Asthma and COPD Management Quiz
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Questions and Answers

What is the primary mechanism by which beta2 adrenergic agonists alleviate bronchospasm?

  • Inhibiting histamine release
  • Increasing ciliary motility
  • Activating alpha1 receptors in the heart
  • Activating beta2 receptors in bronchial smooth muscle (correct)

    • Which medication is categorized as a Short-Acting Beta2 Agonist (SABA)?

  • Formoterol
  • Aformoterol
  • Salmeterol
  • Albuterol (correct)

    • What common side effect should be monitored when a patient is on oral beta2 adrenergic agonists?

  • Increased ciliary motility
  • Bronchospasm
  • Inhibited histamine release
  • Tachycardia (correct)

    • Which of the following medications is primarily indicated for long-term control of asthma?

    <p>Formoterol</p> Signup and view all the answers

    What should nursing actions include when monitoring a patient on beta2 adrenergic agonists?

    <p>Check pulse for significant increases and report accordingly</p> Signup and view all the answers

    What is the primary expected therapeutic action of theophylline?

    <p>Bronchodilation through relaxation of bronchial smooth muscle</p> Signup and view all the answers

    Which medication is contraindicated for clients with tachydysrhythmia?

    <p>Long-acting beta2 agonists</p> Signup and view all the answers

    Which side effect is most commonly associated with moderate to severe toxicity of theophylline?

    <p>Dysrhythmias and seizures</p> Signup and view all the answers

    What is a potential complication associated with the use of beclomethasone?

    <p>Hoarseness</p> Signup and view all the answers

    What should be advised regarding the use of beta-adrenergic blockers in conjunction with beta2 agonists?

    <p>They should not be used concurrently as they negate effects.</p> Signup and view all the answers

    What should clients be instructed to do to manage dry mouth as a side effect of inhaled anticholinergics?

    <p>Suck on sugar-free hard candies and sip fluids</p> Signup and view all the answers

    What is the appropriate nursing action for a client taking oral glucocorticoids for 10 days or longer?

    <p>Monitor for signs of adrenal suppression</p> Signup and view all the answers

    When educating a patient who is prescribed prednisone, which statement is crucial to convey?

    <p>Nystatin is used to treat candidiasis</p> Signup and view all the answers

    In what situation is it essential to increase oral or IV glucocorticoid dosages?

    <p>When experiencing a respiratory infection</p> Signup and view all the answers

    Which of the following medications is contraindicated in clients who have systemic fungal infections?

    <p>Prednisone</p> Signup and view all the answers

    Which leukotriene modifier is indicated for use in children as young as 12 months?

    <p>Montelukast</p> Signup and view all the answers

    What complication is most commonly associated with montelukast usage?

    <p>Depression and suicidal ideation</p> Signup and view all the answers

    What is the primary nursing action when a patient is prescribed zileuton?

    <p>Obtain baseline liver function tests and monitor periodically</p> Signup and view all the answers

    Which medication can cause respiratory depression in newborns if used during pregnancy?

    <p>Hydrocodone</p> Signup and view all the answers

    What precaution should be taken when administering montelukast for exercise-induced bronchospasm?

    <p>Administer 2 hours before exercise</p> Signup and view all the answers

    What characteristic allows Mycobacterium tuberculosis to remain undetected in the body for extended periods?

    <p>Formation of a fibrotic capsule</p> Signup and view all the answers

    Which symptom is commonly associated with active tuberculosis infection?

    <p>Persistent cough</p> Signup and view all the answers

    What is the primary strategy to reduce the risk of tuberculosis transmission in an infected individual?

    <p>Antituberculin therapy for 2 to 3 weeks</p> Signup and view all the answers

    Who should be prioritized for tuberculosis screening?

    <p>Family members of infected individuals</p> Signup and view all the answers

    Which of the following statements is accurate regarding latent tuberculosis?

    <p>Individuals with this condition have Mycobacterium tuberculosis present but are asymptomatic.</p> Signup and view all the answers

    Which of the following risk factors significantly increases the likelihood of developing tuberculosis (TB)?

    <p>Living in a poorly ventilated, crowded environment</p> Signup and view all the answers

    What laboratory test is the most rapid and accurate screening tool for confirming the presence of Mycobacterium tuberculosis?

    <p>QuantiFERON-TB Gold test</p> Signup and view all the answers

    Which symptom is NOT commonly associated with tuberculosis in older adults?

    <p>Severe chest pain</p> Signup and view all the answers

    What is the primary action required when obtaining sputum samples for TB testing?

    <p>Samples must be collected in a negative airflow room</p> Signup and view all the answers

    Which statement accurately reflects the purpose of the Mantoux test in TB evaluation?

    <p>It assesses the immune response to TB exposure.</p> Signup and view all the answers

    What is the role of surfactant in the alveoli?

    <p>It reduces the surface tension to prevent alveolar collapse.</p> Signup and view all the answers

    Which nerve is primarily responsible for the inspiration process?

    <p>Phrenic nerve</p> Signup and view all the answers

    What change occurs to the diaphragm during inspiration?

    <p>It contracts and descends into the abdominal cavity.</p> Signup and view all the answers

    Which of the following procedures requires a client to be NPO before the examination?

    <p>Laryngoscopy</p> Signup and view all the answers

    What is a critical consideration before collecting a sputum specimen for culture and sensitivity testing?

    <p>Check institutional policies for the collection methods.</p> Signup and view all the answers

    Which option is a primary function of the respiratory system?

    <p>Removes carbon dioxide, the waste product of metabolism</p> Signup and view all the answers

    What role does the epiglottis play during swallowing?

    <p>Closes over the glottis to prevent food from entering the tracheobronchial tree</p> Signup and view all the answers

    Which statement accurately describes the bronchioles?

    <p>Branch from secondary bronchi and contain no cilia</p> Signup and view all the answers

    Which function is NOT a secondary function of the respiratory system?

    <p>Removes carbon dioxide</p> Signup and view all the answers

    What is the primary purpose of the alveoli in the respiratory system?

    <p>Act as the basic units for gas exchange</p> Signup and view all the answers

    Which of the following anticoagulants requires routine monitoring of PT and INR to adjust dosing?

    <p>Warfarin sodium</p> Signup and view all the answers

    What is the recommended therapeutic INR range for standard warfarin therapy?

    <p>2 to 3</p> Signup and view all the answers

    Which of the following medications is considered a direct thrombin inhibitor?

    <p>Dabigatran etexilate</p> Signup and view all the answers

    Why is it crucial to monitor vital signs when administering thrombolytic medications?

    <p>To monitor for potential bleeding complications</p> Signup and view all the answers

    Which of the following is an appropriate intervention for a client on anticoagulants?

    <p>Monitoring and advising on bleeding precautions</p> Signup and view all the answers

    What is the main therapeutic effect of anticoagulants?

    <p>They inhibit factors in the clotting cascade.</p> Signup and view all the answers

    Which condition is a contraindication for anticoagulant therapy?

    <p>Active bleeding</p> Signup and view all the answers

    What does the normal activated partial thromboplastin time (aPTT) range indicate?

    <p>The baseline level of clotting function.</p> Signup and view all the answers

    Which of the following interventions should be performed when a client is receiving heparin therapy?

    <p>Regularly check platelet counts.</p> Signup and view all the answers

    What is the appropriate administration technique for subcutaneous heparin injections?

    <p>Administer at a 90-degree angle in the abdomen.</p> Signup and view all the answers

    Which mechanism describes the action of antiplatelet medications in the cardiovascular system?

    <p>They prevent the aggregation of platelets, prolonging bleeding time.</p> Signup and view all the answers

    What is a necessary intervention when administering positive inotropic medications?

    <p>Constantly monitor the client's blood pressure and heart rate.</p> Signup and view all the answers

    Which of the following side effects is most closely associated with digoxin therapy?

    <p>Visual disturbances such as yellow vision.</p> Signup and view all the answers

    In what scenarios should a client be cautious when using cardiac glycosides?

    <p>In the presence of renal disease or electrolyte imbalances.</p> Signup and view all the answers

    Which of the following conditions is a contraindication for the use of antiplatelet medications?

    <p>History of gastrointestinal bleeding disorders.</p> Signup and view all the answers

    Study Notes

    Asthma Overview

    • Asthma is a chronic inflammatory disorder affecting airways, leading to intermittent and reversible airflow obstruction.
    • Obstruction results from inflammation or hyper-responsiveness, causing bronchoconstriction.

    Medication Management

    • Medications target both inflammation and bronchoconstriction, also applicable in chronic obstructive pulmonary disease (COPD).
    • Key medication classes include bronchodilators, methylxanthines, inhaled anticholinergics, and anti-inflammatory agents (e.g., glucocorticoids).

    Bronchodilator Agents

    • Types: Beta2-adrenergic agonists categorized into Short-Acting (SABAs) and Long-Acting (LABAs).
    • SABAs (acute relief):
      • Albuterol, Ephedrine, Epinephrine, Levalbuterol, Metaproterenol, Terbutaline.
    • LABAs (long-term control):
      • Aformoterol, Formoterol, Idacaterol, Salmeterol (select prototypes).

    Expected Pharmacological Actions

    • Beta2 agonists activate beta2 receptors in bronchial smooth muscle, leading to bronchodilation.
    • Effects include relief from bronchospasm, inhibition of histamine release, and enhanced ciliary motility.

    Route of Administration & Therapeutic Uses

    • SABAs: Inhaled for acute relief; oral for long-term control.
    • LABAs: Inhaled for long-term management.

    Complications of Beta2 Agonists

    • Common adverse effects: Tachycardia and angina from alpha1 receptor stimulation.
    • Other effects include tremors from beta2 stimulation in muscle tissue.
    • Contraindications: Not safe in pregnancy/lactation; use caution in clients with heart disease, diabetes, etc.

    Methylxanthines

    • Prototype Medication: Theophylline.
    • Expected Action: Relaxes bronchial smooth muscle; fewer used now due to safety concerns of newer drugs.
    • Therapeutic Use: Long-term control of asthma/COPD, administered orally or IV.

    Inhaled Anticholinergics

    • Prototype Medications: Ipratropium (short-acting), Tiotropium (long-acting).
    • Function: Blocks muscarinic receptors leading to bronchodilation for COPD and asthma relief.

    Glucocorticoids

    • Prototype Inhaled: Beclomethasone; Oral: Prednisone.
    • Action: Prevent inflammation, reduce mucus production, enhance beta2 responsiveness.
    • Used for long-term asthma control and acute management.

    Common Side Effects of Glucocorticoids

    • Risk of difficulty speaking, hoarseness, oral candidiasis; rinse mouth post-inhalation.
    • Long-term use can lead to adrenal suppression, weight gain, and increased appetite.

    Leukotriene Modifiers

    • Prototype Medication: Zafirlukast; alternatives include Montelukast and Zileuton.
    • Action: Reduces inflammation and bronchoconstriction.
    • Therapeutic Use: Long-term asthma therapy, especially in children.

    Antitussives

    • Opioid Prototype: Hydrocodone; Non-Opioid Prototype: Dextromethorphan.
    • Opioids suppress cough by central nervous system action; adverse effects include dizziness and respiratory depression.
    • Non-opioids have fewer effects but can cause mild sedation or nausea; potential for high-dose abuse exists.

    Key Nursing Actions & Education

    • For all medication types, monitor for adverse effects, educate on dosage, and ensure correct inhaler technique.
    • Advise on identifying asthma exacerbation indicators; maintain a symptom log.
    • Emphasize dietary considerations and lifestyle modifications like weight-bearing exercises and avoiding triggers.### Contraindications and Precautions
    • Dextromethorphan is safe during pregnancy; safety of Diphenhydramine is not established.
    • Caution advised with Dextromethorphan and contraindicated for Diphenhydramine during lactation.
    • Beware of high fever risk with concurrent MAOI antidepressant usage.

    Nursing Administration

    • Medications may contain alcohol and/or sucrose.
    • Available in various forms: capsules, lozenges (age >12), liquids, and syrups.
    • Effectiveness assessed by reduced coughing episodes.

    Expectorants: Guaifenesin

    • Guaifenesin increases cough production by thinning mucus; take with a full glass of water.
    • Common uses: treating colds and cough from respiratory disorders, often combined with antitussives or decongestants.
    • Complications include gastrointestinal upset, drowsiness, allergic reactions (e.g., rash).

    Complications of Guaifenesin

    • Use with caution in asthma patients due to possible bronchospasm.
    • Safety of Guaifenesin in pregnancy and lactation is not established.
    • Client education: take with food to mitigate GI upset; report rash or allergy symptoms.

    Mucolytics: Acetylcysteine

    • Used for thinning respiratory secretions; acts as an antidote for acetaminophen poisoning.
    • Complications: aspiration risk, dizziness, hepatotoxicity, monitor vital signs and liver function.
    • Safety in pregnancy and lactation is not established; use caution in specific medical conditions (e.g., asthma, renal disease).

    Decongestants: Phenylephrine and Others

    • Sympathomimetic decongestants alleviate nasal inflammation; effective for allergies and sinusitis.
    • Complications include rebound congestion (limited to 3-5 days use), CNS stimulation, and vasoconstriction effects.
    • Contraindicated in clients with closed-angle glaucoma and used cautiously in coronary artery disease.

    Antihistamines

    • Two generations: First (Diphenhydramine, Promethazine) cause sedation; Second (Loratadine, Cetirizine) have fewer sedative effects.
    • Therapeutic uses: allergic reactions, anaphylaxis, motion sickness, and insomnia management.
    • Common complications: sedation, anticholinergic effects (dry mouth, constipation), potential acute toxicity in children.

    Nasal Glucocorticoids: Mometasone

    • First-line treatment for allergic rhinitis; reduces inflammation and nasal congestion.
    • Common complications: sore throat, nosebleeds, headache; contact provider for persistent symptoms.
    • Client education: administer daily for maximum efficacy; may take time for effect.

    Diagnostic Procedures for Respiratory Status

    • Pulmonary Function Tests (PFTs): Evaluate lung function and breathing difficulties; important for diagnosing lung diseases, withholding inhalers before testing.
    • Arterial Blood Gases (ABGs): Indicate oxygenation and acid-base balance; obtained via arterial puncture, monitor vital signs and perform Allen’s test pre-procedure.
    • Bronchoscopy: Visualizes respiratory structures for diagnosing and treating various lung conditions; requires consent and NPO status prior to the procedure.

    Evaluation of Medication Effectiveness

    • Effectiveness indicated by improved cough productivity, decreased chest congestion, and respiratory diagnostic results reflecting normal function.### Post-Procedure Nursing Actions
    • Continuously monitor vital signs: respirations, blood pressure, pulse oximetry, heart rate, and level of consciousness.
    • Recognize that older adults may experience confusion or lethargy post-medication during bronchoscopy.
    • Assess gag reflex and swallowing ability before resuming oral intake to ensure safety.
    • Wait for cough and gag reflex to return; older adults may have a slower recovery due to local anesthesia effects.
    • Start oral intake with ice chips and progress to fluids after gag reflex restoration.
    • Monitor for fever, productive cough, hemoptysis, and signs of hypoxemia; mild fever <24hr is expected.
    • Prepare for interventions in unexpected responses, such as aspiration or laryngospasm.
    • Provide oral hygiene; encourage coughing and deep breathing every 2 hours for older adult clients.
    • Increased infection risk in older adults due to decreased cough effectiveness and secretion clearance.

    Complications of Bronchoscopy

    • Laryngospasm: Uncontrolled contractions of laryngeal cords, monitor respiratory distress, and have resuscitation equipment ready.
    • Pneumothorax: May occur after a rigid bronchoscopy; monitor breath sounds, oxygen saturation, and follow up with a chest x-ray.
    • Aspiration: Withhold oral intake until the gag reflex returns typically within 2 hours; perform suctioning as necessary.

    Thoracentesis

    • Definition: Surgical perforation of chest wall to obtain specimens, administer medication, or remove fluid/air from pleural space.
    • Indications: Diagnosing pleural effusion causes, empyema, pneumonia, and trauma from injuries or procedures.
    • Client Presentation: Pain, shortness of breath, cough, abnormal breath sounds, dull percussion sounds, decreased chest wall expansion.

    Interpreting Aspirated Fluid

    • Analyze for appearance, cell counts, protein/glucose content, enzymes (LDH, amylase), and culture for abnormalities.

    Preprocedure Considerations for Thoracentesis

    • Ensure informed consent is signed; assess the client’s allergies to anesthesia.
    • Position client upright, support arms and shoulders, and ensure comfort.
    • Obtain pre-procedure x-ray to mark needle insertion site.

    Intraprocedure Nursing Actions for Thoracentesis

    • Assist in maintaining sterile techniques, monitor vital signs and oxygen saturation, and record fluid removal amounts.
    • Limit fluid removal to 1 L at once to prevent re-expansion pulmonary edema.

    Postprocedure Nursing Actions for Thoracentesis

    • Dress the puncture site, check for bleeding/drainage, and monitor vitals and respiratory status hourly.
    • Encourage deep breathing to assist lung expansion and obtain follow-up chest x-ray for effusion resolution.
    • Mediastinal shift: Shift of thoracic structures; monitor vitals and lung sounds.
    • Pneumothorax: Watch for diminished breath sounds, respiratory distress, and use post-procedure chest x-ray to assess.
    • Bleeding: Monitor for hemoptysis; assess thoracentesis site and vital signs for signs of bleeding.
    • Infection: Maintain sterile technique and monitor temperature.

    Chest Tube Management

    • Chest tubes drain fluid, blood, or air from pleural space; restore pressure for lung expansion.
    • Used routinely in emergencies, bedside, or surgical settings.

    Chest Tube System Components

    • Three-Chamber Drainage System:
      • First chamber for drainage collection.
      • Second for water seal; prevents air from entering lungs.
      • Third for suction control (wet or dry options).
    • Maintain fluid levels, monitor for tidaling (normal movement with respiration) and bubbling (expect with air leaks).

    Chest Tube Insertion Considerations

    • Verify consent; inform client breathing will improve post-insertion.
    • Prepare drainage system and position client comfortably, ensuring support.

    Postprocedure Checks for Chest Tubes

    • Monitor vitals and respiratory status regularly; check for drainage amounts and characteristics.
    • Ensure tubing remains below chest level, and assess for complications like air leaks or tube dislodgment.
    • Air Leaks: Continuous bubbling in the water seal chamber indicates leaks; check connections.
    • Tension Pneumothorax: Caused by clamping tubing or mechanical ventilation; look for tracheal deviation and respiratory distress.
    • Chest Tube Removal: Administer pain relief prior; instruct patient on breathing maneuvers to avoid complications.

    Health Promotion and Disease Prevention in Respiratory Disorders

    • Perform hand hygiene and encourage vaccinations against respiratory infections.
    • Promote smoking cessation and limit exposure to allergens.
    • Aim to prevent respiratory infections and promote lung health, especially in vulnerable populations.

    Rhinitis Overview

    • Inflammation of nasal mucosa affecting 10-30% of the world population; may be acute, chronic, allergic, or nonallergic.
    • Symptoms include nasal drainage, congestion, sneezing, itchy eyes, and sore throat.
    • Commonly associated with asthma and other allergic conditions; requires monitoring and management.

    Tuberculosis (TB)

    • Infectious disease caused by Mycobacterium tuberculosis transmitted via aerosolization (airborne route).
    • In the lung, the body encases TB in a nodule (tubercle), visible on a chest X-ray.
    • Infection rate in the U.S.: 2.2 cases per 100,000; approximately 13 million with latent TB.
    • Only a small percentage of latent TB infections become active; the bacillus can remain dormant for years.
    • Primarily impacts the lungs but can spread to any organ via the bloodstream.
    • Transmission risk decreases after 2 to 3 weeks of antituberculin therapy.

    Health Promotion and Disease Prevention

    • Annual screening for high-risk individuals, particularly those born outside the U.S. and migrant workers.
    • Early detection is crucial as TB has a slow onset, often going unnoticed until advanced.
    • Key symptoms necessitating diagnosis: persistent cough, chest pain, weakness, weight loss, fever, night sweats.

    Risk Factors for TB

    • Close contact with untreated individuals, low socioeconomic status, and immunocompromise (HIV, diabetes, etc.).
    • Crowded or poorly ventilated environments, advanced age, immigration from high-prevalence areas, and substance use.

    Expected Findings in TB

    • Persistent cough over 3 weeks, purulent or blood-streaked sputum, fatigue, and lethargy.
    • Symptoms may include night sweats, low-grade fever, and weight loss; older adults may show atypical symptoms.

    Laboratory Tests and Diagnostic Procedures

    • Nucleic Acid Amplification Testing: Rapid detection of M. tuberculosis (results in <2 hours).
    • QuantiFERON-TB Gold: Blood test identifying interferon-gamma response (24-36 hours for results).
    • Mantoux Test: Positive induration indicates potential TB exposure, requiring follow-up tests for active disease.
    • Acid-fast Bacilli Smear and Culture: Positive culture confirms active infection.

    Nursing Actions in TB Management

    • Obtain three early-morning sputum samples; use personal protective equipment.
    • Place clients in negative airflow rooms and ensure airborne precautions are followed.

    Medications for TB

    • Combination therapy with isoniazid, rifampin, pyrazinamide, and ethambutol recommended due to resistance.
    • Isoniazid (INH): Monitor for hepatotoxicity, neurotoxicity; contraindicated with alcohol.
    • Rifampin (RIF): Watch for orange discoloration in urine and potential interference with contraceptives.
    • Pyrazinamide (PZA): Increase fluid intake; assess for gout symptoms.
    • Ethambutol (EMB): Monitor vision regularly for ocular toxicity; contraindicated under age 8.

    Complications of TB

    • Miliary TB: Spread through the bloodstream; symptoms include headaches, neck stiffness, and potential pericarditis.

    Nursing Interventions in TB Care

    • Administer oxygen as needed; promote infection control practices.
    • Educate clients about medication adherence to prevent resistance.

    Pulmonary Embolism (PE)

    • A blockage caused by substance in the pulmonary vasculature, often from venous thromboembolism.
    • Risk factors include long-term immobility, estrogen therapy, and hypercoagulable states.

    Expected Findings in PE

    • Anxiety, sudden chest pressure, dyspnea, tachycardia, and decreased oxygen saturation.

    Diagnostic Tests for PE

    • CT Angiography: Preferred method for detecting PE.
    • D-dimer test: Indicates clot formation; elevated levels suggest potential PE.

    Nursing Actions for PE

    • Administer oxygen therapy, monitor vital signs and respiratory status frequently.
    • Prepare for anticoagulant administration and manage potential side effects.

    Medications for PE Management

    • Anticoagulants: Heparin and warfarin used to prevent clot progression.
    • Direct factor Xa inhibitors: Rivaroxaban and apixaban inhibit thrombin production.
    • Thrombolytics: Agents like alteplase dissolve clots and restore blood flow.

    Patient Education and Safety

    • Importance of medication adherence, monitoring symptoms, and maintaining follow-up evaluations.
    • Teaching proper hand hygiene and safety measures to reduce transmission risks in TB.### Anticoagulant Similarities and Nursing Actions
    • Assess for contraindications: bleeding disorders, uncontrolled hypertension, active bleeding, peptic ulcer disease, stroke history, recent trauma/surgery, pregnancy.
    • Monitor for bleeding, thrombocytopenia, and anemia, as well as vital signs (blood pressure, heart rate, respiration, oxygen saturation) per facility protocol.

    Therapeutic Procedures

    • Embolectomy: Surgical removal of an embolus.

      • Prepare clients: ensure NPO status, obtain informed consent.
      • Monitor postoperative: vital signs, SaO2, incision drainage, and pain management.

    • Inferior Vena Cava Filter (IVCF): Inserted to prevent emboli from reaching pulmonary vasculature when anticoagulation is contraindicated.

      • Similar preparatory and monitoring actions as for embolectomy.

    Client Education for Pulmonary Embolism (PE) Prevention

    • Set up home care services if homebound, including weekly blood draws.
    • Referral services for portable oxygen if experiencing severe dyspnea.
    • Follow prevention recommendations: smoking cessation, avoid immobility, increase physical activity, wear compression stockings.
    • Maintain consistent Vitamin K intake if on warfarin, as fluctuations can affect anticoagulation.
    • Monitor PT and INR regularly; be aware of increased bleeding/bruising risks and precautions needed.

    Complications and Nursing Actions

    • Decreased Cardiac Output: Caused by reduced blood volume.

      • Monitor for hypotension, tachycardia, cyanosis, and jugular venous distention. Administer IV fluids as needed.

    • Hemorrhage: Increased bleeding due to anticoagulants.

      • Assess for bleeding around injection/surgical sites, monitor cardiovascular status, CBC, and bleeding times. Have antidotes ready if necessary.

    Pathophysiology of Pulmonary Embolism

    • PE results from an obstruction in pulmonary vasculature by dislodged materials, primarily from Deep Vein Thrombosis (DVT).
    • Other sources: tumors, amniotic fluid, and foreign substances.

    Nursing Care for Pulmonary Embolism

    • Administer oxygen therapy, maintain IV access, and monitor mental status.
    • Provide emotional support to address anxiety.

    Pneumothorax and Hemothorax

    • Pneumothorax: Air in pleural space, causing lung collapse. Tension pneumothorax can compress the heart and vessels, leading to decreased cardiac output.
    • Hemothorax: Accumulation of blood in pleural space.
    • Risk factors include trauma, older age, and history of COPD.

    Assessment and Expected Findings

    • Symptoms: anxiety, pleuritic pain, respiratory distress indicators (tachypnea, hypoxia), tracheal deviations (tension pneumothorax), and altered breath sounds.
    • Laboratory tests include ABGs to assess hypoxemia.

    Diagnostic Procedures

    • Chest X-ray: Confirms pneumothorax or hemothorax.
    • Thoracentesis: Used to confirm hemothorax; requires positioning and monitoring for vital signs and injection site status.

    Nursing Actions for Chest Trauma

    • Administer oxygen, monitor vital signs and drainage, review pulmonary function tests.
    • Encourage deep breathing and use of incentive spirometry.

    Patient Education

    • Importance of deep breathing, hygiene to prevent infection, and reporting symptoms such as fever, cough, or respiratory difficulties post-procedure.

    Complications of Pneumothorax and Hemothorax

    • Decreased Cardiac Output: Due to pressure and volume changes. Close monitoring and IV fluids are critical.
    • Respiratory Failure: Monitor closely for gas exchange adequacy; mechanical ventilation may be necessary.

    Acute Respiratory Failure and Distress Syndrome

    • ARF caused by inadequate ventilation/oxygenation; results in hypoxemia and physical signs like dyspnea and tachycardia.
    • ARDS caused by various traumas affecting alveolar function leading to fluid accumulation and reduced gas exchange efficiency.

    Laboratory and Diagnostic Tests

    • ABGs provide crucial insight into oxygenation levels and acid-base balance.
    • Imaging like chest X-rays and CT scans reveal pulmonary conditions and complications.

    Interprofessional Care

    • Collaboration with respiratory and pulmonary services for comprehensive care, including oxygen therapy and monitoring. Pain management specialists may assist with severe pain cases.

    Therapeutic Procedures

    • Chest Tube Insertion: Drains air/fluid; requires consent, monitoring vital signs, and ensuring proper drainage system function.
    • Educate patients on the necessity of deep breathing and hand hygiene to prevent infections post-procedure.### Mechanical Ventilation Overview
    • Mechanical ventilation is essential when using PEEP or CPAP to prevent alveolar collapse during expiration.
    • Adhere to facility protocols for monitoring and documenting ventilator settings.
    • Oxygenate patients before suctioning to avoid hypoxemia.

    Monitoring and Assessment

    • Suctioning indications include coarse crackles over the trachea; assess sputum color, amount, and consistency.
    • Regularly monitor vital signs, breathing patterns, and lung sounds per facility protocol.
    • Watch for signs of pneumothorax; a high PEEP may contribute to lung collapse.
    • Perform arterial blood gas (ABG) tests as prescribed after any ventilator adjustments.
    • Maintain ECG monitoring for hypoxemia signs during patient repositioning or suctioning.
    • Continuously check vital signs, including SaO2 levels, and assess pain level.

    Infection Control

    • Implement frequent hand hygiene and proper suctioning techniques.
    • Provide oral care every 2 hours and whenever necessary.
    • Use personal protective equipment (PPE) for clients with SARS-CoV-2, observing droplet and contact precautions.
    • Enforce airborne precautions for aerosol-generating procedures.

    Nutrition Management

    • Assess bowel sounds and monitor elimination patterns; keep daily weight records.
    • Track intake and output; administer enteral or parenteral feedings as directed.
    • Elevate the head of the bed 30° to 45° to prevent aspiration for enteral feedings.

    Medication Management

    • Benzodiazepines (Lorazepam, Midazolam): Reduce anxiety and ventilator resistance; monitor vitals and use cautiously with opioids.
    • General Anesthesia (Propofol): Induces anesthesia; contraindicated in hyperlipidemia and egg allergies; monitor sedation and blood pressure.
    • Corticosteroids (Cortisone acetate, Methylprednisolone): Reduce inflammation; discontinue gradually and monitor weight, blood pressure, and glucose.
    • Opioid Analgesics (Morphine sulfate, Fentanyl): Manage pain; monitor respirations, blood pressure, and be prepared with naloxone.
    • Neuromuscular Blocking Agents (Vecuronium, Atracurium): Assist ventilation; administer only to intubated clients and monitor muscle strength and sedation.
    • Antibiotics (Vancomycin): Treat specific organisms; ensure cultures are taken before the first dose, monitor for reactions.
    • Antivirals (Remdesivir): FDA-approved for SARS-CoV-2; monitor GFR and liver enzymes prior to and during therapy.
    • Anticoagulants (Dalteparin, Enoxaparin): Prevent blood clotting; assess for bleeding and monitor injection sites.

    Therapeutic Procedures

    • Perform intubation and monitor vital signs including ECG, SaO2, and lung sounds.
    • Oxygenate with 100% oxygen prior to intubation and have resuscitation equipment ready.
    • Post-intubation, confirm tube placement and monitor cuff pressure to prevent injury.
    • Apply PEEP to improve lung expansion and facilitate gas exchange.

    Complications and Nursing Actions

    • High intrathoracic pressure from PEEP can decrease cardiac output; monitor fluid input/output closely.
    • Barotrauma from positive pressure ventilation may cause pneumothorax; monitor closely.
    • Ensure endotracheal tube position is secure and assess for aspiration risk; verify NG tube placement.
    • Regularly monitor and maintain hand hygiene to prevent infections; document any changes in patient condition.

    Post-Acute Coronavirus Syndrome

    • Monitor patients for symptoms lasting four weeks or more post-infection, like fatigue and depression.
    • Educate clients on prevention measures for SARS-CoV-2, emphasizing hand hygiene and vaccination adherence.

    ARDS Risk Factors

    • Risk factors for acute respiratory distress syndrome include aspiration, sepsis, trauma, and drug toxicity.

    Patient Education

    • Provide information on communication methods during intubation, hand hygiene, mask-wearing, and vaccination importance.

    Primary and Secondary Functions of the Respiratory System

    • Provides oxygen essential for tissue metabolism.
    • Removes carbon dioxide, a byproduct of metabolism.
    • Contributes to the sense of smell and sound production.
    • Maintains acid–base balance and body water levels.
    • Regulates heat balance.

    Upper Respiratory Airway Components

    • Nose: Humidifies, warms, and filters inhaled air.
    • Sinuses: Air-filled cavities that enhance resonance in speech.
    • Pharynx: Divided into nasopharynx, oropharynx, and laryngopharynx; serves as dual passage for air and food.
    • Larynx (Voice Box): Houses vocal cords; glottis aids in coughing, a primary lung defense mechanism.
    • Epiglottis: Leaf-shaped flap that prevents food from entering the trachea during swallowing.

    Lower Respiratory Airway Components

    • Trachea: Front of the esophagus; bifurcates into right and left bronchi.
    • Mainstem Bronchi: The right bronchus is wider and more vertical than the left; lined with cilia for mucus clearance.
    • Bronchioles: Small terminal bronchioles lack cartilage and don't facilitate gas exchange.
    • Alveolar Structures:
      • Acini includes components distal to terminal bronchioles.
      • Type 2 alveolar cells produce surfactant, preventing alveolar collapse.
    • Lungs:
      • Enclosed in pleural cavity; right lung has three lobes, left lung two to accommodate the heart.
      • Innervated by phrenic, vagus, and thoracic nerves.
      • Pleura layers allow smooth lung movement; blood circulation via pulmonary system.

    Respiratory Process

    • Diaphragm contraction creates negative lung pressure, drawing in air.
    • Gas exchange occurs when air moves to alveoli, oxygen diffusing into capillaries.
    • Effective gas exchange requires coordination of ventilation and perfusion.

    Diagnostic Tests

    • Chest X-ray: Assesses lung appearance; pre-test preparations include removal of metal objects.
    • Sputum Specimen: Collected for organism identification; should be obtained prior to antibiotic therapy.
    • Laryngoscopy and Bronchoscopy: Visual examination of respiratory structures; requires NPO status and sedation.
    • Endobronchial Ultrasound (EBUS): Tissue sampling for diagnosing lung issues.
    • Pulmonary Angiography: Fluoroscopic imaging of pulmonary vessels; requires allergy assessment to contrast material.
    • Thoracentesis: Fluid or air removal from the pleural space; client positioning is crucial.
    • Pulmonary Function Tests: Evaluates lung mechanics; requires avoiding irritants pre-testing.
    • Lung Biopsy: Tissue samples through various methods for analysis; local anesthetic administration.
    • CT and V/Q scans: Imaging tests for diagnosing conditions like pulmonary embolism; involve IV contrast.
    • D-Dimer Test: Evaluates clot presence; normal levels indicate absence of thrombus.

    Chest Injuries

    • Rib Fracture: Results from blunt trauma; may lead to pneumothorax or hemothorax. Pain and shallow breathing are common symptoms.
    • Flail Chest: Caused by trauma, resulting in paradoxical respiration. Symptoms include severe pain and dyspnea.
    • Pulmonary Contusion: Bleeding within lung tissue; major risk is acute respiratory distress syndrome. Symptoms include hypoxemia and crackles.

    General Interventions

    • Maintain optimal positioning (e.g., Fowler’s position).
    • Administer oxygen therapy and pain management as required.
    • Continuous monitoring for respiratory distress and complications such as pneumothorax.
    • Engage in deep breathing and coughing exercises to enhance ventilation.### Pneumothorax
    • Accumulation of atmospheric air in the pleural space leading to lung collapse and increased intrathoracic pressure.
    • Types include spontaneous (due to pulmonary bleb rupture), open (chest wall opening), and tension (buildup of pressure from injury or mechanical ventilation).
    • Assessment findings: absent breath sounds, cyanosis, distended neck veins, dyspnea, hypotension, sharp chest pain, tracheal deviation in tension pneumothorax.
    • Interventions: diagnose with chest x-ray, apply nonporous dressing, administer prescribed oxygen, position in Fowler’s, prepare for chest tube placement.

    Asthma

    • Chronic inflammatory disorder of airways causing obstruction, wheezing, breathlessness, chest tightness, and coughing.
    • Status asthmaticus is a severe, life-threatening episode that may lead to complications like pneumothorax and respiratory arrest.
    • Assessment findings: restlessness, wheezing, absent/diminished lung sounds, use of accessory muscles, tachypnea, cyanosis.
    • Interventions include monitoring vital signs and pulse oximetry, administering bronchodilators/corticosteroids, and educating about trigger avoidance.

    Chronic Obstructive Pulmonary Disease (COPD)

    • Also known as chronic airflow limitation, includes chronic bronchitis (bronchial inflammation/excess mucus) and emphysema (damaged air sacs).
    • Characterized by progressive airflow limitation and can lead to pulmonary insufficiency and cor pulmonale.
    • Assessment findings: cough, dyspnea, sputum production, barrel chest (emphysema), cyanosis, delayed capillary refill.
    • Interventions involve monitoring vital signs, administering oxygen and respiratory treatments, encouraging breathing techniques, and providing nutritional support.

    Pneumonia

    • Infection that affects pulmonary tissue leading to inflammation, stiffening of lungs, and hypoxemia.
    • Can be community-acquired or hospital-acquired with chest x-ray showing consolidation.
    • Assessment findings: chills, elevated temperature, pleuritic pain, tachypnea, productive cough with may include hemoptysis.
    • Interventions focus on oxygen administration, monitoring respiratory status, encouraging deep breathing, and administering antibiotics as prescribed.

    Severe Acute Respiratory Syndrome (SARS)

    • Respiratory illness caused by SARS-associated coronavirus presenting initially with fever, discomfort, and mild respiratory symptoms.
    • Symptoms may progress to dry cough and dyspnea after 2-7 days.
    • Spread through close contact and respiratory secretions; prevention includes avoiding contact with infected individuals and frequent handwashing.

    COVID-19

    • Caused by SARS-CoV-2, older adults and individuals with underlying conditions at increased risk for complications.
    • Symptoms range from mild to severe, common indicators include fever, cough, fatigue, and difficulty breathing.
    • Transmission via respiratory droplets; prevention involves social distancing, mask-wearing, and hand hygiene.
    • Treatment varies; vaccines are recommended for protection against severe illness.

    Influenza

    • Highly contagious viral respiratory infection, primarily caused by types A, B, and C.
    • Annual vaccination recommended, especially for vulnerable populations.
    • Assessment involves fever, chills, muscle aches, cough, and fatigue.
    • Interventions include rest, hydration, and monitoring lung sounds, with supportive therapy and antiviral medications as needed.

    Legionnaire’s Disease

    • Acute bacterial infection caused by Legionella pneumophila, associated with contaminated water sources.
    • Not spread via person-to-person contact, risk is heightened by other health conditions.
    • Symptoms include fever, chills, muscle aches, and dry cough.

    Pleural Effusion

    • Accumulation of fluid in the pleural space; impairs lung expansion.
    • Assessment findings: sharp pleuritic pain, dyspnea, dry cough, tachycardia, decreased breath sounds.
    • Diagnosis is confirmed with chest imaging revealing pleural effusion and mediastinal shift if significant.### Interventions for Pleural Conditions
    • Identify and treat underlying causes of respiratory conditions.
    • Monitor patient's breath sounds for abnormalities.
    • Position clients in Fowler’s position to facilitate breathing.
    • Encourage coughing and deep breathing exercises.
    • Prepare clients for thoracentesis to manage pleural effusion.
    • In cases of recurrent pleural effusion, prepare for pleurectomy or pleurodesis per physician’s prescription.

    Pleurectomy

    • Surgical procedure that strips the parietal pleura away from the visceral pleura.
    • Causes an intense inflammatory response, promoting adhesion formation between pleural layers during healing.

    Pleurodesis

    • Involves instillation of a sclerosing agent into the pleural space via thoracotomy tube.
    • Induces an inflammatory response that causes scarring and adhesion of pleural tissues.

    Empyema

    • Collection of thick, opaque, foul-smelling pus within the pleural cavity, often due to pulmonary infection or lung abscess.
    • Symptoms may include fever, chest pain, cough, dyspnea, weight loss, and pleural exudate seen on chest x-ray.
    • Important assessment indicators include recent illness, elevated temperature, and night sweats.

    Interventions for Empyema

    • Monitor breath sounds and position in semi-Fowler’s or high-Fowler’s position.
    • Administer prescribed antibiotics and assist with drainage via thoracentesis or chest tube.
    • In cases of pleural thickening, prepare for decortication to remove restrictive tissue.

    Pleurisy

    • Inflammation of visceral and parietal pleura, often resulting in sharp pain during respiration.
    • Typically presents as localized chest pain, dyspnea, and pleural friction rub upon auscultation.

    Interventions for Pleurisy

    • Identify and treat underlying causes, monitor lung sounds, and provide analgesics.
    • Apply hot or cold packs and encourage deep breathing to alleviate discomfort.

    Pulmonary Embolism

    • Occurs when a thrombus detaches, travels to the right heart, and lodges in a pulmonary artery, classified into massive, submassive, or low-risk categories.
    • Risk factors include prolonged immobilization, obesity, heart failure, and history of DVT.
    • Early assessment is crucial; look out for signs such as dyspnea, chest pain, and cyanosis among others.

    Interventions for Pulmonary Embolism

    • Elevate the head of the bed and reassure the client.
    • Administer oxygen and notify the Rapid Response Team.
    • Prepare for arterial blood gas analysis and lab studies.
    • Administer anticoagulant therapy and monitor vital signs.

    Histoplasmosis

    • Fungal infection caused by inhalation of Histoplasma capsulatum spores, often found in contaminated soil and bird droppings.
    • Symptoms resemble pneumonia; assessment confirms with skin tests and potential splenomegaly or hepatomegaly.

    Interventions for Histoplasmosis

    • Administer oxygen and monitor breath sounds.
    • Provide antifungal medications and encourage deep breathing.
    • Advise on protective measures while cleaning contaminated areas to prevent spore exposure.

    Sarcoidosis

    • Characterized by the presence of epithelioid cell tubercles in lungs, with an uncertain cause possibly linked to Epstein-Barr virus.
    • Symptoms include night sweats, chest pain, fever, and weight loss.

    Interventions for Sarcoidosis

    • Administer corticosteroids to manage symptoms.
    • Encourage hydration and frequent small meals for nutritional support.

    Occupational Lung Disease

    • Results from exposure to harmful environmental factors like dust and fumes, leading to acute or chronic respiratory issues.
    • Common classifications include pneumoconiosis and occupational asthma.

    Interventions for Occupational Lung Disease

    • Implement preventive measures using respiratory protective devices.
    • Treatment is tailored based on specific respiratory symptoms.

    Tuberculosis

    • Highly communicable disease caused by Mycobacterium tuberculosis, primarily affecting the lungs.
    • Risk factors include living in crowded conditions, history of exposure, and immunosuppression.
    • Symptoms can range from asymptomatic to persistent cough, fever, and night sweats.

    Disease Transmission

    • Transmitted via airborne droplets when an infected person coughs or sneezes.
    • Close contacts must be identified for testing and treatment.

    Assessment and Diagnosis

    • Chest physical examination is inconclusive; chest x-ray may reveal characteristic findings.
    • Tuberculin skin test shows varying positivity thresholds based on risk factors.

    Client History and Manifestations

    • Gather information on previous tuberculosis exposure, vaccination history, and current symptoms.
    • Monitor for common symptoms like fatigue, weight loss, and persistent cough with sputum production.

    Anticoagulants

    • Prevent the formation and extension of clots by inhibiting clotting cascade factors and lowering blood coagulability.
    • Indicated for conditions like myocardial infarction, unstable angina, atrial fibrillation, deep vein thrombosis, and pulmonary embolism.
    • Contraindications include active bleeding, bleeding disorders, ulcers, and liver/kidney disease.
    • Common side effects are hemorrhage, hematuria, epistaxis, and thrombocytopenia.

    Heparin Sodium

    • Inhibits thrombin, preventing fibrinogen conversion to fibrin; does not dissolve existing clots.
    • Therapeutic activated partial thromboplastin time (aPTT) should be 1.5 to 2.5 times normal (30-40 seconds).
    • Regular monitoring is essential; dosage adjustment based on aPTT results is required.
    • Administer subcutaneously in the abdomen, avoid aspiration and massage at the injection site.
    • Antidote: Protamine sulfate.

    Low-Molecular-Weight Heparins (Enoxaparin, Rivaroxaban)

    • Similar action to heparin but with longer half-lives; not interchangeable with heparin.
    • Enoxaparin given to recumbent clients via subcutaneous injection; do not expel the air bubble.
    • Rivaroxaban administered orally, once daily; monitor anti-Xa levels for therapeutic range (0.5-1.2 IU/mL).
    • Antidote is also protamine sulfate.

    Warfarin Sodium

    • Acts as a vitamin K antagonist, inhibiting factors X, IX, VII, and II; prolongs clotting time.
    • Monitored by prothrombin time (PT) and international normalized ratio (INR).
    • Normal PT is 11-12.5 seconds; therapeutic range is 1.5-2 times control value.
    • INR goals: 2-3 for standard therapy, 3-4.5 for high-dose therapy.
    • Antidote: Phytonadione; clients may require bridge therapy with heparin until INR stabilizes.

    Dabigatran Etexilate

    • Direct thrombin inhibitor; prevents fibrinogen to fibrin conversion.
    • Approved for preventing clots in nonvalvular atrial fibrillation; fixed dose twice daily.
    • No routine blood testing required.

    Thrombolytic Medications

    • Activate plasminogen to dissolve clots; primarily used within 4-6 hours of myocardial infarction.
    • Contraindications include active internal bleeding and recent major surgeries.
    • Monitor vital signs, pulses, and for neurological changes during administration; apply direct pressure to puncture sites.

    Antiplatelet Medications

    • Inhibit platelet aggregation, prolonging bleeding time.
    • Used for thrombosis prevention post-myocardial infarction, stent placement, and stroke.
    • Side effects can include bruising, hematuria, and gastrointestinal bleeding.

    Positive Inotropic and Cardiotonic Medications

    • Enhance myocardial contractility; used for short-term management of advanced heart failure.
    • Examples include Dobutamine and Milrinone; monitor for dysrhythmias and hypotension.

    Cardiac Glycosides (Digoxin)

    • Increase intracellular calcium, enhancing myocardial contraction.
    • Display positive inotropic and negative chronotropic/dromotropic effects.
    • Therapeutic range: 0.5-2.0 ng/dL; signs of toxicity include gastrointestinal disturbances and visual changes.

    Diuretics

    • Thiazide diuretics increase sodium and water excretion; used for hypertension and edema.
    • Loop diuretics are potent, promoting rapid diuresis; contraindicated in severe renal failure.
    • Potassium-sparing diuretics help retain potassium while promoting sodium and water excretion; significant hyperkalemia risk.

    Monitoring and Patient Education

    • Vital signs, urine output, and electrolytes must be closely monitored when administering these medications.
    • Clients should be educated on signs of toxicity, dietary considerations, and safety measures to prevent bleeding and complications associated with anticoagulation and diuretics.### Medication Instructions and Administration
    • Medications should be taken with or after meals to reduce gastrointestinal irritation.

    Peripherally Acting α-Adrenergic Blockers

    • Decrease sympathetic vasoconstriction by reducing norepinephrine effects, leading to vasodilation and lower blood pressure.
    • Used to treat hypertension and maintain renal blood flow.
    • Common side effects include orthostatic hypotension, reflex tachycardia, fluid retention, and edema.
    • Monitor vital signs and fluid retention; advise clients to change positions slowly.
    • Educate clients on self-monitoring blood pressure and reducing salt intake.

    Centrally Acting Sympatholytics

    • Stimulate α-receptors in the CNS, inhibiting vasoconstriction, which lowers peripheral resistance.
    • Contraindicated in impaired liver function; treat hypertension.
    • Side effects include edema, drowsiness, dizziness, and hypotension.
    • Monitor vital signs and liver function tests; educate on the importance of not discontinuing medication abruptly.

    Angiotensin-Converting Enzyme (ACE) Inhibitors and Angiotensin II Receptor Blockers (ARBs)

    • ACE inhibitors prevent vasoconstriction and reduce blood pressure by blocking angiotensin I conversion to angiotensin II.
    • ARBs prevent vasoconstriction and aldosterone secretion and block AII receptor binding.
    • Commonly used for hypertension and heart failure; contraindicated with potassium supplements.
    • Side effects include persistent dry cough (common with ACE inhibitors), hypotension, and hyperkalemia.
    • Monitor vital signs and laboratory parameters, including blood counts and renal function.

    Antianginal Medications (Nitrates)

    • Nitrates induce vasodilation and reduce myocardial oxygen consumption.
    • Contraindicated in severe hypotension, increased intracranial pressure, and while using ED medications.
    • Side effects can include headaches, dizziness, hypotension, and reflex tachycardia.
    • Proper administration includes taking sublingual tablets while sitting and monitoring vital signs.

    β-Adrenergic Blockers

    • Block response to β-adrenergic stimulation, leading to lower heart rate and blood pressure.
    • Used for conditions like angina, hypertension, and dysrhythmias; contraindicated in asthma and severe bradycardia.
    • Side effects consist of bradycardia, bronchospasm, and dizziness.
    • Monitor vital signs and withhold medication if pulse or BP is outside prescribed parameters.

    Calcium Channel Blockers

    • Decrease cardiac contractility and workload by promoting vasodilation.
    • Used for angina, dysrhythmias, and hypertension; caution with heart failure patients.
    • Side effects may include bradycardia, hypotension, and peripheral edema.
    • Monitor vital signs, liver enzymes, and ensure clients do not abruptly stop the medication.

    Peripheral Vasodilators

    • Decrease peripheral resistance, increasing blood flow to extremities; effective for conditions like Raynaud’s disease.
    • Side effects include dizziness, tachycardia, and gastrointestinal distress.
    • Monitor vital signs and signs of inadequate blood flow; educate clients on non-smoking and gradual position changes.

    Direct-Acting Arteriolar Vasodilators

    • Relax smooth muscle in arteries, decreasing blood pressure; used for moderate to severe hypertension.
    • Watch for side effects like hypotension, reflex tachycardia, and neurological symptoms.
    • Sodium nitroprusside requires monitoring for cyanide toxicity and should be covered from light.

    Miscellaneous Vasodilator - Nesiritide

    • A recombinant version of human B-type natriuretic peptide; used for decompensated heart failure.
    • Monitor vital signs and signs of resolving heart failure.

    Antidysrhythmic Medications

    • Work by inhibiting abnormal heart conduction; classified into four classes based on mechanism.
    • Side effects vary by class, but often include hypotension and bradycardia.
    • Continuous monitoring of heart rhythm, vital signs, and maintaining therapeutic medication levels is crucial.

    Adrenergic Agonists

    • Dobutamine, dopamine, epinephrine, and norepinephrine serve various cardiac stimulation and blood pressure support roles.
    • Monitor vital signs and urinary output; be alert for dysrhythmias and other adverse effects.
    • Medications like epinephrine are notable for use in emergencies such as cardiac arrest and anaphylaxis.### Electrocardiogram Monitoring
    • Continuous monitoring of the electrocardiogram (ECG) is essential for assessing the heart's electrical activity.
    • Medication administration should be performed through a large vein to ensure proper absorption and minimize irritation.

    Antilipemic Medications

    • Purpose: Lower serum cholesterol, triglycerides, and low-density lipoprotein (LDL) to reduce coronary artery disease risk.
    • Lifestyle changes often insufficient alone; thus, medications prescribed.

    Bile Sequestrants

    • Mechanism: Bind bile acids in the intestines, preventing cholesterol reabsorption.
    • Not suitable as monotherapy in elevated triglyceride cases, may worsen triglyceride levels.
    • Side Effects: Constipation, heartburn, nausea, bloating.
    • Interventions: Ensure proper mixing of cholestyramine in fluids, monitor for peptic ulcer symptoms, instruct fluid intake.

    HMG-CoA Reductase Inhibitors

    • Key Drug: Lovastatin—highly protein-bound; avoid with anticoagulants and certain other medications.
    • Side Effects: Ranges from gastrointestinal disturbances to muscle cramps and elevated liver enzyme levels.
    • Monitor: Serum liver enzymes, vision changes annually, assess effectiveness after 3 months.

    Other Antilipemic Agents

    • Gemfibrozil: Avoid with anticoagulants and HMG-CoA inhibitors due to increased myopathy risk.
    • Nicotinic Acid: Various side effects, including flushing. Advise premedication with aspirin to minimize flushing.

    Skeletal Muscle Relaxants

    • Mechanism: Act at neuromuscular junction or CNS; used for muscle spasms and spasticity.
    • Contraindications: Severe liver, renal, or heart disease.
    • Side Effects: Dizziness, hypotension, drowsiness, and liver toxicity.
    • Monitor: Vital signs, CNS effects, renal function, and assess injury risk.
    • Medication Examples: Baclofen, Carisoprodol, Cyclobenzaprine, Diazepam, Tizanidine.

    Antigout Medications

    • Common Drugs: Allopurinol, colchicine, febuxostat; reduce uric acid levels to manage gout.
    • NSAIDs: Used for pain and inflammation during acute attacks.
    • Monitoring: Serum uric acid levels, fluid intake (2000-3000 mL/day), and avoid high-purine foods (e.g., organ meats).
    • Patient Education: Report any adverse effects and to avoid alcohol/caffeine.

    Antiarthritic Medications

    • Key Focus: Aggressive treatment to prevent joint destruction in rheumatoid arthritis.
    • Types: NSAIDs, glucocorticoids, DMARDs (disease-modifying antirheumatic drugs), and biologics.
    • Biologic DMARDs: Injection site reactions frequent; increased infection and malignancy risks.
    • DMARD Side Effects: Range from injection site inflammation to severe allergic responses; monitor blood counts.

    Osteoporosis Medications

    • Characteristics: Decreased bone mass and increased fragility; treatment aims to reduce fracture risk.
    • Calcium & Vitamin D: Essential for bone integrity and absorption; lifelong supplementation recommended.
    • Medications: Include bisphosphonates, raloxifene, and teriparatide, which decrease bone resorption or promote growth.
    • Monitoring: Mineral bone density and signs of orthostatic hypotension. Administer calcitonin with attention to potential hypocalcemia.

    General Interventions

    • Patient Education: Emphasize adherence to medication regimens, awareness of side effects, and the importance of regular follow-ups including laboratory tests and eye examinations.
    • Lifestyle Modifications: Advise diet changes and exercise to complement medication therapies for overall health improvement.

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    Test your knowledge on the chronic inflammatory disorder of asthma and its relationship with COPD. This quiz covers the mechanisms, obstruction causes, and medication management for both conditions. Understand how bronchodilator agents and anti-inflammatory treatments are used to alleviate symptoms.

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