Chapters 53, 54 & 55

After teaching a client who is receiving an antitussive about the drug, which statement indicates the need for additional teaching?

"I'll keep the room warm and toasty."

When evaluating an asthmatic client's knowledge of self-care, the nurse recognizes that additional instructions are needed when the client makes which of the following statements?

"When I am short of breath, I will increase the use of my fluticasone."

Lung Surfactants

-Replace the surfactant that is missing in the lungs of neonates with RDS. -Begin to act immediately on *instillation into the trachea* -Metabolized in the lungs *Emergency drug; no contraindication* -ant or Infasurf Surfanta, calfactant Infasurf (newest drug) Lucinactant Proactant

Antihistamine drugs

-amine Diphenhydramine (Benadryl) -zine Hydroxyzine & meclizine -adine Loratadine (Claritin)

Sympathomimetic drugs

-erol & -ine Albuterol Arformoterol Rphedrine Epinephrine Formoteral

Xanthines examples

-phylline & caffeine Aminophyline, Dyphyline, Theophyline & Caffine

Asthma - obstructive pulmonary disease

1. Bronchospasm (decreases size of airway) 2. Extra mucous build up (narrowing airway) 3. Inflamed bronchial tissue (narrowing airway)

cystic fibrosis

A genetic disorder that is present at birth and affects both the respiratory and digestive systems (GI & reproduction).

respiratory distress syndrome (RDS)

A respiratory disorder that affects premature infants born without enough surfactant in the lungs. It is treated with respiratory support and surfactant administration

The nurse is listening to a client's lungs and is having difficulty hearing anything. A review of the electronic medical records states that the client has developed atelectasis. Based on this information, what is the best description of atelectasis to tell the client?

Air or fluid accumulation in the pleural space

After reviewing information about drugs used to treat lower respiratory system conditions, a group of nursing students demonstrate understanding of the information when they identify which as an example of a short-acting beta-2 agonist (SABA)?

Albuterol

Drugs to treat upper airways

Antihistamines (blocks cough reflex) Decongestants (decrease blood flow & secretions) Antitussives (blocks histamine; increases secretion) Expectorants (increases cough) Mucolytics (liquifies)

Lower respiratory tract conditions

Atelectasis Pneumonia Bronchitis Bronchiectasis Obstructive pulmonary diseases (CF, COPD, RDS)

A nurse caring for a client in the hospital is being discharged today with a prescription for benzonatate (Tessalon Perles) 200 mg one capsule 3 times daily. What would the nurse tell the client about this prescription during discharge counseling? (Select all that apply.)

Benzonatate can cause GI upset and sedation. The client should drink plenty fluids.

Anticholinergic

Blocks parasympathetic nerve impulses -ium Ipratropium Tiotropium Aclidium Umeclidinium

A female client is diagnosed with type 2 diabetes mellitus, hyperlipidemia, and mild hepatic impairment. She presents to the emergency department after taking promethazine, obtained from a friend, for motion sickness. The nurse would expect what adverse effect?

Cholestatic jaundice

The nurse is reviewing a client's morning blood work and notes a theophylline level of 22.2 mcg/mL (123.21 µmol/L). What action should the nurse take?

Contact the care provider and inform him or her that the client has toxic theophylline levels.

The pulmonologist sees many patients daily who suffer from a variety of respiratory disorders. What are some of the common signs and symptoms many of these patients present? (Select all that apply.)

Cough Increased secretions Mucosal congestion

A 27-year-old athlete with newly diagnosed asthma presents for patient education regarding situations that could precipitate an asthma attack. The nurse teaches that acute episodes of asthma may last minutes to hours. In this teaching, which precipitants would the nurse state may cause the asthma? (Select all that apply.)

Exercise Allergens Pollutants

After teaching a group of students about leukotriene receptor antagonists, the instructor determines a need for additional teaching when the students identify which agent as an example?

Fluticasone

Expectorants Adverse Effects

GI symptoms Headache Dizziness Mild rash Prolonged use may result in masking a serious underlying disorder

components of respiratory membrane and gas exchange

Gas exchange occurs at the alveolar level Consists of: capillary endothelium capillary basement membrane interstitial space alveolar basement membrane alveolar epithelium surfactant layer

A group of nursing students are reviewing information about expectorants. The students demonstrate understanding when they identify which medication as an example?

Guaifenesin

Leukotriene Receptor Antagonists adverse effects

Headache, dizziness, myalgia (aching), nausea, diarrhea and abdominal pain, elevated liver enzyme concentrations, vomiting, and generalized pain

The nurse is encouraging a client to cough frequently and complete deep breathing exercises. The nurse knows that many factors can cause a decrease of gas exchange for clients. Based on this information, what factors can cause a decrease in gas exchange? Select all that apply.

Immobility Thoracic/pulmonary surgery Pneumonia

A nurse is describing the events associated with a common cold to a local community group. Which would the nurse include?

Increased activity of the goblet cells

A client with asthma is administered zileuton along with theophylline. The nurse should be especially alert for which of the following?

Increased serum theophylline

Topical Nasal Decongestants Adverse Effects

Local stinging and burning Rebound congestion Sympathomimetic effects

When describing the major control mechanism for the inspiratory muscle contraction, which would be included?

Medulla

A female client calls the pediatrician's office for a suggestion regarding the best over-the-counter cough and cold medicine for her 6-month-old child. The pediatrician advises against the medication for what reason?

Misuse could result in overdose.

The health care provider has ordered promethazine (Phenergan) for a client who is having a severe allergic reaction. The nurse is aware that this medication is also used to treat what condition?

Nausea and vomiting

Oral Decongestants Adverse Effects

Rebound congestion Sympathetic effects

A group of students are reviewing the common conditions associated with the upper respiratory tract. The students demonstrate understanding of the material when they identify what as a response to a specific antigen?

Seasonal rhinitis

inhaled steroids adverse effects

Sore throat Hoarseness Coughing Dry mouth Pharyngeal and laryngeal fungal infections Inhalation: passes through the oral cavities ****doesn't work immediately****

When describing the action of decongestants, a nurse integrates knowledge of this class of drugs, identifying which mechanism?

Vasoconstriction of small blood vessels of the nasal membranes

sneeze reflex

a respiratory action forcing air outward to expel irritants from the nose

Topical Nasal Steroid Decongestants

action: relieves inflammation adverse effects: local burning, irritation, stinging, dryness of mucosa, and headache

sympathomimetic

agent that mimics the effects of the sympathetic nervous system work on Beta 2 receptors

Leukotriene Receptor Antagonists

block leukotriene receptors and prevent the actions of the leukotrienes (useful in the treatment of asthma) -ast or zileuton Zafirlukast Montelukast Zileuton (inhibitor)

Atelectasis

collapsed lung; incomplete expansion of alveoli nor breathing deep enough or due to outside pressure (tumor or blockage)

UPT Conditions

common cold, seasonal rhinitis, sinusitis, pharyngitis and laryngitis

lower respiratory tract

consists of the bronchial tree and lungs

upper respiratory tract

consists of the nose, mouth, pharynx, epiglottis, larynx, and trachea

Oral Decongestants

decrease nasal congestion related to the common cold, sinusitis, and allergic rhinitis Psuedoephedrine (contains ingredient of meth, so not an OTC drug)

Topical Nasal Decongestants

decrease over production of secretions -zoline Oxymetazoline Nasal Spray (Afrin) Phenylephrine Tetrahydrozoline Xylometazoline

Anticholinergic effects

dry mouth, blurred vision, constipation, urinary retention, sore throat, palpitations

Inhaled Steroids

effective treatment for bronchospasm and asthma -son or -sone Beclomethasone Budesonide Ciclesonide Fluticasone Triamcinolone

Expectorants

improve the ability to cough up mucus from the respiratory tract Guaifenesin

Bronchitis

inflammation of the bronchi (inner lining) Chronic Bronchitis is associated with smoking

Pneumonia

inflammation of the lungs adverse effects: chest pain, fatigue, fever, sweating, chills

Antihistamines

inhibit allergic reactions of inflammation, redness, and itching caused by the release of histamine adverse effects: drowsiness and sedation, anticholinergic effects

Mast Cell Stabilizers

inhibit the release of inflammatory chemicals (histamine) from mast cells and make the airways less likely to narrow. WBC system Cromolyn

Mucolytics

liquefy and loosen thick mucous secretions so they can be expectorated Acetylcysteine Dornase alfa Adverse effects: stomatitis (mouth sores) Bronchospasm

chronic obstructive pulmonary disease (COPD)

permanent, destructive pulmonary disorder that is a combination of chronic bronchitis and emphysema often related to cigarette smoking

The respiratory tract conditions incoming air; most of the conditioning is done by the ciliated mucus membrane that lines the entire tract except the:

pharynx. Most of the conditioning is done by the ciliated mucous membrane that lines the entire respiratory tract, except the pharynx and alveoli. The other choices have ciliated mucous membranes.

Antitussives

relieve or suppress coughing by blocking the cough reflex in the medulla of the brain Codeine Hydrocodone ***caution: history of narcotic addiction**

cough reflex

response of the body to clear air passages of foreign substances and mucus by a forceful expiration (CNS reflex)

controls over respiration

through the medulla in the CNS depends on a balance between the sympathetic and parasympathetic systems

Lung Surfactant nursing considerations

time of birth and exact weight endotracheal tube in place