CPT and Nebulizer Students' Preparation Sheet

Week 2 Preparation Sheet

Date & Time Theory Preparation Clinical Preparation Content Location of Content Materials to
Content Clinical lab Bring
22,23,24 Feb 2022 Altered Respiratory Preparation
Tuesday 09:00- Function  Elsevier Module (NU 201 CPT and El Sevier sheet
16:00 nebulizer skills lab 2022) Handout Clinical
Wednesday 08:00-  Theory content: Health Restoration: London Textbook equipment
16:00 Altered Respiratory Function in the Chapter Complete
Thursday 08:00- Child Commonalities ( Acute & uniform
15:00 Chronic Respiratory Issues)

Case study 1
Tamer is a 7-year-old living at home with his parents and three other siblings. Two siblings are older and one sibling is younger. Tamer
developed asthma when he was a baby. Both of his parents are smokers but they do not smoke in the house. He has one cat and one dog
that live in the house with them. He has to use his albuterol metered-dose inhaler (MDI) on a daily to every-other-day basis. In certain
seasons, he appears to have asthmatic episodes more frequently. His mother administers diphenhydramine (Benadryl) for his runny nose
in spring and winter months. He only visits the health care provider (HCP) every 6 months and as needed. He has not been to the
emergency department since 1 year ago when he had the pulmonary function tests (PFTs) completed. They were within desirable limits
at that time.

Questions to answer prior to the scheduled simulation:

1. Based on this information, what patient education is essential to provide to the parents in managing the asthma?
1. _______avoid contact with the dog and cat to avoid allergy__________
2. _______encourage CPT for child__________
3. ________take the medication regularly as prescribed_________
4. _________encourage regular flow up________
5. _____________take bronchodilator medication if asthmatic episodes occur____
2. Asthma is a chronic airway disorder characterized by hyper responsiveness, airway edema, and mucus production, which accounts for
13 million lost school days per year.
______ True
______ False
1. The only inhalant rescue drug for managing an asthmatic episode that is available as an MDI or nebulizer is which medication?
A. Ipratropium
B. Prednisolone
C. Fluticasone
D. Albuterol
4. Match the respiratory terms in Column A to the correct description in Column B.

Column A Column B
A. Cyanosis ( E ) Wet crackling sounds in the lungs
B. Wheezing ( H ) A collapsed or airless portion of the lung
C. Tachypnea ( I ) Enlargement of terminal phalanx of fi nger(s)
D. Hypoxia ( G ) High-pitched inspiration due to obstruction
E. Rales ( C ) Increased respiratory rate
F. Rhonchi ( D ) Oxygen deficiency
G. Stridor ( B ) High-pitched musical sound on expiration
H. Atelectasis ( A ) Blue-tinged skin or mucous membranes
I. Clubbing ( F ) Low-pitched snoring sound in lungs
J. Retractions ( J ) Inward pulling of soft tissue with respiration

5. There are numerous patient education programs for educating others about asthma. Look at the CDC to search for this information to
promote a nation of breathing easier.
 In Search box, type in www.cdc.gov/asthma
In 2020, how many children suffered from asthma?
Asthma affects around 5.1 million children under the age of 18.

6. When administering MDIs to children, best practices do not require the use of an aerochamber to increase the bioavailability of
medication in the lungs.
______ True
______ False
7. Chest percussion, vibration, and postural drainage are indicated for pediatric patients with which of the following conditions? Select
all that apply
A. Asthma
B. Cystic fibrosis (CF) Pneumonia
C. COPD
D. Pneumonia
E. Respiratory distress

8. When teaching the family how to provide CPT and postural drainage for their loved one at home, what instructions does the nurse
provide?
Bronchodilator should give before postural drainage, percussion
best times for treatments are usually in the morning before breakfast and 1 hour before bedtime.

9. The physician has ordered that the patient receive percussion and vibration to help clear airway secretions for the anterior apical lobe.
Where must the nurse place her hands during percussion and vibration and what about the appropriate postural drainage?

Position baby at sitting position at semi fowler and percuss at shoulder with finger at clavicles

10. The adolescent patient is very frail and thin and has osteoporosis, has just undergone abdominal surgery, and is at risk for developing
respiratory complications. What is the best technique for controlling respiratory secretions in this patient?

Encourage cough exercise

11. You are required to do your drug research for the bellow medications:

Budesonide
(Pulmicort)
Trade name Pulmicort
Generic name budesonide
action anti-inflammatory and immune modifier, Decreased frequency and severity of
asthma attacks. Improves asthma symptoms.
Safe dose 0.5 mg once daily or 0.25 mg twice daily (not to exceed 0.5 mg/day);
Side effect Common: Headache, dysphonia, hoarseness.
Dizziness, wheezing
Nursing consideration Monitor for signs and symptoms of hypersensitivity reactions (rash, pruritis,
swelling of face and neck, dyspnea) periodically during therapy
May cause increase serum and urine glucose concentrations if significant
absorption occurs.
Monitor respiratory status and lung sounds. Assess pulmonary function tests
periodically during and for several months after a transfer from systemic to
inhalation corticosteroids.

Fluticasone
(Flovent)
Trade name Flovent
Generic name Fluticasone
action Decrease in symptoms of allergic or nonallergic rhinitis.
Decrease in symptoms of nasal polyps.
anti-inflammatory and immune modifier.
Safe dose sprays in each nostril twice daily, may be increase to 2 sprays in each nostril 3 times daily
Side effect dizziness, headache, nasal irritation, dry mouth, nausea, vomiting
Nursing consideration Monitor degree of nasal stuffiness, amount and color of nasal discharge, and frequency
of sneezing.
Patients on long-term therapy should have periodic otolaryngologic examinations to
monitor nasal mucosa and passages for infection or ulceration.
Monitor growth rate in children receiving chronic therapy; use lowest possible dose.

Ipratropium (Atrovent)
Trade name Atrovent
Generic name Ipratropium
action Inhibits cholinergic receptors in bronchial smooth muscle, resulting in decreased
concentrations of cyclic guanosine monophosphate (cGMP). Decreased levels of cGMP
produce local bronchodilation.
Safe dose —250– 500 mcg 4 times daily given
Side effect dizziness, headache, nervousness, blurred vision, sore throat;
Nursing consideration Assess for allergy to atropine and belladonna alkaloids; patients with these allergies may
also be sensitive to ipratropium.
Assess respiratory status (rate, breath sounds, degree of dyspnea, pulse) before
administration and at peak of medication.

Albuterol (Proventil,
Ventolin)
Trade name Proventil, Ventolin
Generic name Albuterol
action cyclic-3, 5-adenosine monophosphate (cAMP). Increases in cAMP activate kinases, which
inhibit the phosphorylation of myosin and decrease intracellular calcium. Decreased
intracellular calcium relaxes smooth muscle airways. Relaxation of airway smooth muscle
with subsequent bronchodilation. Relatively selective for beta2 (pulmonary) receptors.
Safe dose 2 mg 3– 4 times daily or 0.3– 0.6 mg/kg/day as extended-release tablets divided twice
daily;
Side effect nervousness, restlessness, tremor, chest pain, palpitations
Nursing consideration Assess lung sounds, pulse, and BP before administration and during peak of medication.
Note amount, color, and character of sputum produce
Observe for paradoxical bronchospasm (wheezing). If condition occurs, withhold
medication and notify health care professional immediately.
Instruct patient to notify health care professional if there is no response to the usual
dose or if contents of one canister are used in less than 2 wk.

Salmeterol (Serevent)
Trade name Serevent
Generic name Salmeterol
 action Produces accumulation of cyclic adenosine monophosphate (cAMP) at beta2-adrenergic
receptors. Relatively specific for beta (pulmonary) receptors. Therapeutic Effects:
Bronchodilation
Safe dose 50 mcg (1 inhalation) twice daily (approximately 12 hr apart).
Side effect headache, nervousness , dizziness
Nursing consideration Assess lung sounds, pulse, and BP before administration and periodically during therapy
Toxicity and Overdose: Symptoms of overdose include persistent agitation, chest pain or
discomfort, decreased BP
May cause serum potassium concentrations, which are usually transient, and dose
related; rarely occurs at recommended doses and is more pronounced with frequent use
of high doses

Racemic epinephrine
Trade name Anapen Junior
Generic name epinephrine
action Results in the accumulation of cyclic adenosine monophosphate (cAMP) at beta-
adrenergic receptors. Affects both beta1(cardiac)-adrenergic receptors and
beta2(pulmonary)-adrenergic receptor sites. Produces bronchodilation.
Safe dose 0.01 mg/kg (not to exceed 0.3 mg/dose)
Side effect angina, arrhythmias, hypertension, tachycardia.
Nursing consideration Assess lung sounds, respiratory pattern, pulse, and BP before administration and during
peak of medication.
Observe for paradoxical bronchospasm (wheezing). If condition occurs, withhold
medication, and notify health care professional immediate

You need to come with three questions:

Q1:
Q2"
Q3:
Resource:
You want to provide Derrick and his family with an action plan and other resources to take home with them, so you provide the
following:
 American Lung Associations :Asthma Action Plan : goo.gl/r44xne
 CDC’s brochures:
 You Can Control Asthma : A Guide to Understanding Asthma and Its Triggers: goo.gl/zTlW8s
 CDC’s podcasts:
Don’t Let Asthma Keep You Out of the Game: goo.gl/wZ9EiS
 [NU 201 Family Focused Nursing Practice]

Related key words:

(Asthma triggers, Asthma Overview, Asthma Pathophysiology, Asthma Etiology, chest physiotherapy, postural drainage, percussion and vibration)

The student needs to bring the following equipment to all clinical experiences:
- Alcohol hand gel - Pencil - Watch - Stethoscope - Measuring tape - Pain assessment tool - Penlight - Scissor - Calculator
Template Submission Details

Submitted By Heba Boshra -Clinical instructor

Approval Curriculum Committee

Authority

Date of Approval: 21-02-2019

Dates
Date of Commencement: 01-04-2019

GTNI Family Focused Nursing Practice Student-Preparation Sheet-Nebulizer and CPT NU201 2022