NR 661 Week 4 VISE Assessment, Familiarize Yourself Already Passed

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 infection or exposure ...

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 infection 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