noninvasive positive pressue contraindications- CPAP, BiPAP
not beneficial for w resp failure after extubation, pt must be alert and ability to protect airway (NG can be used w it)
oxygen tx best practices-start
- check prescription for type, flow, rate, humidification (over 4 L)
- ensure equipment works
oxygen tx best practices- assess
- skin for breakdown 4-8hrs, mouth , nose
- cleanse and lubricate
- response to tx
oxygen best practices- tubing
- pad band and tubing
- cleanse cannula and mask w warm water q 4-8hrs
- position to prevent pulling
oxygen best practices- educate
- smoking/flame
- adequate oxygen supply for travel
- ongoing teaching to enhance adherence
promoting smoking cessation
- -no longer core measure for CMS
- assess desire, past attempts, and methods, nicotine dependence
- NRT best w smoking cessation program
- bupropion (Zyban) decrease cravings
- varenicline (chantix) interfere w nicotine receptors
Alpha 1 antitrypsin (AAT) deficiency
- risk factor for COPD
- AAT inhibits excessive protease act so it only attacks pollutants and not lung structures
- recessive genetic d/o -Z mutation worse
- avoid smoking and environmental pollutents
asthma causes- inflammation
-allergens bind to specific antibodies (IgE) connected to mast cells that release chemicals (histamine) causing inflammation, mucus secretion, and blood vessel dilation
asthma causes- bronchospasm
- narrowing of bronchial tubes around and within bronchial walls
- sm amt of pollutants/viruses stim nerve fibers
- can also be triggered by inflammation
asthma causes-other
aspirin, NSAIDs, GERD
controlled asthma char
- manifestations occur 2x or less per wk
- reliever used 2x or less per wk
partially controlled asthma char (need 1)
uncontrolled (need 3+)
- manifestations/releiver more than 2x wk
- any act intolerance
- any nighttime manifestations
- PEF or FEV1 less than 80% of personal best
asthma control therapy drugs
used to reduce airway sensitivity (responsiveness) to prevent asthma from occuring
-used every day regardless of symptoms
asthma reliever drugs
rescue drugs used to stop an attack once started
bronchodilators
cause bronchiolar smooth muscle relaxation, have no effect on inflammation
-can stim beta-adrenergic receptors or block parasympathetic nervous system
asthma management
- avoid environmental triggers, drugs (aspirin, NSAID, beta blockers), MSG
- use inhaler 30 min before exercise
bronchodilators short acting beta agonist (SABA)
- albuterol (proventil, ventolin)
- fast acting rescue, relax smooth muscle
- carry all times, mon hrt rate, use 5 min before other inhaled drugs
long acting beta agonist (LABA)
- salmeterol (serevent), indacaterol (arcapta)
- long acting controller, relax smooth muscle
- shake well (MDI), not a reliever
cholinergic antagonist
- Ipratropium (atrovent)
- inhibit parasympathetic nervous system- relieve and prevent
- carry all times
- shake well
- increase daily fluid intake
- report blurred vision, eye pain, headache, nausea, palpitations, tremors, inability to sleep
antiinflammatories
decrease inflammatory response, do not cause bronchodilation
corticosteroids
disrupt production pathways of inflammatory mediators, prevention
fluticasone (flovent)
-use daily, good mouth care, not reliever
prednisone (Deltasone, Predone)
-side effects, avoid anyone w upper resp infection, avoid act that lead to injury, take w food, don’t stop taking suddenly
cromone
- prevents inflammatory response, prevention
- Nedocromil (Tilade)
- use daily, not reliever
