meds.docx

**[Respiratory:]** **[Identify the structures and discuss the anatomy within the chest and thoracis cavity including the pulmonary system.]**\ Intercostal muscles, Diaphragm, Accessory muscles and Abdominal muscles, upper and lower respiratory tract Chest cavity encloses the lung protects + gives...

**[Respiratory:]** **[Identify the structures and discuss the anatomy within the chest and thoracis cavity including the pulmonary system.]**\ Intercostal muscles, Diaphragm, Accessory muscles and Abdominal muscles, upper and lower respiratory tract Chest cavity encloses the lung protects + gives room for lung to expand Pleura holds around the lung usually fluid or air space, help lung expand in chest cavity without damage **[Discuss the function of the pulmonary system including the 3-step process by which it does it. ]** Main function → gas exchange, aid in fluid and electrolyte changes Ventilation Neurochemical control + mechanic of breathing - respiratory center, central and peripheral chemoreceptors - muscles (major + accessory), lung elasticity, airway resistance, work of breathing Diffusion Gas Transport - oxygen + carbon dioxide transport Perfusion Control of the Pulmonary Circulation - blood flow aka circulation system pulmonary and bronchial circulation - artery AA, artery away - veins VT, veins towards **[List some of the common clinical manifestations that may indicate pulmonary disfunction.]** Dyspnea not breathing Alter breathing pattern hypo or hyper Coughing Sputum (hemoptysis) discharge or mucus Cyanosis / hypoxemia Nail clubbing Chest pain Hypercapnia **[Identify and differentiate different types of dyspnea and include clinical manifestations seen in each. ]** Subjective experience w/ objective data - pt will have subjective experiances unique experiances - nurse will need to get objective data Respiration rate, scale of breathing, O2 stat, ABGs Transient or Chronic happen at a certain time or constant Dyspnea on exertion when moving Orthopnea when sitting Paroxysmal nocturnal dyspnea night Signs and symptoms nasal flaring, using accessory muscle, retraction, chest tightening, coughing, SOB, wheezing, shadow breathing, breathlessness **[Define and differentiate the following:]** Hyperventilation buildup of O2 - hypocapnia, respiratory alkalosis, - caused by anxiety, acute head injury, pain, etc Hypoventilation buildup of CO2 - hypercapnia, respiratory acidosis - caused by neuro or mechanical issues Hypercapnia buildup of CO2 - hyperventilation of alveoli + increased carbon dioxide + respiratory acidosis - Depressants, opioids, head trauma, CNS infection, spinal cord or neuromuscular disorder/injury Hypoxemia reduced PaO2 in blood - High altitude, pulmonary embolism, pulmonary edema Hypoxia not enough O2 in tissue - Hypoxemia **[Differentiate and compare the different disorders of the upper respiratory, and understand symptoms associated with each and what causes those symptoms]** Common Cold congestion of everything (nose + throat) - Caused rhinovirus, Bacterial infection  - Symptoms  Swollen mucous, sneezing, congestion, sore throat, cough, low fever, Headaches, weakness, aches  - Treatment  Antibiotics, decongestant  Acute rhinitis inflammation of nasal mucous membrane - Causes Allergies, stress, viral illness  - Symptoms Sneezing, stuffy runny noses, tiredness, fatigue  - Treatment  Antibiotics, decongestants, Fluids   Sinusitis inflammation of sinuses mucous membrane - Causes Viruses, bacteria invading membrane of sinuses  - Symptoms Sneezing, mucous, inflamed/pain in sinuses, stuffy/runny nose, headache, fever  - Treatment  Fluids, irrigation with NS, rest  Acute pharyngitis inflammation of throat - Causes viral infection, step etc. - Symptoms fever, cough, nausea, swollen lymph nodes and tonsils  - Treatment meds, sneezing with mouth open Respiratory infections → infection in the lower respiratory track  - Causes Bacteria, virus, fungal etc going into your lungs  - Symptoms Secretion, runny nose, itchy eyes, inflammation, congestion, cough sneezing  - Treatment  Decongestion, antibiotics, fluids, rest  Symptoms of all - Secretions, excess mucus, runny nose, itchy eyes, inflammation, nasal/chest congestion, sneezing, coughing Treatment of all - Antihistamines, intranasal glucocorticoids, nasal decongestant, expectorants, antitussives, analgesic, fluids, antibiotic **[Identify the action, use and contraindications/ cautions and side effects of the following categories of meds and be able to give examples of each.]** Antitussives → nonopioid (dextromethorphan, benzonatate) and opioid (hydrocodone, codeine)  - Therapeutic effect  Cough treatment, Decreasing frequency + intensity  - Action of drug  suppress cough reflex, increase cough threshold - Contradictions   Hypersensitivity, bad for non-chronic productive cough  - Toxic side effects  Dizziness, drowsiness, respiratory depression, constipation, Lightheadedness, nausea, vomiting - Interventions  Vitals, safety, take with food, increase fluids  Expectorant → guaifenesin  - Therapeutic effect Thin mucous secretions = elimination by coughing  - Action of drug  Reducing surface tension, - Contradictions  Hypersensitivity, diabetic, alcohol issues  - Toxic side effects  Drowsiness, dizziness, irritability, nausea, sensitivity, GI distress, allergic reaction  - Interventions  Water and food, Increase fluid intake  Mucolytics → acetylcysteine (inhaled) or hypertonic saline  - Therapeutic effect  large amount of secretion, cystic fibrosis, antidote for acetaminophen poisoning  - Action of drug  liquefy mucus or prevention of liver damage - Contradictions  Respiratory insufficiency, asthma or history of bronchospasm  - Toxic side effects  Bronchospasms, rash, tachycardia, careful with asthma patients  - Interventions  Water, strong rotten egg taste, monitor secretions and respiratory status  Decongestants → phenylephrine, ephedrine, naphazoline, pseudoephedrine  - Therapeutic effect  Treat congestion, decrease nonproductive cough - Action of drug  Stimulates alpha1-adrenergic receptors to reduce inflammation - Alpha1-adrenergic receptors produce vascular constriction = shrinks mucous membranes and reduces nasal secretions  - Toxic side effects  Nervousness, restless, rebound congestion, HTN, DM  - Interventions Take with food and water  Antihistamines → 1^st^-gen diphenhydramine, Promethazine, Dimenhydrinate, 2^nd^ gen Cetirizine, loratadine, Fexofenadine, Intranasal azelastine, Olopatadine - Therapeutic effect  Acute and allergic rhinitis, common cold, sneezing, cough, motion sickness, sleep aid  - Action of drug  Competes with histamine for receptor sites, block H1-receptor sites to prevent secretion and itching  - Contradictions  Narrow glaucoma, urinary retention, liver diseases  - Toxic side effects  Sedation, anticholinergic effects  - Interventions   Fluids + food, monitor input and output, bowel function, avoid sedatives, drowsiness concerns  Nasal glucocorticoids  Mometasone, Fluticasone, Triamcinolone, Budesonide - Therapeutic effect  Decrease Inflammation, allergies  - Action of drug  Decreases inflammation within rhinitis  - Contradictions  hyper-senativity, hypertensions - Toxic side effects  Nosebleeds, headaches/irritation, sore throat, burning in the nose  - Interventions  metered-dose spray, given daily (maintenance care does not rescue) **[Discuss some nutritional considerations when treating someone for common upper respiratory disorders to help boost immune, build strong respiratory muscles.\ ]**high protein and fiber diet strong respiratory muscles Echinacea helps fighting respiratory infections Elderberry boost immune cells + unblock flu virus ability to spread Garlic antiviral compounds Oregano oil antibiotic + antiviral herb Vitamin D + vitamin C boost immune system **[Discuss the mechanism restrictive vs. Obstructive disorders of the pulmonary system. ]** Restrictive limits volume - Spiration, atelectasis, bronchiectasis, bronchiolitis, pulmonary fibrosis - Decrease in total lung capacity due to fluid or decreased elasticity  - Hard to fully expand lungs  Obstructive limit airflow - Asthma, COPD - Hard to exhale or inhale **[Differentiate (briefly) the different disorders of the lower respiratory including the pathophysiology, etiology and treatment:]** Pneumothorax Air in pleural space - Cause puncturing of lung space - Signs + symptoms cyanosis, chest pain/tightness, coughing, fatigue, fast breathing/heart rate - Treatment observation, needle aspiration, blood patch, surgery Pleural effusion Fluid in pleural space - Cause leaking of fluid from other organs - Signs + symptoms SOB, chest pain, fever, cough - Treatment drain, chest tube Aspiration choking on fluid or solid stuff - Cause something entering your airway - Signs + symptoms cough, horsiness, increased saliva, chewing problems - Treatment swallowing or speech therapy, prevention tactics Atelectasis collapse part or all of lung - Cause complication of surgery, injury, mucus, tumor - Signs + symptoms coughing, chest pain, increased HR, rapid breathing, blue skin/lips - Treatment inhaler, physical activity draining mucus or air Pulmonary Fibrosis damaged and scarring of lung tissue - Cause drugs, genetic disorders, - Signs + symptoms SOB, Dry cough, tiredness, weight loss - Treatment medication, oxygen therapy, transplant Pulmonary edema fluid buildup in the lungs - Cause heart, blood clots, high blood pressure - Signs + symptoms anxiety, SOB, coughing, lightheadedness - Treatment prevention, medication, oxygen treatment Asthma chronic inflammation of airway due to triggers - Cause trigger, genetic - Signs + symptoms coughing, wheezing, SOB, chest tightness - Treatment inhaler, oxygen, nebulizer (COPD- Chronic bronchitis, Emphysema) - Cause smoking, inflammation of bronchi - Signs + symptoms coughing, SOB, wheezing, mucus - Treatment oxygen therapy, ventilation Pneumonia infection of air sacs in lungs - Cause infection, viral or bacterial - Signs + symptoms mucus, SOB, decease appetite, chills, fever - Treatment antibiotics, prevention, Pulmonary Embolism blood clot in lung - Cause heart illness, blood clot - Signs + symptoms SOB, back pain, lightheaded tingling - Treatment surgery , prevention + immediate treatment Pulmonary hypertension hypertension in the lungs - Cause hypertension - Signs + symptoms High BP, chest pain, tiredness, edema - Treatment oxygen therapy , diet and lifestyle changes **[Identify the action, use, contraindications/ cautions and side effects and nursing considerations for the following categories of meds and be able to give examples of each and how/why they are used:]** Bronchodilator agents → beta2-adrenergic agonist  short acting SABAs (rescue) long acting LABAs (maintain) - Therapeutic effect  Relieving bronchospasm, histamine release inhibited, Ciliary motility increased  - Action of drug  Inhaled short acting treatment for bronchospasm and asthma, Oral long acting control of asthma  - Contradictions  Avoid stimulants, bronchodilators before inhaled steroids, SABA for acute symptoms , LABA taken daily  - Toxic side effects  Tachycardia, Chest pain  Bronchodilator agent Methylxanthines → theophylline  - Therapeutic effect  Bronchodilation, treatment for asthma or COPD - Action of drug Relaxes smooth muscles of bronchi - Toxic side effects  Dysrhythmia, dizziness, headache, Seizures, hyperglycemia, tachycardia, Hypotension, GI issues, intestinal bleeding  - Interventions monitor for toxicity Bronchodilator agent anticholinergics → Ipratropium bromide (Short-acting), Tiotropium (Long-acting) - Therapeutic effect  Maintaining bronchospasms in COPD, allergen-induced or exercised-induced  - Action of drug  Dilating bronchioles  - Contradictions  - Toxic side effects  Anticholinergic effects  - Interventions  Sugarless candy for dry mouth, clean mouth after inhalation, Do not swallow  Anti-inflammatory agents: glucocorticoids→ Beclomethasone, Budesonide, Formoterol (Inhaled), Prednisone (oral), Hydrocortisone, Methylprednisolone (IV) - Therapeutic effect  Prevention of inflammation  - Action of drug  Suppress airway mucus production, Reduction in airway mucosa  - Toxic side effects  Oral → hyperglycemia, suppression of adrenal gland, Inhaled → hoarseness, candidiasis, osteoporosis, bleeding, Fluid and electrolyte imbalance  - Interventions  Rinse mouth, taper dose to avoid adrenal imbalance, Weight exercises, monitor glucose, potassium, glucose and stools, Avoid NSAIDs  Anti-inflammatory agent: leukotriene modifiers → zafirlukast, montelukast, zileuton  - Therapeutic effect  Short term treatment of asthma attacks, maintenance of chronic asthma, Used for prophylaxis of exercise-induced bronchospasm  - Action of drug  Reduced inflammatory process, Decreased bronchoconstriction  - Toxic side effects  Dizziness, headache, confusion, hepatotoxicity, GI distress, depression, weakness, infection  - Interventions Monitor liver function, behavior, interactions with other drugs, Empty stomach, once daily  Antibiotics → trimethoprim-sulfamethoxazole  - Therapeutic effect Treating chronic bronchitis caused by infections - Action of drug Killing of bacteria cells  - Toxic side effects Renal, hepatic impairment, anemia  - Interventions  Collect sputum first  **[How Does Food Relate to Breathing? List some food choices that would be appropriate for a population with acute or chronic respiratory disorders.]** - Carbohydrates = increases CO2, Fat = least amount of CO2 - Pt encouraged to eat low carb, high protein and fat diet - Eat complex carbs whole-grain, pasta, fruits + vegs - Limit simple carbs sugar, cake, candy etc **[Discuss appropriate patient education associated with eating, energy consumption and nutritional consideration for our patient population with acute or chronic respiratory disorders.]** - Rest before eating, eat early in the morning - Avoid anything that cause gas or bloating - Eat multiple small meal a day - Consider calcium replacement when taking steroids long term **[Musculoskeletal]** **[List the functions of the skeletal muscles]** - Movement, position, stabilize, heat **[Differentiate and give examples of joint classifications.]** - Stability and movement - Synarthrosis Fibrous tissue, just protection, no movement, skull - Amphiarthrosis cartilaginous tissue, limited movement, spine - Diarthrosis synovial joint and cartilaginous tissue, all ROM, normal joints **[Differentiate osteoblasts and osteoclasts]** - Osteoblast form new bones (builds bones) - Osteoclast dissolve old/damaged bones (close out or removes bones) **[Differentiate tendons from ligaments in their structure and function]** Tendons attach muscle to bone - stabilize movement, transferring forces from muscle to bone Ligaments attach bone to bone - stabilize joint by restricting movement **[Compare strain and sprain]**\ Sprain injury to ligaments, will see bruising Strain injury to muscle or tendons, will not see bruising **[Define fracture and differentiate the different classifications of fractures.]** complete vs incomplete full break or partial break open vs close Bone visible through skin or not comminuted Multi-place break linear Straight line without moving bone oblique slanted break occult does not appear in x-ray pathologic disease caused segmented small pieces greenstick corner break impacted bone driven into each other spiral Spiral transverse straight break **[Discuss the possible complications of a fracture]** Inflammation, edema, clotting issues, blood loss Muscle spasm, infection, ischemia, nerve damage, failure to heal, deformity, osteoarthrosis, chronic pain **[Differentiate closed and open reduction]** Close done without exposing the injured bone Open done with exposing the injured bone **[Discuss the treatment for joint injuries (RICE plus)]** Rest, Ice, Compress, elevate **[Discuss the steps of inflammation, Cardinal signs of inflammation and cause for each sign\ ]**steps of inflammation - injury arteriole constriction + vasodilation capillary permeability plasma thicken RBC = warmth + redness biochemical healing cardinal signs of inflammation - Redness increased RBC - Warmth + swelling increased blood flow - Pain + loss of function injury **[Discuss the systemic effects of inflammation and the symptoms attributed. ]** - Risk for cardiovascular, vessel/artery, pneumonia, lung cancer, diabetes - Fever, pallor, CNS changes, swelling, aches **[List the benefits of inflammation]** - Prevent infection - Limits spread of invasion - Tigger clotting - Prepare area for healing - Remove bacteria + dead cells **[Differentiate (briefly) the different bone and joint disorders including the pathophysiology, etiology and treatment:]** Osteoporosis weaken bones - Cause menopause, low calcium, smoking - Signs and symptoms pain, difficulty walking - Treatment diet, exercise, medication Rickets and Osteomalacia weaken bone and muscles - Cause low vit D. - Signs and symptoms weak, deformed bones, pain, stiffness - Treatment calcium and Vit D. supplements, Paget's overgrowth of bone production - Cause viral infection, cancer etc - Signs and symptoms - Treatment medication, mobility aids Osteomyelitis bone infection - Cause bacteria, viruses, fungi etc - Signs and symptoms bone pain, sweating, fever - Treatment medication for infection Lordosis, Kyphosis, Scoliosis - Cause genetic, poor posture - Signs and symptoms - Lordosis inward curvature of spine - Kyphosis increase front to back curve of spine - Scoliosis sideway curve of spine - Treatment physical therapy Muscular Dystrophy stiffen muscle and makes less flexible - Cause genes, production of poor proteins - Signs and symptoms falling down, weaken muscles + cramps, walking toes + waddles - Treatment PT, OT, medication Fibromyalgia flare up of pain in muscles - Cause unknown - Signs and symptoms musculoskeletal pain + fatigue, digestive problems - Treatment pain med, stretching, sleeping Osteoarthritis damage or decreasing of cartilage in joints - Cause wearing and tearing, old age - Signs and symptoms pain, stiffness, tenderness, swelling - Treatment pain management Rheumatoid arthritis inflammation of lining in your joints - Cause age, inflammation, - Signs and symptoms tender/warmth, stiffness - Treatment mobility aid, medication, heat compress Ankylosing Spondylitis fusing of bones - Cause inflammation - Signs and symptoms stiffness, back pain, fatigue - Treatment slowing progressing of disease, no cure, pain management Bursitis, Synovitis, Tendinitis inflammation of soft tissue in joints and muscles Bursitis → fluid-filled sacs near joints become inflamed  Synovitis → synovial joint becomes inflamed  Tendinitis → tendons becomes inflamed  - Cause inflammation and swelling caused by damage - Signs and symptoms stiffness and pain during movement, swelling - Treatment RICE treatment **[Identify the action, use, contraindications/ cautions and side effects and nursing considerations for the following categories of meds and be able to give examples of each and how/why they are used:]** Bisphosphonates Alendronate - Therapeutic effect  Paget's disease of bone treatment - Drug action  Inhibit bone resorption  - Toxic side effects  Esophagitis, GI disturbances, musculoskeletal pain, visual disturbances - Interventions  Take med first thing in the morning, empty stomach, sit or ambulate for 30 mins after meds  Calcitonin-salmon - Therapeutic effect  Postmenopausal osteoporosis, paget's disease, hypercalcemia, cancer  - Drug action  Decreases resorption by inhibiting osteoclast , Inhibits tubular resorption to increase renal calcium excretion   - Toxic side effects  Nausea, nasal dryness/irritation - Interventions  Chvostek, trousseau sign, hypocalcemia, bone density, consume calcium and vit. D Calcium citrate and calcium carbonate - Therapeutic effect  Hypocalcemia treatment, deficiencies of parathyroid hormone, vit. D or calcium  - Drug action  Calcium Supplement  - Toxic side effects  Hypercalcemia, muscle weakness, constipation, abdominal pain  - Interventions  Monitor calcium levels  TNF blocker Etanercept - Therapeutic effect used to treat autoimmune disorders - Drug action blocks TNF-alpha to prevent inflammation - Toxic side effects pain, vomiting, chills - Interventions Methotrexate - Therapeutic effect  Rapid relief of pain and inflammation  - Drug action  Death to rapid replicating cells, immunosuppressive   - Toxic side effects  Increase risk of infection, hepatic toxicity, bone marrow  - Interventions  Monitor bone marrow, bleeding, etc  Raloxidene  - Therapeutic effect  Postmenopausal osteoporosis, protect against breast cancer  - Drug action Decreased bone resorption  - Toxic side effects  Hot flashes, leg cramps  - Interventions  Need high calcium + Vit. D rich foods, monitor bone density, monitor serum calcium **[Discuss gout etiology, signs and symptoms, dietary considerations, education and treatment regimen.]** Gout inflammatory disease of joint, tendons, and other tissues - In the toe - Defective purine metabolism = uric acid accumulation Treatment + drugs - Colicine inhibits migration of leukocytes - Probenecid block reabsorption of uric acid - Allopurinol decrease uric acid production Nursing consideration - Avoid high purine, grapefruit - Monitor lab (CBC) renal + hepatic function - Record fluid output - Take meds with food - Yearly eye exams