Chapter 9 Care of the Patient with a Respiratory Disorder Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc

Chapter 9Chapter 9

Care of the Patient with a

Respiratory Disorder

Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

Slide 2Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

Overview of Anatomy and PhysiologyOverview of Anatomy and Physiology

• External respiration Exchange of oxygen and carbon dioxide between the

lung and the environment

• Internal respiration Exchange of oxygen and carbon dioxide at the cellular

level



• Upper respiratory tract Nose Pharynx Larynx Trachea

• Lower respiratory tract Bronchial tree

• Bronchioles, alveolar ducts, alveoli


• Mechanics of breathing Thoracic cavity

• Lungs Visceral pleura and parietal pleura

• Respiratory movements and ranges Rhythmic movements of the chest walls, ribs, and

muscles allow air to be inhaled and exhaled

• Regulation of respiration Nervous control—medulla oblongata and pons of the

brain; chemoreceptors—in the carotid and aorta




• Respiratory Movements and Ranges Room air when inhaled= 21% Oxygen

• Exhaled air= 16% oxygen Normal Respirations

• Adult= `4-20 bpm

• Newborn= 40-60 bpm

• Early school age child= 22-24 bpm

• Teenager= 20-22 bpm Rate can be affected by many variables

• Sex, age, activity, disease, body temperature, etc.

• Count without patient’s awareness to prevent alteration in breathing pattern


Assessment of the Respiratory SystemAssessment of the Respiratory System

• Subjective data Shortness of breath, dyspnea, cough

• Objective data Expression, chest movement, and respirations Respiratory distress, wheezes, or orthopnea Adventitious breath sounds

• Sibilant wheezes

• Sonorous wheezes

• Crackles

• Pleural friction rubs


Laboratory and Diagnostic ExaminationsLaboratory and Diagnostic Examinations

• Chest roentgenogram (CXR)• Computed tomography (CT)• Pulmonary function testing• Mediastinoscopy• Laryngoscopy• Bronchoscopy• Sputum specimen• Cytological studies• Thoracentesis • Arterial blood gases (ABG)• Pulse oximetry


Figure 9-7Figure 9-7

Fiberoptic bronchoscope.

(A, Courtesy of Olympus America, Melville, New York. B, from Meduri, G.U., et al. [1991]. Protected bronchoalveolar lavage, American Review of Respiratory Disease, 143:855, official journal of the

American Thoracic Society, © American Lung Association.)



Thoracentesis.

(From Lewis, S.M., Heitkemper, M.M., Dirksen, S.R. [2007]. Medical-surgical nursing: assessment and management of clinical problems. [7th ed.]. St. Louis: Mosby.)



Portable pulse oximeter with spring-tension digit probe displays

oxygen saturation and pulse rate.

(From Potter, P.A., Perry, A.G. [2009]. Fundamentals of nursing. [7th ed.]. St. Louis: Mosby.)


Disorders of the Upper AirwayDisorders of the Upper Airway

• Epistaxis Etiology/pathophysiology

• Bleeding from the nose

• Congestion of the nasal membranes leading to capillary rupture

• Primary or secondary Clinical manifestations/assessment

• Bright red bleeding from one or both nostrils

• Can lose as much as 1 liter per hour



• Epistaxis (continued) Medical management/nursing interventions

• Sitting position, leaning forward

• Direct pressure by pinching nose

• Ice compresses to nose

• Nasal packing

• Cautery

• Balloon tamponade



• Deviated septum and nasal polyps Etiology/pathophysiology

• Congenital abnormality

• Injury

• Nasal septum deviates from the midline and can cause a partial obstruction

• Nasal polyps are tissue growths usually due to prolonged inflammation



• Deviated septum and nasal polyps (continued) Clinical manifestations/assessment

• Stertorous respirations (snoring)

• Dyspnea

• Postnasal drip Medical management/nursing interventions

• Pharmacological management Corticosteroids, antihistamines, antibiotics, analgesics

• Nasoseptoplasty

• Nasal polypectomy



• Allergic rhinitis and allergic conjunctivitis (hay fever) Etiology/pathophysiology

• Antigen/antibody reactions in the nasal membranes, nasopharynx, and conjunctiva due to allergens

Diagnostic testing • Allergy testing to determine cause may be helpful

Can be done by skin testing or serum radioallergosorbent test



• Allergic rhinitis and allergic conjunctivitis (continued) Clinical manifestations/assessment

• Edema

• Photophobia

• Excessive tearing

• Blurring of vision

• Pruritus

• Excessive nasal secretions and/or congestion

• Sneezing

• Cough

• Headache



• Allergic rhinitis and allergic conjunctivitis (continued) Diagnostic testing Medical management/nursing interventions

• Pharmacological management Antihistamines Decongestants Corticosteroids Analgesics

• Avoid allergen

• Hot packs over facial sinuses



Projections of paranasal sinuses and oral nasal cavities on the skull and

face.

(From Thibodeau, G.A., Patton, K.T. [2008]. Structure and function of the body. [13th ed.]. St. Louis: Mosby.)



• Obstructive sleep apnea (OSA) Etiology and pathophysiology

• Characterized by partial or complete upper airway obstruction during sleep

• Apnea refers to the cessation of spontaneous respirations

• Hypopnea is the presence of unusually shallow or slow respirations



• Obstructive sleep apnea (OSA) Clinical manifestations

• Frequent awakening at night

• Insomnia

• Excessive daytime fatigue

• Witnessed apneic episodes

• Loud snoring

• Hypercapnia

• Personality changes

• Irritability



• Obstructive sleep apnea (continued) Complications

• Systemic HTN, cardiac dysrhythmia, heart failure, nocturnal hypoexmia, stroke

Diagnostic tests• Polysomnography (sleep study)

Medical management/nursing interventions• Avoid sedatives

• Avoid alcoholic beverages

• Support groups

• Oral appliances

• nCPAP

• Surgery



• Upper airway obstruction Etiology and pathophysiology

• Precipitated by a recent respiratory event

• Common airway obstructions Choking on food Dentures Aspiration of vomitus or secretions The tongue



• Upper airway obstruction (continued) Clinical manifestations/assessment

• Stertorous respirations

• Altered respiratory rate and character; apneic periods

• Hypoxia; cyanosis

• Wheezing; stridor Medical management/nursing interventions

• Open the airway

• Remove obstruction

• Artificial airway; tracheostomy



• Cancer of the larynx Etiology/pathophysiology

• Squamous cell carcinoma

• Heavy smoking and alcohol use

• Chronic laryngitis

• Vocal abuse

• Family history



• Cancer of the larynx (continued) Clinical manifestations/assessment

• Progressive or persistent hoarseness

• Pain radiating to the ear

• Difficulty swallowing

• Hemoptysis Medical management/nursing interventions

• Radiation

• Surgery Partial or total laryngectomy Radical neck dissection


Respiratory InfectionsRespiratory Infections

• Acute rhinitis (common cold) Etiology/pathophysiology

• Inflammation of the mucous membranes of the nose and accessory sinuses

• Virus(es) Clinical manifestations/assessment

• Thin, serous nasal exudate

• Productive cough

• Sore throat

• Fever



• Acute rhinitis (common cold) (continued) Medical management/nursing interventions

• Pharmacological management Analgesic Antipyretic Cough suppressant Expectorant Antibiotic (if infection present)

• No specific treatment

• Encourage fluids



• Acute follicular tonsillitis Etiology/pathophysiology

• Inflammation of the tonsils

• Bacterial or viral infection Clinical manifestations/assessment

• Enlarged, tender, cervical lymph nodes

• Sore throat

• Fever; chills

• Enlarged, purulent tonsils

• Elevated WBC



• Acute follicular tonsillitis (continued) Medical management/nursing interventions

• Pharmacological management Antibiotics; analgesics; antipyretics

• Warm saline gargles

• Tonsillectomy and adenoidectomy Postoperative

o Assess for excessive bleedingo Ice-cold liquids—ice creamo Ice collaro Avoid coughing, sneezing, or vigorous nose blowing



• Laryngitis Etiology/pathophysiology

• Inflammation of the larynx due to virus or bacteria

• May cause severe respiratory distress in children under 5 years old

Clinical manifestations/assessment• Hoarseness

• Voice loss

• Scratchy and irritated throat

• Persistent cough



• Laryngitis (continued) Medical management/nursing interventions

• Pharmacological management Analgesics Antipyretics Antitussives Antibiotics—bacterial

• Viral—no specific treatment, supportive care

• Warm or cool mist vaporizer

• Limit use of voice



• Pharyngitis Etiology/pathophysiology

• Inflammation of the pharynx

• Chronic or acute

• Frequently accompanies the common cold

• Viral, most common

• Bacterial



• Pharyngitis (continued) Clinical manifestations/assessment

• Dry cough

• Tender tonsils

• Enlarged cervical lymph glands

• Red, sore throat

• Fever Medical management/nursing interventions

• Pharmacological management Antibiotics; analgesics; antipyretics

• Warm or cool mist vaporizer



• Sinusitis Etiology/pathophysiology

• Inflammation of the sinuses

• Usually begins with an upper respiratory infection; viral or bacterial

Clinical manifestations/assessment• Constant, severe headache

• Pain and tenderness in involved sinus region

• Purulent exudate

• Malaise

• Fever



• Sinusitis (continued) Medical management/nursing interventions

• Pharmacological management Antibiotics Analgesics Antihistamines

• Vasoconstrictor nasal spray (Afrin)

• Warm mist vaporizer

• Warm, moist packs

• Nasal windows


Disorders of the Lower AirwayDisorders of the Lower Airway

• Acute bronchitis Etiology/pathophysiology

• Inflammation of the trachea and bronchial tree

• Usually secondary to upper respiratory infection

• Exposure to inhaled irritants Clinical manifestations/assessment

• Productive cough; wheezes

• Dyspnea; chest pain

• Low-grade fever

• Malaise; headache



• Acute bronchitis (continued) Medical management/nursing interventions

• Pharmacological management Cough suppressants Antitussives Antipyretics Bronchodilators Antibiotics

• Vaporizer




• Legionnaires’ disease Etiology/pathophysiology

• Legionella pneumophila

• Thrives in water reservoirs

• Causes life-threatening pneumonia

• Leads to respiratory failure, renal failure, bacteremic shock, and ultimately death



• Legionnaires’ disease (continued) Clinical manifestations/assessment

• Elevated temperature

• Headache

• Nonproductive cough

• Difficult and rapid respirations

• Crackles or wheezes

• Tachycardia

• Signs of shock

• Hematuria



• Legionnaires’ disease (continued) Medical management/nursing interventions

• Pharmacological management Antibiotics Antipyretics Vasopressors

• Oxygen

• Mechanical ventilation, if necessary

• IV therapy



• Severe Acute Respiratory Syndrome (SARS) Etiology/pathophysiology

• Infection caused by coronavirus

• Spread by close contact between people

• Airborne

• May be spread by touching contaminated objects Clinical manifestations/assessment

• Temperature

• Headache

• Muscle aches

• Mild respiratory symptoms Dry cough and SOB



• Adult respiratory distress syndrome (continued) Diagnostic tests

• Chest radiograph

• Serum antibody testing

• Nasopharyngeal and oropharyngeal swabs Medical management/nursing interventions

• Pharmacological management Antibiotics Antiviral medications

• Respiratory isolation

• Oxygen



• Anthrax Etiology/pathophysiology

• Bacillus anthracis

• Spread by direct contact with bacteria or spores

• Three types: Cutaneous, GI, inhalational Clinical manifestations/assessment

• Cold or flu-like symptoms

• Hemorrhage, tissue necrosis, and lymphedema Medical management

• Antibiotics



• Tuberculosis Etiology/pathophysiology

• Inhalation of tubercle bacillus (Mycobacterium tuberculosis)

• Infection versus active disease

• Presumptive diagnosis Mantoux tuberculin skin test Chest x-ray film Acid-fast bacilli smear 3

• Confirmed diagnosis Sputum culture; positive for TB bacilli



• Tuberculosis (continued) Clinical manifestations/assessment

• Fever

• Weight loss; weakness

• Productive cough; hemoptysis

• Chills; night sweats Medical management/nursing interventions

• Tuberculosis isolation (acid-fast bacilli [AFB])

• Multiple medications to which the organisms are susceptible



• Pneumonia Etiology/pathophysiology

• Inflammatory process of the bronchioles and the alveolar spaces due to infection

• Bacteria, viruses, mycoplasma, fungi, and parasites Clinical manifestations/assessment


• Severe chills; elevated temperature

• Increased heart rate and respiratory rate

• Dyspnea



• Pneumonia (continued) Medical management/nursing interventions

• Pharmacological management Antibiotics Analgesics Expectorants Bronchodilators

• Oxygen

• Chest percussion and postural drainage

• Encourage to cough and deep-breathe

• Humidifier or nebulizer



• Pleurisy Etiology/pathophysiology

• Inflammation of the visceral and parietal pleura

• Bacterial or viral Clinical manifestations/assessment

• Sharp inspiratory pain

• Dyspnea

• Cough


• Pleural friction rub



• Pleurisy (continued) Medical management/nursing interventions

• Pharmacological management Antibiotics Analgesics Antipyretics

• Oxygen

• Anesthetic block for intercostal nerves



• Pleural effusion/empyema Etiology/pathophysiology

• Pleural effusion

• Accumulation of fluid in the pleural space

• Empyema—infection Clinical manifestations/assessment

• Dyspnea

• Air hunger

• Respiratory distress

• Fever



• Pleural effusion/empyema (continued) Medical management/nursing interventions

• Thoracentesis

• Chest tube with closed water-seal drainage system

• Antibiotics

• Cough and deep-breathe



• Atelectasis Etiology/pathophysiology

• Collapse of lung tissue due to occlusion of air to a portion of the lung

Clinical manifestations/assessment• Dyspnea; tachypnea

• Pleural friction rub; crackles

• Restlessness


• Decreased breath sounds



• Atelectasis (continued) Medical management/nursing interventions

• Pharmacological management Bronchodilators Antibiotics Mucolytic agents Analgesics

• Cough and deep-breathe• Early ambulation• Respiratory treatments

Incentive spirometry; intermittent positive-pressure breathing (IPPB)

Oxygen Chest percussion and postural drainage

• Chest tube



• Pneumothorax Etiology/pathophysiology

• A collection of air or gas in the pleural space, causing the lung to collapse

Clinical manifestations/assessment• Decreased breath sounds

• Sudden, sharp chest pain with dyspnea

• Diaphoresis; tachycardia; tachypnea

• No chest movement on affected side

• Sucking chest wound



Pneumothorax (complete collapse of the right lung).

(From Wilson, S., Thompson, J. [1991]. Respiratory disorders, Mosby’s clinical nursing series. St. Louis: Mosby.)



• Pneumothorax (continued) Medical management/nursing interventions

• Chest tube to water-seal drainage system

• Oxygen

• Analgesics




• Lung cancer Etiology/pathophysiology

• Primary tumor or metastasis

• Small-cell, non–small-cell, squamous cell, and large-cell carcinoma

Clinical manifestations/assessment• Hemoptysis

• Dyspnea; wheezing

• Fever; chills

• Pleural effusion



• Lung cancer (continued) Medical management/nursing interventions

• Surgery Most are not diagnosed early enough for curative

surgical intervention Segmental resection Lobectomy Pneumonectomy

• Radiation

• Chemotherapy



• Pulmonary edema Etiology/pathophysiology

• Accumulation of serous fluid in interstitial tissue and alveoli

Clinical manifestations/assessment• Dyspnea; cyanosis

• Tachypnea; tachycardia

• Pink or blood-tinged, frothy sputum

• Restlessness; agitation

• Wheezing; crackles

• Decreased urinary output; sudden weight gain



• Pulmonary edema (continued) Medical management/nursing interventions

• Pharmacological management Diuretics Narcotic analgesics Nipride

• Oxygen

• Mechanical ventilation, if necessary

• Strict I&O; daily weight

• Low-sodium diet



• Pulmonary embolism Etiology/pathophysiology

• Foreign substance in the pulmonary artery Blood clot, fat, air, or amniotic fluid

Clinical manifestations/assessment• Sudden, unexplained dyspnea, tachypnea

• Hemoptysis

• Chest pain


• Increased WBCs



• Pulmonary embolism (continued) Medical management/nursing interventions

• Pharmacological management Anticoagulants Fibrinolytic agents

• Oxygen

• HOB up 30 degrees



• Acute respiratory distress syndrome (ARDS) Etiology and pathophysiology

• Results from direct or indirect pulmonary injury

• Alveolar capillary membranes are altered resulting increased permeability creating pulmonary edema and hypoxia



• Acute respiratory distress syndrome (continued) Clinical manifestations

• Respiratory distress

• Changes in level of consciousness

• Tachycardia

• Hypotension

• Decreased urinary output



• Acute respiratory distress syndrome (continued) Medical management/nursing interventions

• Pharmacological management Corticosteroids Antibiotics Vasodilators Bronchodilators Mucolytics Diuretics Morphine sulfate Neurologic blocking agents Cardiotonic glycosides (digoxin)



• Acute respiratory distress syndrome (continued) Medical management/nursing interventions

(continued)• Oxygen

• Position changes

• Close assessment of vital signs


Chronic Obstructive Pulmonary Disease (COPD)Chronic Obstructive Pulmonary Disease (COPD)

• Emphysema Etiology/pathophysiology

• The bronchi, bronchioles, and alveoli become inflamed as a result of chronic irritation

• Air becomes trapped in the alveoli during expiration, causing alveolar distention, rupture, and scar tissue

Complication• Cor pulmonale

Right-sided congestive heart failure due to pulmonary hypertension



Disorders of the airways in patients with chronic bronchitis, asthma, and emphysema.

(From Lewis, S.M., Collier, I., & Heitkemper, M.M. [1996]. Medical-surgical nursing: assessment and management of clinical problems. [4th ed.]. St. Louis: Mosby.)


• Emphysema (continued) Clinical manifestations/assessment

• Dyspnea on exertion

• Sputum

• Barrel chest

• Chronic weight loss

• Emaciation

• Clubbing of fingers




Barrel chest. Note increase in AP diameter.


• Emphysema (continued) Medical management/nursing interventions

• Pharmacological management Bronchodilators; corticosteroids; antibiotics; diuretics

• Oxygen (low-flow)

• Chest physiotherapy

• Humidifier

• Pursed-lip breathing

• High-protein, high-calorie diet



• Chronic bronchitis Etiology/pathophysiology

• Hypertrophy of mucous glands causes hypersecretion and alters cilia function

• Increased airway resistance causes bronchospasm Clinical manifestations/assessment


• Dyspnea

• Use of accessory muscles to breathe

• Wheezing



• Chronic bronchitis (continued) Medical management/nursing interventions

• Pharmacological management Bronchodilators Mucolytics Antibiotics


• Pursed-lip breathing



• Asthma Etiology/pathophysiology

• Narrowing of the airways due to various stimuli

• Extrinsic or intrinsic factors

• Influenced by secondary factors

• Antigen-antibody reaction



• Asthma (continued) Clinical manifestations/assessment

• Mild asthma Dyspnea on exertion Wheezing

• Acute asthma attack Tachypnea Expiratory wheezing; productive cough Use of accessory muscles; nasal flaring Cyanosis



• Asthma (continued) Medical management/nursing interventions

• Maintenance therapy Serevent inhalant, prophylactic Corticosteroid inhalant Avoid allergens

• Acute or rescue therapy Proventil inhalant; aminophylline IV Corticosteroid and epinephrine oral or subcutaneous Oxygen



• Bronchiectasis Etiology/pathophysiology

• Gradual, irreversible process that involves chronic dilation of bronchi resulting in loss of elasticity

Clinical manifestations/assessment• Dyspnea; coughing; wheezes and crackles

• Cyanosis; clubbing of fingers

• Fatigue; weakness

• Loss of appetite



• Bronchiectasis (continued) Medical management/nursing interventions

• Pharmacological management Mucolytic agents Antibiotics Bronchodilators


• Chest physiotherapy

• Hydration

• Cool mist vaporizer

• Surgery: Lobectomy



• Nursing diagnoses Airway clearance, ineffective Breathing pattern, ineffective Gas exchange, impaired Anxiety Activity intolerance Nutrition, imbalanced: less than body requirements

Nursing ProcessNursing Process

Chapter 11

Allergy and Respiratory Medications

80Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc.

Chapter 11

Lesson 11.1


Learning Objectives

Identify major antihistamines used to treat breathing problems

Describe the action of antitussive medications List medications used to treat and prevent

asthma attacks


Learning Objectives (cont.)

Describe the major actions and the adverse reactions of the two main categories of bronchodilators


Respiratory System

Upper Respiratory System Oral and nasal cavity, sinuses, pharynx, larynx,

and trachea Lower Respiratory System

Right and left bronchi, right and left lungs, bronchioles, and alveoli


Antihistamines

Six Major Groups Action

Compete with histamine for H1 receptor sites to limit its effectiveness

Limits vasodilation, capillary permeability, and swelling

Limits acetylcholine release, which dries secretions in the bronchioles and gastrointestinal system

Sedative effect on the CNS


Antihistamines (cont.)

Uses Seasonal allergic rhinitis (SAR) Perennial allergic rhinitis (PAR) Perennial nonallergic rhinitis (PNAR) Relieve symptoms of allergic disorders Adjunctive therapy for anaphylaxis Sedation


Antihistamines (cont.)

Adverse Reactions Changes in blood pressure, blurred vision Tachycardia, insomnia, dry mouth, nausea Restlessness, excitability, sedation, tinnitus

Drug Interactions Nursing Process


Antihistamines

Life span considerations Pediatrics:

Infants and young children often have anticholinergic side/adverse effects

Paradoxical reactions may occur: increased nervousness, confusion, or hyperexcitability

Elderly More likely to develop side effects such as dizziness,

syncope (fainting), confusion, and extrapyramidal reactions


Question 1

Which of the following is NOT an adverse reaction that may develop from taking antihistamines?

1. Hypertension

2. Hypotension

3. Tachycardia

4. Bradycardia


Antitussives

Actions: Depress the cough center in the brain Anesthetize stretch receptors in the respiratory

tract Soothe irritated areas in the throat

Uses: Relief of overactive or nonproductive cough


Antitussives (cont.)

Adverse Reactions Constipation, drowsiness, dry mouth, nausea,

postural hypotension Drug Interactions Nursing Process


Question 2

Which of the following is NOT a way that antitussives relieve cough?

1. Act centrally on the cough center in the brain

2. Act peripherally by anesthetizing stretch receptors in the respiratory tract

3. Act locally, primarily by soothing irritated areas in the throat

4. Act systemically to change the expiratory response


Asthma

Asthma is a condition that involves increased inflammation, swelling, and mucus production that lead to bronchiolar constriction. The person is able to breathe air into the lungs but has difficulty breathing out. Wheezing results because the person works to force air out through narrowed, mucus-filled passages during expiration.

The four classes of asthma severity include mild intermittent, mild persistent, moderate persistent, and severe persistent.


COPD

COPD is a chronic, disabling disorder that causes destruction of alveolar walls. This destruction creates unequal areas of ventilation and perfusion in the body, and oxygen and carbon dioxide exchange is impaired. Patients experience difficulty in expiration.


Asthma and COPD Medications

Prophylactic treatment• Cromolyn sodium

• Nedocromil sodium

Actions:• Slows down destruction of sensitized mast

cells; also may provide hyposensitization (decrease in allergic response)


Asthma and COPD Medications (cont.)

Bronchodilators Sympathomimetics

• Relax smooth muscle of bronchi (dilate)

• Vasoconstriction of blood vessels in body (decreases mucosal and submucosal edema)

• Increase the rate and force of heart contraction

Uses:• Relief of symptoms of bronchospasm in acute or chronic

asthma, bronchitis, and COPD



Xanthines• Relax smooth muscle in the bronchi and blood vessels in

the lungs• Directly act on the kidney to produce an increase in

urine production• CNS effects

Uses• Adjunctive therapy for bronchospasm in acute and

chronic bronchial asthma, bronchitis, emphysema• Treatment of neonatal apnea• Acute pulmonary edema



Leukotriene Receptor Inhibitors Reduce symptoms of asthma by blocking

receptors for cysteinyl leukotrienes C4, D4, and E4

Uses Treat acute or chronic asthma in patients unable

to take inhaled glucocorticoids



Corticosteroids Block reaction to allergens and reduce airway

hyperresponsiveness Inhibit cytokine production, protein activation, and

inflammatory cell migration and activation Uses

Inhaled, long-term asthma control Systemic; often used to get quick control of the

disease when beginning long-term therapy or to speed recovery from severe episodes


Question 3

____________________ is a slowly worsening, disabling disorder that is diagnosed by abnormal tests of expiratory flow.

1. Asthma

2. Bronchitis

3. Chronic obstructive pulmonary disease (COPD)

4. Congestive heart failure100Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc.

Chapter 11

Lesson 11.2


Learning Objectives

Identify at least six medications commonly used as decongestants

Describe the mechanism of action for expectorants

List the major contraindications to the use of nasal steroids


Decongestants

Decongestants Directly affect alpha receptors of blood vessels in

the nasal mucosa, causing vasoconstriction Uses: relieve nasal congestion from allergies and

upper respiratory infections


Expectorants

Expectorants Decrease the thickness of respiratory secretions,

thereby facilitating expectoration Uses: treat productive cough, assist with thick

mucus


Topical Intranasal Steroids

Action Antiinflammatory, reduce nasal congestion

Uses Treatment of allergic, mechanical, or chemically

induced local nasal inflammation or nasal polyps when usual treatment has failed to work

Adverse reactions Asthma, headache, lightheadedness, loss of

sense of smell, nasal irritation and dryness, nausea, nosebleeds, perforation of nasal septum, altered sense of taste and smell


Complementary and Alternative Therapies

Allergy Grape seed, stinging nettle, coleus, vitamin C

Asthma Cordyceps, Tylophora, grape seed, coleus, vitamin C

Cold Arabinoxylane, echinacea, elderberry, astragalus,

goldenseal, grapefruit seed extract, zinc, vitamin C Cough

Ground ivy, thyme, licorice, marshmallow


Chapter 12

Antiinfective Medications

Copyright © 2013, 2010, 2006, 2003, 2000, 1995, 1991 by Mosby, an imprint of Elsevier Inc. 107

Chapter 12

Lesson 12.1


Learning Objectives

Identify the major antiinfective drug categories and the organisms against which they are effective

Outline the most important things to teach the patient who is taking antiinfective drugs


Learning Objectives (cont.)

Define "spectrum" and explain what this word means in antiinfective therapy

List some of the most common adverse reactions to medications used to treat infections


Overview

Pathogen Bacteria Fungi Viruses Antimicrobials


Antibiotics

Broad-spectrum Narrow-spectrum Adverse reactions


Penicillins

Main antibiotic for years Overuse Penicillin-resistant strains Broad-spectrum drug of choice


Penicillins (cont.)

Action and Uses Interferes with creation of the mucopeptide

cell wall Used to treat multiple infections Overuse and allergies


Penicillins (cont.)

Adverse Reactions Neuropathy

High parenteral doses Skin eruptions GI symptoms Urticaria Laryngeal edema Anaphylaxis

Drug Interactions


Penicillins (cont.)

Nursing Implications and Patient Teaching Assessment

Signs of infection and allergies Diagnosis Planning

10-day regimen Implementation

Route of administration Evaluation Patient Teaching


Tetracyclines

Actions and uses Broad-spectrum antibioticsAdverse Reactions GI upsetNursing Implications Not for pregnant patients or children under 8 years of

age Can cause sensitivity to light (photosensitivity) so

counsel patient about careful sun exposure Take on empty stomach and avoid dairy within 2 hours

of taking drug.


Macrolides

Actions and uses Alternative for pencillinAdverse Reactions GI upsetNursing Implications Check nursing text for drug interactions: there are

several! Advise patient to take with food and drink extra fluids


Sulfonamides

Broad-spectrum antiinfective Bacteriostatic action: inhibits folic acid

synthesis in the cell


Sulfonamides (cont.)

Action and Uses Urinary tract infections Effectively treats multiple microorganisms Preoperative and postoperative therapy for

bowel surgery


Sulfonamides (cont.)

Adverse Reactions

Drug Interactions Potentiate Decrease effectiveness

Nursing Implications and Patient Teaching Contraindications


Broad-Spectrum Antibiotics

Bactericidal or bacteriostatic


Broad-Spectrum Antibiotics (cont.)

Action and Uses Large number of unrelated drugs used to

treat infections caused by a wide range of susceptible organisms

Gram-positive or gram-negative organisms


Broad-Spectrum Antibiotics (cont.)

Adverse Reactions Superinfections Drug interactions are individualized Food interactions Affected organs: auditory nerves, kidneys, and

liver Cross-sensitivityNursing Implications and Patient Teaching


Question 1

____________________ are plant-like organisms growing in irregular masses, without roots, stems, or leaves and without chlorophyll or other pigments involved in photosynthesis.

1. Bacteria2. Fungi3. Viruses4. Parasites


Question 2

____________________ are usually used to treat acute and chronic urinary tract infections, particularly cystitis, pyelitis, and pyelonephritis, when these infections are caused by Escherichia coli or Nocardia asteroides.

1. Penicillins2. Sulfonamides3. Cephalosporins4. Aminoglycosides


Question 3

An organism that causes an infection is a(n):

1. Teratogen.2. Pathogen.3. Allergen.4. Hydrogen.


Chapter 12

Lesson 12.2


Learning Objectives

Identify the major antiinfective drug categories and the organisms against which they are effective

Outline the most important things to teach the patient who is taking antiinfective drugs

List some of the most common adverse reactions to medications used to treat infections


Antitubercular Drugs

Overview Underdeveloped nations Risks Etiology: Mycobacterium tuberculosis


Antitubercular Drugs (cont.)

Action and Uses Most antitubercular drugs are bacteriostatic;

they have intracellular or extracellular effects that prevent the organism from building new cell walls, thus limiting growth and spread

Some antitubercular drugs are bactericidal Length of treatment Chemoprophylaxis Box 12-1 High-Priority Candidates for

Tuberculosis-Preventive Therapy



Adverse Reactions Common symptoms Toxicity: body sites affected Combination therapy Drug-specific symptoms



Drug Interactions Use of other drugs during therapyNursing Implications and Patient Teaching Assessment Diagnosis

History, chest x-ray, labs Additional patient needs

Planning Length of treatment

Implementation Dose

Evaluation Patient and Family Teaching


Antiparasitic Drugs

Amebicides Anthelmintics Antimalarials


Amebicides

Entamoeba histolytica Relationship to traveling Infection sites in the body


Amebicides (cont.)

Action and Uses Destroy invading amoebae Treatment of intestinal and extraintestinal

amebiasis. Drug choice depends on location


Amebicides (cont.)

Adverse Reactions Common: nausea, vomiting, anorexia,

diarrhea, GI distress, hepatic abscess Drug-specific adverse reactions Overdose


Amebicides (cont.)

Drug Interactions Nursing Implications Patient Teaching


Anthelmintics

Helminthiasis: infestation by worms Common infestations:

Pinworms Roundworms Hookworms Tapeworms Whipworms


Anthelmintics (cont.)

Action and Uses Action is drug specific Drugs used:

Thiabendazole Niclosamide and paromomycin Piperazine and pyrantel pamoate Diethylcarbamazine citrate Mebendazole



Adverse Reactions Drug specific Allergic reaction due to dead microfilaria



Drug InteractionsNursing Implications and Patient Teaching Assessment Diagnosis Planning Implementation

Preventing transmission Evaluation


Antimalarials

Action Interfere with the life cycle of Plasmodium Uses Prevention and treatmentAdverse Reactions Drug-specific: blood dyscrasias, visual and neurologic

changesDrug Interactions Drug-specific: dermatologic, ototoxic, or neurologic

symptoms


Antimalarials (cont.)

Nursing Implications and Patient Teaching Assessment

Symptoms Diagnosis Planning

Treatment is strain related Implementation

Loading dose Prevention

Evaluation Laboratory and diagnostic monitoring; eye examination


Documents

Chapter 9 Care of the Patient with a Respiratory Disorder Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc