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Adults I Exam 3Mally Respiratory(16 questions)Asthma Chronic inflammatory disorder recurrent episodes of wheezing, breathlessness, chest tightness, and cough (especially in early AM/late PM). Associated with airway obstruction that is usually reversible. A)Clinical Manifestationsi)Unpredictable and Variable: may be abrupt or gradual; lasts minutes to hours ii)Feelings of suffocation anxiety iii)Prolonged Expiration r/t narrowed airway – caused by bronchospasm, edema, and mucus in bronchioles(a)When they can’t exhale all the air out, you might see hyper-inflated chest. iv)Wheezing is unreliableto gauge severity. Wheezes usually heard on expiration. v)Acute Attack has S/S of Hypoxemia(a)Restlessness, anxiety, inappropriate behavior, HR and BP, Pulsus Paradoxus(drop in systolic during inspiration >10mm Hg, you need a special monitor to detect this), vi)Severe attacks have no wheezing sounds. No breath sounds at all = bad news B)Complicationsi)Severe AcuteAttack: RR > 30; HR >120; PEFR <40% (Peak Expiratory Flow Rate), usually seen in hospitalii)Life ThreateningAsthma S/S(a)Diaphoresis, drowsy/confused, too dyspneic to speak, required hospital care (often ICU)C)Drug Therapy: correct administration is huge i)MDI = Metered Dose Inhalerwith a spaceris easier and improves adminii)DPI:Dry Powder Inhaler requires less manual dexterity and coordination iii)Nebulizer Therapy: If they are using a non-rebreather maskbut need a nebulizer treatment, put the neb on with oxygen, and return them to their mask afterward. iv)Beta Agonists relieve acute bronchospasm (Bronchodilate)(a)Onset in minutes; Duration 4-8 hours (b)Prevent release of inflammatory mediatorsfrom mast cells(c)Short and Long Acting meds can be mixed together in a nebulizer (d)Short Acting(1)Albuterol (Proventil): nebulizer, MDI(1)Can cause tachycardia, tremors, anxiety(2)If they are using several times per week, this is not good control(2)Levalbuterol (Xopenex) neb, MDI: less likely to cause s/e (e)Long Acting not prescribed for mild asthma (1)Salmeterol (Serevent) (2)Fometerol (1)Foradil Aerolizer nebulizer(2)Perforomist neb(3)Arformoterol (Brovana) neb v)Anticholinergic Drugs(Bronchodilate), block action of ACh. (a)“Usually used in combination with bronchodilator” (?) (b)S/E: Dry Mouth r/t cholinergic effects (c)Short Acting (1)Ipratropuim (Atrovent HFA) nebulizer, MDI(d)Long Acting(1)Tiotropium (Spiriva) DPI – more commonly used in COPD vi)Anti-Inflammatory Drugs (a)Inhaled Corticosteroids(1)Immune suppression; Bronchial hyper-responsiveness; Mucus production(2)Used for prophylactic and maintenance therapy – these are not used in acute episodes. (3)Inhaled steroid has less S/E than systemic steroid. Educate pt’s to rinse their mouth out after using and avoid swallowing med r/t risk of fungal thrush(4)Beclomethasone (Qvar) MDI(5)Budesonide (Pulmicort Turbuhaler)(6)Fluticasone (Flovent)(b)Systemic Corticosteroids(1)Same effects as above; but often given during acute exacerbations (but nota rescue drug)(2)Side Effects