Key Concepts

This chapter includes much needed information to help the nurse apply a knowledge of respiratory disorders to the NCLEX exam. The nurse preparing for the licensure exam should review normal laboratory values, common treatment modalities and pharmacological agents used in the care of the client with respiratory disorders.

Key Terms

• Acute respiratory failure

• Apnea

• Asthma

• Bronchitis

• Continuous positive airway pressure (CPAP)

• Cor pulmonale

• Cyanosis

• Dyspnea

• Emphysema

• Hemoptysis

• Hypoxemia

• Hypoxia

• Pleural effusion

• Pleurisy

• Pneumonia

• Pulmonary embolus

• Tachypnea

Diagnostic Tests

Many diagnostic exams are used to assess respiratory disorders. These clients would receive the usual routine exams: CBC, urinalysis, chest x-ray. The exam reviewer should be knowledgeable of the preparation and care of clients receiving pulmonary exams. While reviewing these diagnostic exams, the exam reviewer should be alert for information that would be an important part of nursing care for these clients:

• CBC

• Chest x-ray

• Pulmonary function tests

• Lung scan

• Bronchoscopy

Pharmacological Agents Used in the Care of the Client with Disorders of the Respiratory System

An integral part of care to clients with respiratory disorders is pharmacological intervention. These medications provide an improvement or cure of the client’s respiratory problems. The nursing exam reviewer needs to focus on the drugs in Table 5.1 through Table 5.4. Included in these tables is information about the most common side and adverse effects as well as pertinent nursing care associated with these medications. These medications are not inclusive of all the agents used to treat respiratory disorders; therefore, you will want to keep a current pharmacology text handy for reference.

Table 5.1. Pharmacological Agents for Respiratory Conditions

Type	Name	Action	Side Effects	Nursing Care
Bronchodilators
Methylxanthine	Theo-Dur (theophylline) Truphylline (aminophylline)	Relaxes bronchial smooth muscles	Palpitations; agitation; tachycardia; nausea; vomiting	Monitor for signs of toxicity. Therapeutic range 10–20 mcg/mL.
Cholinergic antagonists	Atrovent (ipratropium)	Relieve bronchospasm	Headache; nausea; dry mouth	Contraindicated in clients with soybean or peanut allergies.
Adrenergics	Epinephrine (adrenalin)	Stimulate alpha and beta receptors	Tremulousness; headache; tachycardia; vomiting	Teach client to read label of OTC meds.
Beta 2 agonists	Proventil (albuterol) Serevent (salmetrol)	Stimulate beta receptors in the lung, reduces airway resistance	Tremor; tachycardia; palpitations	Concurrent use with digoxin or beta blockers can affect drug level.
Corticosteroids
Inhaled	Flovent (fluticasone) Vanceril (beclomethasone) Azmacort (triamcinolone)	Decreases inflammation and suppresses immune response	Hyperglycemia; Cushing’s syndrome; increased BP; osteoporosis; muscle wasting; gastric upset	Give with meals. Monitor for signs of infection. Taper off medication.
Injectable/Oral	Decadron (dexamethasone) Solu-Cortef (hydrocortisone) Medrol (methylprednisolone)	Same as above	Same as above	Same as above.
Mast cell stabilizers	Intal (cromolyn)	Inhibit release of histamine	Irritation of oral or mucous membranes	Monitor for drug interactions.
Leukotriene modifiers	Singulair (montelukast) Zyflo (zileuton) Accolate (zafirlukast)	Block inflammatory action	Headache; infection; elevated liver enzymes	Monitor for drug interactions. Client should avoid ASA and NSAIDs.
Antitussives	Codeine, dextromethorphan	Suppress cough reflex by direct effect on respiratory center	Nausea; vomiting; sedation	Take only as directed.
Expectorants	Ammonium chloride Guaifenesin K+ iodide	Loosen bronchial secretions	Nausea; drowsiness	Increase fluid intake.

Table 5.2. Pharmacological Agents Used in the Treatment of Community Acquired Pneumonia

Organism Responsible	Recommended Treatment	Action	Side Effects (Adverse Effects)	Nursing Care
Streptococcus pneumoniae	Penicillin, Claforan (cefotaxime), Rocephin (ceftriaxone), Levaquin (levofloxacin)	Bacteriacidal, effective against gram positive and gram negative organisms	Nausea; diarrhea; urticaria (pseudomembranous colitis; superimposed infections)	Assess for fluid imbalances. Diarrheal stools should be checked for the presence of blood, mucus, and white blood cells, which can indicate pseudomembranous colitis.
Haemophilus influenza	Omnipen (ampicillin), Zithromax (azithromycin), Biaxin (clarithromycin)	Bacteriostatic, effective against gram positive and gram negative organisms	Dizziness; headache; nausea; diarrhea; abdominal pain (superimposed infections)	Assess for signs of “ampicillin rash”—dull red nonallergic maculopapular rash and pruritis. Assess for signs laryngeal edema, which indicates anaphylactic reaction.
Legionella pneumophilia	Erythrocin (erythromycin), Levaquin (levofloxacin)	Bacteriacidal, effective against gram positive and gram negative organisms	Abdominal cramps; diarrhea; nausea; (psedomembranous colitis; superimposed infections)	Assess for fluid imbalances. Diarrheal stools should be checked for the presence of blood, mucus, and white blood cells, which can indicate pseudomembranous colitis.
Mycoplasma pneumoniae	Erythrocin (erythromycin), Acromycin (tetracycline) may be used with Rifadin (rifampin)	Bacteriacidal, effective against gram negative organisms	Abdominal cramps; diarrhea; nausea; (pseudomembranous colitis; superimposed infections)	Same as above.
Viruses (influenza A&B, CMV, and coronvirus)	Symmetrel (amantadine), Virazole (ribavirin aerosol)	Antivirals inhibit viral replication	Ataxia; drowsiness; blurred vision; dry mouth	Protect from falls. Offer fluids to prevent dry mouth.
C. pneumoniae (TWAR agent)	Acromycin (tetracycline), Erythrocin (erythromycin), Levaquin (levofloxacin)	Bacteriacidal, effective against gram positive and gram negative organisms	Abdominal cramps; diarrhea; nausea; (pseudomembranous colitis; superimposed infection)	Assess for fluid imbalances. Diarrheal stools should be checked for the presence of blood, mucus, and white blood cells which, can indicate pseudomembranous colitis.

Table 5.3. Pharmacological Agents Used in the Treatment of Hospital-Acquired Pneumonia

Organism Responsible	Recommended Treatment	Action	Side Effects (Adverse Effects)	Nursing Care
Pseudomonas aeruginosa	Amikin (amikacin), Kantrex (kanamycin), Garamycin (gentamicin), Geopen (carbenicillin)	Bacteriacidal; effective against gram-positive and gram-negative organisms	Abdominal cramps; diarrhea; nausea; (pseudomembranous colitis; superimposed infection; tinnitus; changes in urinary output)	Assess for fluid imbalances. Diarrheal stools should be checked for the presence of blood, mucus, and white blood cells; assess for signs of ototoxicity and nephrotoxicity.
Staphylococcus aureus	Unipen (nafcillin), Garamycin (gentamicin)	Same as above	Same as above	Same as above.
Klebsiella pneumoniae	Claforan (cefotaxime), Rocephin (ceftriaxone), Garamycin (gentamicin), Geopen (carbenicillin)	Same as above	Same as above	Same as above.
Pneumocystis carinii	Bactrim (trimethoprim/sulfa methoxazole), Pentam (pentamidine)	Bacteriacidal; effective against gram-positive and gram-negative organisms	Fatigue; headache; insomnia; vomiting; diarrhea; (anemia; nephrotoxicity; thrombocytopenia)	Pentamidine should be infused over 1–2 hours to decrease hypotension. Client should be observed for signs of renal impairment and hypoglycemia.
Aspergillus fumigatus	Fungizone (amphotericin B), Fungizone Nizoral (ketoconozole)	Kill or stop the growth of susceptible fungi by affecting cell membrane or interfere with protein synthesis within the cell	Headache; dizziness; nausea; diarrhea; myalgia; peripheral neuropathy (hepatoxicity; nephrotoxicity)	Drug-to-drug interactions. Use caution when administering. Check vital signs frequently.

Table 5.4. Pharmacological Agents Used in the Treatment of Tuberculosis

Name	Action	Side Effects	Nursing Care
Isoniazid (INH) (first-line drug)	Interferes with cell wall	Deficiency of B6; peripheral neuritis; liver dysfunction	Observe for jaundice. Frequent hearing tests.
Ethambutol HCI (myambutol) (first-line drug)	Suppresses growth of mycobacterium	Optic neuritis; decreased acuity and color vision	Frequent visual tests.
Rifampin (first-line drug)	Same as above	N & V; HA; hepatitis; red discolorations of body fluids	Teach client to avoid alcohol. Teratogenic.
Fluoroquinolones (levoflaxacin, monofloxacin, gatifloxacin)	For strains resistant to RIF, INH, and EMB	N & V; drowsiness; photosensitivity; tendonitis; and tendon rupture	Teach client to avoid prolonged sun exposure, to increase fluid intake, and to report unexplained muscle tenderness
Streptomycin (second-line drug)	Inhibits protein synthesis and suppresses growth of mycobacterium	VIII cranial nerve damage; paresthesia of face, tongue, and hands; renal damage	Ask client to sit quietly 15–30 minutes after injection.
Kanamycin (second-line drug)	Same as above	Same as above	Observe for hematuria. Frequent hearing tests.
Pyrazinamide (first-line drug)	Unknown	Liver damage; gout	Teach client to increase fluid intake. Observe for jaundice.