Respiratory Case Study

Respiratory Case Study

NUR 311

​Appointment 1.

​​Your patient comes into the clinic complaining of shortness of breath and a cough that is worse at night. He is exposed to fumes at his factory job that he’s never been exposed to before. Upon exam, you notice he is wheezing. The physician is going to start him on a beta 2- adrenergic agonist (albuterol inhaler). What do you know about this medication? What would you teach your patient?

Multiple Choice

What is the therapeutic action of the beta adrenergic agonist albuterol?

• Relaxing smooth muscles of bronchioles, increasing bronchodilation

• Suppresses inflammation in the airways, reducing edema

• Reduces inflammation specifically caused by leukotrienes

• Inhibits parasympathetic acetylcholine action on the bronchioles, reducing bronchoconstriction

Multiple Choice

How quickly will the patient expect to see relief after albuterol is administered?

• 10 hours

• 2 hours

• 10 minutes

• 60 minutes

Multiple Select

Which are adverse effects of the beta adrenergic agonist albuterol? Select all that apply. 

• tachycardia

• tremors

• hypotension

• nervousness or restlessness

• hypoglycemia

Multiple Select

The nurse is providing education to the patient prescribed albuterol. When should the patient notify their provider while taking albuterol? Select all that apply. 

• If they are using the rescue inhaler >2x/week

• When they are exercising more often

• If the tremors are interfering with ADLs

• If the medication is not relieving symptoms

• If they experience mild restlessness

​Which electrolyte level should be monitored, especially with long-term use?

Multiple Select

Which condition(s) are contraindicated with albuterol? Select all that apply.

• tachy-dysrhythmias

• hyperthyroidism

• arthritis

• hypertension

• cardiac angina

​Appointment 2.

​Your patient hasn’t been able to control his asthma with just a rescue inhaler. The physician has decided to add an inhaled glucocorticoid (beclomethasone) to his treatment plan. What do you know about inhaled corticosteroids? What would you teach your patient?

Multiple Choice

What is the therapeutic action of the glucocorticoid beclomethasone?

• Relaxing smooth muscles of bronchioles, increasing bronchodilation

• Suppresses inflammation in the airways, reducing edema

• Reduces inflammation specifically caused by leukotrienes

• Inhibits parasympathetic acetylcholine action on the bronchioles, reducing bronchoconstriction

Is an inhaled glucocorticoid used for rescue or prevention?​

Multiple Choice

The nurse is providing education about adverse effects to a patient prescribed an inhaled glucocorticoid. Which information will the nurse include?

• Increased risk of falling from dizziness

• Carry water or juice with you everywhere

• Wear a medical bracelet alerting use of the medication

• Report difficulty eating and white mouth patches

Multiple Choice

How often should the patient use the beclomethasone inhaler?

• Once weekly

• As needed for SOB

• Once daily

• With each meal

​Administration

How long until the patient should expect therapeutic effects?​

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​Should the patient take the albuterol before or after the inhaled corticosteroid?

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​Any other patient teaching?

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​Appointment 3.

​The patient continues to have frequent asthma attacks despite using an albuterol inhaler and an inhaled corticosteroid. The physician decides to send the patient to the emergency department for further treatment. On arrival, the physician orders an albuterol nebulizer treatment. Additionally, the physician orders a nebulizer treatment of ipratropium (an inhaled anticholinergic). What do you know about this medication? What would you teach your patient?

Multiple Choice

What is the therapeutic action of the

nebulizer ipratropium?

• Relaxing smooth muscles of bronchioles, increasing bronchodilation

• Suppresses inflammation in the airways, reducing edema

• Reduces inflammation specifically caused by leukotrienes

• Inhibits parasympathetic acetylcholine action on the bronchioles, reducing bronchoconstriction

Multiple Select

Which are adverse effects of ipratropium nebulizer? Select all that apply.

• Salivation

• Lacrimation

• Constipation

• Urinary retention

• Dry mouth

Multiple Choice

Which are contraindications of ipratropium?

• Incontinence & kidney disease

• Liver failure & essential hypertension

• Peanut allergy & prostatic hyperplasia

• High tyramine diet & diabetic nephropathy

​DUONEB

​Ipratropium is often added to albuterol in a nebulizer formulation because together they have ___________ effects.

​Update 4.

​While in the hospital, the patient is put on a systemic corticosteroid (like prednisone or methylprednisolone). What do you know about this medication? What would you teach your patient?

Multiple Select

Which are adverse effects of systemic steroids like prednisone? Select all that apply.

• Immunosuppression

• Hyperglycemia 

• Weight gain

• Increased appetite

• Gout

Multiple Choice

What special education may the patient need if they also have diabetes? 

Warn the patient that they may need increased amounts of: _______

• insulin

• carbohydrates

• protein

• calcium

​Update 5.

​During his admission, his attending physician decides the patient would benefit from starting a leukotriene inhibitor such as montelukast. What do you know about this medication? What would you teach your patient?

Multiple Choice

What is the therapeutic action of montelukast?

• Relaxing smooth muscles of bronchioles, increasing bronchodilation

• Suppresses inflammation in the airways, reducing edema

• Reduces inflammation specifically caused by leukotrienes

• Inhibits parasympathetic acetylcholine action on the bronchioles, reducing bronchoconstriction

Multiple Choice

Is montelukast used for:

• Rescue intervention

• Prevention

Multiple Choice

Which are contraindications for the leukotriene receptor antagonist montelukast?

• liver disease & asthma attack

• diabetes &

  insomnia

• peptic ulcer disease & HOH

• prostatic hypertrophy & pregnancy

Multiple Choice

What time of day should the patient take montelukast? 

• With breakfast

• With dinner

• At bedtime

• Weekends only

​What about exercise?

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When should the patient take montelukast in regards to their exercise schedule for exercise-induced asthma?

​Appointment 6.

​Your patient heard about a medication his friend is on for asthma called theophylline (a methylxanthine). He wants to know more about the medication to know if he should ask his doctor to try this medication. What do you know about this medication? What would you tell your patient?

Theophylline

Action?

​

Used for ​Acute event or Chronic control?

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​Commonly prescribed medication?

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Multiple Select

Which are adverse effects of the methylxanthine theophylline? Select all that apply.

• Seizures

• Insomnia

• Jaundice

• Hypotension

• Cardiac dysrhythmias

Multiple Choice

What special monitoring is required for theophylline?

• Blood glucose less than 200mg/dL

• Hemoglobin & Hematocrit

• Therapeutic range of medication

• Blood cultures to rule out infection

Multiple Choice

Educate patients to take antihistamines:

• When symptoms begin

• Before exposure to allergen

• When symptoms become unbearable

• In case of anaphylaxis only

Multiple Choice

Educate patients to take antitussives: 

• As long as necessary

• No more than once daily

• For a maximum of seven days

• Every other day

Multiple Select

Which patient condition(s) may be contraindicated for decongestants? Select all that apply.

• Asthma

• Hypertension

• Atrial fibrillation

• Substance use disorder

• Productive cough

Test 2 Thursday noon - Friday noon​

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