N24: Class #8 Obstructive and Inflammatory Lung Disease <ul><li>Emphysema </li></ul><ul><li>Chronic Bronchitis </li></ul><...
Class Objectives <ul><li>Differentiate among the etiology, pathophysiology, clinical manifestations, collaborative care, a...
Chronic Obstructive Pulmonary Disease: COPD <ul><li>Disease of airflow obstruction that is not totally reversible </li></u...
COPD: Etiology <ul><li>Cigarette smoking #1 </li></ul><ul><li>Recurrent respiratory infection </li></ul><ul><li>Alpha 1-an...
Chronic Bronchitis <ul><li>Recurrent or chronic  productive  cough for a minimum of 3 months for 2 consecutive years. </li...
Chronic Bronchitis Pathophysiology <ul><li>Chronic inflammation  </li></ul><ul><li>Hypertrophy & hyperplasia of bronchial ...
Chronic Bronchitis Pathophysiology <ul><li>Narrowing of airway  </li></ul><ul><ul><li>Starting w/ bronchi    smaller airw...
Chronic Bronchitis Pathophysiology <ul><li>Bronchospasm often occurs </li></ul><ul><li>End result </li></ul><ul><ul><li>Hy...
Chronic Bronchitis:  Clinical Manifestations <ul><li>In early stages </li></ul><ul><ul><li>Clients may not recognize early...
Chronic Bronchitis:  Clinical Manifestations <ul><li>Advanced stages </li></ul><ul><ul><li>Dyspnea on exertion   Dyspnea ...
Chronic Bronchitis:  Diagnostic Tests <ul><li>PFTs </li></ul><ul><ul><li>FVC:   Forced vital capacity </li></ul></ul><ul>...
Emphysema <ul><li>Abnormal distension of air spaces </li></ul><ul><li>Actual cause is unknown </li></ul>
Emphysema: Pathophysiology <ul><li>Structural changes </li></ul><ul><ul><li>Hyperinflation of alveoli </li></ul></ul><ul><...
Emphysema: Pathophysiology <ul><li>Mechanisms of structural change </li></ul><ul><li>Obstruction of small bronchioles  </l...
Emphysema: Pathophysiology <ul><li>The end result: </li></ul><ul><li>Alveoli lose elastic recoil, then distend, & eventual...
Emphysema:  Clinical Manifestations <ul><li>Early stages </li></ul><ul><ul><li>Dyspnea </li></ul></ul><ul><ul><li>Non prod...
<ul><li>Later stages </li></ul><ul><ul><li>Hypercapnea </li></ul></ul><ul><ul><li>Purse-lip breathing </li></ul></ul><ul><...
Emphysema: Clinical Manifestations
Emphysema: Clinical Manifestations <ul><li>Pulmonary function </li></ul><ul><ul><ul><li>   residual volume,    lung capa...
Goals of Treatment:  Emphysema & Chronic Bronchitis <ul><li>Improved ventilation </li></ul><ul><li>Remove secretions </li>...
Collaborative Care:  Emphysema & Chronic Bronchitis <ul><li>Treat respiratory infection </li></ul><ul><li>Monitor spiromet...
Collaborative Care:  Medications <ul><li>Anti-inflammatory </li></ul><ul><ul><li>Corticosteroids </li></ul></ul><ul><li>Br...
Collaborative Care:  Emphysema & Chronic Bronchitis <ul><li>Client teaching </li></ul><ul><ul><li>Support to stop smoking ...
Asthma <ul><li>Reversible  inflammation & obstruction </li></ul><ul><li>Intermittent attacks </li></ul><ul><li>Sudden onse...
Asthma <ul><li>Triggers </li></ul><ul><ul><li>Allergens </li></ul></ul><ul><ul><li>Exercise </li></ul></ul><ul><ul><li>Res...
Asthma: Pathophysiology <ul><li>Swelling of mucus membranes (edema) </li></ul><ul><li>Spasm of smooth muscle in bronchiole...
Asthma: Pathophysiology <ul><li>Early phase response: 30 – 60 minutes  </li></ul><ul><ul><li>Allergen or irritant activate...
<ul><li>Late phase response: 5 – 6 hours  </li></ul><ul><ul><li>Characterized by inflammation  </li></ul></ul><ul><ul><li>...
Asthma: Early Clinical Manifestations <ul><li>Expiratory & inspiratory wheezing  </li></ul><ul><li>Dry  or  moist non-prod...
Asthma: Early Clinical Manifestations <ul><li>Wheezing </li></ul><ul><li>Chest tightness  </li></ul><ul><li>Dyspnea  </li>...
Asthma: Severe Clinical Manifestations <ul><li>Hypoxia </li></ul><ul><li>Confusion </li></ul><ul><li>Increased heart rate ...
Endotracheal Intubation
Classifications of Asthma <ul><li>Mild intermittent  </li></ul><ul><li>Mild persistent  </li></ul><ul><li>Moderate persist...
Asthma: Diagnostic Tests <ul><li>Pulmonary Function Tests  </li></ul><ul><ul><li>FEV1 decreased   </li></ul></ul><ul><ul><...
Asthma: Collaborative Care <ul><li>Mild intermittent  </li></ul><ul><ul><li>Avoid triggers  </li></ul></ul><ul><ul><li>Pre...
Asthma: Collaborative Care <ul><li>Moderate persistent asthma  </li></ul><ul><ul><li>Low-medium dose inhaled corticosteroi...
Asthma: Collaborative Care <ul><li>Acute episode  </li></ul><ul><ul><li>FEV1, PEFR, pulse oximetry compared to baseline  <...
Asthma Medications: Anti-inflammatory <ul><li>Corticosteroids  </li></ul><ul><ul><li>Not useful for acute attack  </li></u...
Asthma Medications: Bronchodilators <ul><li> 2-adrenergic agonists </li></ul><ul><ul><li>Rapid onset: quick relief of bro...
Asthma Medications: Bronchodilators con’t <ul><li>Methylxanthines   </li></ul><ul><ul><li>Less effective than beta-adrener...
Asthma: Client Teaching <ul><li>Correct use of medications </li></ul><ul><li>Signs & symptoms of an attack </li></ul><ul><...
Asthma: Nursing Diagnoses <ul><li>Ineffective airway clearance   r/t bronchospasm, ineffective cough, excessive mucus  </l...
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Obstructive And Inflammatory Lung Disease

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Obstructive And Inflammatory Lung Disease

  1. 1. N24: Class #8 Obstructive and Inflammatory Lung Disease <ul><li>Emphysema </li></ul><ul><li>Chronic Bronchitis </li></ul><ul><li>Asthma </li></ul>Christine Hooper, Ed.D., RN Spring 2006
  2. 2. Class Objectives <ul><li>Differentiate among the etiology, pathophysiology, clinical manifestations, collaborative care, and appropriate nursing diagnoses of the client with emphysema and chronic bronchitis. </li></ul><ul><li>Describe the etiology, pathophysiology, clinical manifestations, collaborative care, and appropriate nursing diagnoses of the client with asthma. </li></ul>
  3. 3. Chronic Obstructive Pulmonary Disease: COPD <ul><li>Disease of airflow obstruction that is not totally reversible </li></ul><ul><ul><li>Chronic Bronchitis </li></ul></ul><ul><ul><li>Emphysema </li></ul></ul>
  4. 4. COPD: Etiology <ul><li>Cigarette smoking #1 </li></ul><ul><li>Recurrent respiratory infection </li></ul><ul><li>Alpha 1-antitrypsin deficiency </li></ul><ul><li>Aging </li></ul>
  5. 5. Chronic Bronchitis <ul><li>Recurrent or chronic productive cough for a minimum of 3 months for 2 consecutive years. </li></ul><ul><li>Risk factors </li></ul><ul><ul><li>Cigarette smoke </li></ul></ul><ul><ul><li>Air pollution </li></ul></ul>
  6. 6. Chronic Bronchitis Pathophysiology <ul><li>Chronic inflammation </li></ul><ul><li>Hypertrophy & hyperplasia of bronchial glands that secrete mucus </li></ul><ul><li>Increase number of goblet cells </li></ul><ul><li>Cilia are destroyed </li></ul>
  7. 7. Chronic Bronchitis Pathophysiology <ul><li>Narrowing of airway </li></ul><ul><ul><li>Starting w/ bronchi  smaller airways </li></ul></ul><ul><li> airflow resistance </li></ul><ul><li> work of breathing </li></ul><ul><li>Hypoventilation & CO2 retention  hypoxemia & hypercapnea </li></ul>
  8. 8. Chronic Bronchitis Pathophysiology <ul><li>Bronchospasm often occurs </li></ul><ul><li>End result </li></ul><ul><ul><li>Hypoxemia </li></ul></ul><ul><ul><li>Hypercapnea </li></ul></ul><ul><ul><li>Polycythemia (increase RBCs) </li></ul></ul><ul><ul><li>Cyanosis </li></ul></ul><ul><ul><li>Cor pulmonale (enlargement of right side of heart) </li></ul></ul>
  9. 9. Chronic Bronchitis: Clinical Manifestations <ul><li>In early stages </li></ul><ul><ul><li>Clients may not recognize early symptoms </li></ul></ul><ul><ul><li>Symptoms progress slowly </li></ul></ul><ul><ul><li>May not be diagnosed until severe episode with a cold or flu </li></ul></ul><ul><ul><li>Productive cough </li></ul></ul><ul><ul><ul><li>Especially in the morning </li></ul></ul></ul><ul><ul><ul><li>Typically referred to as “cigarette cough” </li></ul></ul></ul><ul><ul><li>Bronchospasm </li></ul></ul><ul><ul><li>Frequent respiratory infections </li></ul></ul>
  10. 10. Chronic Bronchitis: Clinical Manifestations <ul><li>Advanced stages </li></ul><ul><ul><li>Dyspnea on exertion  Dyspnea at rest </li></ul></ul><ul><ul><li>Hypoxemia & hypercapnea </li></ul></ul><ul><ul><li>Polycythemia </li></ul></ul><ul><ul><li>Cyanosis </li></ul></ul><ul><ul><li>Bluish-red skin color </li></ul></ul><ul><ul><li>Pulmonary hypertension  Cor pulmonale </li></ul></ul>
  11. 11. Chronic Bronchitis: Diagnostic Tests <ul><li>PFTs </li></ul><ul><ul><li>FVC:  Forced vital capacity </li></ul></ul><ul><ul><li>FEV1:  Forcible exhale in 1 second </li></ul></ul><ul><ul><li>FEV1/FVC = <70% </li></ul></ul><ul><li>ABGs </li></ul><ul><ul><li> PaCO2 </li></ul></ul><ul><ul><li> PaO2 </li></ul></ul><ul><li>CBC </li></ul><ul><ul><li> Hct </li></ul></ul>
  12. 12. Emphysema <ul><li>Abnormal distension of air spaces </li></ul><ul><li>Actual cause is unknown </li></ul>
  13. 13. Emphysema: Pathophysiology <ul><li>Structural changes </li></ul><ul><ul><li>Hyperinflation of alveoli </li></ul></ul><ul><ul><li>Destruction of alveolar & alveolar-capillary walls </li></ul></ul><ul><ul><li>Small airways narrow </li></ul></ul><ul><ul><li>Lung elasticity decreases </li></ul></ul>
  14. 14. Emphysema: Pathophysiology <ul><li>Mechanisms of structural change </li></ul><ul><li>Obstruction of small bronchioles </li></ul><ul><li>Proteolytic enzymes destroy alveolar tissue </li></ul><ul><li>Elastin & collagen are destroyed </li></ul><ul><ul><li>Support structure is destroyed </li></ul></ul><ul><ul><li>“ paper bag” lungs </li></ul></ul>
  15. 15. Emphysema: Pathophysiology <ul><li>The end result: </li></ul><ul><li>Alveoli lose elastic recoil, then distend, & eventually blow out. </li></ul><ul><li>Small airways collapse or narrow </li></ul><ul><li>Air trapping </li></ul><ul><li>Hyperinflation </li></ul><ul><li>Decreased surface area for ventilation </li></ul>
  16. 16. Emphysema: Clinical Manifestations <ul><li>Early stages </li></ul><ul><ul><li>Dyspnea </li></ul></ul><ul><ul><li>Non productive cough </li></ul></ul><ul><ul><li>Diaphragm flattens </li></ul></ul><ul><ul><li>A-P diameter increases </li></ul></ul><ul><ul><ul><li>“ Barrel chest” </li></ul></ul></ul><ul><ul><li>Hypoxemia may occur </li></ul></ul><ul><ul><ul><li>Increased respiratory rate </li></ul></ul></ul><ul><ul><ul><li>Respiratory alkalosis </li></ul></ul></ul><ul><ul><li>Prolonged expiratory phase </li></ul></ul>
  17. 17. <ul><li>Later stages </li></ul><ul><ul><li>Hypercapnea </li></ul></ul><ul><ul><li>Purse-lip breathing </li></ul></ul><ul><ul><li>Use of accessory muscles to breathe </li></ul></ul><ul><ul><li>Underweight </li></ul></ul><ul><ul><ul><li>No appetite & increase breathing workload </li></ul></ul></ul><ul><ul><li>Lung sounds diminished </li></ul></ul>Emphysema: Clinical Manifestations
  18. 18. Emphysema: Clinical Manifestations
  19. 19. Emphysema: Clinical Manifestations <ul><li>Pulmonary function </li></ul><ul><ul><ul><li> residual volume,  lung capacity, DECREASED FEV 1 , vital capacity maybe normal </li></ul></ul></ul><ul><li>Arterial blood gases </li></ul><ul><ul><li>Normal in moderate disease </li></ul></ul><ul><ul><li>May develop respiratory alkalosis </li></ul></ul><ul><ul><li>Later: hypercapnia and respiratory acidosis </li></ul></ul><ul><li>Chest x-ray </li></ul><ul><ul><li>Flattened diaphragm </li></ul></ul><ul><ul><li>hyperinflation </li></ul></ul>
  20. 20. Goals of Treatment: Emphysema & Chronic Bronchitis <ul><li>Improved ventilation </li></ul><ul><li>Remove secretions </li></ul><ul><li>Prevent complications </li></ul><ul><li>Slow progression of signs & symptoms </li></ul><ul><li>Promote patient comfort and participation in treatment </li></ul>
  21. 21. Collaborative Care: Emphysema & Chronic Bronchitis <ul><li>Treat respiratory infection </li></ul><ul><li>Monitor spirometry and PEFR </li></ul><ul><li>Nutritional support </li></ul><ul><li>Fluid intake 3 lit/day </li></ul><ul><li>O2 as indicated </li></ul>
  22. 22. Collaborative Care: Medications <ul><li>Anti-inflammatory </li></ul><ul><ul><li>Corticosteroids </li></ul></ul><ul><li>Bronchodilators </li></ul><ul><ul><li>Beta-adrenergic agonist: Proventil </li></ul></ul><ul><ul><li>Methylxanthines: Theophylline </li></ul></ul><ul><ul><li>Anticholinergics: Atrovent </li></ul></ul><ul><li>Mucolytics: Mucomyst </li></ul><ul><li>Expectorants: Guaifenisin </li></ul><ul><li>Antihistamines: non-drying </li></ul>
  23. 23. Collaborative Care: Emphysema & Chronic Bronchitis <ul><li>Client teaching </li></ul><ul><ul><li>Support to stop smoking </li></ul></ul><ul><ul><li>Conservation of energy </li></ul></ul><ul><ul><li>Breathing exercises </li></ul></ul><ul><ul><ul><li>Pursed lip breathing </li></ul></ul></ul><ul><ul><ul><li>Diaphragm breathing </li></ul></ul></ul><ul><ul><li>Chest physiotherapy </li></ul></ul><ul><ul><ul><li>Percussion, vibration </li></ul></ul></ul><ul><ul><ul><li>Postural drainage </li></ul></ul></ul><ul><ul><li>Self-manage medications </li></ul></ul><ul><ul><ul><li>Inhaler & oxygen equipment </li></ul></ul></ul>
  24. 24. Asthma <ul><li>Reversible inflammation & obstruction </li></ul><ul><li>Intermittent attacks </li></ul><ul><li>Sudden onset </li></ul><ul><li>Varies from person to person </li></ul><ul><li>Severity can vary from shortness of breath to death </li></ul>
  25. 25. Asthma <ul><li>Triggers </li></ul><ul><ul><li>Allergens </li></ul></ul><ul><ul><li>Exercise </li></ul></ul><ul><ul><li>Respiratory infections </li></ul></ul><ul><ul><li>Drugs and food additives </li></ul></ul><ul><ul><li>Nose and sinus problems </li></ul></ul><ul><ul><li>GERD </li></ul></ul><ul><ul><li>Emotional stress </li></ul></ul>
  26. 26. Asthma: Pathophysiology <ul><li>Swelling of mucus membranes (edema) </li></ul><ul><li>Spasm of smooth muscle in bronchioles </li></ul><ul><ul><li>Increased airway resistance </li></ul></ul><ul><li>Increased mucus gland secretion </li></ul>
  27. 27. Asthma: Pathophysiology <ul><li>Early phase response: 30 – 60 minutes </li></ul><ul><ul><li>Allergen or irritant activates mast cells </li></ul></ul><ul><ul><li>Inflammatory mediators are released </li></ul></ul><ul><ul><ul><li>histamine, bradykinin, leukotrienes, prostaglandins, platelet-activating-factor, chemotactic factors, cytokines </li></ul></ul></ul><ul><ul><li>Intense inflammation occurs </li></ul></ul><ul><ul><ul><li>Bronchial smooth muscle constricts </li></ul></ul></ul><ul><ul><ul><li>Increased vasodilation and permeability </li></ul></ul></ul><ul><ul><ul><li>Epithelial damage </li></ul></ul></ul><ul><ul><li>Bronchospasm </li></ul></ul><ul><ul><ul><li>Increased mucus secretion </li></ul></ul></ul><ul><ul><ul><li>Edema </li></ul></ul></ul>
  28. 28. <ul><li>Late phase response: 5 – 6 hours </li></ul><ul><ul><li>Characterized by inflammation </li></ul></ul><ul><ul><li>Eosinophils and neutrophils infiltrate </li></ul></ul><ul><ul><li>Mediators are released mast cells release histamine and additional mediators </li></ul></ul><ul><ul><li>Self-perpetuating cycle </li></ul></ul><ul><ul><li>Lymphocytes and monocytes invade as well </li></ul></ul><ul><ul><li>Future attacks may be worse because of increased airway reactivity that results from late phase response </li></ul></ul><ul><ul><ul><li>Individual becomes hyperresponsive to specific allergens and non-specific irritants such as cold air and dust </li></ul></ul></ul><ul><ul><ul><li>Specific triggers can be difficult to identify and less stimulation is required to produce a reaction </li></ul></ul></ul>Asthma: Pathophysiology
  29. 29. Asthma: Early Clinical Manifestations <ul><li>Expiratory & inspiratory wheezing </li></ul><ul><li>Dry or moist non-productive cough </li></ul><ul><li>Chest tightness </li></ul><ul><li>Dyspnea </li></ul><ul><li>Anxious &Agitated </li></ul><ul><li>Prolonged expiratory phase </li></ul><ul><li>Increased respiratory & heart rate </li></ul><ul><li>Decreased PEFR </li></ul>
  30. 30. Asthma: Early Clinical Manifestations <ul><li>Wheezing </li></ul><ul><li>Chest tightness </li></ul><ul><li>Dyspnea </li></ul><ul><li>Cough </li></ul><ul><li>Prolonged expiratory phase [1:3 or 1:4] </li></ul>
  31. 31. Asthma: Severe Clinical Manifestations <ul><li>Hypoxia </li></ul><ul><li>Confusion </li></ul><ul><li>Increased heart rate & blood pressure </li></ul><ul><li>Respiratory rate up to 40/minute & pursed lip breathing </li></ul><ul><li>Use of accessory muscles </li></ul><ul><li>Diaphoresis & pallor </li></ul><ul><li>Cyanotic nail beds </li></ul><ul><li>Flaring nostrils </li></ul>
  32. 32. Endotracheal Intubation
  33. 33. Classifications of Asthma <ul><li>Mild intermittent </li></ul><ul><li>Mild persistent </li></ul><ul><li>Moderate persistent </li></ul><ul><li>Severe persistent </li></ul>
  34. 34. Asthma: Diagnostic Tests <ul><li>Pulmonary Function Tests </li></ul><ul><ul><li>FEV1 decreased </li></ul></ul><ul><ul><ul><li>Increase of 12% - 15% after bronchodilator indicative of asthma </li></ul></ul></ul><ul><ul><li>PEFR decreased </li></ul></ul><ul><li>Symptomatic patient </li></ul><ul><ul><li>eosinophils > 5% of total WBC </li></ul></ul><ul><ul><li>Increased serum IgE </li></ul></ul><ul><ul><li>Chest x-ray shows hyperinflation </li></ul></ul><ul><li>ABGs </li></ul><ul><ul><li>Early: respiratory alkalosis, PaO2 normal or near-normal </li></ul></ul><ul><ul><li>severe: respiratory acidosis, increased PaCO2, </li></ul></ul>
  35. 35. Asthma: Collaborative Care <ul><li>Mild intermittent </li></ul><ul><ul><li>Avoid triggers </li></ul></ul><ul><ul><li>Premedicate before exercising </li></ul></ul><ul><ul><li>May not need daily medication </li></ul></ul><ul><li>Mild persistent asthma </li></ul><ul><ul><li>Avoid triggers </li></ul></ul><ul><ul><li>Premedicate before exercising </li></ul></ul><ul><ul><li>Low-dose inhaled corticosteroids </li></ul></ul>
  36. 36. Asthma: Collaborative Care <ul><li>Moderate persistent asthma </li></ul><ul><ul><li>Low-medium dose inhaled corticosteroids </li></ul></ul><ul><ul><li>Long-acting beta2-agonists </li></ul></ul><ul><ul><li>Can increase doses or use theophylline or leukotriene-modifier [singulair, accolate, zyflo] </li></ul></ul><ul><li>Severe persistent asthma </li></ul><ul><ul><li>High-dose inhaled corticosteroids </li></ul></ul><ul><ul><li>Long-acting inhaled beta2-agonists </li></ul></ul><ul><ul><li>Corticosteroids if needed </li></ul></ul>
  37. 37. Asthma: Collaborative Care <ul><li>Acute episode </li></ul><ul><ul><li>FEV1, PEFR, pulse oximetry compared to baseline </li></ul></ul><ul><ul><li>O2 therapy </li></ul></ul><ul><ul><li>Beta2-adrenergic agonist </li></ul></ul><ul><ul><ul><li>via MDI w/spacer or nebulizer </li></ul></ul></ul><ul><ul><ul><li>Q20 minutes – 4 hours prn </li></ul></ul></ul><ul><ul><li>Corticosteroids if initial response insufficient </li></ul></ul><ul><ul><ul><li>Severity of attack determines po or IV </li></ul></ul></ul><ul><ul><ul><li>If poor response, consider IV aminophylline </li></ul></ul></ul>
  38. 38. Asthma Medications: Anti-inflammatory <ul><li>Corticosteroids </li></ul><ul><ul><li>Not useful for acute attack </li></ul></ul><ul><ul><li>Beclomethasone: vanceril, beclovent, qvar </li></ul></ul><ul><li>Cromolyn & nedocromil </li></ul><ul><ul><li>Inhibits immediate response from exercise and allergens </li></ul></ul><ul><ul><li>Prevents late-phase response </li></ul></ul><ul><ul><li>Useful for premedication for exercise, seasonal asthma </li></ul></ul><ul><ul><li>Intal, Tilade </li></ul></ul><ul><li>Leukotriene modifiers </li></ul><ul><ul><li>Interfere with synthesis or block action of leukotrienes </li></ul></ul><ul><ul><li>Have both bronchodilation and anti-inflammatory properties </li></ul></ul><ul><ul><li>Not recommended for acute asthma attacks </li></ul></ul><ul><ul><li>Should not be used as only therapy for persistent asthma </li></ul></ul><ul><ul><li>Accolate, Singulair, Zyflo </li></ul></ul>
  39. 39. Asthma Medications: Bronchodilators <ul><li> 2-adrenergic agonists </li></ul><ul><ul><li>Rapid onset: quick relief of bronchoconstriction </li></ul></ul><ul><ul><li>Treatment of choice for acute attacks </li></ul></ul><ul><ul><li>If used too much causes tremors, anxiety, tachycardia, palpitations, nausea </li></ul></ul><ul><ul><li>Too-frequent use indicates poor control of asthma </li></ul></ul><ul><ul><li>Short-acting </li></ul></ul><ul><ul><ul><li>Albuterol[proventil]; metaproterenol [alupent]; bitolterol [tornalate]; pirbuterol [maxair] </li></ul></ul></ul><ul><ul><li>Long-acting </li></ul></ul><ul><ul><ul><li>Useful for nocturnal asthma </li></ul></ul></ul><ul><ul><ul><li>Not useful for quick relief during an acute attack </li></ul></ul></ul><ul><ul><ul><li>Salmeterol [serevent] </li></ul></ul></ul>
  40. 40. Asthma Medications: Bronchodilators con’t <ul><li>Methylxanthines </li></ul><ul><ul><li>Less effective than beta-adrenergics </li></ul></ul><ul><ul><li>Useful to alleviate bronchoconstriction of early and late phase, nocturnal asthma </li></ul></ul><ul><ul><li>Does not relieve hyperresponsiveness </li></ul></ul><ul><ul><li>Side effects: nausea, headache, insomnia, tachycardia, arrhythmias, seizures </li></ul></ul><ul><ul><li>Theophylline, aminophylline </li></ul></ul><ul><li>Anticholinergics </li></ul><ul><ul><li>Inhibit parasympathetic effects on respiratory system </li></ul></ul><ul><ul><li>Increased mucus </li></ul></ul><ul><ul><li>Smooth muscle contraction </li></ul></ul><ul><ul><li>Useful for pts w/adverse reactions to beta-adrenergics or in combination w/beta-adrenergics </li></ul></ul><ul><ul><li>Ipratropium [atrovent] </li></ul></ul><ul><ul><li>Ipratropium + albuterol [Combivent] </li></ul></ul>
  41. 41. Asthma: Client Teaching <ul><li>Correct use of medications </li></ul><ul><li>Signs & symptoms of an attack </li></ul><ul><ul><li>Dyspnea, anxiety, tight chest, wheezing, cough </li></ul></ul><ul><li>Relaxation techniques </li></ul><ul><li>When to call for help, seek treatment </li></ul><ul><li>Environmental control </li></ul><ul><li>Cough & postural drainage techniques </li></ul>
  42. 42. Asthma: Nursing Diagnoses <ul><li>Ineffective airway clearance r/t bronchospasm, ineffective cough, excessive mucus </li></ul><ul><li>Anxiety r/t difficulty breathing, fear of suffocation </li></ul><ul><li>Ineffective therapeutic regimen management r/t lack of information about asthma </li></ul>

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