We use cookies to give you the best experience possible. By continuing we’ll assume you’re on board with our cookie policy

Asthma revision Paper

Presenting Complaint

Persistent unrelieved cough, shortness of breath, tight feeling in the chest, and wheezing

Present Illness

The patient is a 67 year-old Chinese male. He was brought to his general physician with a history of fever and chills accompanied by productive coughing and difficulty of breathing two days prior to admission. Ventolin rotacaps was started but there was still persistence of cough associated with difficulty of breathing and orthopnea. His physician admitted him to the hospital for further evaluation, management, and treatment.

We will write a custom essay sample on Asthma revision specifically for you
for only $16.38 $13.9/page

Order now

Current Medications

Ventolin rotacaps aerosol inhaler was started as the patient’s initial medication. Salbutamol sulfate is the generic name for Ventolin rotacaps.[1]

Salbutamol is a bronchodilator used for the treatment of asthma, chronic bronchitis, and other breathing disorders. It works by opening the airways and making breathing easier.[2]

The usual dose to relieve asthma symptoms is 1-2 inhalations or “puffs”. More puffs may be needed to relieve symptoms during a more severe attack. The usual dose for long-term treatment of asthma is 1-2 puffs or 1 puff in children 6 years and older three or four times per day. The maximum daily dose is 8 puffs for adults and 4 puffs for children.[3]

For preventing exercise-induced asthma, the usual dose is 2 puffs before exercise for adults and 1 puff before exercise for children. Dosage is usually individualized by the doctor.[4] Anyone allergic to any of the ingredients and those with abnormal heart rhythm associated with fast heart rate should not use this drug.[5]

Side effects of Ventolin rotacaps include nervousness and or tremors or shakiness. Some patients may rarely experience dry or irritated throat. However, patients should check with their doctor as soon as the following side effects are experienced:[6]

Less common side effects

Rare side effects

§  headache

§  fast heartbeat

§  palpitations

§  transient muscle cramps

§  insomnia

§  nausea

§  weakness

§  dizziness
§  drowsiness

§  flushing

§  restlessness

§  irritability

§  chest discomfort or pain

§  difficulty urinating

§  increased blood pressure

§  vomiting

§  dizziness

§  increased alertness or hyperactivity

§  unusual taste in mouth

Patients who experience hives with swelling of lips, face, or throat; or difficulty breathing should get emergency medical attention, for this may mean hypersensitivity to the drug.[7]

Medical and Surgical History

The patient is positive for asthma and pulmonary tuberculosis (PTB). No other medical history or surgical history was presented.

Asthma is a disease characterized by an increased responsiveness of the trachea and bronchi to various stimuli. This disease is manifested by recurrent attacks of widespread narrowing of the airways, difficult breathing, wheezing and cough. It is most commonly an allergic reaction to some extrinsic allergen or may be triggered by infection termed infectious asthma, or may be associated with emotional stress.[8] Asthma cannot be cured, but most people with asthma can control it so that they have few and infrequent symptoms and can live active lives.[9]

Individuals with asthma often need quick-relieves or “rescue” medicines to stop asthma symptoms before they get worse. Short-acting inhaled beta-agonists may be used and preferred most as a quick-relief medicine. Such medicines are bronchodilators. They act quickly to relax tightened muscles around the airways so that the airways can open up and allow more air to flow through.[10]

Pulmonary tuberculosis (PTB), on the other hand, is a contagious bacterial infection caused by Mycobacterium tuberculosis (M. tuberculosis). The lungs are primarily involved, but the infection can spread to other organs.[11] This disease manifests itself by forming tubercles or lesions in the tissues affected, most commonly the lungs.[12] Pulmonary tuberculosis refers to tuberculosis of the lungs marked by ulceration and formation of cavities in the lungs.[13] It is attended by fever and cough.[14]

Examination of the lungs by stethoscope can reveal crackles or unusual breath sounds.[15] Enlarged or tender lymph nodes may be present in the neck or other areas.[16] Fluid may be detectable around a lung.[17] Clubbing of the fingers or toes may be present.[18]

The Directly Observed Treatment Short-course (DOTS) is the recommended strategy by the World Health Organization (WHO) for PTB control, which comprises Government commitment to ensuring sustained, comprehensive PTB control activities; Case detection by sputum smear microscopy among symptomatic patients self-reporting to health services; Standardized short-course chemotherapy using regimens of six to eight months, for at least all confirmed smear positive cases. Good case management includes directly observed therapy (DOT) during the intensive phase for all new sputum positive cases, the continuation phase of rifampicin-containing regimens and the whole re-treatment regimen; A regular, uninterrupted supply of all essential anti-PTB drugs; and a standardized recording and reporting system that allows assessment of case-finding and treatment results for each patient and of the PTB control program performance overall.[19]

Allergies

The patient experiences skin asthma due to fried eggs, chicken, and dairy products.

Skin asthma in Asia is called eczema. Eczema is a general term for an itchy red rash. It can range in size, from affecting a small area that looks like a little patch of dry skin, to the entire surface of the body. In the acute phase, the skin blisters, weeps and oozes serum. In its chronic phase it is dry, thick and scaly. The primary conventional treatment for eczema is corticosteroid ointments applied topically. In severe cases, oral steroids may be given. Dairy products, eggs, chicken and food additives, are irritants and should be the first on the list to eliminate.

Family and Social History

The patient’s family history is positive for hypertension. He is a widower. Two of his sons live with him. He stopped smoking in his 40s.

Hypertension or high blood pressure is defined as repeatedly elevated blood pressure exceeding 140 over 90 mmHg. It is treated with regular aerobic exercise, salt restrictions, medications, and if overweight – weight reduction.[20] Usually, no symptoms are present. Patient may occasionally experience a mild headache. Severe symptoms comprise severe headache, tiredness, confusion, vision changes, and angina-like chest pain, heart failure, blood in urine, nosebleed, irregular heartbeat, and ear noise or buzzing.[21]  Medications may include diuretics, beta-blockers, calcium channel blockers, angiotensin-converting enzyme (ACE) inhibitors, angiotensin receptor blockers (ARBs), or alpha blockers. Medications such as hydralazine, minoxidil, diazoxide, or nitroprusside may be required if the blood pressure is very high.[22]

Review of systems

Vital Signs:

                                   Patient                                                Normal

Blood Pressure:          170/100                                              120/80

Respirations:               22 breaths per minute                        12 to 20 breaths per minute

Pulse:                          92 beats per minute.                           60 to 100 beats per minute

Temperature:              99° F.                                                 98.6° F plus or minus 1° F

O2 Saturation:             95%                                                    95% to 100%

General Appearance:  conscious, coherent, ambulatory

Head:                          Normal

Ear:                             Normal

Eyes:                           Anicteric schlera (eyes not yellow); pinkish palpebral conjunctiva

Nose:                          Normal

Cardiovascular:          Adynamic precordium

Heart:                         Regular rhythm; negative murmur

Abdomen:                  Flat, soft, normal bowel sound

Skin:                           Warm; no pallor; no jaundice

Extremities:                Normal

Neurological:              Normal

Diagnostic Tests

1.      Complete Blood Count

The complete blood count (CBC) provides information about a person’s white blood cell, red blood cell and platelet count.  It is one of the most common tests performed and is an integral part of the diagnosis process.

Hematology
Patient Count
Normal Count
White Blood Cell (WBC)
9.0 K/UL
4.8 – 10.8 K/UL
Red Blood Cell (RBC)
5.5  M/UL
4.50 – 5.80 M/UL
Hemoglobin
16.2 GM/DL
13.6 – 17.2 GM/DL
Hematocrit
47 %
40.2 – 51.4 %
Platelet
350
160 – 400
Neutrophils
82% (High)
45 – 75%
Lymphocytes
18% (Low)
20 – 48%
Monocytes
5%
1 – 9%

The patient’s complete blood count indicated normal white blood cell count. Red blood cells were also within normal range. The same is true for hemoglobin, hematocrit, and platelet counts. However, neutrophils are increased with bacterial infection.[23] While lymphocytes are low at 18 percent. Monocytes are normal. A low lymphocyte count indicates immunodeficiency problems.[24] A sputum sample was obtained.  Sputum samples are collected to identify organisms infecting the airway.[25]

2.      Chest X-Ray

A chest x-ray was taken. Results revealed hazy opacities in both lungs, more in the right with cystic images in the upper lung zones. The heart and great vessels are normal in configuration. The left hemidiaphragm is flattened with tenting deformities in both hemidiaphragms. The left costophrenic sulcus is blunted. The bony thorax is intact.

Doctor’s impression was pulmonary tuberculosis with bullae / blebs. Pleurodiaphragmatic adhesions and pleural effusion and / or thickening on the left.

3.      Other Laboratory Results

Desired Test
Reference Values
Results
FBS
3.9 – 5.8
6.09 mmol/L
Creatinine
44 – 150
61.88 Vmol/L
Triglycerides
0.41 – 1.86
0.51 mmol/L
Cholesterol
3.09 – 5.8
5.6 mmol/L
HDL
1.3 – 3.15
3.32 mmol/L
LDL
Up to 3.9
2.05 mmol/L
Uric Acid
3.4 – 7.0
7.7 mg/L

4.      Clinical Microscopy

Color:              Yellow

Transparency: Turbid

Reaction / pH: 5.0

Specific gravity:

Albumin:         positive +

Sugar:             positive +

WBC:             3-6

RBC:              0-1

Epithelial Cells: None

Amorphous Urates / PO4: Moderate

Clinical microscopy includes urine and fluid analysis. Urine undergoes many changes during states of disease or body dysfunction before blood composition is altered to a significant extent. The procedure is useful as an indicator of health or disease, especially in the areas of metabolic and renal disorders.[26]

5.      Electrocardiogram (EKG)

QRS:                                      102 ms

QT/QTC:        270      /           407 ms

PR:                                         148 ms

P:                                            138 ms

RR/PP:            440      /           435 ms

P/QRS/T:        92/       91/       -61 Degrees

The patient’s electrocardiogram results revealed suspected arm lead reversal, interpretation assumes no reversal. Sinus tachycardia; rightward axis; incomplete right bundle branch block. Cannot rule out inferior infarct, age undetermined. Patient’s EKG is abnormal.

The EKG, a tracing of the electrical activity in the heart, is recorded on heat-sensitive graph paper. Time is measured horizontally, and voltage is measured vertically. On the EKG graph paper, one small square is equal to 0.04 seconds in time. One large square contains five of the small squares and, therefore, is equal to 0.20 seconds (ie, 5 x 0.04 seconds). A complete cardiac cycle (ie, one polarization and depolarization of the heart) is represented on the EKG by the letters P, Q, R, S, and T. Interval measurements (ie, PR, QRS, QT) on the EKG assess the length of time it takes an impulse to travel through the heart.[27] Please refer to Appendix 1 for normal and abnormal heart rhythms.

Day 2

Vital Signs:

                                   Patient                                                Normal

Blood Pressure:          140/90                                                120/80

Respirations:               21 breaths per minute                        12 to 20 breaths per minute

Pulse:                          110 beats per minute.                         60 to 100 beats per minute

Temperature:              99° F.                                                 98.6° F plus or minus 1° F

Breath sounds:                       Rhonchi

Rhonchi is an abnormal breath sound heard on auscultation indicating secretions in the airway.[28]

The following medications were thus initiated for the patient: D5W at 1L; ampoule aminophylline to run at 20 drops per minute. Salbutamol (ventolin volmax) was continued every 4 hours. Hydrocortisone 200mg IV every 6 hours. Cefuroxime 750 mg IV every 8 hours. Paracetamol 500mg tablet every 4 hours for fever, and O2 inhalation.

D5W at 1L is an intravenous solution (IV) used to supply water, calories, and electrolytes to the body.  It is also used as a mixing solution for other IV medications.[29]

Aminophylline is used to prevent and treat wheezing, shortness of breath, and difficulty breathing caused by asthma, chronic bronchitis, emphysema, and other lung diseases. It relaxes and opens air passages in the lungs, making it easier to breathe. Aminophylline controls symptoms of asthma and other lung diseases but does not cure them.[30]

Salbutamol is a bronchodilator used for the treatment of asthma, chronic bronchitis, and other breathing disorders. It works by opening the airways and making breathing easier.[31]

Hydrocortisone is a corticosteroid used to relieve inflammation characterized by swelling, heat, redness, and pain. The drug is injected or added to an intravenous fluid that will drip through a needle or catheter placed in the vein. Hydrocortisone is similar to a natural hormone produced by the adrenal glands. It is used to treat, but not cure, certain forms of arthritis; asthma; and skin, blood, kidney, eye, thyroid, and intestinal disorders. It is sometimes used to reduce side effects from other medications. This medication is sometimes prescribed for other uses also.[32]

Cefuroxime is used to treat certain infections caused by bacteria, such as bronchitis; gonorrhea; Lyme disease; and infections of the ears, throat, sinuses, urinary tract, and skin. Cefuroxime is in a class of medications called cephalosporin antibiotics. It works by stopping the growth of bacteria. Antibiotics will not work for colds, flu, or other viral infections.[33]

Paracetamol is classified as nonopioid analgesic and antipyretics. It is equivalent to acetaminophen or aspirin. It relieves pain by elevating the pain threshold.  It reduces fever through its action on the heat regulating center of the brain.  It is prescribed for the relief of fever as well as aches and pains.[34]

Day 3

Vital Signs:

                                   Patient                                                Normal

Blood Pressure:          170/80                                                120/80

Respirations:               27 breaths per minute                        12 to 20 breaths per minute

Pulse:                          129 beats per minute.                         60 to 100 beats per minute

Temperature:              99° F.                                                 98.6° F plus or minus 1° F

Medications added in day three was Felodipine (Dilofen) 5mg tablet OD. Salbutamol (Ventolin volmax) 4mg 2 tablets twice a day. D5W + 2 amps Aminophylline, Zertin 1 capsule twice a day, ciprofloxacin 500mg 1 tablet twice a day, and Streptomycin.

Felodipine is in a class of drugs called calcium channel blockers. Felodipine relaxes or widens the blood vessels (veins and arteries), which makes it easier for the heart to pump and reduces its workload. It is used to treat hypertension (high blood pressure).[35]

Zertin is a brand name of Cetirizine HCl, used to relieve symptoms of hay fever, seasonal allergy, and allergy to other substances (such as dust mites, animal dander, and molds), including runny nose; sneezing; and red, itchy, tearing eyes. It is also used to treat symptoms of hives, including itching and rash. Cetirizine is in a class of medications called antihistamines. It works by blocking histamine, a substance in the body that causes allergic symptoms.[36]

Ciprofloxacin is an antibiotic in a group of drugs called fluoroquinolones. Ciprofloxacin fights bacteria in the body.[37] Streptomycin on the other hand, is an antibiotic drug the first of a class of drugs called aminoglycosides.[38] It was the first antibiotic remedy for tuberculosis. Streptomycin stops bacterial growth by damaging cell membranes and inhibiting protein synthesis.[39]

Day 4

Vital Signs:

                                   Patient                                                Normal

Blood Pressure:          170/80                                                120/80

Respirations:               22 breaths per minute                        12 to 20 breaths per minute

Pulse:                          103 beats per minute.                         60 to 100 beats per minute

Temperature:              99° F.                                                 98.6° F plus or minus 1° F

Positive body weakness observed.

Patient was unable to sleep in day 4, doctor ordered diphenhydramine to be administered. Nebulization was revised to ambroxol. Hold salbutamol. Captopril 25mg was given and patient was connected to EKG. Moderate high back rest. Soft diet was advised.

Diphenhydramine is an antihistamine, relieves red, irritated, itchy, watery eyes; sneezing; and runny nose caused by hay fever, allergies, and the common cold. It also may relieve the itching of insect bites, sunburns, bee stings, poison ivy, poison oak, and minor skin irritation. Diphenhydramine is also used to prevent and treat motion sickness, induce sleep, treat Parkinson’s disease, and relieve cough caused by minor throat or airway irritation.[40]

Ambroxol is a strong expectorant; a metabolite of bromhexine. It is an expectoration improver and mucolytic agent used in the treatment of acute and chronic disorders characterized by the production of excess or thick mucus. It works to decrease mucus viscosity by altering its structure. [41]

Captopril is used to treat high blood pressure and heart failure. It decreases certain chemicals that tighten the blood vessels, so blood flows more smoothly and the heart can pump blood more efficiently.[42]

Day 5

Vital Signs:

                                   Patient                                                Normal

Blood Pressure:          140/90                                                120/80

Respirations:               21 breaths per minute                        12 to 20 breaths per minute

Pulse:                          94 beats per minute.                           60 to 100 beats per minute

Temperature:              99° F.                                                 98.6° F plus or minus 1° F

Hydrocortisone use reduced, nebulization reduced also.

Day 6

Vital Signs:

                                   Patient                                                Normal

Blood Pressure:          150/90                                                120/80

Respirations:               20 breaths per minute                        12 to 20 breaths per minute

Pulse:                          92 beats per minute.                           60 to 100 beats per minute

Temperature:              99° F.                                                 98.6° F plus or minus 1° F

Patient was considered stable. Patient and his family requested if they may be discharged to continue medications at home instead. On his exercise of his right to autonomy, the patient was prescribed home medicines: Salvex at 1 tablet 3 times a day; ciprofloxacin (zalvos) 1 tablet twice daily; allopurinol 300mg 1 tablet once a day only; felodipine 5mg 1 tablet once a day only; nifedipine 10 mg 1 tablet twice daily; fixcom 4 four tablets a day, salbutamol (volmax) 4mg twice daily. Patient was discharged and advised to return for a follow-up check up after 1 week.

Salvex is a brand name for the generic salbutamol. It is used for the treatment and prevention of bronchospasm in bronchial asthma, bronchitis, emphysema. And acute dyspnoea.[43]

Zalvos tablet is ciprofloxacin. It is used for the treatment of mild to moderate lower respiratory tract, skin and skin structure, bone and joint and gastrointestinal infection, septicemia, endocarditis, and urinary tract infections.[44]

Allopurinol is used to treat gout, high levels of uric acid in the body caused by certain cancer medications, and kidney stones. Allopurinol is in a class of medications called xanthine oxidase inhibitors. It works by reducing the production of uric acid in the body. High levels of uric acid may cause gout attacks or kidney stones. Allopurinol is used to prevent gout attacks, not to treat them once they occur.[45]

Felodipine is in a class of drugs called calcium channel blockers. It is used to treat high blood pressure. It relaxes the blood vessels so the heart will not have to pump as hard.[46]

Nifedipine is used to treat high blood pressure. It relaxes the blood vessels so the heart does not have to pump as hard. It also increases the supply of blood and oxygen to the heart to control chest pain or angina. If taken regularly, nifedipine controls chest pain, but it does not stop chest pain once it starts. [47]

Fixcom 4 is a drug that contains Rifampicin 150 mg, INH 75 mg, pyrazinamide 400 mg, ethambutol 275 mg. Fixcom 4 is used to treat pulmonary and extrapulmonary tuberculosis.[48]

Salbutamol is a bronchodilator used for the treatment of asthma, chronic bronchitis, and other breathing disorders. It works by opening the airways and making breathing easier.[49]

Discussion

The patient’s medical history along with a family history of hypertension made this a very challenging case. The hospital staff monitored the patient closely. They were observant to the slightest change in his condition. I feel that the patient should have remained in the hospital for a few days longer to ensure that his condition was stable and that he would not have further complications. However, patient was discharged on his exercise of his right to autonomy. Patient was provided with his home medication instruction sheet, and his attending physician advised him to return for follow up check up after a week.

The patient’s medical treatment was appropriate. Any changes observed in the patient were promptly recorded and relayed to the doctor who would manage his condition.

Appendix 1
Summary of Normal and Abnormal Heart Rhythms

Rate in beats
Rhythm        per minute

Normal sinus rhythm        Regular       60 to 100

Sinus tachycardia          Regular       100 to 160

Sinus bradycardia          Regular       < 60

Sinus arrest/pause         Irregular     Varying rates that can
become bradycardic

Premature atrial           Irregular     Follows underlying
contractions                             rhythm

Atrial fibrillation        Irregularly   160-180
Irregular

Atrial flutter             Regularly     Atrial rate: 240 to 300
irregular     Ventricular rate 120
to 150

Paroxysmal atrial          Regular       160 to 250
tachycardia

Premature junctional       Irregular     60 to 100
contractions

Junctional rhythm          Regular       40 to 60

Accelerated junctional     Regular       60 to 100
rhythm

Junctional tachycardia     Regular       100 to 180

Premature ventricular      Irregular     Based on underlying
contractions                             rhythm

Ventricular fibrillation   Irregular     Too fast to count

Ventricular tachycardia    Regular       100 to 250

First degree heart block   Regular       60 to 100

Second degree heart        Regular or    Atrial rate > ventricular
block (Type I)             irregular     rate

Second degree heart        Regular or    Atrial rate > ventricular
block (Type II)            irregular     rate

Third degree heart         Regular       Normal atrial rate;
block                                    slower ventricular rate

P wave to
P waves                  QRS ratio

Normal sinus rhythm        Identical and upright    1:1

Sinus tachycardia          Identical                1:1

Sinus bradycardia          Identical                1:1

Sinus arrest/pause         Appear different than    1:1
normal sinus beats

Premature atrial           Different                1:1
contractions               morphology

Atrial fibrillation        Not identifiable         Not
applicable

Atrial flutter             Not identifiable         2:1, 3:1, 4:1

Paroxysmal atrial          May not be               1:1
tachycardia                visible

Premature junctional       May proceed, occur       Decreased
contractions               with, or follow QRS      P:QRS ratio

Junctional rhythm          May proceed, occur
with, or follow QRS

Accelerated junctional     May proceed, occur
rhythm                     with, or follow QRS

Junctional tachycardia     May proceed, occur
with, or follow QRS

Premature ventricular      No P wave accompanying   Decreased
contractions               abnormal beat            P:QRS ratio

Ventricular fibrillation   No P wave

Ventricular tachycardia    Not identifiable         No P:QRS
ratio

First degree heart block   Identical                1:1

Second degree heart                                 P waves >
block (Type I)                                      QRS

Second degree heart                                 P waves >
block (Type II)                                     QRS

Third degree heart         No relationship
block                      between P waves
and QRS

PR interval           QRS width

Normal sinus rhythm        0.12 to 0.20          0.06 to 0.12

Sinus tachycardia          0.12 to 0.20          0.06 to 0.12
shortens with
increased rate

Sinus bradycardia          0.12 to 0.20          0.06 to 0.12

Sinus arrest/pause         0.12 to 0.20          0.06 to 0.12

Premature atrial           0.12 to 0.20          0.06 to 0.12
contractions                                     normal except
abnormal beats

Atrial fibrillation        Not measurable        < 0.10

Atrial flutter             No PR interval        < 0.10 flutter
waves resemble
sawtooth

Paroxysmal atrial          Difficult to          Normal or
tachycardia                measure               widened

Premature junctional       < 0.20; surrounding   Normal or
contractions               PR are normal         widened

Junctional rhythm          Variable              < 0.12

Accelerated junctional     Variable              < 0.12
rhythm

Junctional tachycardia     < 0.12                < 0.12

Premature ventricular      No PR interval        Broad, increased
contractions                                     amplitude

Ventricular fibrillation   None                  Coarse, fine,
or zigzag

Ventricular tachycardia    None                  Broad and
> 0.12

First degree heart block   Prolonged > 0.20      Normal

Second degree heart        Progressively         0.10 or less
block (Type I)             longer

Second degree heart        Constant except       0.10 or less
block (Type II)            for dropped beat

Third degree heart         NA                    Depends on
block                                            location of escape
pacemaker

Treatment

Normal sinus rhythm        Not necessary

Sinus tachycardia          Treat the cause

Sinus bradycardia          Oxygen ([O.sub.2]), warming blankets, IV
atropine, if needed (PRN)

Sinus arrest/pause         IV atropine, pacemaker PRN

Premature atrial           [O.sub.2], correct electrolyte imbalance,
contractions               treat pain

Atrial fibrillation        [O.sub.2], digoxin, synchronized
cardio-version, anticoagulation therapy

Atrial flutter             Antiarrhythmic medications, cardio-version,
rapid atrial pacing

Paroxysmal atrial          [O.sub.2], IV adenosine, vagal maneuvers
tachycardia

Premature junctional       Seldom treated
contractions

Junctional rhythm          [O.sub.2], IV fluids pacemaker

Accelerated junctional     Relieve symptoms
rhythm

Junctional tachycardia     [O.sub.2], vagal maneuvers, synchronized
cardioversion

Premature ventricular      No treatment unless symptomatic
contractions

Ventricular fibrillation   Defibrillation, IV medications,
cardiopulmonary resuscitation (CPR)

Ventricular tachycardia    Procainamide, cardioversion or
defibrillation and CPR if no pulse

First degree heart block   Observe for progression to 2nd or
3rd degree block

Second degree heart        [O.sub.2], IV therapy, IV medications,
block (Type I)             transcutaneous or transvenous pacing

Second degree heart        [O.sub.2], IV therapy, IV medications,
block (Type II)            transcutaneous or transvenous pacing

Third degree heart         [O.sub.2], IV therapy, IV medications,
block                      transcutaneous or transvenous pacing

References

[1] Nursing 2005 Drug Handbook. 25th Anniversary Edition. Ambler, PA: Lippincott Williams & Wilkins, 2005.
[2] Nursing 2005 Drug Handbook. 25th Anniversary Edition. Ambler, PA: Lippincott Williams & Wilkins, 2005.
[3] Nursing 2005 Drug Handbook. 25th Anniversary Edition. Ambler, PA: Lippincott Williams & Wilkins, 2005.
[4] Nursing 2005 Drug Handbook. 25th Anniversary Edition. Ambler, PA: Lippincott Williams & Wilkins, 2005.
[5] RXMed. Retrieved on March 1, 2007 from http://www.rxmed.com/b.main/b2.pharmaceutical/b2.1.monographs/CPS-%20Monographs/CPS-%20(General%20Monographs-%20V)/VENTOLIN.html
[6] RXMed. Retrieved on March 1, 2007 from http://www.rxmed.com/b.main/b2.pharmaceutical/b2.1.monographs/CPS-%20Monographs/CPS-%20(General%20Monographs-%20V)/VENTOLIN.html
[7] RXMed. Retrieved on March 1, 2007 from http://www.rxmed.com/b.main/b2.pharmaceutical/b2.1.monographs/CPS-%20Monographs/CPS-%20(General%20Monographs-%20V)/VENTOLIN.html
[8] Biagio John, Melloni. Melloni’s Illustrated Medical Dictionary. Baltimore: The Williams & Wilkins Company, 1979.
[9] National Heart, Lung, and Blood Institute. Diseases and Conditions Index. Asthma. 2006. Retrieved on March 1, 2007 from http://www.nhlbi.nih.gov/health/dci/Diseases/Asthma/Asthma_WhatIs.html
[10] National Heart, Lung, and Blood Institute. Diseases and Conditions Index. Asthma. 2006. Retrieved on March 1, 2007 from http://www.nhlbi.nih.gov/health/dci/Diseases/Asthma/Asthma_WhatIs.html
[11] Pulmonary Tuberculosis. Medline Plus. U.S. National Library of Medicine and the National Institutes of Health. Retrieved on March 2, 2007 from http://www.nlm.nih.gov/medlineplus/ency/article/000077.htm
[12] Biagio John, Melloni. Melloni’s Illustrated Medical Dictionary. Baltimore: The Williams & Wilkins Company, 1979.
[13] Biagio John, Melloni. Melloni’s Illustrated Medical Dictionary. Baltimore: The Williams & Wilkins Company, 1979.
[14] Biagio John, Melloni. Melloni’s Illustrated Medical Dictionary. Baltimore: The Williams & Wilkins Company, 1979.
[15] Pulmonary Tuberculosis. Medline Plus. U.S. National Library of Medicine and the National Institutes of Health. Retrieved on March 2, 2007 from http://www.nlm.nih.gov/medlineplus/ency/article/000077.htm
[16] Pulmonary Tuberculosis. Medline Plus. U.S. National Library of Medicine and the National Institutes of Health. Retrieved on March 2, 2007 from http://www.nlm.nih.gov/medlineplus/ency/article/000077.htm
[17] Pulmonary Tuberculosis. Medline Plus. U.S. National Library of Medicine and the National Institutes of Health. Retrieved on March 2, 2007 from http://www.nlm.nih.gov/medlineplus/ency/article/000077.htm
[18] Pulmonary Tuberculosis. Medline Plus. U.S. National Library of Medicine and the National Institutes of Health. Retrieved on March 2, 2007 from http://www.nlm.nih.gov/medlineplus/ency/article/000077.htm
[19] World Health Organization. Pulmonary Tuberculosis. Retrieved on February 28, 2007 from www.who.org
[20] Hypertension. MedicineNet.com. Retrieved on February 28, 2007 from http://www.medterms.com/script/main/art.asp?articlekey=3846
[21] Medline Plus Medical Encyclopedia. Hypertension. U.S. National Library of Medicine and the National Institutes of Health. Retrieved on March 2, 2007 from http://www.nlm.nih.gov/medlineplus/ency/article/000468.htm
[22] Medline Plus Medical Encyclopedia. Hypertension. U.S. National Library of Medicine and the National Institutes of Health. Retrieved on March 2, 2007 from http://www.nlm.nih.gov/medlineplus/ency/article/000468.htm
[23] Wilkins, Stoller, Scanlan.  Egan’s Fundamentals of Respiratory Care.  Eighth edition. Missouri: Mosby, Inc., 2003.
[24] Wilkins, Stoller, Scanlan.  Egan’s Fundamentals of Respiratory Care.  Eighth edition. Missouri: Mosby, Inc., 2003.
[25] Wilkins, Stoller, Scanlan.  Egan’s Fundamentals of Respiratory Care.  Eighth edition. Missouri: Mosby, Inc., 2003.
[26] Oregon Health and Science University. Urinalysis Procedure. Retrieved on March 2, 2007 from http://www.ohsu.edu/pathology/POC/procedures/urinalysis.pdf
[27] Hutchinson, Bettyman. Basic electrocardiogram interpretation for perioperative nurses. 1999.
[28] Wilkins, Stoller, Scanlan.  Egan’s Fundamentals of Respiratory Care.  Eighth edition.

Missouri: Mosby, Inc., 2003.
[29] Spratto, Woods.  PDR Nurse’s Drug Handbook.  New Jersey:  Delmar Publishers, 2001
[30] Medline Plus Drug Information. Aminophylline. U.S. National Library of Medicine and the National Institutes of Health. Retrieved on March 2, 2007 from http://www.nlm.nih.gov/medlineplus/druginfo/medmaster/a601015.html
[31] Nursing 2005 Drug Handbook. 25th Anniversary Edition. Ambler, PA: Lippincott Williams & Wilkins, 2005.
[32] Medline Plus Drug Information. Hydrocortisone injection. U.S. National Library of Medicine and the National Institutes of Health. Retrieved on March 2, 2007 from http://www.nlm.nih.gov/medlineplus/druginfo/medmaster/a682871.html
[33] Medline Plus Drug Information. Cefuroxime. U.S. National Library of Medicine and the National Institutes of Health. Retrieved on March 2, 2007 from http://www.nlm.nih.gov/medlineplus/druginfo/medmaster/a601206.html
[34] Nursing 2005 Drug Handbook. 25th Anniversary Edition. Ambler, PA: Lippincott Williams & Wilkins, 2005.
[35] Nursing 2005 Drug Handbook. 25th Anniversary Edition. Ambler, PA: Lippincott Williams & Wilkins, 2005.
[36] Medline Plus Drug Information. Cetirizine. U.S. National Library of Medicine and the National Institutes of Health. Retrieved on March 2, 2007 from http://www.nlm.nih.gov/medlineplus/druginfo/medmaster/a698026.html
[37] Nursing 2005 Drug Handbook. 25th Anniversary Edition. Ambler, PA: Lippincott Williams & Wilkins, 2005.
[38] Nursing 2005 Drug Handbook. 25th Anniversary Edition. Ambler, PA: Lippincott Williams & Wilkins, 2005.
[39] Nursing 2005 Drug Handbook. 25th Anniversary Edition. Ambler, PA: Lippincott Williams & Wilkins, 2005.
[40] Medline Plus Drug Information. Diphenhydramine. U.S. National Library of Medicine and the National Institutes of Health. Retrieved on March 2, 2007 from http://www.nlm.nih.gov/medlineplus/druginfo/medmaster/a682539.html
[41] http://www.mucosolvan.com/com/Main/mucosolvan/agent/index.jsp
[42] Medline Plus Drug Information. Captopril. U.S. National Library of Medicine and the National Institutes of Health. Retrieved on March 2, 2007 from http://www.nlm.nih.gov/medlineplus/druginfo/medmaster/a682823.html
[43] MIMS Drug Information. Salvex. Retrieved on March 3, 2007 from http://www.mims-online.com/mimsonline/drugdetails.aspx?id=3442&dcname=Ph&SearchType=Brand
[44] MIMS Drug Information. Zalvos Tablet. Retrieved on March 3, 2007 from http://www.mims-online.com/mimsonline/drugdetails.aspx?id=3792&dcname=Ph&SearchType=Brand
[45] Medline Plus Drug Information. Allopurinol. U.S. National Library of Medicine and the National Institutes of Health. Retrieved on March 2, 2007 from http://www.nlm.nih.gov/medlineplus/druginfo/medmaster/a682673.html
[46] Nursing 2005 Drug Handbook. 25th Anniversary Edition. Ambler, PA: Lippincott Williams & Wilkins, 2005.
[47] Nursing 2005 Drug Handbook. 25th Anniversary Edition. Ambler, PA: Lippincott Williams & Wilkins, 2005.
[48] MIMS Drug Information. Fixcom 4 Tablet. Retrieved on March 3, 2007 from http://www.mims-online .com / mimsonline / drugdetails . aspx?id = 4947 & dcname = Ph&SearchType = Brand
[49] Nursing 2005 Drug Handbook. 25th Anniversary Edition. Ambler, PA: Lippincott Williams & Wilkins, 2005.

How to cite this page

Choose cite format:

Asthma revision. (2018, Sep 08). Retrieved from https://paperap.com/paper-on-asthma-revision/

We will write a custom paper sample onAsthma revisionspecifically for you

for only $16.38 $13.9/page
Order now

Our customer support team is available Monday-Friday 9am-5pm EST. If you contact us after hours, we'll get back to you in 24 hours or less.

By clicking "Send Message", you agree to our terms of service and privacy policy. We'll occasionally send you account related and promo emails.
No results found for “ image
Try Our service