Nursing Application: Bronchodilators

Click on the words/text that indicate an active COPD process not well maintained by current treatment regimens. These would be the findings reported to Jack's healthcare provider when providing a status update and request for medication regimen changes.

*moderate respiratory distress marked by positional breathing and retractions *neck veins are mildly distended *inspiratory and expiratory wheezing

Click on the words/text that indicate that Jack's COPD is a chronic condition. These would be the findings there would be no need report to Jack's healthcare provider when providing a status update and request for medication regimen changes.

*shortness of breath *a chronic cough *productive cough with yellow to brownish sputum for the last few years *Neck veins are mildly distended *Chest is barrel shaped *Lung sounds are equal bilaterally but diminished to mid and lower fields

After giving Jack a nebulizer treatment with albuterol, he complains of feeling "shaky" and a slight tremor in his hands is noticed. His heart rate is 102, which is elevated from what it was prior to the breathing treatment. Based on knowledge of the medications, the nurse understands Jack's reaction can be attributed to which factor?

An expected side effect

Place each drug into the correct class of bronchodilator

Anticholinergic -Ipratropium Beta-Agonist -Albuterol Xanthine Derivative -Theophylline

Identify which theophylline blood level fits into which category.

Standard therapeutic range -10 and 20 mcg/mL Level most clinicians advise -5 to 15 mcg/mL Level at Which Symptoms of Toxicity Usually Occur -≥ 25 mcg/mL

A patient taking theophylline reports drinking 2-3 energy drinks everyday due to low energy. What is an appropriate response by the nurse of those listed below?

"Energy drinks contain a large amount of caffeine which is not good to mix with theophylline."

What health promotion activities will the nurse encourage Jack to complete?

*Stop smoking *Receive the flu and pneumonia vaccine as scheduled

Why is it important a patient either rinses their mouth out or brushes their teeth after using an inhaler? Select all that apply.

*To prevent fungal infections *To prevent dental carries

1. Antagonizes acetylcholine receptors, producing bronchodilation 2. Exact mechanism of action unknown; increases cAMP; antagonizes adenosine receptors 3. Selectively stimulates beta-2 adrenergic receptors, relaxing airway smooth muscle

1. Ipratropium 2. theophylline 3. Albuterol

The nurse is caring for a 19-year-old male patient who has been newly diagnosed with asthma. The following medication order has been prescribed by the healthcare provider. -Albuterol 90mcg 2 puffs as need for shortness of breath -Formoterol 160/4.5 mcg 1 puff bid The nurse is charged with providing medication administration teaching. Please place the instruction steps in chronological order.

1. Wash your hands 2. Exhale completely 3. Administer first puff of albuterol 4. Wait 1-2 minutes 5. Administer second puff of albuterol 6. Wait 2-5 minutes 7. Administer 1 puff of formoterol 8. Brush your teeth

One single, standard dose of theophylline is equivalent to how many cups of coffee?

3

Which of the medications listed should be used for rescue treatments?

Albuterol

Ipratropium, albuterol, and theophylline are all metabolized by which means?

CY450

A patient is hospitalized with a severe exacerbation of chronic obstructive pulmonary disease to receive theophylline intravenously. What therapeutic effect is expected?

Increased ease of breathing

A patient is taking a xanthine derivative as part of treatment for chronic obstructive pulmonary disease. The nurse will monitor for which adverse effects associated with the use of xanthine derivatives?

Palpitations