RESPIRATORY MEDICATIONS PART 1 PDF

HLTENN040 Administer and monitor medicines and Intravenous Therapy Christine Prendergast HLT54121 DIPLOMA OF NURSING RESPIRATORY MEDICATIONSPART 1 Acknowledgement of Country We respectfully acknowledge the Wurundjeri People of the Kulin Nation, who are the Traditional Owners of the land on whi...

HLTENN040 Administer and monitor medicines and Intravenous Therapy Christine Prendergast HLT54121 DIPLOMA OF NURSING RESPIRATORY MEDICATIONSPART 1 Acknowledgement of Country We respectfully acknowledge the Wurundjeri People of the Kulin Nation, who are the Traditional Owners of the land on which Swinburne’s Australian campuses are located in Melbourne’s east and outer-east, and pay our respect to their Elders past, present and emerging. We are honoured to recognise our connection to Wurundjeri Country, history, culture, and spirituality through these locations, and strive to ensure that we operate in a manner that respects and honours the Elders and Ancestors of these lands. We also respectfully acknowledge Swinburne’s Aboriginal and Torres Strait Islander staff, students, alumni, partners and visitors. We also acknowledge and respect the Traditional Owners of lands across Australia, their Elders, Ancestors, cultures, and heritage, and recognise the continuing sovereignties of all Aboriginal and Torres Strait Islander Nations. 4 A & P Review of upper airway Upper Respiratory Tract Nose Nasal sinuses Throat Pharynx Larynx Upper trachea 5 Influenza • Can effect the entire upper respiratory tract including the nose, sinuses, throat, larynx and trachea. • Spread through airborne particles or contaminated surfaces • Influenza virus - an acute onset, highly contagious • Symptoms: fever, rigor, nasal discharge, cough, lethargy. • Can progress to pneumoniaelderly and young at greater risk 6 Allergic Rhinitis (Hayfever) • Person inhales pollen/dust from the air • The body's immune system mistakes the allergen (pollen, dust) as a harmful invader • The body produces antibodies to attack and destroy the allergen. This is an allergic response • The increase in antibodies causes cells of the respiratory system, to release a chemical called histamine • Histamine triggers the symptoms of sneezing, itchy eyes, etc. 7 Over the counter (OTC) medications • • • • • • • Cough suppressants Expectorants Mucolytics Anti-Muscarinic Antihistamines Anti-pyretic Sympathomimetic Decongestants 8 Cough suppressants (anti-tussive) Coughing • • A protective reflex to remove airway irritants A common symptom in many conditions & is a side effect of some drugs Purpose of cough suppressants: • • To reduce the frequency and severity of the coughing – (not to stop coughing all together) For a dry cough only. 9 Cough Suppressants (Antitussives) Mechanism of action: • Interrupt coughing reflex in the brain • Many cough suppressants are narcotic agents • May cause CNS depression→drowsiness • Many can cause nausea & vomiting Examples: Codeine (Codeine linctus), Pholcodine (Duro-Tuss dry cough), Dextromethorphan (Benedryl, Bosolvon, Robitussin) 10 Expectorants – removal of sputum Mechanism of action •Stimulate mucus secretion in dry irritated areas of respiratory tract •Used for people experiencing a dry cough •Chest rubs – eucalyptus/pine oil can be inhaled to activate mucosal glands •Effects can be promoted by regular coughing, fluid intake, and deep breathing Examples: Vicks cough syrup, Dimetapp, Robitussin chesty cough 11 Mucolytics Reduce viscosity (chemical breakdown) •Alter the structure of mucus, thereby enhancing the flow of mucus out of the respiratory tract •Chronic respiratory diseases affect cilia function and mucous clearance. •Used for people with Cystic Fibrosis Examples: •Bromhexine (Bisolvon, Durotuss chesty cough) • Acetylcysteine (Mucomyst) 12 Decongestants •Nasal congestion: vasodilation and increased swelling of tissues in the airway lining •Action = vasoconstriction in mucous membranes to reduce swelling •Can increase heart rate / blood pressure & cause insomnia Examples: •Oxymetazoline (Dimetapp Nasal Spray, Drixine nasal) • Tramazoline (Spray Tish) 13 Anti-histamines •Allergic reactions cause the release of histamine •Anti-histamines block the effects of histamine (airway swelling, sneezing, throat irritation, rash) • Used for allergic reactions •Can cause sedation Examples: •Cetirizine (Zyrtec), •Fexofenadine (Telfast), •Loratadine (Claratyne) •Promethazine (Phernergan) http://www.jnjaust.com.au/products/zyrtec/ 15 Oxygen Therapy Oxygen is treated as a drug because: • it can be toxic, • can cause adverse reactions • when used outside of health care facilities needs to be prescribed by a doctor for home use Used therapeutically to correct tissue hypoxia due to: • respiratory failure • anaemia • cardiovascular deficiencies • high altitude sickness 16 Oxygen – Clinical Measurements Fraction of inspired oxygen (Fi02) – • The percentage of oxygen in the air you inhale • FiO2 ranges are from 21% (e.g. in room air) to 100% (e.g. pure oxygen). 1L = 24% 2L = 28% 3L = 32% 4L = 36% 5 - 6 L = 40% 6-7 L = 50% 7-8 L = 60% via nasal cannula via mask 17 Hypoxia Hypoxia – a deficiency of oxygen reaching the tissues of the body Hypoxaemia - reduced oxygen in the blood caused by: •Hypoventilation •respiratory depression •cardiac failure •anaesthesia Ischaemia- death of tissue due to lack of oxygen caused by •Infarction •Embolism •Hypoperfusion e.g in shock/hypovolaemia Anaemia Inadequate Hb in presence of normal oxygenation 18 Oxygen delivery Nasal Cannula @1 – 4 litres/min delivers 24 to 44% O2 Usually run 1 to 4 litres/min Simple face mask @ 6– 12 litres/min delivers 35 to 60% O2 http://www.hudsonrci.com/Products/ 19 Oxygen Delivery (Oxygen First Aid, pp 141) Pocket mask with Oxygen nipple @ 15L/min delivers between 54% to 80% O2 Bag-valve-mask (with reservoir) @ 10-15 litres/min delivers 95 to 100% O2 http://www.hudsonrci.com/Products/ www.laerdal.com.au 21 Oxygen Toxicity – Nursing Considerations Caution when administering 02 to COPD patients • If COPD patients are given extra O2 the usual stimulus to breathe (hypoxic drive) can be depressed leading to hypoventilation and respiratory failure • Don’t administer O2 greater than 2 litres per minute as stimulation to breathe is triggered by lowered 02 levels • Always refer to Doctor’s orders 22 Oxygen Toxicity Oxygen toxicity Toxicity can develop if over 60% 02 is delivered for extended periods Exposure to pure oxygen (80-100%) for periods of 6 to 10 hours may cause ◘irritation ◘collapse of alveoli 23 Oxygen – Safety Issues Oxygen Cylinders • Always store under cover - store away from heat sources – in a dry cool area. • Ensure that any seals are attached to the regulator. • No naked flames near oxygen 24 Reference List Crisp, J. & Taylor, C. (2012). Potter & Perry’s Fundamentals of Nursing. (8th ed). Marrickville, Australia: Mosby Elsevier. Koutoukidis, G., Stainton, K. & Hughson, J. (2013). Tabbner’s Nursing Care: Theory and Practice. (6th ed). Chatswood, Australia: Elsevier. Lippman, J. (2005). Oxygen First Aid. Divers Alert Network. National Asthma Council Australia. http://www.nationalasthma.org.au/content/view/301/403/