Term
The patient is wheezing and the nurse administers the scheduled dose of theophylline (Theo-Dur) 400 mg po. How does the nurse determine whether the medication is having the desired effect?
A. Notes that the theophylline level is therapeutic at 35 mcg/ml.
B. Observes that the heart rate is normal at 70/minute
C. Notices that the patient is jittery and nervous
D. Observes that wheezing has decreased and airflow has improved. |
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Definition
| D. Observes that wheezing has decreased and airflow has improved. |
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Term
Why are the Xanthine drugs (theophylline, aminophylline) used with caution? |
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Definition
They have lots of serious side effects:
1. a narrow therapeutic window which means patients become toxic when levels are too high. They can develop cardiac rhythm disturbances, vomitting, abdominal pain and confusion.
2. Also, smoking affects absorption! If the patient decreases the number of cigarettes smoked, theophylline levels go up (and can become toxic) |
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Term
| Is albuterol (Proventil) used for prevention or rescue in the treatment of asthma? What should the patient be taught? |
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Definition
Albuterol is a short acting inhaled beta agonist used as a rescue drug to quickly bronchodilate.
It could be used preventively 30-60 minutes prior to exercise for patients with exercise induced asthma.
Teaching: Should be carried with patient at all times.
Correct use of inhaler.
Side effects: tachycardia, sweating, jittery feeling, hypertension |
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Term
| How should the nurse evaluate the effectiveness of the albuterol nebulizer treatment? |
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Definition
Monitor respirations and breath sounds. Assess O2 saturation and remaining vital signs for possible tachycardia and hypertension. Look at chest - still working to breathe (retractions)?
Ideally patient should note that he is breathing more easily. |
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Term
The patient's heart rate increases to 150 and bp to 160/100 after his nebulizer treatment with albuterol (Proventil). The physician changes the medication to ipratropium (Atrovent). Why?
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Definition
| Patients who cannot tolerate the sympathetic effects of the sympathomimetic, albuterol, might respond to the anticholinergic drug ipratropium (Atrovent) which will bronchodilate without as many adverse effects. |
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Term
| What precautions should the nurse recall when administering the anticholinergic ipratropium (Atrovent) to her patient being treated for COPD? |
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Definition
1. The patient needs to be adequately hydrated, as ipratropium (Atrovent) will dry secretions.
2. Ipratropium (Atrovent) can cause urinary retention (encourage voiding prior to treatment).
3. Patients with peanut allergies should not use ipratropium (Atrovent)! |
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Term
1. Can fluticasone (Flovent) be used as a rescue inhaler?
2. Should fluticasone (Flovent) be used when the patient has an active infection in the respiratory system? |
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Definition
1. No, fluticasone (Flovent) is an inhaled steroid which depresses the inflammatory response and takes 2-3 weeks to reach effective levels - much too late to help the patient to breathe immediately!
2. No, steroids depress inflammation and immune response and the patient needs these responses to fight infection. The patient needs to notify PCP if he has a temperature. |
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Term
| What should the patient be instructed to do after inhaling a steroid? |
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Definition
| The patient should rinse his mouth with water to prevent thrush as well as decrease systemic absorption and GI upset and nausea. |
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Term
1. What are some ways that patients who are taking warfarin (Coumadin) can be taught to prevent injury?
2. What is the antidote for Coumadin
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Definition
1. Use electric razor, not straight edge.
Avoid contact sports
Use soft bristle tooth brush.
If bleeding occurs, apply pressure. Notify physician if internal bleeding (blood in urine, stool, sputum)
Notify PCP of all other meds as well as herbals that patient takes
Need for periodic INR/PT lab test evaluations.
Avoid OTC drugs such as Aspirin and Ibuprofin
2. Vitamin K is the antidote for coumadin |
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Term
1. What lab test is used to monitor the therapeutic effects of heparin?
2. What is the antidote for heparin? |
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Definition
1. aPTT. The therapeutic range for a heparinized patient is 1.5-3 times higher than control (the normal time blood takes to clot in a healthy person not receiving anticoagulants).
2. Protamine sulfate is the antidote to heparin. Luckily, because of the short half life of heparin, usually we can turn off the heparin IV and wait. But protamine will quickly reverse the effects. |
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