Question

Please help

1. what is Nursing and Safety Considerations when the patient with Allergies/Reactions: with

Fluoride

budesonide/ formoterol

Tramadol

sertraline (Zoloft)

2. can you help me how to do COPD inservice

Answer 1

1.

a. Any cutaneous exposure of fluoride should be treated with calcium-containing gels.

The patient should be placed on a cardiac monitor and an electrocardiogram should be obtained. Correct electrolyte abnormalities, especially hyperkalemia, hypocalcemia, and hypomagnesemia. Correct calcium deficiencies with IV calcium chloride or calcium gluconate. Cardiac arrhythmias from fluoride toxicity are difficult to treat because they do not respond to lidocaine, cardioversion, or defibrillation.

Perform gastric aspiration and lavage. Small-bore nasogastric tube aspiration, followed by lavage, is recommended because of the potential severity of this ingestion and the ineffective adsorption of fluoride to activated charcoal. Although fluoride does not bind to activated charcoal, use of activated charcoal is still recommended for patients with intentional ingestions when a polysubstance overdose is possible.

Lavage with milk or a solution containing calcium carbonate or magnesium hydroxide (eg, milk of magnesia) is theoretically attractive but has not been proven beneficial. Lavage with 1%-5% calcium chloride solution has been recommended, to bind fluoride in the stomach. Gastric aspiration and lavage are most effective when instituted within 1 hour of ingestion. Hemodialysis is used for critically ill patients whose condition is refractory to all other forms of treatment.

Consult a toxicologist or poison control center for current acute management recommendations. For intentional ingestions, consider psychiatric consultation after medical clearance.

Calcium chloride is administered to correct hypocalcemia that may result from fluoride poisoning.

Calcium gluconate moderates nerve and muscle performance and facilitates normal cardiac function. For systemic hypocalcemia, the agent can be given intravenously initially, and then calcium levels can be maintained with a high-calcium diet. Some patients require oral calcium supplementation.

b. Budesonide/ formoterol allergy is suspected to stop the medication as soon as possible and informed to the concerned doctor.

Call for the poison control center or call for medical help.

Manage the hypokalemia

c. Assess for the signs and symptoms of tramadol allergy

Manage the dehydration of the patient

Maintain the IV fluids to correct the electrolyte imbalances

2. Patients who have the chronic obstructive pulmonary disease (COPD) might be on a fast or slow downward cycle, depending on how much help they receive from their physicians, nurses, therapists, and home health aides.

COPD patients often become depressed and frustrated with their inability to breathe freely and live an active life. But national pulmonary experts say they can have a better quality of life if they follow certain guidelines. And home care nurses and aides can help them achieve their goals.

COPD consists of a group of diseases causing airway obstructions that result in patients having trouble breathing, which is called dyspnea. Those diseases include chronic bronchitis, asthma, and emphysema.

Men 65 or older who smoke are at the greatest risk for COPD. The rate of women diagnosed with chronic bronchitis and emphysema rose from 7 per 100,000 population in 1979 to 17.1 per 100,000 population in 1995. During that period, the rate of men with diseases increased slightly from 23.8 per 100,000 to 26.3 per 100,000.

COPD patients may become anxious, depressed, and frustrated by their inability to do their daily activities as well or as fast as before. Aides, nurses, and family members can help ease those emotional difficulties by creating a relaxing atmosphere.

Home care staff also should help alleviate patients' fears because when COPD patients become afraid, their oxygen levels decrease and they begin to pant or have shallow respiration, which is difficult on the respiratory system.

COPD patients, unlike heart patients, need more fat in their diet, "When someone is panting heavily and is short of breath, they need something to insulate them, and most patients with emphysema are very thin, without enough insulation." The diet should have fewer carbohydrates because they turn quickly into sugar and waste energy. "It doesn't hurt them necessarily, but it takes them so much time and energy to eat." They'll need a mixture of proteins, but meats should be easier to chew. Meatloaf or chicken salad, for example, are excellent sources of protein.

Because COPD patients breathe through their mouths, their tongues become dry and crusted and they may lose some of their sense of taste. Fluids should be increased most of the time because patients lose so much fluid through their mouths, and most of them are taking diuretics because of the mucus in their lungs. "They're going to need small amounts of fluid at one time. They can't stop to drink a whole glass of water because it wears them out, so break an 8 oz. glass down into two 4 oz. glasses, or have them suck on ice chips."

It's possible to find less strenuous activities COPD patients might enjoy. COPD patients must be careful to avoid weather that will make their condition worse. For example, cold weather might cause their lungs to constrict, trapping mucus inside. Summer weather might not be any better.