Respiratory System Quiz
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Questions and Answers

What function do the conducting airways serve in the respiratory system?

  • Trapping foreign particles in the air
  • Facilitating gas exchange in the lungs
  • Moving air to and from the lungs (correct)
  • Protecting the lungs from infections

    • Which part of the lungs is responsible for the majority of gas exchange?

  • Diaphragm
  • Alveoli (correct)
  • Pleura
  • Bronchi

    • What term describes the movement of blood through the lungs?

  • Ventilation
  • Diffusion
  • Perfusion (correct)
  • Inspiration

    • Which structure is located at the apex of the lung?

    <p>Thoracic cavity top</p> Signup and view all the answers

    Which mechanism triggers a reflex to remove foreign particles from the air?

    <p>Irritant receptors</p> Signup and view all the answers

    What occurs during the process of inspiration?

    <p>Air is drawn into the lungs</p> Signup and view all the answers

    What is the primary role of the mucosal lining in the airways?

    <p>Warming and humidifying air</p> Signup and view all the answers

    Which of the following statements about the lungs is incorrect?

    <p>The lungs are rigid organs.</p> Signup and view all the answers

    What is the primary reason glucocorticoids are used during acute exacerbations?

    <p>To reduce inflammation over several hours</p> Signup and view all the answers

    When administering multiple inhalers, which should be used first?

    <p>Short-acting beta-2 agonist</p> Signup and view all the answers

    Which of the following is NOT a common adverse reaction associated with glucocorticoids?

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

    What is the therapeutic range for theophylline, which must be monitored closely?

    <p>5-15 mcg/ml</p> Signup and view all the answers

    What should clients be advised to avoid when taking theophylline?

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

    What should a nurse monitor for with long-term glucocorticoid therapy?

    <p>Signs of infection</p> Signup and view all the answers

    What is the mechanism of action of inhaled anticholinergic drugs?

    <p>Blocking muscarinic receptors</p> Signup and view all the answers

    What should patients taking theophylline be educated about regarding toxicity?

    <p>Mildly elevated levels can cause insomnia</p> Signup and view all the answers

    Which of the following interactions increases theophylline levels?

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

    What nursing intervention is essential when a patient is prescribed high-dose glucocorticoids?

    <p>Taper the dose gradually</p> Signup and view all the answers

    What does tidal volume (TV) represent?

    <p>The amount of air that moves into and out of the lungs during a normal breath.</p> Signup and view all the answers

    What role do peripheral chemoreceptors play in respiratory control?

    <p>They trigger an increase in ventilation in response to low oxygen levels.</p> Signup and view all the answers

    Which of the following correctly describes vital capacity (VC)?

    <p>The sum of tidal volume, inspiratory reserve volume, and expiratory reserve volume.</p> Signup and view all the answers

    What is the primary function of lung receptors?

    <p>To sense irritants and prevent excessive lung inflation.</p> Signup and view all the answers

    Which statement about central chemoreceptors is true?

    <p>They respond primarily to pH changes in the brain.</p> Signup and view all the answers

    What characterizes forced vital capacity (FVC)?

    <p>It is the amount of air forcibly exhaled after maximal inhalation.</p> Signup and view all the answers

    What does residual volume (RV) refer to?

    <p>The air that remains in the lungs after forced respiration.</p> Signup and view all the answers

    What occurs at the alveolar capillary junctions?

    <p>Carbon dioxide attempts to escape the lungs.</p> Signup and view all the answers

    What is the primary action of inhaled glucocorticoids in asthma management?

    <p>Suppress inflammation</p> Signup and view all the answers

    What is the duration of action for the short-acting beta 2 agonist albuterol?

    <p>3-6 hours</p> Signup and view all the answers

    Which of the following should be monitored in a patient taking monoamine oxidase inhibitors (MAOI)?

    <p>Heart rate</p> Signup and view all the answers

    What is a common adverse reaction associated with inhaled glucocorticoids?

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

    Which of the following is a common adverse reaction associated with intranasal decongestants?

    <p>Rebound congestion if used for more than 3-5 days</p> Signup and view all the answers

    How often should long-acting beta 2 agonists like salmeterol and formoterol be administered?

    <p>1-2 puffs BID</p> Signup and view all the answers

    What is the primary mechanism of action for sympathomimetic decongestants?

    <p>Stimulation of alpha-1 receptors leading to vasoconstriction</p> Signup and view all the answers

    Which of the following best describes intranasal glucocorticoids?

    <p>Require regular daily use for maximum effect</p> Signup and view all the answers

    What is a recommended practice to prevent oropharyngeal candidiasis when using inhaled glucocorticoids?

    <p>Rinse and spit after each use</p> Signup and view all the answers

    Which medication should not be used alone for asthma management when a glucocorticoid is ineffective?

    <p>Long-acting beta 2 agonist</p> Signup and view all the answers

    What should be avoided in patients with cardiovascular conditions when taking oral decongestants?

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

    Which of these drugs is an effective non-opioid antitussive?

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

    What is the typical dosing schedule for short-acting beta 2 agonists for acute bronchospasm?

    <p>Every 4-6 hours PRN</p> Signup and view all the answers

    What potential effect can occur with the misuse of dextromethorphan?

    <p>Euphoria at high doses</p> Signup and view all the answers

    Which symptom may be a result of the adverse reactions from intranasal glucocorticoids?

    <p>Burning and itching of nasal mucosa</p> Signup and view all the answers

    Which is true concerning the administration of intranasal decongestants?

    <p>Effects are intense and rapid when administered intranasally.</p> Signup and view all the answers

    What is the primary mechanism of action for opioid cough suppressants?

    <p>Suppress cough reflex by affecting the cough center</p> Signup and view all the answers

    Which of the following is a common adverse reaction associated with opioid cough suppressants?

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

    What should clients be advised regarding the use of guaifenesin?

    <p>They should take it with food to prevent GI upset</p> Signup and view all the answers

    What is an important nursing intervention for clients using acetylcysteine?

    <p>Monitor for potential bronchospasms in asthmatic patients</p> Signup and view all the answers

    Which of the following statements about the administration of mucolytics is true?

    <p>Administration can be done via inhalation or orally</p> Signup and view all the answers

    What is a key precaution to take when administering opioid cough suppressants?

    <p>Close monitoring for respiratory depression is necessary</p> Signup and view all the answers

    What might clients experience when using acetylcysteine, and what should they be informed about?

    <p>It has a characteristic odor similar to rotten eggs</p> Signup and view all the answers

    For which situation might laxatives be necessary when taking opioid cough suppressants?

    <p>To address possible constipation</p> Signup and view all the answers

    Study Notes

    Respiratory System

    • The respiratory system comprises the air passages and the lungs.
    • It's divided into two parts based on function:
      • Conducting airways: air moves through these passages from the atmosphere to the lungs.
      • Respiratory tissues: gas exchange occurs within these tissues.
    • Lungs are soft, spongy, cone-shaped organs located in the chest cavity.
    • They are separated by the mediastinum and are divided into lobes (three in the right lung, two in the left).
    • The apex (top) of the lung lies against the top of the thoracic cavity.
    • The base (bottom) of the lung lies against the diaphragm.

    Respiratory Structures

    • The structures involved in respiration include:
      • Nasal cavity
      • Nasopharynx
      • Oropharynx
      • Epiglottis
      • Laryngeal pharynx
      • Esophagus
      • Visceral pleura
      • Parietal pleura
      • Upper lobe of right lung
      • Right main bronchus
      • Trachea
      • Left main bronchus
      • Middle lobe
      • Lower lobe
      • Bronchioles
      • Alveolar duct
      • Alveolus
      • Pulmonary vein
      • Respiratory bronchioles
      • Lobules
      • Pulmonary artery
      • Surfactant
      • Alveolar macrophage
      • Red blood cell
      • Capillary
      • Alveolar epithelium
      • Alveolar capillary junction
      • Alveolar basement membrane
      • Mediastinum
      • Diaphragm

    Protective Structures

    • Hairs and turbinates in the nose trap and remove foreign particles.
    • Cilia in the upper and lower airways remove particles along with mucus.
    • The mucosal lining warms and humidifies air.
    • Irritant receptors trigger a sneeze or cough reflex to remove irritants.
    • Immune protections include an immune coating in the respiratory tract mucosa, and macrophages in the alveoli.

    Ventilation

    • Depends on the conducting airways including:
      • Nasopharynx
      • Oropharynx
      • Larynx
      • Tracheobronchial tree
    • Main function is to move air into and out of the lungs without participating in gas exchange.
    • Inspiration is the drawing of air into the lungs as respiratory muscles expand the chest cavity.
    • Expiration is the movement of air out of the lungs as the chest muscles recoil and the chest cavity becomes smaller.

    Respiratory Control

    • Brainstem (Pons and Medulla) control centers: Send neural impulses to the diaphragm, intercostal muscles, and accessory muscles causing contraction or relaxation.
    • Lung receptors located in the epithelium and smooth muscles of airways near alveolar-capillary junctions.
    • These receptors sense irritants and trigger a cough to prevent excessive lung inflation and reduce capillary pressure.

    Chemoreceptors

    • Key sensors for alterations in blood chemistry (oxygen, carbon dioxide, and acid-base status).
    • Two types:
      • Central chemoreceptors are located in the brainstem and respond to pH changes.
      • Peripheral chemoreceptors are located in the carotid and aortic bodies and trigger an increase in ventilation to low oxygen levels.

    Lung Capacities

    • Tidal Volume (TV): Approximate volume of air that moves into and out of the lungs during a normal breath (500 ml).
    • Inspiratory Reserve Volume (IRV): Additional volume of air that can be inhaled after a normal breath (Approx. 3000 ml).
    • Expiratory Reserve Volume (ERV): Additional volume of air that can be exhaled after a normal breath (Approx. 1100 ml).
    • Vital Capacity (VC): The maximal volume of air that can be moved in and out of the lungs. (Approx. 4600 ml). This is the sum of IRV, TV and ERV.
    • Forced Vital Capacity (FVC): Maximal amount of air that can be exhaled from the lungs during forced exhalation.
    • Residual Volume (RV): Amount of air that remains in the lungs after maximum exhalation.
    • Total Lung Capacity (TLC): Total amount of air in the lungs when they are maximally expanded. This is the sum of VC and RV.

    Diffusion

    • Oxygen and carbon dioxide are exchanged at alveolar capillary junctions.
    • Effectiveness depends on partial pressure and solubility of gases, as well as the thickness of membranes.

    Partial Pressure

    • The collision of oxygen and carbon dioxide creates pressure.
    • Partial pressure of oxygen (PaO2) in arterial blood.
    • Partial pressure of carbon dioxide (PaCO2) in arterial blood. Both are measured in mm Hg.

    Gas Exchange

    • The exchange of gases (oxygen and carbon dioxide) between the alveoli and blood.

    Alveolar Gas Exchange

    • Oxygen moves from the alveoli into the capillaries, and carbon dioxide moves from the capillaries into the alveoli.
    • This is driven by differences in partial pressure.

    Oxygen and Carbon Dioxide Transport

    • PaO2 of arterial blood normally is above 80 mm Hg.
    • PaO2 is a major factor in determining the percentage of hemoglobin bound to oxygen (known as oxygen saturation).
    • Carbon dioxide is transported dissolved in plasma, as bicarbonate, or bound to hemoglobin.

    Carbon Dioxide Diffusion and Transport

    • Carbon dioxide is a cellular waste product released into the bloodstream.
    • It's dissolved in the plasma, bound to hemoglobin, and diffused into red blood cells as bicarbonate.
    • It diffuses through the alveolar capillary junction to be exhaled through the lungs.

    Functions of Bronchial Smooth Muscle

    • Tone of the bronchial smooth muscles surrounding the airways determines the airway radius.
    • The presence or absence of airway secretions influences airway patency.
    • Bronchial smooth muscle is innervated by the autonomic nervous system (sympathetic, parasympathetic).

    Impaired Ventilation

    • A problem of blocking air flow in and out of the lungs due to compression or narrowing of the airways.
    • Also, disruption of the neuronal transmissions needed to stimulate the mechanics of breathing.

    Impaired Diffusion

    • Restricted transfer of oxygen or carbon dioxide across the alveolar capillary junction.
    • Depends on solubility, partial pressure of the gas, and membrane thickness and surface area.

    Impaired Ventilation-Perfusion (V/Q) Matching

    • Causes of increased V/Q ratio (lung ventilated but not perfused):
      • Emphysema
      • Heart disease
      • Pulmonary hypertension
      • Liver disease
    • Causes of decreased V/Q ratio (lung perfused but not ventilated):
      • COPD
      • Chronic bronchitis
      • Asthma
      • Pulmonary edema
      • Airway obstruction
      • Pneumonia

    Altered Ventilation and Diffusion

    • Obstruction or restriction of airflow: examples are bronchoconstriction and suffocation.
    • Inhibition of neural stimulation/mechanics of breathing: examples are drug overdose and cervical nerve damage.
    • Increased thickness or decreased surface area of alveolar-capillary junction
    • Decreased partial pressure or decreased solubility of gases.

    General Manifestations of Impaired Ventilation and Diffusion

    • Cough, mucus, hemoptysis
    • Dyspnea, orthopnea
    • Adventitious lung sounds
    • Use of accessory respiratory muscles
    • Chest pain
    • Barrel chest

    Effects of Impaired Ventilation and Diffusion

    • Hypoxemia: Decreased oxygen in arterial blood, leads to decrease in PaO2.
    • Hypoxia: Oxygen deprivation in the cells.
    • Hypercapnia: Increase in carbon dioxide in the blood.

    Hypoxemia

    • Results from inadequate oxygen in the air or disease of the respiratory system, dysfunction of the neurological system, or alterations in circulatory function.
    • Mechanisms include hypoventilation, impaired diffusion of gases, or inadequate circulation through the pulmonary capillaries, or mismatching of ventilation and perfusion.

    Hypercapnia

    • Caused by hypoventilation or mis-match between ventilation and perfusion
    • Common causes include COPD and sleep apnea

    Symptoms of Respiratory Distress and Hypoxia

    • Early: restlessness, tachycardia, tachypnea, exertional dyspnea, orthopnea, anxiety.
    • Late: extreme restlessness, severe dyspnea, slowing of respiratory rate, bradycardia, peripheral or central cyanosis, and intercostal retractions

    Cyanosis

    • Oxygen saturation < 85%.
    • Discoloration of the skin (bluish or purple)
    • Different types:
      • Central: skins and lips affected
      • Peripheral: hands, fingers, feet, and toes
      • Circumoral (perioral): only the mouth and lips affected

    Clubbing

    • Caused by chronic low blood oxygen.

    Treating Impaired Ventilation and Diffusion

    • Remove obstructions
    • Restore integrity of chest wall and lungs
    • Decrease inflammation and mucus
    • Open and maintain integrity of airways
    • Provide supplemental oxygen
    • Control infectious processes
    • Use mechanical ventilation when needed (priority).

    Lab or Diagnostic Tests (for respiratory problems)

    • Pulmonary function test (PFTs): evaluate lung function during breathing.
    • Arterial blood gas (ABG): determines acid-base imbalances, and the degree of hypoxemia and hypercapnia in arterial blood.
    • Pulse oximetry: non-invasive; measures oxygen saturation in the blood.
    • Bronchoscopy: direct visualization of bronchioles.
    • Radiograph, CT, MRI: detect structural problems, presence of consolidation, obstruction, or cavities in the lungs
    • Nuclear (V/Q) lung scan: detects pulmonary embolism, and lung diseases like COPD and emphysema by using radioactive material inspired into the lungs.
    • Culture and sensitivity test: determines microorganisms in blood or sputum from the lungs to dictate appropriate antibiotic treatment (if indicated).
    • Thoracentesis: determines presence of pleural effusion.

    Alterations of the Respiratory System

    • Asthma, Pneumonia, COPD (including emphysema and chronic bronchitis), Acute respiratory distress syndrome (ARDS), Respiratory Syncytial Virus (RSV), and COVID-19

    Asthma

    • Intermittent or persistent airway obstruction due to bronchial hyper-responsiveness, chronic inflammation, bronchoconstriction, and excess mucous production.
    • Pathogenesis: allergens trigger mast cells to release mediators leading to bronchoconstriction and inflammation causing airflow limitation and increased airway responsiveness.

    Asthma Pathophysiology

    • Tracheal and bronchial linings overreact to stimuli (allergens, etc).
    • Smooth muscle spasms constrict airways.
    • Mucosal edema and thickened secretions further block airways.
    • IgE antibodies attached to mast cells combine with antigens.

    Asthma Pathogenesis

    • Allergen triggers mast cells, releasing histamine, leukotrienes, interleukins, and prostaglandins
    • Inflammatory cells infiltrate the airways and release cytokines and other mediators
    • Edema and epithelial injury lead to impaired mucociliary function.
    • Airflow limitation and increased airway responsiveness occur.

    Asthma Attack Anatomy

    • Inhaled air → primary bronchi → trachea → bronchial tubes→alveoli.

    Asthma: Narrowed Bronchiole

    • Airway obstructed with mucus plug or spasm in the bronchioles.
    • Blood vessels engorged from inflammation.

    Asthma Causes

    • Extrinsic:

      • Pollen
      • Animal dander
      • Feather or down pillows
      • Dust or mold
      • Irritants or noxious fumes
      • Variations in temperature or humidity
      • Food additives containing sulfites

    • Intrinsic

      • Emotional stress or anxiety
      • Fatigue
      • Endocrine changes (hypo/hyperthyroidism)
      • Genetic predisposition
      • Physical exertion

    Asthma Pathophysiologic Changes Asthma

    • Sudden dyspnea, wheezing, chest tightness, diminished breath sounds (due to bronchial constriction)
    • Initially non-productive cough.
    • Later, coughing with thick, clear, or yellow sputum (due to excess mucous).
    • Tachycardia, tachypnea, use of accessory respiratory muscles (due to hypoxemia).

    Asthma Treatment

    • Stepwise approach based on asthma severity
    • Control of symptoms: ranged from controlled to very poorly controlled.
    • Mild intermittent, mild persistent, moderate persistent, severe persistent.

    Chronic Obstructive Pulmonary Disease (COPD)

    • Emphysema and chronic bronchitis.
    • Emphysema: permanent enlargement of air sacs (alveoli) and destruction of lung tissue caused by chronic smoking.
    • Chronic bronchitis: chronic inflammation of the bronchial lining with an accumulation of mucus, often in the setting of smoking, but other causes exist.

    Emphysema

    • Irreversible enlargement of the air spaces beyond terminal bronchioles.
    • Destruction of alveolar walls → obstruction of airflow.
    • Chronic smoking is a major cause

    Emphysema Clinical Manifestations

    • Persistent cough
    • Dyspnea
    • Wheezing
    • Barrel chest
    • Pursed lip breathing

    Emphysema Treatment

    • Maintain optimal lung function
    • Smoking cessation
    • Pharmacologic therapy (possibly)
    • Lung volume reduction or transplant (possibly).

    Chronic Bronchitis

    • Persistent, productive cough lasting ≥3 months, for ≥2 consecutive years.
    • Chronic inflammation and edema of airways.
    • Hyperplasia of bronchial mucus glands & smooth muscles.
    • Destruction of cilia.
    • Squamous cell metaplasia.
    • Bronchial wall thickening, fibrosis

    Chronic Bronchitis Clinical Manifestations

    • Productive cough
    • Purulent sputum
    • Dyspnea
    • Adventitious lung sounds
    • Hypoxemia and hypercapnia
    • Cyanosis ("Blue Bloater")

    Chronic Bronchitis Treatment

    • Smoking cessation
    • Pulmonary rehabilitation
    • Pharmacologic therapy:
      • Bronchodilators
      • Steroidal anti-inflammatory drugs
      • Mucolytic agents
    • Supplemental oxygen

    Management of COPD

    • Measurement of lung function.
    • Classification of COPD severity (mild, moderate, severe, very severe)

    Management of Stable COPD

    • Pharmacologic management:
      • Bronchodilators
      • Glucocorticoids
      • Phosphodiesterase-4 inhibitors (PDE4 inhibitor)

    Management of COPD Exacerbations

    • Pharmacologic management:
      • Short-acting beta agonists (SABAs) - specifically inhaled.
      • Inhaled anticholinergics
      • Systemic glucocorticoids
      • Antibiotics
      • Supplemental oxygen (to maintain oxygen saturation of 88% - 92%).

    Pneumonia

    • Infectious process; respiratory droplet spread.
    • Causes inflammation in the lungs, mostly in bronchioles, interstitial lung tissue, and alveoli.
    • Products of inflammation accumulate → consolidation.

    Pneumonia Clinical Manifestations

    • Sudden onset fever
    • Chills
    • Cough
    • Sputum production
    • Fatigue
    • Loss of appetite
    • Dyspnea
    • Tachypnea
    • Tachycardia
    • Pleuritic pain
    • Crackles in lungs

    Pneumonia Diagnostic Criteria

    • History and physical examination
    • Complete blood cell count
    • Chest X-ray
    • Thoracic CT scan
    • Gram stain
    • Culture and sensitivity test
    • Pulse oximetry and arterial blood gases

    Classifications of Pneumonia

    • Source of infection: Community-acquired, Hospital-acquired
    • Immune status of host: Pneumonia in the immunocompromised person.

    Pneumonia Treatment

    • Restore optimal ventilation and diffusion
    • Identify pathogen and target with appropriate pharmacologic treatment
    • Supplemental oxygen

    Acute Respiratory Distress Syndrome (ARDS)

    • Progression from lung injury to respiratory distress within 24 to 48 hours.
    • Severe acute inflammation and pulmonary edema (without fluid overload or impaired cardiac function).
    • Mortality rate 30-40% if untreated. (multisystem organ failure).
    • Caused by injury to alveolar and pulmonary capillaries, which causes inflammatory mediators to increase capillary permeability. This leads to increased interstitial osmotic pressure and pulmonary edema.

    ARDS Pathophysiology

    • Progression from lung injury to respiratory distress within 24-48 hours.
    • Severe acute inflammation and pulmonary edema.

    ARDS Phases 1 and 2

    • Phase 1: injury reduces blood flow; results in platelets aggregating and releasing histamine, serotonin, and bradykinin.
    • Phase 2: these substances damage the alveolar-capillary membrane, increasing capillary permeability. Fluid shifts to the interstitial space.

    ARDS Phases 3 and 4

    • Phase 3: capillary permeability increases resulting to fluid and protein leakage; increasing interstitial osmotic pressure causing pulmonary edema.
    • Phase 4: decreased blood flow and fluids in the alveoli cause surfactant damage and impair production; resulting in alveoli collapse. This impedes gas exchange and decreases lung compliance.

    ARDS Phases 5 and 6

    • Phase 5: insufficient oxygen can cross alveolar-capillary junction, but carbon dioxide can release. Oxygen and carbon dioxide levels decrease.
    • Phase 6: pulmonary edema worsens causing inflammation to lead to fibrosis impeding gas exchange even further.

    ARDS Treatment

    • Humidified oxygen
    • Ventilatory support
    • Sedatives, opioids, neuromuscular blockers
    • Sodium bicarbonate
    • IV fluids, vasopressors (to maintain blood pressure).

    COVID-19

    • A novel coronavirus that causes respiratory symptoms (ranging from mild to severe).
    • Life-threatening coronaviruses include SARS-CoV, MERS-CoV, and SARS-CoV-2.
    • Symptoms: early includes fever, nausea, vomiting, diarrhea, sore throat, cough, dyspnea.
    • Later include hypoxia (cyanosis, confusion, somnolence, chest pain/pressure), anosmia/ageusia, malaise, myalgia, fatigue, anorexia.
    • Attacks alveolar epithelial cells and capillary endothelial cells; can cause strong inflammatory response leading to cytokine storm, pulmonary edema and ARDS.
    • Other organ systems can be affected and hypercoagulability can lead to clots.
    • Post-acute complications ("Long Covid-19"): fatigue, dyspnea, arthralgias, lingering lung damage (impaired diffusion capacity & restrictive lung damage)
    • Death risk increased in vulnerable populations (elderly, obese, pre-existing disease)

    RSV

    • Common viral infection of the lungs
    • Most children have RSV once by age 2.
    • Severe RSV is seen in babies under 12 months or older patients.

    RSV Symptoms

    • Congested or runny nose
    • Dry cough
    • Low-grade fever
    • Sore throat
    • Sneezing
    • Headache

    RSV Prevention

    • Hand washing
    • Avoiding exposure (November-March)
    • Avoiding smoking
    • Pharmacology for preventing RSV infection in infants, children, and elderly (ex: nirsevimab, aka Beyfortus) - antibody injection

    RSV Diagnosis and Treatment

    • Diagnosis: physical symptoms, labs (CBC), rapid antigen test (swab), X-rays
    • Treatment: supportive care (fever reducers, nasal drops); hospitalization if severe (fluids, oxygen)

    Pharmacology (general notes)

    • Targets components of illness (bronchoconstriction and inflammation).
    • Guidelines for treating asthma and COPD are available from GINA or similar resources.

    Administration of Asthma Drugs

    • Technique for using inhalers is critical for effective drug delivery to the lung site..
    • Types of inhalers: Metered dose inhalers (MDIs), dry-powder inhalers (DPIs), and nebulizers.

    Asthma, COPD, and Other Respiratory Medicines

    • Short-acting beta agonists (SABAs), inhaled corticosteroids (inhalers), combination therapies (inhalers) are commonly used.
    • Other add-on medications exist (e.g., monoclonal antibodies, PDE4 inhibitors, long-acting beta agonists (LABAs), long-acting muscarinic antagonists (LAMAs)
    • Use a valved holding chamber/spacer with HFA inhalers to help manage drug delivery more effectively.

    Beta-2 Agonists

    • Drugs: Albuterol, salmeterol, levalbuterol, formoterol
    • MOA: activate beta-2 receptors in lungs, causing bronchodilation
    • Administration: inhaled (preferred over oral).
    • Adverse reactions: tachycardia, tremor, angina
    • Drug-food interactions: beta blockers (especially non-selective) and MAOIs.
    • Nursing considerations: monitor heart rate (avoid >20 bpm from baseline); monitor for angina symptoms (chest pain, arm pain, palpitations; avoid substances with caffeine).

    Inhaled Glucocorticoids

    • Drugs include: beclomethasone, fluticasone, budesonide.
    • MOA: primarily suppress inflammation, may increase beta receptors, & decrease mucous production..
    • Uses: maintenance/prophylaxis of asthma (fixed schedule).
    • Adverse reactions: hoarseness, oropharyngeal candidiasis ("thrush")
    • Nursing interventions: monitor for oral candidiasis; advise clients to rinse and spit after inhaler use, report any oral white patches.

    Glucocorticoids for acute exacerbations

    • Drugs = Prednisone, methylprednisolone
    • Administration= mainly oral, or IV
    • Use = short high-dose course (5-7 days) for exacerbations (reduces inflammation)
    • Adverse reactions = include adrenal suppression, osteoporosis, hyperglycemia, GI upset and peptic ulcer.
    • Interventions: Taper dose, monitor glucose, advise clients to take with food. Monitor for infections.

    Order of Inhaler Use

    • If multiple inhalers are used, the short-acting beta-2 agonist is usually administered first, followed by the glucocorticoid. Time administration of different medications by 5 minutes or as directed.

    Theophylline

    • MOA: relaxes smooth muscles of bronchi causing bronchodilation.
    • Uses: for some with chronic asthma (not preferred for acute exacerbations), nocturnal symptoms.
    • Administration: oral (dose individualized), IV for emergencies (as aminophylline).
    • Adverse reactions: include nausea, constipation, dizziness, sedation, and GI effects. Food and Drug interactions: Avoid caffeine, cigarettes, Ciprofloxacin, and other medications that may increase blood levels.
    • Nursing evaluations/interventions: Monitor for toxicity—therapeutic range is 5-15 mcg/mL, and adjust dosages accordingly. Advise clients to avoid caffeine and smoking, monitor for cardiac symptoms

    Inhaled Anticholinergics

    • Drugs: Ipratropium, tiotropium, and aclidinium.
    • MOA: block muscarinic receptors in the bronchi to reduce bronchoconstriction.
    • Administration: inhaled; do not swallow tiotropium capsules.
    • Adverse reactions: some anticholinergic side effects can occur (dry mouth, headache; glaucoma). Soy lecithin is in some meds, so be careful.

    Leukotriene Modifiers

    • Drug = Montelukast
    • MOA = blocks leukotriene receptors, reducing inflammation, edema, and decreased mucus plugging.
    • Use= maintenance/prophylaxis of asthma (adults and children—over 6 months of age).
    • Admin= by mouth at bedtime.
    • Adverse reactions: serious neuropsychiatric disorders (suicide ideations/depression/aggressive behavior). Nursing Evaluation: monitor behavioral changes and advise clients to report any signs of these problems.

    Antihistamines

    • Drugs = diphenhydramine, chlorpheniramine (first generation); cetirizine, fexofenadine, loratadine, azelastine (second generation).
    • MOA: inhibit H1 receptors at various sites to block histamine effects, reducing edema, redness, itching, etc.
    • Uses: treat allergy and cold symptoms, allergies.
    • Nursing considerations with first generation are that they are sedating and cause anticholinergic effects that are serious for the elderly.

    Sympathomimetic Decongestants

    • Drugs= pseudoephedrine, phenylephrine, oxymetazoline (ex: Afrin nasal drops).
    • MOA: stimulate alpha-1 adrenergic receptors on blood vessels, leading to vasoconstriction, reducing edema.
    • Uses= reducing nasal congestion.
    • Intranasal may cause intense and rapid action, but rebound congestion may occur if administered chronically.
    • Oral may cause delaying onset, but effects are more prolonged.
    • Nursing consideration when administering oral or intranasal include: monitor for symptoms indicating overstimulation of the central nervous system (ex= tachycardia, increased BP or agitation).

    Intranasal Glucocorticoids

    • Drugs= mometasone, budesonide, fluticasone.
    • First-line therapy for chronic allergic rhinitis.
    • MOA= suppress inflammatory response to allergens..
    • Dosage and administration: typically daily, used before symptoms start.
    • Adverse reactions: localized nasal side effects (bleeding, burning, itching) or rare systemic effects (ex= adrenal suppression)

    Non-Opioid Cough Suppressants

    • Drug= dextromethorphan, benzonatate
    • MOA= dextromethorphan is most effective but is non-opiod and opioid-derived; benzonatate is derived from tetracaine which works as a local anesthetic.
    • Benzonatate reduces sensitivity so it shouldn't be chewed.
    • Adverse Reactions = potential for euphoria with dextromethorphan at higher doses, and some local anesthetic effects.
    • Additional Considerations = avoid use with MAOIs.

    Opioid Cough Suppressants

    • Drugs = opioids (codeine, hydrocodone/combination with other meds)
    • MOA = suppress cough reflex directly, affecting the cough center in the brain.
    • Adverse reactions = GI upset (nausea, constipation), CNS effects (dizziness, sedation), respiratory depression.
    • Nursing considerations = advise that drugs should be taken with food if nausea is suspected or advise of additional effects if driving or operating dangerous machinery.
    • Additional considerations: Abuse potential exists.

    Expectorants- Guaifenesin

    • Drug= Guaifenesin (ex= Robitussin, Mucinex)
    • MOA= Stimulates respiratory secretions, making coughs more productive.
    • Adverse Reactions: GI upset, dizziness/drowsiness, which warrants counseling on driving or operating dangerous machinery.
    • Additional Nursing Considerations = recommend fluid intake.

    Mucolytics (e.g., Acetylcysteine)

    • Drug = acetylcysteine.
    • MOA = decreases viscosity of mucus, enhancing flow.
    • Administration = Usually via inhalation given orally or intravenously for overdose scenarios.
    • Adverse reactions: Bronchospasm—possible concern in people with asthma..
    • Nursing evaluations = education about smell, monitoring for aspiration, and providing suction (if necessary). Monitor for bronchospasm in clients with asthma.

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