and expiratory

ronchi: caused by mucous, inspiratory/expiratory

Respiratory Distress Trouble shooting

1. Airway

2. Ventilation

3. Oxygenation

4. Respiratory Rate

Diet for pt with Respiratory Problems

- high cal

- easy to eat

- high protein

- low carbs (carbs metabolize into CO2 which = more acid in the body... not good)

Epistaxis

Child: anterior/bleeding stops spontaneously

Adult: posterior

First aid: lean forward, pinch soft part of lower portion of nose for 10-15 mins

Cauterization and packing if absolutely necessary

S/S of rhinitis

watery eyes/nose, sneezing, altered smell

chronic: HA, congestion, pressure, post nasal drip leading to cough

meds/tx for rhinitis

antihistamines, leukotriene receptor antagonists

rest, fluids, avoid crowds

sinusitis

blocked sinuses

acute/chronic = >3 weeks

s/s pain over sinues, nasal obs, congestion, fever, malaise, ha

treat: abx, decongestants, nasal corticosteroids, antihistamines, increase fluids

Pharyngitis S/S & Tx

scratchy throat, painful sore throat, difficulty swallowing

TX: abx, antifungal abx, increase fluids

Treatment for Laryngeal Cancer

adequate ventilation/oxygenation

radiation

chemo

surgery

non surgical: asses resp. status, pulse ox, ABGs, high fowlers

Why would we give a pt who had a radical neck dissection a tricyclic antidepressant?

General GOOD post op care

1. airway

2. pain mgmt

3. surgical site infection prevention

4. TC&DB

5. Antiembolics

6. Ambulation

7. frequent VS

8. nutrition

Suctioning Trach

assess need q2h (crackles, moist cough, restless/agitated, decreased SpO2

explain procedure, collect equipment, assess SpO2, HR for baseline, wash hands put on gloves, open package, fill cup with water, put on sterile gloves, provide preoxygenation, insert cath w/o suction, pull out 1/2-3/4" and suction for 10 seconds, reoxygenate after each suction pass

When should you D/C suctioning?

pts vitals:

- HR drop by 20 bpm

- HR increase by 40 bpm

- SpO2 decrease to <90%

Trach suctioning can cause vagal stimulation

what does that cause?

- decrease bp

-decrease hr

- decrease consciouness

-cold/clammy

- accompanies vagal reaction: gag/vomit

What to do if Vagal stimulation occurs?

- stop suction

- oxygenate

- lay flat/feet up (NOT trendelenburg)
- open fluids (NEED ORDER)

Who should get inactived flu shot and who should get live attenuated?

Inactive: health care workers, 50+, chronic heart/lung problems, women in 2nd/3rd trimester, those who work/live in LTCF

Live: ages 5-49 (none of above issues)

Pt has "gunky" alveoli what will their blood gases look like?

hypoxia because CO2 diffuses easier than O2 and will keep diffusing even if problem

Norm CO2, decreased O2 level

PaO2 level norms

80-100 (healthy people)

55-60 (COPD)

Decreases by 1 every year after age 60

70 year old without health issues will have a PaO2 of 70.

Ventilatroy responses to hypoxia and hypercapnia

Atelectasis

leads to a decrease in PaO2

blood is shunted away from alveolia if hey are collapsed

clots in capillaries mean that the blood is not going through and air will not be sent there

S/S of Atelectasis

diminished/absent breath sounds

crackles heard in areas of consolidation

fever

chest pain on inspiration

Pneumonia

Etiology

cigarette smoking

immobile

immunocompromised

decreased gag reflex

sedated

caused by: aspiration, inhalation, hematogeous

S/S pneumonia

fever

chills

SOB

productive cough

Pt should be discharged with NO MORE than ONE of the following:

T >100.4

P >100

RR >24

SBP <90

O2 <90%

inability to take PO (unless baseline)

Ineffective Breathing Pattern

Ineffective Airway Clearance

Interventions:

-elevate HOB, monitor, TC&DB

- increase fluids (3L/day), TC&DB

Non Small Cell Lung Cancer (more treatable)

Small Cell Lung Cancer (difficult to treat)

NSCLC:

adenocarcinoma (women/non smokers) hardest to treat, squamous cell carcinoma (men), large cell (smokers)

SCLC:
survival rate of about 5%

Sites of Metastasis in Lung Cancer

how long does it take for lung cancer tumor to grow 1cm?

8-10 years

Pulmonary Fibrosis

connective scar tissue

no compliance, elasticity or exchange of gases

POOR PROGNOSIS

Tx: give O2 for what elasticity remains

s/s: non productive cough, DOE, insp. crackles, clubbing

care: steroids, chemo

Sarcoidosis

chronic granulatomous growths, unk cause

Complications: pulm fibrosis, cor pulmonale, bronchiectasis (dilation of large bronchi)

care: corticosteroids, methotrexate, imuron/cytoxan

Pulmonary Embolism

Risk Factors

Pulmonary Embolism Etiology & S/S & Treatment

DVTs (has to be on venous side to get to lungs)

S/S: Classic Triad: dyspnea, chest pain (sudden), hemoptysis

Treat: thrombolytic therapy, heparin, supportive: O2, pain relief, activity restriction

Prevent: Aboots, lovenox (low molecular weight heparin)

Chronic Bronchitis

"BLUE BLOATERS"

chronic productive cough >3mo. in course of 2 consecutive years (already ruled out: ACE inhib, allergy, pneumonia, TB)

Chronic Bronchitis

Assess

generalized cyanosis

RSHF (edematous)

distended neck veins

crackles

expiratory wheezes

clubbing

Emphysema

"PINK PUFFERS"

abn. permanent enlargement of air spaces. accompanies by destruction of their walls and without fibrosis

alveoli dry up

barrell chest (air gets trapped)

Panlobular (genetic component)

pursed lip breathers (allows longer exhale)

Nursing Plans for Chronic Bronchitis and Emphysema

lowest amt of O2 to prevent CO2 retention

monitor for s/s of fluid overload (cor polmonale: edema, distended neck veins, crackles), baseline ABGs, teach pursed lip breathing and diaphragmatic breathing, tripod position

Etiology of COPD

cigarette smoking

occupational

air pollution

chronic infection

heredity

aging

S/S of COPD

Collaborative Care of COPD

bronchodilators

corticosteroids

hydration

rest

teach

influ/pneumo vaccine

long term O2

O2 indications for COPD

PaO2 <55 on room air and SpO2 <90%

NO MORE THAN 2L/MIN

S/S hypoxemia

dyspnea

tachypnea

decrease SpO2

tachycardia

S/S hypercapnia

dyspnea

tachypnea

disorientation

tachycardia

latent tb

vs

tb disease

Latent: No symptoms, cannot infect others, skin test usually positive, CXR and sputum tests normal

Disease: bad cough >2weeks, coughing up blood or sputum, weight loss, chills,fever, night sweats, possible to infect, skin test positive, abn CXR w/or w/o positive sputum

how long does it take to get sputum results back?

3-6 weeks

Positive Test for TB

induration of 5mm: immunocompromised

induartion of 10mm: drug users, people born outside us, people living in LTCF

induration of 15mm: positive for people with no other risk factors

Bacillus Calmette-Guerin (BCG)

Treatment regimine for TB

started on all four drugs until sputum results come back, then just 1

Not considered uncontagious until THREE negative sputum smears come back

S/E of TB meds

N/V, yellow skin/eyes, fever >3days, abd pain, easy bruising/bleeding, tinnitus, hearing loss