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What is Nasal congestion?
Dilation of the nasal blood vessels
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What causes this dilation of blood vessels that in turn causes nasal congestion?
- Infection
- Inflammation
- Allergies
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What is the etiology of nasal congestion?
the dilation of nasal blood vessels causes transudation of fluid into tissue spaces, leading to the swelling of the nasal cavity.
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What is the action of nasal decongestants?
- stimulate alpha adrenergic receptors:
- produce nasal vascular vasoconstriction
- shrinks nasal mucous membranes
- reduces nasal secretion
- *Agonists: ^BP (contraindicated in HTN)
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Name some nasal decongestants.
- Oxymetazoline (Afrin)
- Nahazoline (Allerest)
- Pseudoephedrine (Sudafed)
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What ways are nasal decongestants administered?
- Nasal spray (topicals are no longer than 5days)
- Nasal drops (d/t rebound congestion)
- Tablet
- Capsule
- Liquid
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What are the possible interactions with Afrin, Allerest, & sudafed?
- Sudafed may <effect of betablockers
- ^HTN, Dysrhythmias with MAOIs
- ^Restlessness, palpitations w/caffeine
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What are the s/e of nasal decongestants?
- Nervous, Jittery, restless
- Alpha-adrenergic effect: HTN, tachy, hyperglycemia
- Rebound nasal congestion: topically
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Frequent use of nasal decongestants can cause what?
- Tolerance
- Rebound nasal congestion
- **use no longer than 5 days
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What should a nurse teach a client started on nasal decongestants?
- Read OTC labels
- Don't take longer than 5 days
- Lie down or hyperextend neck to instill
- Blow nose prior to instillation of sprays or solutions
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What is an Intranasal Glucocorticoid?
- Steroids, effective for Tx of Allergic Rhinitis.
- Have antiinflammatory axn thus <s/s like rhinorrhea, sneezing, & congestion
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The Intranasal Glucocorticoids; Fluticasone (Flonase) & Triamcinolone (Nasacort) are Antiinflammatory agents used for what?
- Tx of Allergic Rhinitis
- Used alone on in combo w/H1 antihistamines
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The intranasal Glucocorticoid "Dexametasone" (Decadron) should be used no longer than how many days & why?
- 30 days
- to avoid systemic effects
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What is the action of Antitussives?
They act on the cough-control center in the medulla to suppress the cough reflex.
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Why would a client need an Antitussive?
for suppression of an irritating & nonproductive cough.
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What are the three different types of Antitussives?
- Narcotic: Codeine
- Nonnarcotic: Dextropmethorphan (Benylin DM)
- Combination preparations
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What forms do Antitussives come in?
- Oral
- Throat sprays
- Gargles
- Lozenges
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What are the s/e of Antitussives?
- Nausea
- Drowsiness
- Inability to cough
- Narcotic extra s/e: Resp depression, constipation, dependence
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What patient teaching should be done when a client is given an Antitussive Rx?
- Do NOT drink fluids for 30min after taking lozenges or chewables
- Do NOT mix w/alcohol or other sedating meds
- Caution: driving car or machinery
- Prevent constipation
- NO long term use
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What is the purpose of Expectorants?
to loosen bronchial secretions so they can be eliminated by coughing.
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What is the best natural expectorant?
Hydration
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Name the Expectorant meds.
- Guaifenisin (Robitussin, Humibid)
- Iodinated Glycerol
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Which drug is an Antitussive/Expectorant?
Robitussin DM
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What are the s/e of Expectorants?
minimal w/Guaifenesin: N/V
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What patient teaching is done with Expectorants?
Enc. fluids to help thin secretions
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With the combination of Guaifenesin & Codeine (Cheratussin, Gusiatussin), what is the action?
- Suppress cough reflex by acting on cough center in the medulla.
- Reduce viscosity of tenacious secretion
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What is the indications for Cheratussin or Gusiatussin? (Guaifenesin & codeine combo)
Nonproductive & irritating cough
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What are the s/e of the combo drug Cheritussin or Gusiatussin? (Guaifenesin & codeine)
- Drowsiness
- Dizziness
- Nausea
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What is the action of Corticosteroids?
Anti-inflammatory agents used to reduce airway inflammation.
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What forms do Corticosteroids come in?
- Nasal sprays
- Inhalers
- Oral
- IV
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What are the Corticosteroids indicated for?
- Asthma
- COPD
- Sinusitis
- Allergic Rhinitis
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The nasal or oral Inhalant Corticosteroids have fewer s/e, which drugs are they?
- Fluticansone (Flonase)
- Beclomethasone (Vanceril)
- Flunisolide (Aerobid)
- Triamcinolone (Nasacort, Azmacort)
- Budesonide (Rhinocort)
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What Corticosteroid is given orally?
Prednisone
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What Corticosteroid is given via IV?
Methylprednisolone (Solu-Medrol)
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What are the s/e of Corticosteroids?
- Local Effects: Throat irritation, cough
- Cardiac, fluid, electrolyte disturbances
- ^blood sugar
- MS: Osteoporosis, Retarded growth
- CNS
- GI: bleeding, ^appetite
- Suppression of immune system
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What patient teaching needs to be done when a client is started on Corticosteroids?
- Told potential s/e
- Steps for proper use of MDIs
- Do NOT abruptly stop med
- Take every dose
- Notify MD if taking other meds
- Avoid exposure to infections
- Take orals meds w/meals
- Administer Bronchodilators first
- Notify MD of any s/e
- Daily calcium/Vit D supplements
- Monitor blood sugars
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What are the proper steps to administering an inhaler such as an MDI?
- Shake canister well
- Exhale
- Inhale slowly
- Hold breath for 10 seconds
- Wait 3-5min before next puff
- Rinse mouth
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