NUR 2474 - Test # 2 Review
Topics to review:
1. Educating patients on how to use metered dose inhalers (wait 1 min between puffs, etc.).
a. For any patient prescribed an inhaler, the RN should ensure the client can self
administer the medication.
i. Teach back needed
b. The patient should wait 1-2 minutes between puffs
c. The patient should wait 5 minutes between 2 different inhalers
d. The patient should take a bronchodilator before a corticosteroid medication (B before C)
e. The patient must keep track of doses on their inhaler
f. If opening a new inhaler, the patient should shake it and test before use.
g. If dexterity is limited, a spacer can be used to get more medication in the airway.
h. If the patient uses a steroid, they must wash their mouth out after use.
i. If not, fungal infection may occur
i. The patient should hold breath 10 seconds after receiving a puff.
2. Know the difference between short and long term treatments for asthma and COPD
a. Short term asthma treatment:
i. Bronchodilator: albuterol
1. Acts as a rescue inhaler during asthma attacks.
2. Onset is in 5 minutes and will last longer.
ii. Xanthine Derivatives: theophylline
1. Dilates airways
2. Can have high drug interactions in the body
iii. IV/ inhaled glucocorticoids.
, b. Long term asthma treatment:
i. Bronchodilator: salmeterol.
1. Used to control symptoms of asthma
2. Never is used alone (often with steroid)
ii. Anticholinergics: ipratropium bromide
1. For long term asthma prevention
2. Works very slowly.
3. Fast onset, short duration
* Tiotropium has longer duration that Ipratropium
iii. Corticosteroids: fluticasone or Budesonide
1. Non bronchodilation
2. Can take several weeks to show
c. COPD treatment:
i. Bronchodilator- short acting albuterol
ii. Steroid
iii. Must keep o2 saturation between 88-92%
3. Know classifications for respiratory drugs (what’s used as a rescue inhaler, and what
is for long term management)
a. Rescue inhalers: albuterol, epinephrine, metaproterenol, IV steroid
b. Long term: salmeterol, ipratropium, theophylline, montelukast ,fluticasone
4. Treatment of acute asthma
a. Oxygen use
b. Short acting bronchodilator- albuterol
c. Corticosteroid- ipratropium bromide IV
d. Will relieve hypoxemia, reduce airway inflammation, and relieve obstruction.
5. Administration of bronchodilator (MOA,SE,Considerations)
a. MOA: mimics the sympathetic NS and opens up the lungs and stimulates beta receptors
b. Fast acting: used for acute asthma relief, Long acting is for chronic asthma
management and COPD
c. AE: tachycardia, angina, tremors, nervous and shaky feeling, hyperglycemia.
d. Considerations: ensure patient takes medication as prescribed and does not
overuse short acting bronchodilator. Never use it alone with asthma treatment.
6. Administration of glucocorticoids (IV vs inhaled, nursing interventions, pt. education)
a. MOA: works to stop the inflammatory process in the lungs, preventing
bronchoconstriction. Stabilizes WBC membranes that release bronchial constricting
substances, increases bronchial smooth muscle beta adrenergic stimulation.
b. Inhaled: used for asthma and is the most tolerated and fast acting, but can also
be IV for systemic effects on the body.
c. AE: throat and mouth irritation, dry mouth, oral fungal infections.
d. Must be used with another drug for asthma control.
e. Nursing interventions: must teach patients to rinse mouth out after steroid use
to prevent oral fungal infections, take bronchodilator 5 mins before steroid.
7. Tiotropium administration, onset, and therapeutic level timeframes
Topics to review:
1. Educating patients on how to use metered dose inhalers (wait 1 min between puffs, etc.).
a. For any patient prescribed an inhaler, the RN should ensure the client can self
administer the medication.
i. Teach back needed
b. The patient should wait 1-2 minutes between puffs
c. The patient should wait 5 minutes between 2 different inhalers
d. The patient should take a bronchodilator before a corticosteroid medication (B before C)
e. The patient must keep track of doses on their inhaler
f. If opening a new inhaler, the patient should shake it and test before use.
g. If dexterity is limited, a spacer can be used to get more medication in the airway.
h. If the patient uses a steroid, they must wash their mouth out after use.
i. If not, fungal infection may occur
i. The patient should hold breath 10 seconds after receiving a puff.
2. Know the difference between short and long term treatments for asthma and COPD
a. Short term asthma treatment:
i. Bronchodilator: albuterol
1. Acts as a rescue inhaler during asthma attacks.
2. Onset is in 5 minutes and will last longer.
ii. Xanthine Derivatives: theophylline
1. Dilates airways
2. Can have high drug interactions in the body
iii. IV/ inhaled glucocorticoids.
, b. Long term asthma treatment:
i. Bronchodilator: salmeterol.
1. Used to control symptoms of asthma
2. Never is used alone (often with steroid)
ii. Anticholinergics: ipratropium bromide
1. For long term asthma prevention
2. Works very slowly.
3. Fast onset, short duration
* Tiotropium has longer duration that Ipratropium
iii. Corticosteroids: fluticasone or Budesonide
1. Non bronchodilation
2. Can take several weeks to show
c. COPD treatment:
i. Bronchodilator- short acting albuterol
ii. Steroid
iii. Must keep o2 saturation between 88-92%
3. Know classifications for respiratory drugs (what’s used as a rescue inhaler, and what
is for long term management)
a. Rescue inhalers: albuterol, epinephrine, metaproterenol, IV steroid
b. Long term: salmeterol, ipratropium, theophylline, montelukast ,fluticasone
4. Treatment of acute asthma
a. Oxygen use
b. Short acting bronchodilator- albuterol
c. Corticosteroid- ipratropium bromide IV
d. Will relieve hypoxemia, reduce airway inflammation, and relieve obstruction.
5. Administration of bronchodilator (MOA,SE,Considerations)
a. MOA: mimics the sympathetic NS and opens up the lungs and stimulates beta receptors
b. Fast acting: used for acute asthma relief, Long acting is for chronic asthma
management and COPD
c. AE: tachycardia, angina, tremors, nervous and shaky feeling, hyperglycemia.
d. Considerations: ensure patient takes medication as prescribed and does not
overuse short acting bronchodilator. Never use it alone with asthma treatment.
6. Administration of glucocorticoids (IV vs inhaled, nursing interventions, pt. education)
a. MOA: works to stop the inflammatory process in the lungs, preventing
bronchoconstriction. Stabilizes WBC membranes that release bronchial constricting
substances, increases bronchial smooth muscle beta adrenergic stimulation.
b. Inhaled: used for asthma and is the most tolerated and fast acting, but can also
be IV for systemic effects on the body.
c. AE: throat and mouth irritation, dry mouth, oral fungal infections.
d. Must be used with another drug for asthma control.
e. Nursing interventions: must teach patients to rinse mouth out after steroid use
to prevent oral fungal infections, take bronchodilator 5 mins before steroid.
7. Tiotropium administration, onset, and therapeutic level timeframes
