*NURSING > STUDY GUIDE > NR 661 Week 4 VISE Assessment, Familiarize Yourself Already Passed (All)
Know presentation, DX and Management Diagnoses List 1. Acute bronchitisDESCRIPTION Acute cough due to inflammation of the bronchioles, bronchi, and trachea; usually follows an upper respiratory in... fection or exposure to a chemical irritant. ETIOLOGY Adenovirus Rhinovirus Influenza A and B Parainfluenza RISK FACTORS Upper respiratory infection Air pollutants Smoking and/or secondary exposure Reflux esophagitis Allergy Chronic obstructive pulmonary disease Acute and chronic sinusitis Infants Older adults Immunosuppression ASSESSMENT FINDINGS Cough: dry and nonproductive, then productive; may be purulent URI symptoms Fatigue Fever due to bacterial infection; more common in smokers and patients with COPD Fever due to viral cause (unusual after first few days) Burning sensation in chest Crackles, wheezes Chest wall pain DIFFERENTIAL DIAGNOSIS Pneumonia Tuberculosis Asthma DIAGNOSTIC STUDIES Decision criteria for chest radiographs: tachypnea, hypoxia, fever, abnormal lung exam Only consider chest X-ray if high index of suspicion for pneumonia or superimposed heart failure Consider PPD: expect negative results PREVENTION Smoking cessation Avoid known respiratory irritants Treat underlying conditions that contribute to risk (asthma, gastroesophageal reflux disease, etc.) Influenza immunization for high-risk populations NONPHARMACOLOGIC MANAGEMENT Increase fluid intake Use humidifier Rest Smoking cessation Consider honey in children older than 1 year Patient education about disease, treatment, expected cause of cough, and emergency actions PHARMACOLOGIC MANAGEMENT Cough suppressants for nighttime relief Avoid antihistamines Antibiotics if organism is bacterial Antivirals if influenza diagnosed Decongestants and antihistamines are ineffective unless sinusitis or allergy is underlying Bronchodilators if wheezing or prior history of asthma Although antibiotics are commonly prescribed, they are NOT recommended. ACUTE BRONCHITIS PHARMACOLOGIC MANAGEMENT Class Drug Generic name (Trade name®) Dosage How Supplied Comments Cough Suppressants Suppress cough in the medullary center of the brain dextromethorphan/guaifenesi n Adult: 10 mL q 4 hr Max: 4 doses in 24 hours Children 6-12 years: 5 mL q 4-6 hr; Max: 4 doses in 24 hr Children <6 years: not recommended Do not use if taking an MAO inhibitor or for 2 weeks after stopping an MAO inhibitor Contraindicated in Parkinson’s disease Potential drug interaction with some SSRIs Avoid in patients who are having difficulty clearing Robitussin DM secretions various generics Dextromethorphan 10 mg/5 mL Guaifenesin 100 mg/5 mL Although antibiotics are commonly prescribed, they are NOT recommended. ACUTE BRONCHITIS PHARMACOLOGIC MANAGEMENT dextromethorphan Adult and ≥12 years: 10 mL q 6-8 hr prn for cough Max: 4 doses in 24 hr Children 6-12 years: 5 mL every 6- 8 hr prn for cough Max: 4 doses in 24 hr 4-6 years: 2.5 mL every 6-8 hr prn for cough Max: 4 doses in 24 hr Do not use if taking an MAO inhibitor or for 2 weeks after stopping an MAO inhibitor Contraindicated in Parkinson’s disease Potential drug intervention with some SSRIs Avoid in patients who are having difficulty clearing secretions Do not use if on a sodium restricted diet Delsym Dextromethorphan 15 mg/5 mL (alcohol free/orange or grape flavor) Adult: 10 mL q 12 hr Children 6-12 years: 5 mL q 12 hr Children 4-6 years: 2.5 mL q 12 hr codeine/guaifenesin Adults and children ≥ 12 years: 10 mL q 4 hr prn cough Max: 6 doses in 24 hr Children 6-12 years: 5 mL q 4 hr prn cough Max: 6 doses in 24 Do not use if taking an MAO inhibitor or for 2 weeks after stopping an MAO inhibitor Contraindicated in Parkinson’s disease Potential drug interaction with Although antibiotics are commonly prescribed, they are NOT recommended. ACUTE BRONCHITIS PHARMACOLOGIC MANAGEMENT hr some SSRIs Schedule V medication Avoid in patients who are having difficulty clearing secretions Avoid narcotic cough suppressants in patient with COPD or asthma May be habit forming May aggravate constipation Robitussin AC Each 5 mL contains 100 mg guaifenesin and 10 mg codeine Antitussives Topical anesthetic effect on the respiratory stretch receptors benzonatate Adults and children > 10 years: 100-200 mg TID prn cough Max: 600 mg daily Do not break or chew capsule - can produce local anesthesia and may reduce patient’s gag reflex Monitor for dizziness, drowsiness and visual changes Begins to act in 15- 20 minutes and lasts for 3-8 hours Avoid use in patients sensitive to or taking agents with PABA - possible adverse CNS effects Tessalon Caps: 100 mg, 200 mg Expectorants guaifenesin Adult: 200-400 mg PO q 4 hr prn Max: 2400 mg/day Children 2-5 Caution if nephrolithiasis Caution in patients Although antibiotics are commonly prescribed, they are NOT recommended. ACUTE BRONCHITIS PHARMACOLOGIC MANAGEMENT years: 50-100 mg. PO q 4 hr prn Max: 600mg/ day Children 6-11 years: 100-200 mg PO q 4 hr prn Max: 1200 mg/day Children ≥12 years: 200-400 mg PO q 4 hr prn; Max: 2400 mg/day [Show More]
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