Presentation on theme: "Nancy Pares, RN, MSN Metropolitan Community College."— Presentation transcript:
Nancy Pares, RN, MSN Metropolitan Community College
One of the most important organ systems Upper respiratory tract ◦ Nose, nasal cavity, pharynx, and paranasal sinuses (see pg 579 in Adams) ◦ ‘air conditioning’ of the respiratory tract Warm, humidify and clean the air
Sympathetic nervous system ◦ Constricts arterioles of the nose-widens the airway (relief of stuffiness) Parasympathetic nervous system ◦ Dilates the aterioles of the nose-shrinks the airway (causes stuffiness)
Primary action: block the actions/attachment of histamine at the H1 receptors ◦ OTC remedies for allergic rhinitis, motion sickness and insomnia ◦ Reduces inflammation and symptoms
Diphenhydramine (Benedryl) Action: blocks histamine from reaching its receptors Uses: often combined with analgesics, decogestants, and expectorants; treatment of rashes, allergic reactions, Parkinson’s disease, motion sickness and insomnia
Fexafenadine (Allegra) Action: reduces nasal congestion, sneezing, tearing of the eyes. Use:same as 1 st generation Contraindication: hypersensitivity to drug; may have synergistic sedative effects.
First generation drugs have more significant side effects than 2 nd generation Side/effects ◦ Sedation or rarely excitability ◦ Anticholinergic effects (everything dries up) ◦ Nursing Moms may have decreased lactation (Category C) ◦ Respiratory secretions thicken ◦ Young children may exhibit hypersensitivity or overdose
Promenthazine (Phenergan): motion sickness and n/v Antihistamines may also be used for vertigo and insomnia Contraindications: ◦ Hx of heart disease, narrow angle glaucoma, seizure disorder, CNS stimulation, renal impairment,or prostate disease.
Action: ◦ stimulate alpha 1 adrenergic receptors in vascular smooth muscle which produces vasoconstriction. Vasoconstriction reduces the blood flow which slows the production of mucus and relieves symptoms.
Routes of administration/side effects: ◦ intranasal-few side effects Rebound congestion Use no longer than 3-5 days If dependence is developed, change to intranasal glucocorticoid ◦ oral No rebound congestion Onset of action is much slower
Antihistamines: ◦ Auscultate breath sounds ◦ Monitor VS (including ECG w HD) ◦ Monitor thyroid labs (antihistamines may cause thyroid storm ◦ Monitor vision changes and neuro status, especially LOC ◦ Measure I&O ◦ Monitor glucose levels ◦ Observe for anticholinergic crisis
Decongestants: ◦ Assess VS, especially pulse and BP ◦ Monitor urinary output/flow ◦ Do not use with other OTC cold preps ◦ Immediately report palpitations, CP, dizziness, visual changes, excessive dry mouth ◦ Use proper technique on use and care of nasal spray dispensers.
Antitussives (opioid and non opioid) ◦ Dampen the cough reflex Expectorants ◦ Reduce the thickness-increases flow Mucolytics ◦ Break down the chemical structure
Codeine/hydrocodone ◦ Action: raise the cough threshold in CNS; usually classified as Schedule III, IV or V ◦ S/E Respiratory depression Minimal potential for dependence ◦ Nursing Implications; Caution use in asthma Used in combination with antihistamines, decong (pg 590) Monitor for drowsiness; know what s/e to report
Dextromethorphan(Benylin) ◦ Action/S/E: raises the cough threshold s/e are rare ◦ Nursing implications: No risk of dependence Contraindicated in treatment of chronic cough (asthma, smoking, emphysema)
Benzonatate (Tessalon) ◦ Action: Suppresses cough by anesthetizing stretch receptors of lungs ◦ S/E uncommon, may include sedation, nausea, HA ◦ Nursing implications: Teach not to chew the pill-numbing effects
Guaifenesin(Robitussin) ◦ Most common ◦ Tolerated by most ◦ Available OTC ◦ Few adverse effects
Critical thinking: ◦ When would an expectorant be used? ◦ When would an antitussive be used?
Monitoring cough characteristics Assess history of the cough Use antitussives when cough interferes with ADL’s, rest or sleep Teach goals of therapy Caution food and water immediately following taking med Teach about environmental modifications Do not suppress productive cough Maintain adequate fluid intake Teach to read label-do not take more than recommended dose Teach not to use prescription with OTC Keep all meds out of reach of children-call Poison Control if ingested---no use of Ipecac (gag reflex diminished)
Basic Physiology of lower resp. tract ◦ Trachea, bronchus, lung ◦ See page 594 in Adams ◦ Bronchioles are elastic smooth muscle which dilate and constrict based on metabolic needs. Controlled by autonomic nervous system Fight or flight response Beta 2 adrenergic receptors stimulated=bronchodilation Parasympathetic nervous system action bronchoconstriction
Aerosol ◦ Delivers to immediate site of action=fewer systemic effects ◦ Used for bronchospasm or decrease viscosity of mucous in bronchi Nebulizer ◦ Machine that vaporizes liquid via face mask or handheld Dry Powder Inhaler (DPI) ◦ Takes fine powder directly to bronchi Metered Dose Inhalers (MDI) ◦ Uses a propellant to deliver measured dose to the lungs with each breath MUST USE DEVICES CORRECTLY: ONLY 10-50% OF DRUG ACTUALLY REACHES LUNGS.
General info: -relax bronchial smooth muscle=widening the airway -beta agonists alone have no anti-inflammatory properties -some agents activate beta 1 and beta 2 receptors -newer agents only activate beta 2 receptors -inhaled beta adrenergic agents have little systemic toxicity
Action/Use: bronchodilatation via beta 2 receptor activation ◦ Classification by duration of action Ultra short (effects last 2-3 hrs) Short (effects last 5-6 hrs) Intermediate ( 8 hrs) Long (12 hrs) Formoterol (Foradil) Prototype: salmertol (Seravent) ◦ S/E Cardiac (tachycardia, dysrhythmias), hyperglycemia, tolerance of med, insomnia, nervousness, tremor ◦ Nursing Interventions/contraindications: Monitor VS- especially BP; no MAOI’s, TAD, or antihistamines; teach about meds (timing, use of, s/s to report)
Action/use: ◦ Bronchodilatation; chronic persistent asthma ◦ Related to caffeine; stimulate CNS Route: IV or po (not inhaled) Nursing Interventions: ◦ Assess VS-esp RR and lung sounds;monitor K+ levels, monitor for insomnia, hyperstimulation; limit use of caffeine and smoking; teach about meds (timing, use, as prescribed) ◦ Prototype: theophylline (Theo-dur)
Action/use: ◦ Blocks cholinergic receptors in bronchial smooth muscle; chronic bronchitis, nasal congestion S/E/route: ◦ Irritation of upper respiratory tract, dry mouth, GI distress, HA and anxiety; bitter taste ◦ MDI ◦ Prototype: ipratropium bromide (Atrovent) Nursing interventions: ◦ Wait 5 min between this med and any other, proper technique, rinse mouth, report changes in urinary pattern
Action/Use: ◦ Anti inflammatory; prophylactic treatment of bronchial asthma S/E/routes: ◦ Local: hoarseness; systemic: adrenal gland atrophy, peptic ulcers, osteoporosis; growth a concern in children ◦ Oral = prednisone; IV= Solu-Medrol Nursing interventions: ◦ Monitor VS, Assess for s/s of infection, assess lung sounds, oxygen sats, weight gain/loss, teach about meds.
Assessment: ◦ Gas exchange Cyanosis, activity tolerance, labs, pulm tests ◦ Monitor effectiveness of therapy Change in cough, resp. effort, lung sounds, nature and quality of secretions ◦ Monitor for adverse effects of drugs
Ineffective airway clearance RT bronchoconstricion Impaired gas exchange RT disease process Risk for injury RT adverse effects of drugs Deficient knowledge RT disease process and medication regime
The client will: ◦ Experience effective cough and clear breath sounds… ◦ Have 02 sats >90% …. ◦ Verbalize improvement in respiratory secretions ….
Disease specific (amounts of 02) Drug specific monitoring Monitor for S/E