Question

Questions 5-11

Concept Map: Asthma Mark Norse, a 22-year-old man, who lives in a small mountain town in Colorado, is highly allergic to dust and pollen. Anxiety seems to play a role in exacerbating (triggering) his asthma attacks. Mr. Norse's wife drove him to the clinic this morning when his wheezing worsened and did not respond to be clomethosone (Vanceri) and ipratropium bromide (Atrovent) inhalers. Upon arrival his vital signs are B/P 152/84, P 124, R 42, T. 100.4. You start Mr. Norse on O2 4 L/min via nasal cannula and an IV of D/SW at KVO rate of 40gtts/hour. His ABG's are pH 7.31, CO2 26, HCO3 26 and O2 sats at 88% 1. Identify the underlying pathophysiology of asthma. 2. Are Mr. Norse's vital signs acceptable? If not, state the abnormalities which give you concern. 3. State the difference between rescue and control medications for asthma 4. State how bronchodilators work (Pg. 331) 5. State the difference between Beta2-adrenergie agonists and cholinergic antagonists 6. Identify the drug classifications of Vanceril and Atrovent. 1. Are Vanceril and/or Atrovent appropriate for use during an asthma attack? If not state, why. The physician orders albuterol 3mg via nebulization STST. 8. What is the rationale for this order? 9. What is the rational for starting the patient on 02 immediately? 10. What are some of the side effects of bronchodilators and one nursing intervention you can provide to minimize the effects of the drug. 11. List the specific side effects of the anticholinergies agents and signs and symptoms you would monitor to determine an adverse event. After several hours of intravenous and oral rehydration and a second Albuterol treatment Mr. Norse's wheezing and chest tightness resolve, and he is able to expectorate his secretions. The physician discusses Mr. Norse's asthma management with him and tells the patient that his inhalers meet his needs on a day-to-day basis but fail him during an asthma attack. The physicis discharges the patient with the following prescriptions Oral steroid "burst" prednisone 40mg orally for 5 days Albuterol (Proventil) MDI and a spacer

Answer 1

5. Beta 2 adrenergic agonist :-

#. Mechanism of Action

- Stimulate Beta2-adrenergic receptors, smooth muscle relaxation

- Promote bronchodilation/relieve bronchospasm

#. Cholinergic antagonist action :

-Parasympatholytic

-Anticholinergic drugs

-Bind to cholinoceptors

-Parasympathetic actions interrupted while sympathetic are unopposed

6. Drug classification of Atrovent is Bronchodilator and Anticholinergic .

Drug classification of Vanceril is Inhaled corticosteroid ( Beclomethasone )

7. Vanceril and Atrovent is not appropriate for use in asthma attack . Administering the bronchodilator albuterol (Proventil) first allows the other drugs to reach deeper into the lungs as the bronchioles dilate. Anticholinergics such as ipratropium bromide (Atrovent) also help bronchodilate, but to a lesser extent. Corticosteroids such as beclomethasone (Vanceril) do not dilate and are therefore given last.

8. The rationale for Albuterol is that it's a bronchodilator and it dilates the bronchioles.