Chapter 33 Therapy for asthma, airway inflammation and bronchoconstriction PrepU
The nurse has finished teaching a 15-year-old client how to use an inhaler to treat asthma. What statement by the client suggests an understanding of the teaching? A."I should take a deep breath, hold it while I administer the medication, and then exhale." B. "I need to shake the inhaler well before taking the medication." C. "I need to take three short, quick breaths to inhale the medication." D. "I need to wait at least 30 minutes after the first inhalation before taking a second."
"I need to shake the inhaler well before taking the medication." Just before each use, the client should shake the inhaler well. After shaking, proper technique involves exhaling before placing the inhaler in the mouth; taking a slow, deep breath while delivering the medication into the mouth; and holding the breath for approximately ten seconds before exhaling slowly. A subsequent dose can be administered within a few minutes of the first.
A patient tells you that her friend has recommended using caffeine to treat her asthma. How would you appropriately respond to this patient? "Caffeine is a bronchodilator, so it might help to use it along with your prescription medications." "Your friend doesn't know what he's talking about. Caffeine doesn't treat any symptoms of asthma." "You could try replacing your medications with caffeine for a while, but you should switch back if it doesn't seem to work as well." "Prescription drugs have been proven effective in treating asthma, and caffeine hasn't been. Since uncontrolled asthma can be deadly, I wouldn't recommend that you switch from your medications to caffeine."
"Prescription drugs have been proven effective in treating asthma, and caffeine hasn't been. Since uncontrolled asthma can be deadly, I wouldn't recommend that you switch from your medications to caffeine." Since, in general, herbal and dietary therapies in asthma have not been studied in controlled clinical trials, they are unproven and should be avoided. Because asthma can result in death in a matter of minutes, patients should be counseled not to use dietary or herbal supplements in place of prescribed bronchodilating and anti-inflammatory medications. Although caffeine is a mild bronchodilator, combining it with bronchodilating drugs can increase the adverse effects of those drugs.
During the summer, a female client experiences increased periods of acute symptoms of her asthma. The health care provider increases the dose frequency of which of her medications? Epinephrine Omalizumab Salmeterol Albuterol TAKE ANOTHER QUIZ
Albuterol Albuterol is the initial drug of choice for acute bronchospasm.
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 Formoterol Salmeterol Arformoterol
Albuterol Albuterol is a SABA. Formoterol, salmeterol, and arformoterol are all long-acting beta-2 agonists.
Mr. Ashum is prescribed an albuterol inhaler as part of his treatment regimen for asthma. What is the mechanism of action for this medication? Albuterol causes stimulation of the bronchial tissue. Albuterol blocks the stimulation of the beta-2 receptors. Albuterol decreases vital capacity. Albuterol causes relaxation of the bronchial smooth muscles.
Albuterol causes relaxation of the bronchial smooth muscles. The main result of albuterol binding to beta-2 receptors in the lungs is relaxation of bronchial smooth muscles. This relaxation of bronchial smooth muscle relieves bronchospasm, reduces airway resistance, facilitates mucous drainage, and increases vital capacity.
The client has been diagnosed with asthma and is being treated with two inhalers, albuterol and flunisolide. The nurse teaches the client that the two medications should be administered in what order? Flunisolide first, wait five minutes and then follow with albuterol Albuterol first, wait five minutes and then follow with flunisolide Flunisolide followed immediately by albuterol Albuterol followed immediately by flunisolide
Albuterol first, wait five minutes and then follow with flunisolide Albuterol is a bronchodilator and should be used first, given time to open the airways, and then the inhaled corticosteroid is administered.
A nurse cares for several clients who have asthma. Which client should the nurse monitor most closely because of a heightened risk for asthma-related death? An Asian American client with a history of cigarette smoking A 17-year-old client who experiences exercise-induced asthma a 76-year-old client who takes theophylline An African American client taking salmeterol
An African American client taking salmeterol Salmeterol has a black box warning addressing a small but significant increase in the risk of life-threatening asthma episodes in patients using salmeterol. This is based on a study that showed African American clients had a greater risk of asthma-related deaths than did other groups. For this reason, an African American client taking salmeterol likely has a higher risk than the other listed clients.
A client is prescribed a leukotriene receptor antagonist. The nurse should evaluate the effectiveness of the medication therapy based on the long term management of symptoms associated with which respiratory condition? Asthma Emphysema Chronic bronchitis Pneumonia
Asthma Leukotriene receptor antagonists block or antagonize receptors for the production of leukotrienes D4 and E4, thus blocking many of the signs and symptoms of asthma. This class of medication is not typically associated with the long term management of any of the other options.
Chronic obstructive pulmonary disease (COPD) encompasses which of the following? Select all that apply: Asthma Pulmonary embolism Pulmonary hypertension Chronic bronchitis Pneumonia
Asthma Chronic bronchitis COPD encompasses asthma, chronic bronchitis, chronic obstructive bronchitis, emphysema, or a combination of the conditions.
A client is experiencing an acute asthmatic attack. Which agent would be most effective? Inhaled steroid Leukotriene receptor antagonist Mast cell stabilizer Beta-2 selective adrenergic agonist
Beta-2 selective adrenergic agonist A beta-2 selective adrenergic agonist or sympathomimetic would be most appropriate because these agents are rapidly distributed after injection and rapidly absorbed after inhalation. An inhaled steroid would require 2 to 3 weeks to reach effective levels. Leukotriene receptor antagonists and mast cell stabilizers do not have immediate effects.
A client arrives in the emergency room with an attack of acute bronchiectasis. What is the principal pathologic finding in the diagnosis of bronchiectasis? Increase in the red blood cell concentration in the blood Leakage of fluid into the alveolar interstitial spaces Chronic, irreversible dilation of the bronchi and bronchioles Obstruction of the pulmonary vasculature by a clot
Chronic, irreversible dilation of the bronchi and bronchioles Bronchiectasis is a chronic disease that involves the bronchi and bronchioles. It is characterized by dilation of the bronchial tree, chronic infection, and inflammation of the bronchial passages. It is not caused by increased red blood cell concentration in the blood, leakage of fluid into the alveolar interstitial spaces, or the obstruction of the pulmonary vasculature by a clot.
A nurse would expect to increase the dosage of theophylline if the client has a current history of which of the following? Hyperthyroidism Cigarette smoking Gastrointestinal upset Alcohol intake
Cigarette smoking Nicotine increases the metabolism of xanthines; therefore, an increased dosage would be necessary. Hyperthyroidism, gastrointestinal, upset or alcohol intake requires cautious use of the drug because these conditions may be exacerbated by the systemic effects of the drug. The drug dosage may need to be decreased in these situations.
The nurse is monitoring a premature infant diagnosed with respiratory distress syndrome (RDS). Which assessment finding will serve to demonstrate that the instillation of surfactant as a treatment has been effective? Return of cough reflex Body temperature within normal range Clear breath sounds Infant is interested in surroundings
Clear breath sounds Treatment is aimed at instilling surfactant to prevent atelectasis and to allow the lungs to expand. The absence of any abnormal breath sounds would indicate proper expansion of the alveoli. None of the other options are directly associated with the resolution of the collapsed alveoli.
A nurse is providing discharge planning for a 45-year-old woman who has a prescription for oral albuterol. The nurse will question the patient about her intake of which of the following? Coffee Alcohol Salt Vitamin C
Coffee The nurse should assess the patient's intake of caffeine, including coffee, tea, soda, cocoa, candy, and chocolate. Caffeine has sympathomimetic effects that may increase the risk for adverse effects. Alcohol, salt, and vitamin C intake is important to assess, but does not potentiate the effects of albuterol.
Shane, a 25-year-old man, is diagnosed with asthma. He began an albuterol MDI 2 weeks ago. He reports that his symptoms persist in spite of using albuterol MDI as prescribed. What advice should the nurse give the client? Contact the health care provider to obtain an increased dosage of albuterol. Contact the health care provider to obtain adjunctive medications. Use the MDI more often. Clean the MDI thoroughly on a regular basis.
Contact the health care provider to obtain adjunctive medications. Explain to the client the importance of administering the drug as prescribed and encourage consultation with the health care provider if the symptoms do not abate with the recommended therapy. Using the MDI more frequently than recommended can result in rebound bronchoconstriction, which may motivate the client to increase MDI use, stimulating the cycle of rebound. This practice is not recommended.
A client with asthma has been prescribed an anti-inflammatory medication. How does an anti-inflammatory drug reduce this client's bronchoconstriction? Increasing ability to metabolize medication Decreases formation of mucus secretions Increasing uptake of corticosteroids to medication Decreasing airway hyperreactivity to stimuli
Decreasing airway hyperreactivity to stimuli Bronchodilators, or antiasthmatics, are medications used to facilitate respirations by dilating the airways. They are helpful in symptomatic relief or prevention of bronchial asthma and for bronchospasm associated with chronic obstructive pulmonary disease (COPD). Reducing inflammation prevents and reduces bronchoconstriction by decreasing airway hyperreactivity to various stimuli that decreases mucosal edema and formation of mucus secretions that narrow airways. Anti-inflammatory drugs do not increase the ability to metabolize medication or increase uptake of steroids.
A client who has been admitted to the healthcare center has been diagnosed with emphysema. The arterial blood gas results reveal respiratory acidosis. Based on this information, what should the nurse explain to the client that is the cause of the respiratory acidosis? Too little carbon dioxide in the blood Presence of food in the respiratory passage Excess carbon dioxide in the blood Inflammation of the pleura
Excess carbon dioxide in the blood If a person has a breathing disorder, carbon dioxide can build up in the body, dangerously lowering the blood pH. This condition, called respiratory acidosis, can be caused by disorders, such as emphysema, severe pneumonia, asthma, and pulmonary edema. Too little carbon dioxide in the blood is called respiratory alkalosis. Coughing and sneezing are protective reflexes needed to dislodge materials from the respiratory passages. Pleurisy is an inflammation of the pleura caused by infection, injury, or tumor.
A nurse is providing health education to a client recently diagnosed with asthma and prescribed albuterol and ipratropium. Which of the client's statements suggests a need for clarification by the nurse? "I'll try to make sure that I drink plenty of fluids each day." I'll keep taking my medications until I'm not experiencing any more symptoms." "I'll make sure I don't take my inhalers more often than they've been prescribed." "I'm a heavy coffee drinker, but I know that I now know I need to cut down on this."
I'll keep taking my medications until I'm not experiencing any more symptoms." Antiasthma medications should normally be taken on a regular schedule, not solely based on immediate symptoms. They should not be discontinued in the absence of symptoms. Increasing fluid intake, limiting caffeine, and adhering to the administration schedule are correct actions.
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 temperature Increased secretions Mucosal congestion
Increased secretions Mucosal congestion Cough Common signs and symptoms of respiratory disorders include cough, increased secretions, mucosal congestion, and bronchospasm. Increased temperature is not common among respiratory disorders unless infection is involved.
The nurse is caring for a client with chronic obstructive pulmonary disease. The plan of care will focus on what client problem? Risk for aspiration Lack of patent airway Activity intolerance Adverse effects of medication therapy
Lack of patent airway Asthma, emphysema, chronic obstructive pulmonary disease (COPD), and respiratory distress syndrome (RDS) are pulmonary obstructive diseases. All but RDS involve obstruction of the major airways. RDS obstructs the alveoli. Pain, activity intolerance, and adverse effects of medication therapy are conditions identified to detect, manage, and minimize the unexpected outcomes the nurse should be especially aware of the potential for an obstructed airway in these clients.
Which medication is used to treat acute airflow obstruction? Metaproterenol Beclomethasone Montelukast Azelastine
Metaproterenol Metaproterenol is a short-acting beta-2 agonist used as a quick-relief medication. Beclomethasone is an inhaled corticosteroid used as a long-term control medication. Montelukast is a leukotriene antagonist used for prophylactic treatment of chronic asthma. Azelastine is a second-generation antihistamine.
The nurse is monitoring the serum theophylline level in a client who is taking the drug. The most recent result reveals a level of 18 mcg/mL. Which adverse effects would the nurse expect to find? Select all that apply. Nausea Diarrhea Headache loss of appetite Convulsions
Nausea Diarrhea Headache loss of appetite The therapeutic range for theophylline is 5-15 mcg/mL. Findings associated with theophylline levels between 15 and 20 mcg/mL include anorexia, nausea, vomiting, diarrhea, headache, and insomnia. Convulsions would be associated with theophylline levels over 20 mcg/mL.
A nurse is caring for a client with chronic bronchiectasis. The nurse should assess the patient for which clinical manifestation? Purulent cough Angina Pigeon chest Pulmonary hypertension
Purulent cough Clients present with the signs and symptoms of acute infection, including fever, malaise, myalgia, arthralgia, and a purulent, productive cough. A client with bronchiectasis would not present with pulmonary hypertension, chest deformity, or chest pain related to lack of oxygen to the heart.
A 42-year-old male client has a history of smoking for 20 years. The client states he is feeling fine and asks why stopping smoking is necessary. What information might the nurse share with the client about smoking? Smoking decreases the size of the tubes leading to the lungs The chest becomes more elastic with increased time of smoking Carbon dioxide levels may decrease in the lungs Smoking causes the respiratory system to increase oxygen delivery to the lungs
Smoking decreases the size of the tubes leading to the lungs Smoking can decrease the efficiency of the respiratory system. Nicotine causes a decrease in bronchial diameter, constriction of blood vessels, a decrease in ciliary function (which assists in moving foreign particles out of the respiratory tract), and can destroy lung tissue over time. These factors can all result in a decrease in gas exchange. In addition, many tobacco products contain substances (e.g., tars) that can build up in the lungs. The chest does not become more elastic with increased time of smoking; instead, it loses elasticity and becomes stiffer. Thus, the lungs cannot expand, and the change in the ratio of pressure of oxygen and carbon dioxide in the lungs is the effect of aging on the respiratory system.
A client is experiencing an episode of status asthmaticus. What is the primary challenge facing the staff as they attempt to manage the client's respiratory crisis? The bronchospasm does not respond to usual treatment measures There is an unusually large amount of thick secretions in the airways The client's underlying medical condition complicates treatment The client's lungs are reacting to multiple allergens at once
The bronchospasm does not respond to usual treatment measures An extreme case of asthma is called status asthmaticus; this is a life- threatening bronchospasm that does not respond to usual treatment and occludes airflow into the lungs. Status asthmaticus is not associated with thick secretions or underlying medical conditions. While the crisis may have been initially triggered by exposure to allergens, it is the ineffectiveness of usual treatment that poses the greatest problem.
What action by the client would indicate that the client understands how to use an inhaler? The client inhales as soon as the inhaler enters his or her mouth. The client holds his or her breath for several seconds after compressing the canister. The client uses a spacer to administer a powdered medication. The client exhales as soon as he or she compresses the inhaler
The client holds his or her breath for several seconds after compressing the canister. Holding the breath prevents exhalation of medication still remaining in the mouth. The client should inhale when the canister is compressed, not as soon as the inhaler enters his or her mouth. The client should only administer one dose of medication at a time, and the client should wait to exhale until after the breath has been held as long as possible. Spacers are not used with powdered medications.
Why are inhaled steroids used to treat asthma and COPD? They act locally to decrease release of inflammatory mediators They act locally to improve mobilization of edema They act locally to increase histamine release They act locally to decrease histamine release
They act locally to decrease release of inflammatory mediators When administered into the lungs by inhalation, steroids decrease the effectiveness of the inflammatory cells. This has two effects, which are decreased swelling associated with inflammation and promotion of beta-adrenergic receptor activity, that may promote smooth muscle relaxation and inhibit bronchoconstriction.
Respiratory symptoms are treated with many types of drugs, including anti-inflammatory agents. analgesics. bronchoconstrictors. histamines.
anti-inflammatory agents. Frandsen, Geralyn, & Smith Pennington, Sandra, Abrams' Clinical Drug Therapy: Rationales for Nursing Practice, 12th ed., Philadelphia, Wolters Kluwer, 2021, Chapter 33: Drug Therapy for Asthma, Airway Inflammation, and Bronchoconstriction, OVERVIEW OF ASTHMA, p. 654.
A client has been prescribed medication therapy for the treatment of newly diagnosed asthma. During teaching, the nurse should alert the client to potential exacerbation of what concurrent medical condition? gastroesophageal reflux disease urinary retention dermatitis cataracts
gastroesophageal reflux disease Asthma may aggravate gastroesophageal reflux disease because antiasthma medications that dilate the airways also relax muscle tone in the gastroesophageal sphincter and may increase acid reflux. The relationship between asthma medications and the other options is not supported by research data.
A nurse is providing education to a 56-year-old man who is admitted to the emergency department with an acute asthma attack. The nurse's initial assessment reveals that the patient has a history of pneumonia, drinks large quantities of coffee, and eats a high-calorie diet. Albuterol is prescribed for him. The important consideration when the nurse is preparing a teaching plan will be that the patient is a 56-year-old man. has a history of pneumonia. prefers a high-calorie diet. has a high coffee intake.
has a high coffee intake. Caffeine has sympathomimetic effects that may increase the risk for adverse effects with albuterol. The nurse should assess the patient's intake of caffeine through coffee, tea, soda, cocoa, candy, and chocolate. The patient's age, history of pneumonia, and preference for high-calorie food would not have important implications for his albuterol drug therapy.
A client has been diagnosed with chronic obstructive pulmonary disease. The client has been prescribed bronchodilators by nebulizer for home use. The nurse should teach the client to: keep an extra oxygen tank on hand for propelling the medication. sit in a fully upright position when administering the medication. take the exact number of puffs that have been prescribed. gargle with an alcohol-based mouthwash after each dose.
sit in a fully upright position when administering the medication. Clients should sit in the Fowler position when inhaling nebulized medications. Compressed air (not oxygen) is used. Inhalers require a prescribed number of "puffs," not nebulizers. The client should rinse his or her mouth after administration, but an alcohol-based solution is not necessary.
