Chapter 9
Care of the Patient with a
Respiratory Disorder
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respiratory system song
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Overview of Anatomy and
Physiology
• External respiration

Exchange of oxygen and carbon dioxide between the
lung and the environment
• Internal respiration

Exchange of oxygen and carbon dioxide at the cellular
level
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Slide 2
Overview of Anatomy and
Physiology
• Upper respiratory tract

Nose
 Pharynx
 Larynx
 Trachea
• Lower respiratory tract

Bronchial tree
• Bronchioles, alveolar ducts, alveoli
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Slide 3
Overview of Anatomy and
Physiology
• Mechanics of breathing

Thoracic cavity
• Lungs

Visceral pleura and parietal pleura
• Respiratory movements and ranges

Rhythmic movements of the chest walls, ribs, and
muscles allow air to be inhaled and exhaled
• Regulation of respiration

Nervous control—medulla oblongata and pons of the
brain; chemoreceptors—in the carotid and aorta
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Slide 4
Overview of Anatomy and Physiology
• Respiratory Movements and Ranges

Room air when inhaled= 21% Oxygen
• Exhaled air= 16% oxygen

Normal Respirations
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Adult= 14-20 bpm
Newborn= 40-60 bpm
Early school age child= 22-24 bpm
Teenager= 20-22 bpm
Rate can be affected by many variables
• Sex, age, activity, disease, body temperature, etc.
• Count without patient’s awareness to prevent alteration
in breathing pattern
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Slide 5
Assessment of the Respiratory
System
• Subjective data

Shortness of breath, dyspnea, cough
• Objective data

Expression, chest movement, and respirations
 Respiratory distress, wheezes, or orthopnea
 Adventitious breath sounds
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Sibilant wheezes
Sonorous wheezes
Crackles
Pleural friction rubs
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Slide 6
Laboratory and Diagnostic
Examinations
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Chest roentgenogram (CXR)
Computed tomography (CT)
Pulmonary function testing
Mediastinoscopy
Laryngoscopy
Bronchoscopy
Sputum specimen
Cytological studies
Thoracentesis
Arterial blood gases (ABG)
Pulse oximetry
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Slide 7
Figure 9-7
(A, Courtesy of Olympus America, Melville, New York. B, from Meduri, G.U., et al. [1991]. Protected
bronchoalveolar lavage, American Review of Respiratory Disease, 143:855, official journal of the
American Thoracic Society, © American Lung Association.)
Fiberoptic bronchoscope.
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Slide 8
Figure 9-8
(From Lewis, S.M., Heitkemper, M.M., Dirksen, S.R. [2007]. Medical-surgical nursing: assessment and
management of clinical problems. [7th ed.]. St. Louis: Mosby.)
Thoracentesis.
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Slide 9
Figure 9-9
(From Potter, P.A., Perry, A.G. [2009]. Fundamentals of nursing. [7th ed.]. St. Louis: Mosby.)
Portable pulse oximeter with spring-tension digit probe displays
oxygen saturation and pulse rate.
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Slide 10
Disorders of the Upper Airway
• Epistaxis


Why does Katarina have frequent epistaxis?
Etiology/pathophysiology
• Bleeding from the nose
• Congestion of the nasal membranes leading to capillary
rupture
• Primary or secondary

Clinical manifestations/assessment
• Bright red bleeding from one or both nostrils
• Can lose as much as 1 liter per hour
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Slide 11
Disorders of the Upper Airway
• Epistaxis (continued)

Medical management/nursing interventions
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Sitting position, leaning forward
Direct pressure by pinching nose below the bone
Ice compresses to nose
Nasal packing
Cautery
Balloon tamponade
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Slide 12
Disorders of the Upper Airway
• Deviated septum and nasal polyps

Etiology/pathophysiology
• Congenital abnormality
• Injury
• Nasal septum deviates from the midline and can cause
a partial obstruction
• Nasal polyps are tissue growths usually due to
prolonged inflammation
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Slide 13
Disorders of the Upper Airway
• Deviated septum and nasal polyps (continued)

Clinical manifestations/assessment
• Stertorous respirations (snoring)
• Dyspnea
• Postnasal drip

Medical management/nursing interventions
• Pharmacological management
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Corticosteroids, antihistamines, antibiotics, analgesics
• Nasoseptoplasty
• Nasal polypectomy
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Slide 14
Disorders of the Upper Airway
• Allergic rhinitis and allergic conjunctivitis (hay fever)
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
What could Katie do to decrease her symptoms?
Etiology/pathophysiology
• Antigen/antibody reactions in the nasal membranes,
nasopharynx, and conjunctiva due to allergens

Diagnostic testing
• Allergy testing to determine cause may be helpful

Can be done by skin testing or serum radioallergosorbent
test
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Slide 15
Disorders of the Upper Airway
• Allergic rhinitis and allergic conjunctivitis (continued)
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Clinical manifestations/assessment
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Edema
Photophobia
Excessive tearing
Blurring of vision
Pruritus
Excessive nasal secretions and/or congestion
Sneezing
Cough
Headache
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Slide 16
Disorders of the Upper Airway
• Allergic rhinitis and allergic conjunctivitis (continued)
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Diagnostic testing
Medical management/nursing interventions
• Pharmacological management
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Antihistamines
Decongestants
Corticosteroids
Analgesics
• Avoid allergen
• Hot packs over facial sinuses
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Slide 17
• http://studentnurses3.blogspot.com/p/medical-surgical-nursingmnemonics.html?m=1
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Slide 18
Figure 9-3
(From Thibodeau, G.A., Patton, K.T. [2008]. Structure and function of the body. [13th ed.]. St. Louis: Mosby.)
Projections of paranasal sinuses and oral nasal cavities on the skull and
face.
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Slide 19
Disorders of the Upper Airway
• Obstructive sleep apnea (OSA)

Etiology and pathophysiology
• Characterized by partial or complete upper airway
obstruction during sleep
• Apnea refers to the cessation of spontaneous
respirations
• Hypopnea is the presence of unusually shallow or slow
respirations
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Slide 20
Disorders of the Upper Airway
• Obstructive sleep apnea (OSA)
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Clinical manifestations
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Frequent awakening at night
Insomnia
Excessive daytime fatigue
Witnessed apneic episodes
Loud snoring
Hypercapnia
Personality changes
Irritability
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Slide 21
Disorders of the Upper Airway
• Obstructive sleep apnea (continued)

Complications
• Systemic HTN, cardiac dysrhythmia, heart failure,
nocturnal hypoexmia, stroke
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Diagnostic tests
• Polysomnography (sleep study)
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Medical management/nursing interventions
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Avoid sedatives
Avoid alcoholic beverages
Support groups
Oral appliances
nCPAP
Surgery
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Slide 22
Disorders of the Upper Airway
• Upper airway obstruction
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Etiology and pathophysiology
• Precipitated by a recent respiratory event
• Common airway obstructions
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Choking on food
Dentures
Aspiration of vomitus or secretions
The tongue
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Slide 23
Disorders of the Upper Airway
• Upper airway obstruction (continued)

Clinical manifestations/assessment
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Stertorous respirations
Altered respiratory rate and character; apneic periods
Hypoxia; cyanosis
Wheezing; stridor
Medical management/nursing interventions
• Open the airway
• Remove obstruction
• Artificial airway; tracheostomy
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Slide 24
Disorders of the Upper Airway
• Cancer of the larynx
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Etiology/pathophysiology
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Squamous cell carcinoma
Heavy smoking and alcohol use
Chronic laryngitis
Vocal abuse
Family history
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Slide 25
Disorders of the Upper Airway
• Cancer of the larynx (continued)
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Clinical manifestations/assessment
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Progressive or persistent hoarseness
Pain radiating to the ear
Difficulty swallowing
Hemoptysis
Medical management/nursing interventions
• Radiation
• Surgery
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
Partial or total laryngectomy
Radical neck dissection
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Slide 26
Respiratory Infections
• Acute rhinitis (common cold)

Etiology/pathophysiology
• Inflammation of the mucous membranes of the nose
and accessory sinuses
• Virus(es)

Clinical manifestations/assessment
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Thin, serous nasal exudate
Productive cough
Sore throat
Fever
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Slide 27
Respiratory Infections
• Acute rhinitis (common cold) (continued)
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Medical management/nursing interventions
• Pharmacological management
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Analgesic
Antipyretic
Cough suppressant
Expectorant
Antibiotic (if infection present)
• No specific treatment
• Encourage clear fluids
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Slide 28
Respiratory Infections
• Acute follicular tonsillitis
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Etiology/pathophysiology
• Inflammation of the tonsils
• Bacterial or viral infection
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Clinical manifestations/assessment
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Enlarged, tender, cervical lymph nodes
Sore throat
Fever; chills
Enlarged, purulent tonsils
Elevated WBC
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Slide 29
Respiratory Infections
• Acute follicular tonsillitis (continued)

Medical management/nursing interventions
• Pharmacological management
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Antibiotics; analgesics; antipyretics
• Warm saline gargles and oral care
• Tonsillectomy and adenoidectomy

Postoperative
o Assess for excessive bleeding
o Ice-cold liquids—ice pops
o Ice collar
o Avoid coughing, sneezing, or vigorous nose blowing
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Slide 30
Respiratory Infections
• Laryngitis

Etiology/pathophysiology
• Inflammation of the larynx due to virus or bacteria
• May cause severe respiratory distress in children under
5 years old

Clinical manifestations/assessment
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Hoarseness
Voice loss
Scratchy and irritated throat
Persistent cough
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Slide 31
Respiratory Infections
• Laryngitis (continued)
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Medical management/nursing interventions
• Pharmacological management
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Analgesics
Antipyretics
Antitussives
Antibiotics—bacterial
• Viral—no specific treatment, supportive care
• Warm or cool mist vaporizer
• Limit use of voice
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Slide 32
Respiratory Infections
• Pharyngitis
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Etiology/pathophysiology
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Inflammation of the pharynx
Chronic or acute
Frequently accompanies the common cold
Viral, most common
Bacterial
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Slide 33
Respiratory Infections
• Pharyngitis (continued)
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Clinical manifestations/assessment
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Dry cough
Tender tonsils
Enlarged cervical lymph glands
Red, sore throat
Fever
Medical management/nursing interventions
• Pharmacological management
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Antibiotics; analgesics; antipyretics
• Warm or cool mist vaporizer
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Slide 34
Respiratory Infections
• Sinusitis
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Etiology/pathophysiology
• Inflammation of the sinuses
• Usually begins with an upper respiratory infection; viral
or bacterial
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Clinical manifestations/assessment
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Constant, severe headache
Pain and tenderness in involved sinus region
Purulent exudate
Malaise
Fever
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Slide 35
Respiratory Infections
• Sinusitis (continued)
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Medical management/nursing interventions
• Pharmacological management
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Antibiotics
Analgesics
Antihistamines
Vasoconstrictor nasal spray (Afrin)
Warm mist vaporizer
Warm, moist packs
Nasal windows
Why are we concerned about untreated sinusitis?
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Slide 36
Disorders of the Lower Airway
• Acute bronchitis
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Etiology/pathophysiology
• Inflammation of the trachea and bronchial tree
• Usually secondary to upper respiratory infection
• Exposure to inhaled irritants

Clinical manifestations/assessment
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Productive cough; wheezes
Dyspnea; chest pain with breathing
Low-grade fever
Malaise; headache
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Slide 37
Disorders of the Lower Airway
• Acute bronchitis (continued)
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Medical management/nursing interventions
• Pharmacological management
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Cough suppressants
Antitussives
Antipyretics
Bronchodilators
Antibiotics
• Vaporizer – cool mist
• Encourage fluids
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Slide 38
Disorders of the Lower Airway
• Legionnaires’ disease
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Etiology/pathophysiology
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Legionella pneumophila
Thrives in water reservoirs
Causes life-threatening pneumonia
Leads to respiratory failure, renal failure, bacteremic
shock, and ultimately death
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Slide 39
Disorders of the Lower Airway
• Legionnaires’ disease (continued)
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Clinical manifestations/assessment
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Elevated temperature
Headache
Nonproductive cough
Difficult and rapid respirations
Crackles or wheezes
Tachycardia
Signs of shock
Hematuria
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Slide 40
Disorders of the Lower Airway
• Legionnaires’ disease (continued)
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Medical management/nursing interventions
• Pharmacological management
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Antibiotics
Antipyretics
Vasopressors
• Oxygen
• Mechanical ventilation, if necessary
• IV therapy
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Slide 41
Disorders of the Lower Airway
• Severe Acute Respiratory Syndrome (SARS)
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Etiology/pathophysiology
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Infection caused by coronavirus
Spread by close contact between people
Airborne
May be spread by touching contaminated objects
Clinical manifestations/assessment
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Temperature
Headache
Muscle aches
Mild respiratory symptoms

Dry cough and SOB
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Slide 42
Disorders of the Lower Airway
• Adult respiratory distress syndrome (continued)
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Diagnostic tests
• Chest radiograph
• Serum antibody testing
• Nasopharyngeal and oropharyngeal swabs
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Medical management/nursing interventions
• Pharmacological management
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Antibiotics
Antiviral medications
• Respiratory isolation
• Oxygen
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Slide 43
Disorders of the Lower Airway
• Anthrax
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Etiology/pathophysiology
• Bacillus anthracis
• Spread by direct contact with bacteria or spores
• Three types: Cutaneous, GI, inhalational

Clinical manifestations/assessment
• Cold or flu-like symptoms
• Hemorrhage, tissue necrosis, and lymphedema
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Medical management
• Antibiotics
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Slide 44
Disorders of the Lower Airway
• Tuberculosis
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Etiology/pathophysiology
• Inhalation of tubercle bacillus (Mycobacterium
tuberculosis)
• Infection versus active disease
• Presumptive diagnosis
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Mantoux tuberculin skin test
Chest x-ray film
Acid-fast bacilli smear  3
• Confirmed diagnosis
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Sputum culture; positive for TB bacilli
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Slide 45
Disorders of the Lower Airway
• Tuberculosis (continued)
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Clinical manifestations/assessment
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Fever
Weight loss; weakness
Productive cough; hemoptysis
Chills; night sweats
Medical management/nursing interventions
• Tuberculosis isolation (acid-fast bacilli [AFB])
• Multiple medications to which the organisms are
susceptible
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Slide 46
Disorders of the Lower Airway
• Pneumonia

Etiology/pathophysiology
• Inflammatory process of the bronchioles and the
alveolar spaces due to infection
• Bacteria, viruses, mycoplasma, fungi, and parasites

Clinical manifestations/assessment
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Productive cough
Severe chills; elevated temperature
Increased heart rate and respiratory rate
Dyspnea
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Slide 47
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Slide 48
Disorders of the Lower Airway
• Pneumonia (continued)
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Medical management/nursing interventions
• Pharmacological management
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Antibiotics
Analgesics
Expectorants
Bronchodilators
Oxygen
Chest percussion and postural drainage
Encourage to cough and deep-breathe
Humidifier or nebulizer
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Slide 49
Disorders of the Lower Airway
• Pleurisy
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Etiology/pathophysiology
• Inflammation of the visceral and parietal pleura
• Bacterial or viral
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Clinical manifestations/assessment
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Sharp inspiratory pain
Dyspnea
Cough
Elevated temperature
Pleural friction rub
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Slide 50
Disorders of the Lower Airway
• Pleurisy (continued)
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Medical management/nursing interventions
• Pharmacological management
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Antibiotics
Analgesics
Antipyretics
• Oxygen
• Anesthetic block for intercostal nerves
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Slide 51
Disorders of the Lower Airway
• Pleural effusion/empyema
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Etiology/pathophysiology
• Pleural effusion
• Accumulation of fluid in the pleural space
• Empyema—infection

Clinical manifestations/assessment
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Dyspnea
Air hunger
Respiratory distress
Fever
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Slide 52
Disorders of the Lower Airway
• Pleural effusion/empyema (continued)
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Medical management/nursing interventions
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Thoracentesis
Chest tube with closed water-seal drainage system
Antibiotics
Cough and deep-breathe
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Slide 53
Disorders of the Lower Airway
• Atelectasis
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Etiology/pathophysiology
• Collapse of lung tissue due to occlusion of air to a
portion of the lung
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Clinical manifestations/assessment
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Dyspnea; tachypnea
Pleural friction rub; crackles
Restlessness
Elevated temperature
Decreased breath sounds
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Slide 54
Disorders of the Lower Airway
• Atelectasis (continued)
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Medical management/nursing interventions
• Pharmacological management
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Bronchodilators
Antibiotics
Mucolytic agents
Analgesics
• Cough and deep-breathe
• Early ambulation
• Respiratory treatments
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
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Incentive spirometry; intermittent positive-pressure breathing
(IPPB)
Oxygen
Chest percussion and postural drainage
• Chest tube
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Slide 55
Disorders of the Lower Airway
• Pneumothorax
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Etiology/pathophysiology
• A collection of air or gas in the pleural space, causing
the lung to collapse

Clinical manifestations/assessment
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Decreased breath sounds
Sudden, sharp chest pain with dyspnea
Diaphoresis; tachycardia; tachypnea
No chest movement on affected side
Sucking chest wound
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Slide 56
Figure 9-13
(From Wilson, S., Thompson, J. [1991]. Respiratory disorders, Mosby’s clinical nursing series. St. Louis: Mosby.)
Pneumothorax
(complete collapse of the right lung).
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Slide 57
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Slide 58
Disorders of the Lower Airway
• Pneumothorax (continued)

Medical management/nursing interventions
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Chest tube to water-seal drainage system
Oxygen
Analgesics
Encourage fluids
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Slide 59
Disorders of the Lower Airway
• Lung cancer

Etiology/pathophysiology
• Primary tumor or metastasis
• Small-cell, non–small-cell, squamous cell, and large-cell
carcinoma

Clinical manifestations/assessment
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Hemoptysis
Dyspnea; wheezing
Fever; chills
Pleural effusion
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Slide 60
Disorders of the Lower Airway
• Lung cancer (continued)

Medical management/nursing interventions
• Surgery
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
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Most are not diagnosed early enough for curative surgical
intervention
Segmental resection
Lobectomy
Pneumonectomy
• Radiation
• Chemotherapy
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Slide 61
Disorders of the Lower Airway
• Pulmonary edema

Etiology/pathophysiology
• Accumulation of serous fluid in interstitial tissue and
alveoli

Clinical manifestations/assessment
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Dyspnea; cyanosis
Tachypnea; tachycardia
Pink or blood-tinged, frothy sputum
Restlessness; agitation
Wheezing; crackles
Decreased urinary output; sudden weight gain
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Slide 62
Disorders of the Lower Airway
• Pulmonary edema (continued)

Medical management/nursing interventions
• Pharmacological management



•
•
•
•
Diuretics
Narcotic analgesics
Nipride
Oxygen
Mechanical ventilation, if necessary
Strict I&O; daily weight
Low-sodium diet
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Slide 63
Disorders of the Lower Airway
• Pulmonary embolism

Etiology/pathophysiology
• Foreign substance in the pulmonary artery


Blood clot, fat, air, or amniotic fluid
Clinical manifestations/assessment
•
•
•
•
•
Sudden, unexplained dyspnea, tachypnea
Hemoptysis
Chest pain
Elevated temperature
Increased WBCs
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Slide 64
Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.
Slide 65
Disorders of the Lower Airway
• Pulmonary embolism (continued)

Medical management/nursing interventions
• Pharmacological management


Anticoagulants
Fibrinolytic agents
• Oxygen
• HOB up 30 degrees
Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.
Slide 66
Disorders of the Lower Airway
• Acute respiratory distress syndrome (ARDS)

Etiology and pathophysiology
• Results from direct or indirect pulmonary injury
• Alveolar capillary membranes are altered resulting
increased permeability creating pulmonary edema and
hypoxia
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Slide 67
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Slide 68
Disorders of the Lower Airway
• Acute respiratory distress syndrome (continued)

Clinical manifestations
•
•
•
•
•
Respiratory distress
Changes in level of consciousness
Tachycardia
Hypotension
Decreased urinary output
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Slide 69
Disorders of the Lower Airway
• Acute respiratory distress syndrome (continued)

Medical management/nursing interventions
• Pharmacological management









Corticosteroids
Antibiotics
Vasodilators
Bronchodilators
Mucolytics
Diuretics
Morphine sulfate
Neurologic blocking agents
Cardiotonic glycosides (digoxin)
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Slide 70
Disorders of the Lower Airway
• Acute respiratory distress syndrome (continued)

Medical management/nursing interventions
(continued)
• Oxygen
• Position changes
• Close assessment of vital signs
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Slide 71
Chronic Obstructive Pulmonary
Disease (COPD)
• Emphysema

Etiology/pathophysiology
• The bronchi, bronchioles, and alveoli become inflamed
as a result of chronic irritation
• Air becomes trapped in the alveoli during expiration,
causing alveolar distention, rupture, and scar tissue

Complication
• Cor pulmonale

Right-sided congestive heart failure due to pulmonary
hypertension
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Slide 72
Figure 9-14
(From Lewis, S.M., Collier, I., & Heitkemper, M.M. [1996]. Medical-surgical nursing: assessment and
management of clinical problems. [4th ed.]. St. Louis: Mosby.)
Disorders of the airways in patients with chronic bronchitis, asthma,
and emphysema.
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Slide 73
Chronic Obstructive Pulmonary
Disease (COPD)
• Emphysema (continued)

Clinical manifestations/assessment
•
•
•
•
•
•
Dyspnea on exertion
Sputum
Barrel chest
Chronic weight loss
Emaciation
Clubbing of fingers
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Slide 74
Figure 9-16
Barrel chest. Note increase in AP diameter.
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Slide 75
Chronic Obstructive Pulmonary
Disease (COPD)
• Emphysema (continued)

Medical management/nursing interventions
• Pharmacological management

•
•
•
•
•
Bronchodilators; corticosteroids; antibiotics; diuretics
Oxygen (low-flow)
Chest physiotherapy
Humidifier
Pursed-lip breathing
High-protein, high-calorie diet
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Slide 76
Chronic Obstructive Pulmonary
Disease (COPD)
• Chronic bronchitis

Etiology/pathophysiology
• Hypertrophy of mucous glands causes hypersecretion
and alters cilia function
• Increased airway resistance causes bronchospasm

Clinical manifestations/assessment
•
•
•
•
Productive cough
Dyspnea
Use of accessory muscles to breathe
Wheezing
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Slide 77
Chronic Obstructive Pulmonary
Disease (COPD)
• Chronic bronchitis (continued)

Medical management/nursing interventions
• Pharmacological management



Bronchodilators
Mucolytics
Antibiotics
• Oxygen (low-flow)
• Pursed-lip breathing
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Slide 78
Chronic Obstructive Pulmonary
Disease (COPD)
• Asthma

Etiology/pathophysiology
•
•
•
•
Narrowing of the airways due to various stimuli
Extrinsic or intrinsic factors
Influenced by secondary factors
Antigen-antibody reaction
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Slide 79
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Slide 80
Chronic Obstructive Pulmonary
Disease (COPD)
• Asthma (continued)

Clinical manifestations/assessment
• Mild asthma


Dyspnea on exertion
Wheezing
• Acute asthma attack




Tachypnea
Expiratory wheezing; productive cough
Use of accessory muscles; nasal flaring
Cyanosis
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Slide 81
Chronic Obstructive Pulmonary
Disease (COPD)
• Asthma (continued)

Medical management/nursing interventions
• Maintenance therapy



Serevent inhalant, prophylactic
Corticosteroid inhalant
Avoid allergens
• Acute or rescue therapy



Proventil inhalant; aminophylline IV
Corticosteroid and epinephrine oral or subcutaneous
Oxygen
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Slide 82
Chronic Obstructive Pulmonary
Disease (COPD)
• Bronchiectasis

Etiology/pathophysiology
• Gradual, irreversible process that involves chronic
dilation of bronchi resulting in loss of elasticity

Clinical manifestations/assessment
•
•
•
•
Dyspnea; coughing; wheezes and crackles
Cyanosis; clubbing of fingers
Fatigue; weakness
Loss of appetite
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Slide 83
Chronic Obstructive Pulmonary
Disease (COPD)
• Bronchiectasis (continued)

Medical management/nursing interventions
• Pharmacological management



•
•
•
•
•
Mucolytic agents
Antibiotics
Bronchodilators
Oxygen (low-flow)
Chest physiotherapy
Hydration
Cool mist vaporizer
Surgery: Lobectomy
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Slide 84
Nursing Process
• Nursing diagnoses

Airway clearance, ineffective
 Breathing pattern, ineffective
 Gas exchange, impaired
 Anxiety
 Activity intolerance
 Nutrition, imbalanced: less than body requirements
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Slide 85
Chapter 11
Allergy and Respiratory Medications
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86
Chapter 11
Lesson 11.1
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87
Learning Objectives



Identify major antihistamines used to treat
breathing problems
Describe the action of antitussive medications
List medications used to treat and prevent
asthma attacks
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88
Learning Objectives (cont.)

Describe the major actions and the adverse
reactions of the two main categories of
bronchodilators
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89
Respiratory System

Upper Respiratory System


Oral and nasal cavity, sinuses, pharynx, larynx,
and trachea
Lower Respiratory System

Right and left bronchi, right and left lungs,
bronchioles, and alveoli
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90
Antihistamines


Six Major Groups
Action




Compete with histamine for H1 receptor sites to limit
its effectiveness
Limits vasodilation, capillary permeability, and
swelling
Limits acetylcholine release, which dries secretions in
the bronchioles and gastrointestinal system
Sedative effect on the CNS
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91
Antihistamines (cont.)

Uses

Seasonal allergic rhinitis (SAR)
 Perennial allergic rhinitis (PAR)
 Perennial nonallergic rhinitis (PNAR)
 Relieve symptoms of allergic disorders
 Adjunctive therapy for anaphylaxis
 Sedation
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92
Antihistamines (cont.)

Adverse Reactions





Changes in blood pressure, blurred vision
Tachycardia, insomnia, dry mouth, nausea
Restlessness, excitability, sedation, tinnitus
Drug Interactions
Nursing Process
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93
Antihistamines
Life span considerations
 Pediatrics:



Infants and young children often have anticholinergic
side/adverse effects
Paradoxical reactions may occur: increased
nervousness, confusion, or hyperexcitability
Elderly

More likely to develop side effects such as dizziness,
syncope (fainting), confusion, and extrapyramidal
reactions
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94
Question 1
Which of the following is NOT an adverse
reaction that may develop from taking
antihistamines?
1.
2.
3.
4.
Hypertension
Hypotension
Tachycardia
Bradycardia
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95
Antitussives

Actions:




Depress the cough center in the brain
Anesthetize stretch receptors in the respiratory
tract
Soothe irritated areas in the throat
Uses:

Relief of overactive or nonproductive cough
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96
Antitussives (cont.)

Adverse Reactions



Constipation, drowsiness, dry mouth, nausea,
postural hypotension
Drug Interactions
Nursing Process
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97
Question 2
Which of the following is NOT a way that
antitussives relieve cough?
1.
2.
3.
4.
Act centrally on the cough center in the brain
Act peripherally by anesthetizing stretch
receptors in the respiratory tract
Act locally, primarily by soothing irritated
areas in the throat
Act systemically to change the expiratory
response
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98
Asthma


Asthma is a condition that involves increased
inflammation, swelling, and mucus production
that lead to bronchiolar constriction. The
person is able to breathe air into the lungs but
has difficulty breathing out. Wheezing results
because the person works to force air out
through narrowed, mucus-filled passages
during expiration.
The four classes of asthma severity include
mild intermittent, mild persistent, moderate
persistent, and severe persistent.
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99
COPD

COPD is a chronic, disabling disorder that
causes destruction of alveolar walls. This
destruction creates unequal areas of
ventilation and perfusion in the body, and
oxygen and carbon dioxide exchange is
impaired. Patients experience difficulty in
expiration.
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100
Asthma and COPD Medications
 Prophylactic
treatment
• Cromolyn sodium
• Nedocromil sodium
 Actions:
• Slows down destruction of sensitized mast
cells; also may provide hyposensitization
(decrease in allergic response)
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101
Asthma and COPD Medications
(cont.)

Bronchodilators

Sympathomimetics
• Relax smooth muscle of bronchi (dilate)
• Vasoconstriction of blood vessels in body (decreases
mucosal and submucosal edema)
• Increase the rate and force of heart contraction

Uses:
• Relief of symptoms of bronchospasm in acute or chronic
asthma, bronchitis, and COPD
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102
Asthma and COPD Medications
(cont.)

Xanthines
• Relax smooth muscle in the bronchi and blood vessels in
the lungs
• Directly act on the kidney to produce an increase in
urine production
• CNS effects

Uses
• Adjunctive therapy for bronchospasm in acute and
chronic bronchial asthma, bronchitis, emphysema
• Treatment of neonatal apnea
• Acute pulmonary edema
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103
Asthma and COPD Medications
(cont.)

Leukotriene Receptor Inhibitors


Reduce symptoms of asthma by blocking
receptors for cysteinyl leukotrienes C4, D4, and
E4
Uses

Treat acute or chronic asthma in patients unable
to take inhaled glucocorticoids
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104
Asthma and COPD Medications
(cont.)

Corticosteroids



Block reaction to allergens and reduce airway
hyperresponsiveness
Inhibit cytokine production, protein activation, and
inflammatory cell migration and activation
Uses


Inhaled, long-term asthma control
Systemic; often used to get quick control of the
disease when beginning long-term therapy or to
speed recovery from severe episodes
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105
Question 3
____________________ is a slowly
worsening, disabling disorder that is
diagnosed by abnormal tests of expiratory
flow.
1.
2.
3.
4.
Asthma
Bronchitis
Chronic obstructive pulmonary disease
(COPD)
Congestive heart failure
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106
Chapter 11
Lesson 11.2
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107
Learning Objectives



Identify at least six medications commonly
used as decongestants
Describe the mechanism of action for
expectorants
List the major contraindications to the use of
nasal steroids
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108
Decongestants

Decongestants


Directly affect alpha receptors of blood vessels in
the nasal mucosa, causing vasoconstriction
Uses: relieve nasal congestion from allergies and
upper respiratory infections
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109
Expectorants

Expectorants


Decrease the thickness of respiratory secretions,
thereby facilitating expectoration
Uses: treat productive cough, assist with thick
mucus
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110
Topical Intranasal Steroids

Action


Uses


Antiinflammatory, reduce nasal congestion
Treatment of allergic, mechanical, or chemically
induced local nasal inflammation or nasal polyps
when usual treatment has failed to work
Adverse reactions

Asthma, headache, lightheadedness, loss of
sense of smell, nasal irritation and dryness,
nausea, nosebleeds, perforation of nasal septum,
altered sense of taste and smell
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111
Complementary and Alternative
Therapies

Allergy


Asthma


Cordyceps, Tylophora, grape seed, coleus, vitamin C
Cold


Grape seed, stinging nettle, coleus, vitamin C
Arabinoxylane, echinacea, elderberry, astragalus,
goldenseal, grapefruit seed extract, zinc, vitamin C
Cough

Ground ivy, thyme, licorice, marshmallow
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112
Chapter 12
Antiinfective Medications
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113
Chapter 12
Lesson 12.1
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114
Learning Objectives


Identify the major antiinfective drug
categories and the organisms against which
they are effective
Outline the most important things to teach the
patient who is taking antiinfective drugs
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115
Learning Objectives (cont.)


Define "spectrum" and explain what this word
means in antiinfective therapy
List some of the most common adverse
reactions to medications used to treat
infections
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116
Overview





Pathogen
Bacteria
Fungi
Viruses
Antimicrobials
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117
Antibiotics



Broad-spectrum
Narrow-spectrum
Adverse reactions
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118
Penicillins




Main antibiotic for years
Overuse
Penicillin-resistant strains
Broad-spectrum drug of choice
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119
Penicillins (cont.)
Action and Uses
 Interferes with creation of the mucopeptide
cell wall
 Used to treat multiple infections
 Overuse and allergies
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120
Penicillins (cont.)
Adverse Reactions

Neuropathy






High parenteral doses
Skin eruptions
GI symptoms
Urticaria
Laryngeal edema
Anaphylaxis
Drug Interactions
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121
Penicillins (cont.)
Nursing Implications and Patient Teaching
 Assessment



Diagnosis
Planning



10-day regimen
Implementation


Signs of infection and allergies
Route of administration
Evaluation
Patient Teaching
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122
Tetracyclines
Actions and uses

Broad-spectrum antibiotics
Adverse Reactions

GI upset
Nursing Implications



Not for pregnant patients or children under 8 years of
age
Can cause sensitivity to light (photosensitivity) so
counsel patient about careful sun exposure
Take on empty stomach and avoid dairy within 2 hours
of taking drug.
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123
Macrolides
Actions and uses

Alternative for pencillin
Adverse Reactions

GI upset
Nursing Implications


Check nursing text for drug interactions: there are
several!
Advise patient to take with food and drink extra fluids
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124
Sulfonamides


Broad-spectrum antiinfective
Bacteriostatic action: inhibits folic acid
synthesis in the cell
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125
Sulfonamides (cont.)
Action and Uses
 Urinary tract infections
 Effectively treats multiple microorganisms
 Preoperative and postoperative therapy for
bowel surgery
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126
Sulfonamides (cont.)
Adverse Reactions
Drug Interactions


Potentiate
Decrease effectiveness
Nursing Implications and Patient Teaching

Contraindications
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127
Broad-Spectrum Antibiotics

Bactericidal or bacteriostatic
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128
Broad-Spectrum Antibiotics
(cont.)
Action and Uses
 Large number of unrelated drugs used to
treat infections caused by a wide range of
susceptible organisms
 Gram-positive or gram-negative organisms
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129
Broad-Spectrum Antibiotics
(cont.)
Adverse Reactions
 Superinfections
 Drug interactions are individualized
 Food interactions
 Affected organs: auditory nerves, kidneys, and
liver
 Cross-sensitivity
Nursing Implications and Patient Teaching
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130
Question 1
____________________ are plant-like
organisms growing in irregular masses,
without roots, stems, or leaves and without
chlorophyll or other pigments involved in
photosynthesis.
1.
2.
3.
4.
Bacteria
Fungi
Viruses
Parasites
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131
Question 2
____________________ are usually used to
treat acute and chronic urinary tract
infections, particularly cystitis, pyelitis, and
pyelonephritis, when these infections are
caused by Escherichia coli or Nocardia
asteroides.
1.
2.
3.
4.
Penicillins
Sulfonamides
Cephalosporins
Aminoglycosides
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132
Question 3
An organism that causes an infection is a(n):
1.
2.
3.
4.
Teratogen.
Pathogen.
Allergen.
Hydrogen.
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133
Chapter 12
Lesson 12.2
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134
Learning Objectives



Identify the major antiinfective drug categories
and the organisms against which they are
effective
Outline the most important things to teach the
patient who is taking antiinfective drugs
List some of the most common adverse
reactions to medications used to treat infections
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135
Antitubercular Drugs
Overview
 Underdeveloped nations
 Risks
 Etiology: Mycobacterium tuberculosis
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136
Antitubercular Drugs (cont.)
Action and Uses
 Most antitubercular drugs are bacteriostatic; they
have intracellular or extracellular effects that
prevent the organism from building new cell
walls, thus limiting growth and spread
 Some antitubercular drugs are bactericidal
 Length of treatment
 Chemoprophylaxis
 Box 12-1 High-Priority Candidates for
Tuberculosis-Preventive Therapy
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137
Antitubercular Drugs (cont.)
Adverse Reactions




Common symptoms
Toxicity: body sites affected
Combination therapy
Drug-specific symptoms
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138
Antitubercular Drugs (cont.)
Drug Interactions

Use of other drugs during therapy
Nursing Implications and Patient Teaching


Assessment
Diagnosis



Planning



Length of treatment
Implementation


History, chest x-ray, labs
Additional patient needs
Dose
Evaluation
Patient and Family Teaching
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Antiparasitic Drugs



Amebicides
Anthelmintics
Antimalarials
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Amebicides



Entamoeba histolytica
Relationship to traveling
Infection sites in the body
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Amebicides (cont.)
Action and Uses
 Destroy invading amoebae
 Treatment of intestinal and extraintestinal
amebiasis.
 Drug choice depends on location
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Amebicides (cont.)
Adverse Reactions
 Common: nausea, vomiting, anorexia,
diarrhea, GI distress, hepatic abscess
 Drug-specific adverse reactions
 Overdose
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Amebicides (cont.)



Drug Interactions
Nursing Implications
Patient Teaching
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Anthelmintics


Helminthiasis: infestation by worms
Common infestations:





Pinworms
Roundworms
Hookworms
Tapeworms
Whipworms
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Anthelmintics (cont.)
Action and Uses
 Action is drug specific
 Drugs used:





Thiabendazole
Niclosamide and paromomycin
Piperazine and pyrantel pamoate
Diethylcarbamazine citrate
Mebendazole
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Anthelmintics (cont.)
Adverse Reactions
 Drug specific
 Allergic reaction due to dead microfilaria
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Anthelmintics (cont.)
Drug Interactions
Nursing Implications and Patient Teaching




Assessment
Diagnosis
Planning
Implementation


Preventing transmission
Evaluation
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Antimalarials
Action

Interfere with the life cycle of Plasmodium
Uses

Prevention and treatment
Adverse Reactions

Drug-specific: blood dyscrasias, visual and
neurologic changes
Drug Interactions

Drug-specific: dermatologic, ototoxic, or neurologic
symptoms
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Antimalarials (cont.)
Nursing Implications and Patient Teaching

Assessment



Diagnosis
Planning


Treatment is strain related
Implementation



Symptoms
Loading dose
Prevention
Evaluation

Laboratory and diagnostic monitoring; eye examination
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