assessment question

[zacarias, ASN, RN]

OK,

Last night was a very hard night. I had one guy almost going to code from COPD, but we managed to prevent that. He is SO end-stage COPD. Anyway, besides him, I had another pt with failure to thrive, pneumonia who is going hospice...anyway, I was worried she sounded overloaded but needed help to listen to her back. The charge nurse and I both listened and agreed that she actually had no crackles, just some rhonchi cuz she was snoring LOL. Anyway, respiratory therapy before this had come in and said she sounded wet. My question is, I know RTs have in depth training on respiratory issues but this lady was not overtly "wet" in her lungs. I know lung assessment is often subjective but what gives here???

Also, I've been around Xopenex, Albuterol, and Atrovent since a nurse but I'm not sure exactly the distinction or why one is better than the other. Can anyone help explain. I think Xopenex is supposed to be easier on the heartrate??

Thanks

[loafin']

OK,

Last night was a very hard night. I had one guy almost going to code from COPD, but we managed to prevent that. He is SO end-stage COPD. Anyway, besides him, I had another pt with failure to thrive, pneumonia who is going hospice...anyway, I was worried she sounded overloaded but needed help to listen to her back. The charge nurse and I both listened and agreed that she actually had no crackles, just some rhonchi cuz she was snoring LOL. Anyway, respiratory therapy before this had come in and said she sounded wet. My question is, I know RTs have in depth training on respiratory issues but this lady was not overtly "wet" in her lungs. I know lung assessment is often subjective but what gives here???

Also, I've been around Xopenex, Albuterol, and Atrovent since a nurse but I'm not sure exactly the distinction or why one is better than the other. Can anyone help explain. I think Xopenex is supposed to be easier on the heartrate??

Thanks

I will address your question regarding the respiratory meds.

Both xopenex and albuterol are both beta2 agonist or sympathomimetics. The medications bind to beta2 receptor sites in the bronchial smoothe muscle causing relaxation. I will explain the difference between these two as I understand it. Albuterol is made up of two isomers, an R-isomer(1.25mg) and an S-isomer(1.25mg), making the 2.5mg dose. The S-isomer once thought to be inert is now being shown to have detrimental effects such as causing bronchoconstriction. Xopenex is actually the R-isomer(responsible for bronchodilation) only of albuterol. Essentially the same medication excluding the S-isomer. Now, the decreased cardiac side effects associated with xopenex is the standard adult dose of 0.63mg(also comes in 1.25mg and 0.31mg) which is actually 1/2 albuterol minus S-isomer. Either med may cause cardiac side effects, but 0.63mg xopenex is less likely than 2.5mg albuterol.

Ok, atrovent like atropine is an anticholinergic or parasympatholytic. Atrovent blocks the parasympathic response of causing bronchoconstriction, just like atropine blocks it's response of slowing heart rate.

A sympathomimetic and a parasympatholytic can be very effective in promoting and prolonging bronchodilation.

Hope this helps.