Nursing Care of Dyspnea: The 6th Vital Sign in Individuals with ...

Nursing Care of Dyspnea: The 6th Vital Sign in Individuals with Chronic Obstructive Pulmonary Disease (COPD)MedicationsInhaled/Oral SteroidsGlucocoticosteriods (inhaled)beclomethasone• Alti-beclomethasone® MDI (CFC)50µg• QVAR® MDI(HFA) 50 µg, 100 µgbudesonide• Pulmicort® Nebuamp® WetNebulization 0.125 mg/ml, 0.25mg/ml and 0.5 mg/ml• Pulmicort® Turbuhaler® PD100µg, 200 µg, and 400 µgfluticasone• Flovent® Diskus® PD 50 µg, 100µg, 250 µg, and 500 µg• Flovent® MDI(HFA) 50 µg, 125 µg,and 250 µgGlucocorticosteroids (oral):prednisone• Prednisone 5 mg and 50 mg tablets• Deltasone® 5 mg and 50mg tabletsmethylprednisolone• Medrol® 4 mg tablets and 16 mgtabletsCorticosteroids (intravenous):methylprednisoloneSoluCortef ®SoluMedrol ®Actions• Prevents andsuppressesactivation andmigration ofinflammatory cells• Reduces airwayswelling, mucusproduction, andmicrovascularleakage• Increasesresponsiveness ofsmooth musclebeta receptorsSide EffectsInhaled route• sore throat• hoarse voice• thrushOral or IV route-shortterm (less than 2 weeks):• weight gain• increased appetite• mood changes• easy bruising• muscle cramps• mild reversible acneOral route-long term(more than 2 weeks):• adrenal suppression• immuno-suppression• osteoporosis• hyperglycemia• hypertension• weight gain• cataracts• glaucoma• peptic ulcer• ecchymosis• avascular necrosis ofthe hipPharmacokineticsbeclomethasoneAbsorption: 20%Distribution: 10-25% in airways(no spacer)Metabolism: minimalExcretion: less than 10% inurine/fecesHalf-Life: 15 hrsbudesonideAbsorption: 39%Distribution: 10-25% in airways(no spacer)Metabolism: liverExcretion: 60% urine, smalleramounts in fecesHalf-Life: 2-3 hrsfluticasoneAbsorption: 30% aerosol, 13.5% powderDistribution: 10-25% in airways(no spacer), 91% protein bindingMetabolism: liverExcretion: less than 5% in urine,97-100% in fecesHalf-Life: 14 hrsprednisoneAbsorption: well absorbedDistribution: widely distributed;crosses placentaMetabolism: liver, extensivelyExcretion: urine, breast milkHalf-Life: 3-4 hrsIV steroids:Absorption: rapidDistribution: widely distributedMetabolism: liverExcretion: urineHalf-Life: 18 to 36 hrs, depending onthe drugNursing ConsiderationsRinsing, gargling andexpectorating afterinhalation can minimizethese side effects.A spacer should beused with MDIs toreduce side effects.Assess denture fit toavoid thrush.Rinse mouth, also priorto reinsertion of dentures.May irritate gum line andmedication deposits mayaccumulate inimproper fitting dentures.Promote good dentalhygiene.Assess baseline bonedensity.Dietary education(calcium, protein)Promote eye/dentalhealth and regulareye/teeth examinations.Monitor glucose level.Skin care education re:dry, thin, bruising.Avoid use of adhesivebandages. Use VitaminE lotion.116