May need supplemental O2 May need artificial ventilation Drug therapy Long

May need supplemental o2 may need artificial

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May need supplemental O2 May need artificial ventilation Drug therapy
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Long acting o Daily maintenance Goal is to prevent attacks o Inhaled steroids o Oral steroids o Systemic corticosteroids (Prednisone) o Anti-IgE o Bronchodilators o Leukotriene modifiers o Advair o Symbicort o Do NOT use in acute attack Short acting o Rescue inhaler o SABA Common side effect = tremors (ok) o Inhaled anticholinergic? o Bronchodilators o USING AN INHALER (MDI) Know the steps Know what is proper vs improper Know why Know when to replace Know how to clean Education is key Have the pt demonstrate If medications are not used correctly Medication is less effective because most of the medication does not get into the lungs STEPS Check with book 1. Take off cap and shake inhaler 2. Hold upright 3. Have pt breathe all the way out 4. Hold in the way told by the doctor a. 1-2 in away from the mouth b. Using a spacer c. Directly in the mouth d. Depends on order 5. If spacer a. Press down on inhaler
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b. Breathe in slowly through mouth within 5 sec 6. If no spacer a. Breathe in slowly through mouth b. While breathing in slowly -> then press down on inhaler one time c. Must start breathing in before then press the inhaler 7. Keep breathing in slowly and as deeply as possible 8. Hold breath for 10 sec 9. Slowly exhale 10. May repeat after 1 minute if need another puff a. Some meds you can do 2 puffs back to back b. Depends on med 11. Rinse out mouth after a. To prevent fungal infections in mouth When to clean inhaler 1. If powder around hole where medicine sprays out How to clean inhaler Remove metal canister from L-shaped plastic mouthpiece Rinse only the mouthpiece and cap in warm water Let dry overnight Put canister pack in, in morning Put cap on When to replace inhaler Very important so don’t run out of medication Know how many puffs in canister Know how many puffs take per day Ex. 200 puffs in canister 8 puffs per day = med will last 25 days put note in calendar to go get new med at 20 days! Dry Powdered Inhaler (DPI) 1. Check for dust/ dirt 2. May be held upright or horizontal 3. Do not shake 4. Tilt head back and exhale all air prior to putting device in mouth 5. Breathe in deeply and quickly 6. Hold breath 10 sec or as long as can 7. Do not use this in humid place Shower room
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Simpler than MDI Delivered only by inspiratory effort so not good for patients with low FEV Comparison of Metered-Dose and Dry Powder Inhalers Metered-Dose Inhaler (MDI)* Dry Powder Inhaler (DPI) Shake before use May be needed for some (e.g., albuterol), but not for others (Read package insert) No Inspiration Slow Rapid Spacer May be used with inhaled corticosteroids or for more effective delivery (Read package insert) None permitted Counting device Many have an external device, but some do not Most preloaded forms include counter Inhalations/dose Often 2/dose Often 1/dose Cleaning Use water for plastic case Avoid moisture Nursing care Education Prevention of attacks Med use Identify and then avoid triggers
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