RSV & Asthma
How long should a patient wait between puffs when using albuterol?
1 minute
Interventions of leukotrienes
Administered orally in the evening Monitor LFTs
Side effects of leukotrienes
Allergic reaction Mood or behavior changes include suicidal ideation Tremors/ shaking Sinus pain Liver damage
A nurse is teaching an adolescent about managing asthma and using a peak flow expiratory flow meter. Which of the following statements by the client demonstrates an understanding of the teaching? A. "I will use my peak flow meter whenever I feel short of breath." B. "I will continue to take my medication when my peak flow rate is in the green zone." C. "I need to use the average of 3 readings when I measure my flow rate." D. "My asthma is being controlled if my flow rate is in the yellow zone."
B. "I will continue to take my medication when my peak flow rate is in the green zone." (This statement by the adolescent indicates an understanding of the teaching. A peak flow rate in the green zone indicates the current treatment has been effective; therefore, the adolescent should continue with their current medication regimen.) Incorrect answers: A. the nurse should instruct the adolescent to use a rescue medication when they feel short of breath because this is a manifestation of an acute attack. C. The nurse should instruct the adolescent to obtain 3 readings and to write down the highest of the 3 readings rather than the average. D. The nurse should inform the adolescent that a flow rate in the yellow indicates inadequate control of asthma.
Routes of administration for specific steroids
Beclomethasone diproproionate (QVAR)- inhalant Flonase-Intranasal Prednisone- Oral Hydrocortisone- IV
Overuse of SABA can cause rebound _______.
Bronchospasm
A nurse is auscultating the lungs of a client who is having an acute asthma attack. Which of the following sounds should the nurse expect to hear? A. Loud bubbling B. Snoring/ rattling C. Noisy wheezing
C. Noisy wheezing (Asthma causes the bronchioles to constrict, creating a wheezing sound.) Incorrect answers: A. loud bubbling or gurgling indicates course crackles, which reflect moisture in the lungs. Crackles are not a manifestion of asthma. B. Snoring or rattling indicates a partial blockage of the airway (rhonchi)
What drinks should patients avoid when taking methylxanthines?
Caffeinated drinks
Side effects of mast cell stabilizers
Throat irritation Coughing Skin rashes Dry rashes
Interventions of methylxanthines
Use with caution in cardiac patients; can cause cardiac stimulation Teach patient to reduce caffeine intake Requires serum theophylline level monitoring *therapeutic range 10-20mcg/mL*
Interventions of mast cell stabilizers
protect medication from moisture and heat
What is the therapeutic response of Methylxanthines?
relax smooth muscles, resulting in bronchodilation and reduced bronchospasm
Normal Heart Rate for Infants
120-160 beats per minute (preterm, neonate, & infants)
Normal Respiration Rate for Infants
30-50 breaths per minute
Normal Systolic Blood Pressure for Infants
60-80 mmHg
A nurse is performing an admission assessment for a client who has asthma and reports several food allergies. Which of the following actions should the nurse take first? A. Document the client's food allergies in the medical record B. Ask the client to identify the specific food allergies C. Monitor the client for indications of anaphylaxis D. Have. epinephrine available for administration
B. Ask the client to identify the specific food allergies
Interventions of steroids
Give oral steroids with meals Monitor blood glucose Monitor for signs of infection Steroid doses must be tapered and should not be stopped abruptly Educate patients to rinse their mouth after using inhaled steroids
Side effects of Beta-2-Agonists
Increased heart rate/ palpitations Increased BP Irritability Nervousness Anxiety Tremors Insomnia
Side effects of steroids
Increased risk of infection Candidiasis (inhaled steroids) Osteoporosis Cataracts Bruising Increased blood sugars Weight gain Fluid retention
Side effects of Theophylline toxicity?
Nausea Vomiting Insomnia Seizures
Therapeutic action of steroids
Reduce inflammation by blocking the action of prostaglandins
Therapeutic action of mast cell stabilizers
Reduce inflammation by preventing the release of histamine
Therapeutic action of leukotrienes
Reduces bronchoconstriction and mucous production
A nurse is caring for a client who has asthma and is prescribed a short-acting beta2-agonist. Which of the following should the nurse identify as the expected outcome of the medication? A. Reduces frequency of attacks B. Reverses bronchospasm C. Prevents inflammation D. Decreases chronic manifestions
B. Reverses bronchospasm The nurse should identify that the expected outcome of SABA is the reversal of bronchospasm. They bind to beta2-adrenergic receptors in the lungs, resulting in the relaxation of the bronchial smooth muscles. Although, overuse of this medication can CAUSE bronchospasm.
A nurse is providing teaching to a mother whose 5-month-old has been having RSV symptoms for 2 days. Which of the following is an appropriate statement about the child's condition? A. Your child should start to feel better after 4 days of symptoms. B. Your child will likely start to worsen in the next couple of days C. I'm glad you came to hospital. We'll take the best care of your child. D. Have you also been having symptoms?
B. Your child will likely start to worsen in the next couple of days (RSV symptoms are typically their worst on days 3-5)
Client 1 6 months old Temp 98.7 HR 170 RR 60 Oxygen saturation 90% Mild intercostal & substernal retractions, Nasal flaring Nasal cannula @ 2 L/min Client 2 9 months old Temp 99.2 HR 145 RR 60 Oxygen saturation 90% Belly breathing, mild subcostal retractions High flow nasal cannula @ 7 L / 40% You are a nurse in a Pediatric ICU. Which of the following patients would you see first?
Client 1: Increased work of breathing starts from least priority to highest: Tachypnea Accessory Muscle Use Belly Breathing Retractions Grunting Nasal Flaring Head Bobbing
Side effects of Anticholinergics
Dry mouth Bitter taste Mucosal ulcers Headache Blurred Vision Urinary Retention
A nurse is providing teaching to a client with asthma who has a new prescription for a short acting beta2-agonist (SABA) bronchodilator. Which of the following pieces of information should the nurse share? A. The SABA will provide prolonged control of asthma attacks B. SABAs are also available in an oral form C. The SABA will have to be taken with an inhaled glucocorticoid D. Notify the provider if the SABA is needed more than twice per week
SABA bronchodilators are used as a PRN rescue medication to stop ongoing asthma attacks. If the client requires the SABA more than 2x/week, the provider should be notified because a prescription for a LABA might be required. Using a SABA more than 2x/week can lead to serious adverse effects.
