Missing Classes?

The counseling office recommends getting transcript evaluations before graduation. This way, the student knows which classes still need to be completed before receiving a degree. Right now is a good time to do so because it takes some time for them to evaluate the transcript. All you need is an official transcript of all schools attended and an evaluation form from the counseling office. Once the paper is filled out, turn it into Admissions and Records. Find out what classes you need because the summer is a perfect time to complete these classes!

question of the week

for the week of 02.23.09

A client takes digoxin for heart failure. A nurse should report which side effects to the charge nurse?

1. bradycardia, hypotension

2. blurred vision, yellow vision

3. anorexia, vomiting

4. fatigue, headache

Exam #4: Ch. 17, 48-50 (Endocrine System)

Ch. 17-Fluid and Electrolytes
1. Review calcium regulation.
-present in the body as free or ionized, bound to proteins like albumin, and complexed with phosphate, citrate, or carbonate
-serum calcium levels reflect all three forms
*plasma acidosis: decreases albumin bound calcium, thus increasing ionized calcium
*plasma alkalosis: increases albumin bound calcium, thus decreasing ionized calcium
*calcium balance controlled by parathyroid hormone (PTH), calcitonin, and vitamin D
-PTH: produced by parathyroid gland and stimulated by low serum calcium
>increases movement of calcium out of bones, GI absorption of calcium, and renal tubule reabsorption of calcium
-calcitonin: produced by thyroid gland and stimulated by high serum calcium
>opposes PTH action—decreases GI absorption, increases calcium deposition into bone, and promote renal excretion
-vitamin D: formed through UV rays in precursors found in skin or diet
>aids in absorption of calcium in GI

2. Identify clients at risk for calcium imbalance.
*hypercalcemia
-hyperparathyroidism
-malignancies: cause bone destruction from tumor invasion or secrete a parathyroid-like protein to stimulate calcium release from bones
-vitamin D overdose
-prolonged immobility: bone mineral loss and increased plasma calcium concentration
-rarely occurs from increased calcium intake
*hypocalcemia
-removal or injury of parathyroid gland
-acute pancreatitis: causes lipolysis which produces fatty acids that combine with calcium ions
-multiple blood transfusions: citrate used as anticoagulant binds to calcium
-low calcium diet or decreased absorption from laxative abuse or other syndromes

3. Recognize the signs and symptoms of hypercalcemia and hypocalcemia.
*hypercalcemia
-reduced excitability of muscles and nerves: decrease in memory, confusion, disorientation, fatigue, muscle weakness, constipation, cardiac dysrhythmias, and renal calculi
*hypocalcemia
-increased excitability of muscles and nerves: tetany, manifested by Chvostek’s sign and Trousseau’s sign, laryngeal stridor, dysphasia, numbness and tingling around the mouth or in extremities, and ventricular tachycardia from decreased cardiac contractility

4. Use the NP to provide care to a client with a calcium imbalance.
*assessment
-subjective: ALOC, confusion, memory loss, fatigue, muscle weakness, numbness and tingling around mouth and extremities
-objective: disorientation, constipation, cardiac dysrhythmias, renal calculi, tetany, dysphasia, laryngeal stridor
-dx: serum calcium levels, ionized calcium levels

*diagnoses
-risk for injury

**planning/implementation
*hypercalcemia
-promote excretion of calcium in urine: loop diuretics, hydrate with isotonic saline solutions, 3000-4000 ml fluid intake (also to decrease kidney stone formation)
-lower serum calcium levels: synthetic calcitonin, low calcium diet
-enhance bone mineralization: mobilization with weight-bearing activity
-Aredia: hypercalcemia associated with malignancy; inhibits osteoclast action which breaks down bone and releases calcium as a result
-Mithracin: cytotoxic antibiotic; inhibits bone resorption to lower serum calcium levels
*hypocalcemia: treat the underlying cause
-oral or IV calcium, but not IM
-high calcium diet with vitamin D supplements or calcium supplements for low tolerance of dairy products
-treat pain and anxiety to prevent respiratory alkalosis induced hypocalcemia

Ch. 48-Nursing Assessment: Endocrine System
1. Review the normal regulation of hormonal secretion.
-stimulate or inhibit hormone synthesis or secretion using:
*simple feedback: based on blood levels of a particular substance
-negative feedback: increase or decrease of secretion depending
>calcium regulation: low serum calcium stimulates PTH to increase calcium levels, once achieved the increased calcium levels inhibit further PTH release
-positive feedback: increases target organ action beyond normal
>pressure receptors in the vagina during birth stimulate more oxytocin secretion to make stronger uterine contractions
*complex feedback: hormone stimulation or inhibition involving multiple glands
*nervous system control: hormone secretion directly affected by nervous system actvity like pain, emotion, sexual excitement, and stress
*physiologic rhythms: secretions by rhythms originating in the brain structure like the circadian rhythm related to sleep-wake or dark-light cycles

2. Review the actions of the different hormones and their sources.
**hypothalamus: secretes releasing and inhibiting hormones to the anterior pituitary gland to stimulate or inhibit release of hormones
*releasing hormone:
-corticotropin-releasing hormone (CRH)
-thyrotropin-releasing hormone (TRH)
-growth hormone-releasing factor or somatotropin-releasing hormone
-gonadotropin-releasing hormone (GnRH)
-prolactin-releasing hormone
*inhibiting hormone
-somatostatin: inhibits growth hormone release
-prolactin-inhibiting hormone
**anterior pituitary
*tropic hormone: precursor hormones with control the secretion of hormones by other glands
>thyroid stimulating hormone (TSH), adrenocortiocotropic hormone (ACTH), follicle stimulating hormone (FSH), and luteinizing hormone
*growth hormone: affects growth and development of skeletal muscle and long bones
*prolactin: stimulates breast development for lactation after childbirth
**posterior pituitary: hormones actually produced in hypothalamus, but stored here until release is triggered
*antidiuretic hormone (ADH): regulates fluid volume by stimulating reabsorption of water in renal tubules, making concentrated urine; also a potent vasoconstrictor
*oxytocin: stimulates ejection of milk into mammary glands and contraction of uterine smooth muscle
**thyroid gland: regulated by TSH from anterior pituitary
*thyroxine (T4) and triiodothyronine (T3): affect metabolic rate, caloric requirements, oxygen consumption, carbohydrate and lipid metabolism, growth and development, brain functions, and other nervous system activities
*calcitonin: lowers serum calcium levels by inhibiting calcium resorption from bone, increasing calcium storage in bones, and increasing kidney excretion of calcium and phosphorus
**parathyroid glands
*parathyroid hormone (PTH): regulate blood level of calcium
-stimulates bone resorption and inhibits bone formation
-increases calcuim reabsorption and phosphate excretion
-stimulates conversion of vitamin D in most active form to enhance intestinal absorption of calcium
**adrenal glands
*adrenal medulla
-catecholamines: stress response neurotransmitters
*adrenal cortex: any hormones secreted are referred to as corticosteroids except androgens
-cortisol: glucocorticoid; regulates blood glucose concentration by stimulating hepatic conversion of amino acids to glucose; necessary to maintain life
>antiinflammatory action, maintains vascular integrity and fluid volume
-aldosterone: mineralocorticoid; maintain extracellular fluid volume by promoting reabsorption of sodium and excretion of potassium and hydrogen ions
-adrenal androgens: stimulates pubic and axillary hair growth and sexual drive in females in the form of estrogen
>negligible amounts in men
**pancreas (islets of Langerhans)
*glucagon: increases blood glucose through stimulation of glycogenolysis, gluconeogenesis, and ketogenesis
*insulin: facilitates glucose transport into cell membrane

3. Effects of the sympathetic and parasympathetic system.
-insulin secreted by both systems

Ch. 49-Nursing Management: Diabetes Mellitus
1. Differentiate the pathophysiology of the different types of DM.
-Type 1 DM: destruction of islets by immune system, therefore there is a little to no insulin production
-Type 2 DM: pancreas can produce insulin, but is insufficient and/or poorly utilized by the body
-Gestational: high blood glucose during pregnancy and high risk of developing type 2 diabetes
-Pre-Diabetic: not enough to be diagnosed, but high risk of type 2 diabetes if not treated
>Fasting glucose and OGTT higher than normal
-Secondary Diabetes: result of another medical condition or treatment which causes high glucose levels

2. Differentiate normal, pre-diabetic, and diabetic blood-glucose levels.
-normal: 70-120 mg/dl
-pre-diabetic: >100 -<126>140-<200 mg/dl casual
-diabetic: >126 mg/dl when fasting or >200 mg/dl casual

3. Use the NP to provide care to a pre-diabetic patient and a diabetic patient.
*assessment
-subjective: obesity, family history, history of viral infections, surgery, or medical conditions, thirst, hunger, poor healing
-objective: Kussmaul respirations (rapid, deep breathing with fruity odor), weight loss
-dx: Hb A1c, FSBG, IGT, IFG

*diagnoses
-ineffective theraupeutic regimen management
-risk for injury
-risk for infection
-powerlessness
-imbalanced nutrition: more than body requirements

*planning
-active patient participation
-few or no episodes of acute hyperglycemic emergencies or hypoglycemia
-maintain blood glucose within normal range
-prevent/delay chronic conditions
-maintain ADLs with minimal stress

*implementation
-identify those at risk
-teach how to monitor blood glucose regularly
-teach insulin therapy
-emphasize personal hygiene and foot care
-medical alert bracelet and ID

4. Know the action of the oral hypoglycemic agents.
*not insulin, works to improve mechanisms which insulin and glucose are produced and used
*three main actions: increases insulin production from pancreas, decreases glucose production from liver, and/or improves insulin use by body
-sulfonylureas (Glucotrol, Amaryl): increases insulin production from pancreas
-meglitinides (Prandin, Starlix): increases insulin production from pancreas
-biguanides (Glucophage): decreases glucose production from liver, improves insulin use by body
-alpha-glucosidase inhibitors (Precose): slows absorption of carbohydrates in small intestine
-thiazolidinediones (Actos, Avandia): greatly improves insulin use by body

5. Know the onset, peak action, and duration of the different types of insulin.
*rapid-acting (Humalog, Novolog, Apidra, Exubera): peaks 60-90 minutes
-onset: 15 minutes
-duration: 3-4 hours
*short-acting (regular): peaks 2-3 hours
-onset: 30-60 minutes
-duration: 3-6 hours
*intermediate-acting (NPH): peaks 4-10 hours
-onset: 2-4 hours
-duration: 10-16 hours
*long-acting (Lantus, Levemir): no peak
-onset: 1-2 hours
-duration: 24+ hours

6. Explain the information needed to teach a diabetic patient about exercise and the management of their diabetes.
-teach patient it is essential to diabetes management because it increases insulin receptor sites, lowers blood glucose, and contributes to weight loss
-individualized exercise plan: done after medical clearance with a gradual progression
-monitor blood glucose before, during, and after
-exercise after meals with small carbohydrate snacks every 30 minutes

7. Explain the pathophysiology of DKA, HHS, hypoglycemia and hyperglycemia.
*DKA: profound deficiency of insulin causes breakdown of fat with ketones as a byproduct
-lowers pH causing metabolic acidosis
-ketones are excreted in the urine and electrolytes become depleted
*HHS: inadequate hydration paired with polyuria cause blood glucose to be >400 mg/dl and high serum osmolality
*hypoglycemia: too much insulin in proportion to glucose in the blood
*hyperglycemia: too much glucose in proportion to insulin in the blood

8. Use the NP to provide care for a patient with DKA, HHS, and hypoglycemia
**DKA
*assessment:
-subjective: type 1 diabetes, illness or infection, poor self management, neglect, lethargy, weakness, nausea, vomiting
-objective: inadequate insulin dosage, dehydration, abdominal pain, Kausmall respirations (rapid, deep rhythm), fruity smelling breath
-dx: blood glucose >300 mg/dl, ABG pH <7.3,>add D5 to prevent hypoglycemia when blood glucose levels approach 250 mg/dl
>replace potassium
>sodium bicarbonate, if pH <7>400 mg/dl, increased serum osmolality, and little to no ketone bodies in blood or urine (unlike DKA because of circulating insulin)

*diagnoses:
-risk for injury

*planning (like DKA):
-maintain patent airway
-correct fluid/electrolyte imbalance, more than DKA
-insulin therapy (after fluids have begun)

*implementation:
-administer oxygen
-1/2 NS or NS to restore urine output and blood pressure
>add D5 to prevent hypoglycemia when blood glucose levels approach 250 mg/dl
>replace potassium
>sodium bicarbonate, if pH <7>70 mg/dl, investigate further; begin treatment if <70 mg/dl
--alert patients should be given 15-20 g of a simple carbohydrate like orange juice
--avoid fatty foods as they decrease absorption of sugar
--continue to monitor BG and give scheduled snacks
-if after 2-3 doses of simple carbohydrates do not work or the patient is not alert
--administer 1 mg of glucagon IM or SQ
--give complex carbohydrate after recovery
--20-30 ml D50 IVP in acute care setting

9. List and explain the chronic complications resulting from diabetes.
*microvascular angiopathy: thickening of capillary and arteriole vessel membranes particularly in the eyes, kidneys and skin
-retinopathy:
--proliferative: most severe; occlusion of small blood vessels involving retina and vitreous
--non-proliferative: most common; partial occlusion of small blood vessels in retina
-neuropathy: damage of vessels which supply blood to glomeruli of kidneys; nerve damage caused by metabolic complications of diabetes
--sensory: abnormal sensation of hands and/or feet bilaterally
--autonomic: can affect nearly all body systems
-integumentary problems: infection and necrosis caused by a combination of loss of nerve sensation and poor blood circulation

10. Use the NP to provide care to a patient specific to each of these complications.
*angiopathy:
*retinopathy: treat early with annual dilated eye exams
-photocoagulation
-cryotherapy
-vitrectomy
*neuropathy: tight glucose control, BP management, yearly screening of microalbuminuria in urine and serum creatinine, drug therapy
*integumentary problems: treat infections quickly and vigorously

Ch. 50-Nursing Management: Endocrine Problems (incomplete)
2. Differentiate between the signs and symptoms of Addison's disease and Cushing's disease.
-Addison's disease: lack of corticosteroids; progressive weakness, fatigue, weight loss, skin hyperpigmentation, anorexia, confusion
-Cushing's disease: excess corticosteroids; weight gain (moon face, trunk weight, water retention), secondary diabetes, purple-red straie, slow wound healing,

question of the week

for the week of 02.16.09

A client has been admitted with complaints of lower abdominal pain, difficulty swallowing, nausea, dizziness, headache and fatigue. During the initial observation the client exhibits agitation, fearfulness, and tachycardia. The client remarks, "I am too sick to return to work." The client is diagnosed as having somatoform disorder. During a team discussion of the plan of care, a nurse should consider that the behavior is?

1. controlled by the subconscious mind
2. manipulative to avoid work responsibilities
3. usually responsive to a variety of strategies
4. modifiable through reality therapy

Question of the Week

for the week of 02.09.09

A client is admitted with the diagnosis of infective endocarditis (IE). History of which finding is most important for the nurse to report to the registered nurse (RN)?

1. tiredness and drowsiness
2. a rash that appeared suddenly
3. fever for the past 24 hours
4. clubbing of the nails

Student Nurses Association Meeting Agenda
February 23, 2009
1:00pm in Locke-229

I. Call Meeting to Order
II. Welcome
III. Approval of January 26, 2009 SNA Meeting Minutes
IV. Old Business
V. New Business

1. CPK fundraiser for March
2. Easter Toy Drive for Family Ties (Easter April 12th)
   
3. Reimbursements
4. Reorder needed items
5. SNA Leadership Award
   

VI. PDA Party with Mr. Meza
VII. Raffle of T-shirts and Unbound Nursing Software
IX. Adjournment

http://futurenursesfall2009.blogspot.com/2009/02/sna-is-having-pda-party-in-february.html

Exam #3: Ch. 56-60 (Neurological System)

Ch. 56-Nursing Assessment: Nervous System
1. Review the functions of the cerebral lobes.
*frontal: higher cognitive function, memory retention, voluntary motor movement, voluntary eye movement, expressive speech
*temporal: receptive speech, integration of somatic, visual, and auditory data
*parietal: sensory cortex, control and interpret spatial information
*occipital: sight processing

2. Describe the effects of aging on the nervous system.
*CNS
-loss of neurons in certain areas of brainstem, cerebellum, and cerebral cortex
>enlargement of ventricles
>decreased brain weight
>decreased blood flow
>decreased CSF production
-glycosylated hemoglobin (Hb A1C): risk factor for accelerated cerebral atrophy
*PNS
-changes to anterior horn cells, peripheral nerves, and target organ muscle
-deteriorated myelin sheath, therefore decreased nerve conduction
-decreased neuromuscular activity
>slower BP response to position change and body temperature
*additional relevent changes
-decreased memory, vision, hearing, taste, smell, vibration/position sense, muscle strength, and reaction time
>decreased dietary intake
>increased perceptual confusion
>fall/fracture risk

3. Differentiate the effects of the sympathetic and parasympathetic nervous system.
*both are part of the autonomic nervous system which governs involuntary functions of cardiac muscle, smooth (involuntary) muscle, and glands
-sympathetic nervous system (T1-L2): “fight or flight” response
>release of norepinepherine and acetylcholine
>occurs throughout body
>imagine what the body would do if a bear was attacking you
-parasympathetic nervous system (S2-S4): conserves and restores energy stores of the body
>releases acetylcholine
>acts in localized and discrete regions of the body
>imagine what the body would do after thanksgiving dinner

4. Explain common neurological assessment abnormalities.
*mental status
-ALOC: unable to speak, obey commands, or open eyes appropriately with verbal or painful stimulus
-anosognosia: unable to recognize bodily defect or disease
*speech
-aphasia: loss of language faculty
-dysphasia: difficulty with use of language
-dysarthria: lack of coordination in articulating speech
*eyes
-aniscoria: unequal pupil size
-diplopia: double vision
-homonymous hemianopsia: loss of vision in one eye
*cranial nerves
-dysphasia: difficulty swallowing
-ophthalmoplegia: paralysis of eye muscles
-papilledema: “choked disc”; swelling of optic nerve head
*motor system
-apraxia: inability to perform learned movements
-ataxia: lack of coordination in movement
-dyskinesia: fragmentary movements due to impairment of power
-hemiplegia: one-sided paralysis
-nystagmus: jerking of eyes while tracking objects
-opisthotonus: arching of back with head retraction
*sensory system
-analgesia: loss of pain sensation
-anesthesia: absence of sensation
>hyperesthesia/hypoesthesia: increase/decreased in sensation
-astereognosis: inability to recognize object form by touch
*reflexes
-Babinski’s sign: upgoing toes with plantar stimulation
-Brudzinski’s sign: neck lesion results in neck pain and reflex flexion of hip and knee
-Kernig’s sign: reflex contraction and pain when in supine position and hips are flexed 90 degrees
*spinal cord
-bladder dysfunction
>atonic: no muscle tone/contractility
>hypotonic: decreased muscle tone/contractility
>hypertonic: increased muscle tone, but decreased capacity
-paraplegia: paralysis of lower extremities
-quadriplegia: paralysis of all extremities

5. Explain different types of diagnostic studies of the neurological system and appropriate nursing responsibilities.
*cerebral angiography: catheter inserted into femoral artery, when vascular lesions or tumors are suspected, then x-rayed
-observe for bleeding
-apply pressure dressing and ice to promote hemostasis and prevent swelling
*electroencephalography (EEG): monitors electrical activity of surface cortical neurons of the brain
-withhold stimulants
-inform patient it is similar to an ECG, no pain involved
*electromyography (EMG): records electrical activity associated with innervation of skeletal muscles
-inform patient of slight discomfort with needle insertion
*lumbar puncture (LP): CSF aspiration at L3-L4 or L4-L5 interspace to assess CNS disease
-monitor neurologic system and vital signs
-encourage fluids
-label specimen
-maintain strict asepsis
-patient should be flat lying after procedure
-assure there is no tumor which could be herniated with procedure
*computed tomography scan (CT): computer assisted x-ray on several thin cross sections of body parts
-elicit allergies to contrast media
-remain calm during procedure and explain scanner
-non-invasive if no dye is used
*magnetic resonance imaging (MRI): imaging using magnetic energy with greater contrast than CT scan
-screen body for metal parts
-be aware of contraindications
-the patient will need to lie still for about an hour
-administer sedatives if necessary
*myelography: detects spinal lesions by x-ray of spinal cord and vertebral column with contrast media
-pre-procedure sedation
-empty bladder
-table will move during test
-patient should lie flat for a few hours after procedure
-encourage fluids
-monitor neurological system and vital signs
-headache and n/v may occur
*positron emission tomography (PET): assess cell death or damage by using radioactive material to measure metabolic activity
-explain procedure and that there will be 2 IV lines required
-no sedatives or tranquilizers involved
-empty bladder pre-procedure
-different activities may need to be performed during test
-glucose monitoring is necessary due to injected venous scan material
*carotid duplex studies: combined ultrasound and doppler technology to evaluate stenosis of carotid and vertebral arteries
-explain procedure to patient

Ch. 57-Nursing Management: Acute Intracranial Problems
1. Explain factors that affect intracranial pressure and cerebral blood flow.
*ICP
-arterial pressure, venous pressure, intraabdominal/intrathoracic pressure, posture, temperature, and ABGs, particularly CO2
*CBF
-carbon dioxide, oxygen, hydrogen ion
>low CO2: relaxes smooth muscle, dilates cerebral vessels, decreased cerebrovascular resistance, and increased CBF
>high CO2: constricts cerebral vessels, increased cerebrovascular resistance, increases CBF, and increased O2 tension
>low O2 tension: causes lactic acid which leads to vasodilation and the accumulation of hydrogen ions
--acidosis: autoregulation is lost and CBF would then be directly influenced by systemic BP, hypoxia, and catecholamines

2. Use the NP to provide are to a patient with IICP.
*assessment
-subjective: obtain from family/friend familiar with patient
-objective: LOC, deviations from normal bodily functions, neurological assessment
-dx: CT or MRI

*diagnoses
-ineffective tissue perfusion (cerebral)
-decreased intracranial adaptive capacity
-risk for disuse syndrome

*planning
-maintain patent airway
-have ICP within normal limits
-demonstrate normal fluid and electrolyte balance
-no complications secondatry to immobility or decreased LOC

*implementation
-suction airway
-reposition from side to side
-elevate HOB
-NG tube for gastric distention unless contraindicated
-decrease environmental stimuli and hazards
-assess ABGs, F&E, and pain
-minimize actions which promote ICP

3. Use the NP to provide care for a patient with an acute head injury.
*assessment
-subjective: how injury was inflicted, anticoagulant usage, use of alcohol or drugs, risky behaviors, headache, mood changes, impaired judgement, fear, denial, anger, agression
-objective: ALOC, type of laceration and bruising, patency of airway, fluid leakage, Cushing’s triad, vomiting, incontinence, uninhibitied sexual expression, pupil dysfunction, neurological function, muscle strength
-dx: CT, MRI, PET

*diagnoses
-ineffective tissue perfusion (cerebral)
-hyperthermia
-acute pain (headache)
-impaired physical mobility
-anxiety
-potential complication: increased ICP

*planning
-adequate cerebral oxygenation and perfusion
-remain normothermic
-control pain and discomfort
-free from infection
-maximal cognitive, motor, and sensory function

*implementation
-protective gear education
-safe driving education
-explain need for frequent neurological checks
-check for CSF leaks
-care for the immobile patient
-surgery consent from family if needed

4. Explain the types of head injuries and related complications.
*scalp lacerations
-external head trauma
-excessive blood loss
-risk for infection
*skull fractures
-linear, depressed, simple, comminuted, compound
>intracranial infection, hematoma, meningeal, and brain tissue damage
*minor head trauma
-concussion: sudden transient mechanical head injury
>repeated minor head trauma could lead to a more progressive, serious problem
*major head trauma
-contusion: bruising of brain tissue
-laceration: bleeding of brain tissue
>brain hemorrhage
*epidural hematoma
-bleeding between dura and inner brain surface
*subdural hematoma
-bleeding between dura mater and arachnoid layer
*intracerebral hematoma
-bleeding within the brain

5. Explain the indications for and types of cranial surgery
*stereotactic
-uses precision apparatus to drill Burr hole
-removes small brain tumors and abscesses, drains hematomas, ablative procedures for extrapyramidal diseases, and repair of arteriovenous malformations
-reduces surrounding tissue damage
-also ionizing radiation procedure
*craniotomy
-removal of brain part by sawing Burr hole

6. Use the NP to provide care to a patient post-cranial surgery
*assessment
-subjective: how injury was inflicted, anticoagulant usage, use of alcohol or drugs, risky behaviors, headache, mood changes, impaired judgement, fear, denial, anger, agression
-objective: ALOC, type of laceration and bruising, patency of airway, fluid leakage, Cushing’s triad, vomiting, incontinence, uninhibitied sexual expression, pupil dysfunction, neurological function, muscle strength
-dx: CT, MRI, PET

*diagnoses
-ineffective tissue perfusion (cerebral)
-decreased intracranial adaptive capacity
-risk for disuse syndrome

*planning
-return to normal consciousness
-control pain and discomfort
-maximize neuromuscular functioning
-rehabilitate to maximal ability

*implementation
-therapeutic communication
-explain procedure
-prevent ICP
-suction airway
-reposition from side to side
-elevate HOB
-NG tube for gastric distention unless contraindicated
-decrease environmental stimuli and hazards
-assess ABGs, F&E, and pain
-minimize actions which promote ICP

7. Use the NP to provide care to a patient with bacterial meningitis.
*assessment
-subjective: how injury was inflicted, anticoagulant usage, use of alcohol or drugs, risky behaviors, headache, mood changes, impaired judgement, fear, denial, anger, agression
-objective: ALOC, type of laceration and bruising, patency of airway, fluid leakage, Cushing’s triad, vomiting, incontinence, uninhibitied sexual expression, pupil dysfunction, neurological function, muscle strength
-dx: CT, MRI, PET

*diagnoses
-decreased intracranial adaptive capacity
-disturbed sensory perception
-acute pain
-hyperthermia

*planning
-maximize return of neurologic function
-resolve infection
-control pain and discomfort

*implementation
-darken room and cool towel for photophobia
-manage fever
-assess for dehydration
-respiratory isolation
-therapeutic communication

Ch. 58-Nursing Management: Stroke
1. Differentiate the pathophysiology of each type of stroke.
*anatomy of cerebral circulation
-internal carotid arteries: anterior circulation
-vertebral arteries: posterior circulation
*regulation of cerebral blood flow
-cerebral autoregulation: changes to vessel diameter to compensate for systemic BP changes
-systemic BP, CO, and blood viscosity all affect brain blood flow
-collateral circulation: compensation for decreased cerebral blood flow
-ICP
*artherosclerosis: hardening and thickening of arteries can lead to thrombus formation and contribute to emboli
*ischemic stroke: inadequate blood flow to brain from partial or complete artery occlusion
-thromobotic stroke: injury to vessel wall and blood clot fomration
>narrowing of vessel by plaque
-embolic stroke: clot blocks blood flow
*hemorrhagic stroke: bleeding into brain tissue itself or into subarachnoid space or ventricles
-intracerebral hemorrhage: bleeding within the brain by a ruptured vessel
>hypertension
-subarachnoid hemorrhage: bleeding into CSF-filled space between arachnoid and pia mater on brain surface

2. Using a system’s approach, identify the complications resulting from an acute stroke.
*motor function
-impairment of mobility, respiration, swallowing/speech, gag reflex, and ADLS
*communication
-aphasia, dysphasia, dysarthria
*affect
-uncontrolled exaggerated emotional responses related to loss of functions
*intellectual function
-impaired memory and judgement
>right brain stroke: impulsive decisions and memory problems related to language
>left brain stroke: cautious decisions
-difficulty making generalizations; difficulty learning
*spatial-perceptual alterations
-right side stroke: decreased perception of self and illness, decreased sensory input form affected side, decreased object recognition by sight, touch, sound and decreased ability to carry out learned sequential movements on demand
*elimination
-initial and temporary
>secondary result

3. Use the NP to provide care to a patient with stroke.
*assessment
-subjective: description of current illness, hisotyr of similar symptoms, current medications, risk factors such as HTN and family history
-objective: LOC, cognition, motor ability, cranial nerve function, deep tendon reflexes (all should be monitored continuously)
-dx: non-contrast CT scan for confirmation and cause

*diagnoses
-ineffective tissue perfusion (cerebral)
-ineffective airway clearance
-impaired physical mobility
-impaired verbal communication
-unilateral neglect
-impaired urinary elimination
-impaired swallowing
-situational low self esteem

*planning
-maintain or improve LOC
-attain maximum physical functioning
-maximum self-care abilities and skills
-stable body functions
-maximal communication skills
-adequate nutrition
-avoid further complications
-effective coping

*implementation
-focused prevention on risk factors
-respiratory patency and function
>positioning, suctioning, oxygenation, gag reflex
-monitor neurological signs
-monitor cardiac rhythm and vital signs
-monitor IV and I&O
-monitor lung sounds and heart sounds
-ROM exercises
-observe lower extremity edema
>TEDs and SCDs
-elevation to avoid dependent edema
-hygiene care
-bladder training or foley care
-mouth care
-therapeutic communication
-monitor possible changes to senses and perceptions
-familial support
-patient education regarding home care

Ch. 59-Nursing Management: Chronic Neurologic Problems
1. Explain the pathophysiology and types of seizures
*abnormal neurons spontaneously fire
*generalized seizures: involve both sides of the brain
-tonic-clonic: loss of consciousness, stiffening of body, then subsequent jerking
-typical absence seizure: staring spell may be resulting from hyperventilation or flashing lights
>children
-atypical absence seizures: staring spells accompanied by peculiar behavior or confusion
*partial seizures: begin at one side of brain and can evolve to both
-simple partial seizure: no loss of consciousness and short lasting
-complex partial seizures: ALOC, longer than one minute, involves emotional, behavioral, cognitive, and affective function followed by confusion

2. Use the NP to provide care to the patient with seizure disorder, multiple sclerosis, myasthenia gravis and Parkinson’s disease
**seizure disorder
*assessment
-subjective: history of seizures, current compliance with medications, family history of seizures, changes before seizure, anxiety, depression, changes in sexual drive
-objective: bitten tongue, soft tissue damage, abnormal RR or breath sounds, HTN, tachycardia, bradycardia, GI/GU incontinence, type of seizure, weakness, paralysis
-dx: toxiclology screen, serum levels, LP

*diagnoses
-ineffective breathing pattern
-risk for injury
-ineffective coping
-ineffective therapeutic regimen management

*planning
-free of injury during seizure
-optimal mental/physical health while taking anti-seizure drugs
-satisfactory psychosocial functioning

*implementation
-identify precipitating events
-promote safety measures
-good general health habits
-record details of seizure
-maintain airway and safety
-therapeutic communication
-medic alert bracelet

**multiple sclerosis
*assessment
-subjective: past infections or vaccines, use/compliance to current medications, family history, malaise, weight-loss, dysphagia, decreased GI/GU function, generalized muscle weakness, numbness, tingling, muscle spasms, blurred/lost vision, anger, depression, euphoria
-objective: apathy, inattentiveness, pressure ulcers, scanning speech, impaired hearing, muscular weakness
-dx: CSF analysis, MRI

*diagnoses
-impaired physical mobility
-sexual dysfunction
-impaired urinary elimination pattern
-interrupted family processes

*planning
-maximal neuromuscular function
-independent ADLs
-optimal psycho-social well-being
-adjust to illness
-decrease precipitating factors

*implementation
-therapeutic communication
-prevent complications of immobility
-bladder training/ foley care
-maintain strong immune system

**Parkinson’s Disease
*assessment
-subjective: CNS trauma, encephalitis, fatigue, dysphasia, weight loss, decreased GI/GU function, excessive sweating, loss of dexterity, difficulty initiating movements, muscle soreness and cramping, mood swings, hallucinations
-objective: blank face, slow monotonous speech, infrequent blinking, ankle edema, postural hypotension, drooling, tremor, poor coordination, rigieity, stooped posture, shuffling gait

*diagnoses
-impaired physical mobility
-impaired verbal communication
-deficient diversional activity
-imbalanced nutrition: less than body requirements

*planning
-maximal neurological function
-maintain ADLS as long as possible

*implementation
-physical exercise
-well balanced diet
-encourage independence
-avoid secondary complications

**myasthenia gravis
*assessment
-subjective: fatigue level, affected body parts, severity, coping abilities
-objective: RR and depth, SpO2, and muscle strength
-dx: ABGs, pulmonary function tests
*diagnoses
-ineffective breathing pattern
-ineffective airway clearance
-impaired verbal communication
-imbalanced nutrition: less than body requirements
-disturbed sensory perception (visual)
-activity intolerance
-disturbed body image

*planning
-return of muscle endurance
-manage fatigue
-avoid secondary complications
-maintain quality of life

*implementation
-adequate ventilation
-drug therapy and monitor side effects (drug-drug interactions)
-daily planning
-balanced diet

Ch. 60-Nursing Management: Alzheimer’s Disease and Dementia
1. Explain the pathophysiology of dementia and Alzheimer’s disease
*dementia: neurodegeneration and vascular disorders
*Alzheimer’s Disease: plaque of the brain, abnormal protein threads inside nerve cells and loss of neuron connections

2. Use the NP to provide care for a patient with dementia and Alzheimer’s Disease.
*assessment
-subjective: repeated head trauma, family history, malnutrition, incontinence, poor personal hygiene, disturbed sleep pattern, impaired coping, forgetfulness
-objective: disheveled appearance, loss of recent memory, disorientation, agitation, confusion, inability to do simple tasks
-dx: diagnoses by exclusion

*diagnoses
-disturbed thought process
-self-care deficit
-risk for injury
-wandering

*planning
-maintain functional ability as long as possible
-safe environment and minimal injuries
-meet personal care needs
-maintain dignity

*implementation
-assess for depression and suicide ideation
-work with caregiver to monitor ongoing changes
-consistency to reduce anxiety or disruptive behavior

3. Explain the general categories of drug therapy for Alzheimer’s Disease.
*drugs for…
-decreased memory and cognition: block cholinesterase to improve functional abilities
-depression: improve cognitive ability
-behavioral problems: atypical anti-psychotics with uncertain side effects
-sleep disturbances

4. List general nursing care instructions for the caregiver.
-provide a safe environment
-stop potentially dangerous behavior early
-reinforce routine and continue communication
-monitor diet
-reduce stress triggers
-know when caring for the patient is too much

Question of the Week

for the week of 02.02.09

A nurse enters a client's room to discover that the client has no pulse or respirations. After calling for help and giving two breaths, what is the next action the nurse should take?

1. continue to oxygenate with a pocket mask
2. check for a carotid pulse
3. initiate closed-chest massage at a rate of 100 bpm
4. obtain the crash cart from the hallway

Exam #2-Ch. 17, 26-19 (Respiratory System)

Ch. 17-Fluid, Electrolytes and Acid-Base Imbalances
1. Know the normal ABG value.
*pH: 7.35-7.45
-high: alkalosis
-low: acidic

*PaCO2 (respiratory): 35-45 mm Hg
-high: acidic
-low: alkalosis

*HCO3 (metabolic): 22-26 mEq/L
-high: alkalosis
-low: acidic

*What is the overall pH?
*Is it respiratory or metabolic?
*Is there compensation?
-zero compensation
-partial compensation
-total compensation

2. Review the processes of acid-base regulation.
*buffer system
-fastest acting, primary system
-change strong acids into weaker acids or neutralize acid

*respiratory system
-excrete by-products of cellular metabolism, CO2 and water

*renal system
-reabsorb and conserve bicarbonate
-eliminate excess H ions

3. Recognize clients at risk for acid-base imbalances.
-patients with diabetes mellitus, chronic obstructive pulmonary disease, kidney disease, vomiting, diarrhea, older patients, or patients with serious illnesses

4. Use the NP to provide nursing care to a client with an acid-base imbalance.
*assessment
-subjective: past medical history, medications, diet, lifestyle, health perception, tingling, numbness, n/v/d, light-headedness
-objective: irregular breathing, low BP, irregular heartrate, confusion, lethargy
-dx: serum electrolyte values, ABGs, serum glucose, BUN, creatinine

*diagnoses
-ineffective breathing pattern
-risk for injury
-acid/base imbalance

*planning
-replacement of electrolyte and oral/intravenous fluids

*implementation
-treat underlying cause

5. Given lab values, identify the acid-base imbalance and the resulting nursing care.
*respiratory acidosis, hypoventilation
-7.3, 50, 30
-deep breath

*respiratory alkalosis, hyperventilation
-7.5, 30, 20
-deep breath

*metabolic acidosis, severe diarrhea
-7.3, 30, 20
-Lactated Ringer’s

*metabolic alkalosis, severe vomiting or excess gastric suctioning
-7.5, 50, 30
-anti-enemics, monitor suctioning

Ch. 26-Nursing Assessment of the Respiratory System
1. Review the factors that control respiration.
*chemoreceptors: responds to change of chemical composition of the fluid surrounding it
-central, peripheral
-changes respiratory rate

*mechanical receptors: stimulated by physiologic factors like irritants, muscle stretching, and alveolar wall distortion
-located in lungs, upper airways, chest walls, and diaphragm

2. Explain the pulmonary changes associated with aging. (Table 26-4)
*alterations in:
-structure: decreased elasticity and compliance
-defense mechanisms: less forceful cough, less functional cilia, and dry mucous membranes
-respiratory control: decreased response to changes in blood gases

3. Explain the different diagnostic tests. (Table 26-11)
*blood studies: assesses Hb, Hct, and ABGs

*oximetry: assesses oxygen saturation

*sputum studies: tests infecting microorganism

*skin tests: tests for allergic responses

*radiologic studies: screens lungs for lesions, areas of inadequate airflow, and evaluates change

*endoscopic examinations: uses scopes to inspect the lungs and collect specimen

*lung biopsy: obtain tissue, cells, or secretions for evaluation

*thoracentesis: locally anesthesized, fluid collected from pleural space

*pulmonary function tests: measure lung volumes and air-flow to diangose pulmonary disease, monitor disease progression, and evaluate disability /response to bronchodilators

*exercise testing: determines exercise capacity for disability evaluation

4. Use the NP to provide care to the patient pre- and post- thoracentesis/ bronchoscopy. (Table 26-11)
*thoracentesis:
-explain and obtain signed permission for procedure
-position patient upright with elbows on overbed table with feet supported
-instruct patient not to cough or talk during procedure
-observe signs of hypoxia and pneumothorax
-monitor lung sounds in all fields after procedure
-encourage deep breathing for lung expansion
-send specimen to lab

*bronchoscopy
-NPO 6-12 hours prior
-obtain signed permission
-administer ordered sedative before procedure
-continue NPO status until gag reflex returns after procedure
-monitor laryngeal gag reflex
-monitor recovery from sedative
-monitor for hemorrhage and pneumothorax
-blood tinged mucus is not abnormal

Ch. 27- Nursing Management: Upper Respiratory Problems
1. Use the NP in care of a client with influenza and OSA
**Influenza
*assessment
-subjective: abrupt onset of symptoms (cough, fever, myalgia), headache, sore throat, weakness, patient health history
-objective: dyspnea, crackles, purulent sputum
-dx: influenza in the community

*diagnoses
-risk for infection
-ineffective airway clearance
-ineffective breathing

*planning
-symptom relief
-prevention of secondary infection

*implemenation
-drug therapy: antivirals to relieve symptoms and prevent spread

*evaluation
-does the patient have difficulty in breathing?
-is the patient free of secondary infection?

**OSA
*assessment
-subjective: frequent awakenings at night, insomnia, daytime sleepiness, witnessed apneic episodes, snoring, morning headaches, personality changes, irritability, inability to concentrate, impaired memory…
-objective: hypertension, dysrhythmias
-dx: polysomnography (more than 10 episodes of oxygen desaturation of below 90%)

*diagnoses
-ineffective breathing
-disturbed sleep pattern

*planning
-patient will understand methods to treat mild-severe OSA

*implementation
-avoid sedatives and alcohol 3-4 hours before sleep
-referral to weight loss programs for OSA r/t excessive weight
-oral appliance to prevent airflow obstruction
-CPAP, BiPAP, or uvulopalatoplasty
-monitor SpO2, HR, BP...

*evaluation
-does the patient demonstrate understanding of the treatment methods?

Ch. 28-Nursing Management: Lower Respiratory Problems
1. Explain the pathophysiology of pneumonia, HAP, CAP, tuberculosis, pulmonary edema, pulmonary hypertension, cor pulmonale, lung cancer, pulmonary embolus, and atelectasis.
-pneumonia: congestion (fluid fills alveoli), red hepatization (dilation of capillaries, making the lung appear red and granular), gray hepatization (decreased blood flow and consolidation of affected part of lung), resolution (exudate lysed by macrophages and gas-exchange returns to normal)
-HAP: same as above, acquired in hospital
-CAP: same as above, acquired in community
-tuberculosis: active bacteria that multiply and cause clinically active disease
-pulmonary edema: increased hydrostatic pressure or decreased colloidal oncotic pressure pulls fluids into interstitial space
-pulmonary hypertension: deficient release of vasodilators to pulmonary epithelium causing increased pulmonary pressure
-cor pulmonale: enlargement of right ventricle secondary to diseases of the lung, thorax, or pulmonary circulation
-lung cancer: hypersecretion of mucus, desquamation of cells, cancerous cells of upper lobes
-pulmonary embolus: thrombus, fat or air embolus, or tumor tissue blocking pulmonary arteries obstructing perfusion
-atelectasis: collapsed, airless alveoli commonly caused by airway obstruction from retained exudate and secretions observed in post-operative patients

2. Identify clinical situations and patient populations at risk for developing the listed pulmonary conditions.
-pneumonia: decreased defense mechanisms-age, air pollution, ALOC, immune suppression, prolonged immobility, chronic diseases, debilitating illiness, inhalation of noxious substances, tube feeding, malnutrition, smoking, upper respiratory tract infection, intubation…
-HAP: VAP and HCAP
-CAP: smokers
-tuberculosis: immunocompromised, exposure to infected individuals
-pulmonary edema: most commom cause is left-sided HF
-pulmonary hypertension: use of Fen-Phen, more women than men
-cor pulmonale: patients with disease of lung, thorax, or pulmonary circulation
-lung cancer: smokers or exposure to second-hand smoke
-pulmonary embolus: post-surgery or childbirth-immobilization, stroke, history of DVT, and malignancy
-atelectasis: post-operative patients

3. Use the NP to care for clients with pneumonia, HAP, CAP, pulmonary edema, pulmonary hypertension, cor pulmonale, lung cancer, pulmonary embolus, and atelectasis.
**pneumonia, HAP, CAP
*assessment
-subjective: chest pain, confusion, fatigue, headache, sore throat, nausea,
-objective: sudden onset of fever, shaking chills, SOB, productive cough, rust-colored sputum, crackles, bronchial breath sounds, vomiting, diarrhea
-dx: chest x-ray, CBC, blood stain, sputum test

*diagnoses
-impaired gas-exchange
-ineffective breathing pattern
-ineffective airway clearance

*planning
-clear breath sounds
-normal breathing patterns
-no signs of hypoxia
-normal chest x-ray
-no complications related to pneumonia

*implementation
-teaching: hygiene, rest, exercise, and good health habits
-position to minimize risk of aspiration, repositioning every 2 hours
-“good lung down”
-elevate HOB for tube feedings and VAP patients
-infection control
-CDB/IS
-medication routine

**tuberculosis
*assessment
-subjective: weight loss, fatigue, malaise, night sweats, anorexia
-objective: productive cough with white, frothy sputum, chest pain
-dx: chest x-ray, TB skin test, bacteriologic studies

*diagnoses
-ineffective breathing pattern
-imbalanced nutrition: less than body requirements
-noncompliance
-activity intolerance
-ineffective health maintenance

*planning
-comply with therapeutic regimen
-no recurrence of disease
-normal pulmonary function
-prevention of disease spread

*implementation
-isolation
-appropriate drug therapy
-stage disease
-teach patient to prevent spreading disease
-follow-up care

**lung cancer
*assessment
-subjective: exposure to airborne carcinogens, smoking history, frequent respiratory infections, persistent cough, chest pain, headache
-objective: fever, jaundice, edema of neck and face, clubbing, lung sounds (stridor, wheezing), unsteady gait
-dx: chest x-ray, sputum testing, bronchoscopy, MRI, PET, lung scan…

*diagnoses
-ineffective airway clearance
-ineffective health maintenance
-ineffective breathing pattern

*planning
-effective breathing pattern
-adequate airway clearance
-adequate oxygenation of tissues
-minimize pain

*implementation
-referral to quit smoking
-teach methods to reduce pain
-therapeutic communication, therapy

**pulmonary embolus
*assessment
-subjective: anxiety
-objective: rapid and weak pulse, low BP, hypoxemia, severe dyspea, pallor, dysrhythmia, ALOC, crackles, blood streaked sputum
-dx: ventilation-perfusion lung scan, D-dimer test

*diagnoses
-inadequate tissue perfusion
-inadequate cardiac output
-decreased level of comfort

*planning
-maximize breathing
-monitor VS
-limit progression and recurrence

*implementation
-position in semi-fowlers
-therapeutic communication
-teaching regarding long term anti-coagulation

**pulmonary hypertension
-treat underlying cause

**pulmonary edema
-monitor cardiac and respiratory function
-fluid therapy

**atelectasis: CDB, IS

**cor pulmonale:
-chronic management, resulting from COPD: continuous low-flow O2 during sleep, exercise, and small, frequent meals to feel better and be more active

4. Nursing care of a post lung/chest surgery patient. (Table 28-2)
-monitory respiration
-reposition
-oxygen therapy
-monitor bubbling and tidaling in water-seal chamber
-prevent air leaks and keep drainage container below chest
-pain management
-IS

Ch. 29-Nursing Management: Obstructive Pulmonary Disease
1. Recognize the clinical profile of a patient with COPD.
-exposure to noxious particles and gases: smoker, occupational chemical and dusts, urban air pollution
-prone to infection
-AAT deficiency: hereditary risk factor
-aging: change to lung structure, thoracic cage, and respiratory muscles

2. Explain the measure needed to teach patients to prevent COPD.
-quit or do not begin smoking
-avoid exposure to occupational and environmental pollutants
-IS: shows how much function has been lost, but can be regained

3. Explain the pathophysiology of asthma, emphysema and bronchitis.
-asthma: chronic inflammation causing acute airflow limitation, hyperresponsiveness occurs with exposure to allergens or irritants
-emphysema: abnormal permanently enlarged air spaces with destructed walls and no obvious fibrosis
-bronchitis: chronic productive cough for 3 months in each of the last 2 consecutive years with not other cause

4. Explain information needed to teach patients on the correct use of MDI’s and PDI’s.
-when it is appropriate to use
-does it need to be shaken?
-duration of inspiration
-cleaning and storage of inhaler

5. Use the NP to provide care to a client with asthma, emphysema and bronchitis
**asthma
*assessment
-subjective: past medical history, medications, family history, lifestyle, sleep pattern, stress
-objective: body positioning, sweating, eczema, cyanosis, wheezing, crackles, nasal drainage, use of accessory muscles, tachycardia, low SpO2
-dx: ABGs, allergy skins tests, peak expiratory flow rate

*diagnoses
-ineffective airway clearance
-inadequate gas exchange
-inadequate tissue perfusion

*planning
-maintain >80% of personal best PEFR or FEV1
-have minimal symptoms during day and night
-maintain acceptable activity levels
-have no or decrease incidence of asthma attacks
-have knowledge to carry out management

*implementation
-educate to identify personal triggers and how to avoid or reduce risk of attack
-educate on medications which can inhibit bronchodilation or immunity
-monitor lung sounds and cardiac functions for red flags
-deep breath

**emphysema and bronchitis
*assessment
-subjective: exposure to smoke or irritants, weight loss/gain, past medical history, family history, lifestyle, PND, headache, soreness, anxiety, constipation, gas, bloating
-objective: cyanosis, poor skin turgor, shallow breathing, tachycardia, ascites, barrel chest, accessory muscle use, wheezing, crackles
-dx: ABGs, chest x-ray, pulmonary function tests

*diagnoses
-ineffective airway clearance
-inadequate tissue perfusion
-ineffective breathing pattern
-disturbed sleep pattern

*planning
-prevent disease progression
-improve activity tolerance
-symptom relief
-no COPD related complications
-improve quatity of life
-ability to implement long-term treatment

*implementation
-breathing techniques
-monitor respiratory and cardiac function
-position techniques to maximize breathing
-oxygen therapy

6. Methods of oxygen administration and related nursing care. (Table 29-22)
-nasal cannula: pad ears to avoid pressure points
-simple face mask: clean, check for pressure points on ears, and keep at 5 L/min
-partial rebreathing mask: check for occlusion
-non-rebreathing mask: snug fit with the bag adequately inflated at inspiration and expiration
-oxygen-conserving cannula: check for pressure points on ears, for long-term use
-transtracheal catheter: not appropriate for patients with excessive mucus
-face tent: maintain aerosol at body temperature
-tracheostomy collar: clean to prevent aspiration and infection
-tracheostomy T-bar: should be removed when suctioning, and emptied as necessary
-venturi mask: check for occlusion

7. Explain the mode of action of the different drug categories used in the management of these conditions and resulting nursing care. (Table 29-7)
*anti-inflammatory agents: decreases inflammatory response
-administer in AM with milk
-discontinue gradually over time
-observe for epigastric distress
-long-term corticosteroid therapy should be paired with vitamin D and calcium

*mast cell stabilizers: inhibit release of mast cells to suppress other inflammatory cells
-educate patient on correct use

*anti-cholinergics: blocks bronchoconstriction
-may cause blurred vision if contact with eyes
-cautious use for narrow-angle glaucoma or prostatic enlargement patients

*leukotriene modifiers: reverse bronchospasms of acute asthma attacks
-monitor liver enzymes
-effects metabolism of erythromycin, warfarin, and theophylline
-take 1 hour before or 2 hours after meals

*B2-adrenergic agonists: prevent bronchoconstriction and increase mucociliary function
-cautious use patients with diabetes, hypertension, angina, or cardiac disorders
-overuse may cause rebound bronchospasm

*methylxanthines: bronchodilator
-monitor cardiac function