Respiratory Medication Updates for Advanced Practice Clinicians: Proven Strategies for Prescription Success
Nurse practitioners, physician assistants and physicians have confided in me that they felt apprehension ordering respiratory medications due to an inability to stay current on pharmacology best practices and the complexity required to manage multiple conditions or symptoms at once. It can feel overwhelming. I certainly understand that we want to help our patients achieve their best outcomes. We also certainly don’t want to contribute to dire patient consequences.
I have been able to assist countless healthcare providers to overcome their prescriptive and administration fears. One particular nurse stands out in my memory. She was scared. And absolutely refused to give a prescribed medication to a patient on our unit. We went together, and both delivered the medication that the patient needed. After a “thank you” and many years later, she became a highly respected nurse practitioner with the Pulmonary Division of our institution. She never gave up and kept asking questions. She wanted to learn, and that curiosity to learn propelled her to high achievement in her specialty.
As we walk together through this essential content, I will present real world case studies to reinforce key points, whether you work in an inpatient or outpatient setting. I will talk through assessment findings and laboratory results to guide expert level pharmacology decisions. You will conclude this comprehensive respiratory medication update with all the information, the evidence and best practice guidance to feel confident with your prescriptive decision making.
Program Information
Objectives
Differentiate the two receptors in the lungs which are responsible for airway constriction and dilation.
Analyze the medication options for patients with alpha-1 anti-trypsin deficiency.
Choose the medications which are prescribed for asthma and COPD.
Determine the medications which are used during acute asthma attack.
Evaluate the vaccines recommended for patients with pulmonary conditions.
Manage the medications which are recommended for the COVID-19 patient both out- and in-patient.
Formulate a medication regimen for a tuberculosis patient, both newly diagnosed and with drug-resistant tuberculosis.
Plan the treatment protocol for a patient with pulmonary hypertension.
Distinguish between antiviral medications for viral respiratory diseases.
Choose the best antibiotic for the in- and out-patient with bacterial pneumonia.
Outline
Pulmonary Anatomy, Physiology & Lung Receptors
Pulmonary ventilation key factors
Improve diffusion of CO2 and O2 are dependent on a specific variable
Variables that affect the transport of CO2 and O2 at the cellular level
Muscarinic and beta-2 receptors in the lung are vital for airway dilation – but how much?
Club cell and columnar cell for airway patency
Role of the sympathetic and parasympathetic nervous system in airway disease
Alpha-1 Antitrypsin Deficiency
Why are levels of alpha-1 antitrypsin reduced in some people?
Medications to treat alpha-1 antitrypsin deficiency
Monitoring patient parameters after administering medications
Asthma – Not Just Bronchodilators Anymore
How is asthma diagnosed?
Role of white blood cells, histamine & the arachidonic pathway in asthma
Medications that affect IgE mediator release - a major contributor to asthma
Global Initiative for Asthma (GINA) medication options
Role of corticosteroids in asthma treatment
Short acting beta agonists (SABA) & long-acting beta agonists (LABA) - the difference and monitoring parameters
Muscarinic antagonists, leukotriene modifiers & phosphodiesterase inhibitors - must know indications and contraindications to treat the asthma patient
Monoclonal antibodies for asthma relief
Chronic Obstructive Pulmonary Disease (COPD) – Long Term Pharmacologic Therapies
COPD causes, symptoms and diagnostic tests
Non-pharmacologic treatments
SABA and LABA - when and how much
Inhaled corticosteroids alone or in combination with bronchodilators
Vaccines are a must – which ones and at what age to administer
SARS-CoV2, COVID-19 – what is new … A LOT!!!
Pathophysiology of SARS-CoV2
Is the virus only transmitted via air … you have to see this data?
Laboratory parameters for SARS-CoV2
How effective are all those COVID-19 vaccines?
Which antiviral medications are FDA approved and which are still in clinical trials?
Baricitinib and Tocilizumab show a lot of promise
So, what about Ivermectin – data on its effectiveness
Dexamethasone is effective, but only in certain patient populations
Cystic Fibrosis (CF)
Role of genetics and genetic testing in development of CF
CF affects more than the lungs
What medications are prescribed and routes of administration
Role of monoclonal antibodies – what you must monitor in your patient for these medications
Tuberculosis (TB): Still prevalent & Highly Contagious
What is Mycobacterium tuberculosis and how is it detected?
Geographic concerns for newly diagnosed and multi-drug resistant-TB
First line medications for drug susceptible TB (doses, how often & how long to take)
Multi-drug resistant TB treatments
Pulmonary Hypertension
Diagnosis of pulmonary hypertension
12-lead ECG results in a patient with pulmonary hypertension
World Health Organization (WHO) treatment classifications
How to choose between calcium channel blockers, phosphodiesterase inhibitors, endothelin receptor antagonizes and prostacyclin agonists
Bacterial and viral pathogens associated with acute bronchitis
Clinical features - from days to weeks after infection
Role of dextromethorphan – watch out for this side effect
Decide between an anti-viral or antibacterial - look for this in your patient
Aspergillosis
Causes and who is at risk for aspergillosis
Voriconazole, Posaconazole, Amphotericin B – these are the “must do” monitoring parameters
Legionnaires Disease
Which test should be used to diagnose Legionnaires Disease - urine, blood culture or polymerase chain reaction
Patient susceptibility to Legionnaires Disease
Ciprofloxacin, Moxifloxacin, Clarithromycin, Erythromycin, Amikacin, Levofloxacin, Azithromycin - look carefully at the indications and contraindications
Pertussis (Whooping Cough) – Still Present Despite Vaccinations
Three phases of pertussis
Medications and monitoring parameters
Pharmacology for cough suppression
Pneumonia
Community acquired, hospital acquired & ventilator associated
Community acquired treatment options
Options for antibiotics based on patient history
Hospital acquired pharmacology
How to treat methicillin resistant staphylococcus aureus
Pneumocystis Pneumonia
What is the protozoan causing this?
Trimethoprim-sulfamethoxazole is not for everyone - renal adjustment? Pregnancy?
Atovaquone indications - contraindications and monitoring
Use of Pentamidine and Primaquine with Clindamycin – how much and how long
You commonly rely on EKG and Chest X-Ray results to diagnose a wide variety of cardiac and respiratory conditions, yet even the most seasoned NPs, PAs, and RNs can struggle to truly master interpretation of these key tests.
We understand the complexities involved and have heard your requests for a program that will advance your skills and confidence. Cheryl Herrmann, RN, MS, APRN, CCRN, CCNS-CSC/CMC, is the critical care/cardiac expert clinician selected to develop this program – to take your own practice to another level!
Don’t miss this opportunity to:
Analyze QRS axis to determine diagnosis
Contrast left anterior and posterior hemiblocks
Recognize the location of acute coronary syndromes
Interpret chest x-rays for differential diagnosis
Perform more efficient and effective patient assessments
Cheryl’s practical insights and research-based updates will elevate new ways of thinking. You will be able to rapidly assess, take information from the incoming test results and initiate the best treatments for your patients.
Program Information
Objectives
Analyze EKG changes associated with ischemia, injury and infarction patterns.
Specify the features of right bundle branch block from the features of left bundle branch block.
Evaluate axis deviation and the implications for clinical practice.
Assess common cardiac and pulmonary disorders using the chest x-ray.
Detect the placement of invasive lines on chest x-rays.
Develop a systematic approach to chest x-ray interpretation.
Incorporate the clinical pearls of EKG and chest x-ray interpretation into daily practice.
Outline
Part I: The ABCs of 12-Lead EKG Interpretation
The 12-Lead EKG
Cardiac electrical conduction system
Electrical vectors
Normal polarity & P-QRS-T configuration of each lead
Ace the Axis
Left & right axis deviation
Causes & criteria
Methods of determining axis deviation
Clinical applications
Beat the Bundles
Right & left bundle branch blocks
Causes & complications
Left anterior & left posterior hemiblocks
Correlate the Coronary Anatomy
The coronary arteries
Left ventricular walls
Relationship to the 12-lead
Differential Diagnosis in Acute Coronary Syndrome
Ischemia, injury & infarction patterns
Reciprocal changes
STEMI vs. NSTEMI
Coronary spasm
Takotsubo cardiomyopathy
Putting it all Together
The 30-second diagnosis
Coronary angiographic correlation
Presentations, analysis & clinical applications
Advanced Interpretation
Atrial & ventricular hypertrophy
WPW – Wolff-Parkinson-White Syndrome
Prolonged QT intervals
Part II: Chest X-Ray Interpretation as Easy as Black & White
The Chest X-Ray
Technique
Black & white principles
Projections
Systematic Approach
Bone structures & Intercostal spaces
Soft tissues & vasculature
Pleural surfaces
Heart & great vessels
Invasive lines
As Easy as Black
Identifying pneumothorax & subcutaneous emphysema
Treatment priorities
As Easy as White
Identifying:
Pleural Effusion
Pulmonary Edema
Pneumonia
ARDS
Cardiomyopathy
Cardiac Tamponade
Clinical applications & interventions
Beyond the Basics
Identification & Initial Treatment of:
Aortic aneurysm
Post-op changes with pneumonectomy
Esophagogastrectomy
Dextrocardia
Target Audience
Nurses
Nurse Practitioners
Clinical Nurse Specialists
Physician Assistants
Copyright :03/04/2022
Respiratory Distress: Assess and Respond with Skill and Confidence
Respiratory failure leads to respiratory distress, which leads to panic for both the patient and the clinical staff. You only have minutes to act, and failure to act can lead to poor patient outcomes. Learn the must-have skills to confidently respond to your deteriorating patients.
Have you ever been at a loss to explain your patient’s respiratory symptoms and what they mean? Are they typical of the patient’s chronic condition, or a sign of a new, acute stage or problem? Why is your patient’s diagnosis not supported by presenting symptoms or lab results? Could these be red flags of a rapidly deteriorating condition that needs your ability to intervene – and quickly?
Having a deeper understanding of the cardio-pulmonary relationship can lead to more appropriate and timely treatments, which ultimately will drive better patient outcomes. Knowing whether respiratory failure is the result of an oxygen problem or a carbon dioxide problem is a critical piece. This intense training course will provide new clinical insights and critical thinking skills, so you won’t need to feel uncertain, scared, or at risk anymore. You will leave with a clear algorithm for assessment, a means to dissect ventilation/perfusion inequalities, and a thorough knowledge of the best treatment modalities.
Program Information
Objectives
Evaluate the types of ventilation/perfusion inequalities and how to treat them.
Differentiate between lung-based vs cardiac-based disease.
Evaluate the presentation differences between obstructive and restrictive lung diseases.
Distinguish between shunt effect and dead-space effect.
Choose the type of assessment techniques that are best to learn quickly about the deteriorating patient’s condition.
Apply the best treatment modalities to optimize outcomes for a patient in crisis.
Outline
Respiratory Failure: Quickly Identify and Distinguish
Is it an oxygenation or a ventilation problem?
Why does it matter?
Best Approaches to Differentiate Cardiac and Pulmonary Symptoms
Advanced understanding of breath sounds
X-rays don’t tell the whole story
Not all edema is visible
Evaluating the patient’s response to therapy
Confidently Assess Respiratory Disease
Dig deeper into ABG interpretation
Tips to focus on one system at a time
Treatment strategies to begin as you assess
Transition the Patient from Crisis to Stable
Solutions to calm the panic-stricken patient
When lab results don’t correlate with the presentation
WHY is the patient presenting the way they are?
Stair-step Strategy to Determine Treatment
What about bronchodilators?
Oxygen is a drug – how to optimize oxygen delivery
When oxygen therapy isn’t enough – positive pressure ventilation vs mechanical ventilation
Mistakes YOU Can Prevent
Misinterpretation of obstructive vs restrictive disease – or both?
All that wheezes may not be respiratory
Improper treatment modalities – start simple and work up
Missed clues from an urgent situation – know when to call in reinforcements
Target Audience
RNs, RTs, NPs, and PAs from:
Medical-Surgical floors
Cardiology
Neurology
Critical Care
Emergency
Urgent Care
Skilled Nursing Facilities
Anyone desiring next level skills to proactively assess and intervene in the care of the patient experiencing respiratory distress!
Copyright :04/17/2020
Pulmonary Emergencies
We will discuss crucial assessment findings and interventions for pulmonary emergencies including mechanical ventilation criteria for the following:
Respiratory Failure
Pulmonary Embolism
COPD
ARDS
Program Information
Target Audience
Nurses, Nurse Practitioners, Clinical Nurse Specialists, Other
Objectives
Prioritize nursing actions for respiratory emergencies.
Inspect blood gases with respect to compensation, etiology and pH.
Outline
Acute Respiratory Failure
Etiology
Impaired Ventilation
Signs, Symptoms, Diagnostics
Management
Acute Respiratory Distress Syndrome
Etiology
Signs, Symptoms, Diagnostics
Management
COPD
Signs, Symptoms, Diagnostics
Management
Acute Severe Asthma
Signs, Symptoms, Diagnostics
Management
Pulmonary Embolism
Management
Anticoagulant Therapy
Mechanical Ventilation
Assist Control Ventilation
Synchronized Intermittent Mandatory Ventilation
Pressure Support Ventilation
Low Tidal Volume Ventilation
Copyright :04/14/2016
All Things Pulmonary
Easy ABG Interpretation
Never MISS Respiratory Assessment Clues
The Pulmonary Drug Cabinet from A to Z
Management Strategies for Emergent Events
Mechanical Ventilation Tips ALL Nurses Should Know
Respiratory conditions can quickly change from stable to life-threatening situations where seconds count. Attend this comprehensive program and gain the skills and knowledge you need to manage any situation. Drawing on over 20 years of critical care experience, Cyndi Zarbano, MSN, BSN, CCRN, CEN, PCCN, CMSRN, CLNC, NLCP, will teach you the latest evidence-based approaches to evaluating and treating patients with pulmonary problems. You’ll have the opportunity to enhance your assessment skills, improve your ability to quickly interpret lab findings and explore the latest treatment techniques for airway management. You will leave with practical, immediately-applicable strategies that improve patient outcomes and enhance your expertise!
Program Information
Objectives
Evaluate key components of a quick physical assessment designed to pinpoint causes of an acute respiratory emergency.
Demonstrate interventions to minimize complications related to ARDS.
Assess the use of steroids in the emergency management of asthma.
Determine the most common causes of abnormal ABGs.
Appraise the “5–point check” in relation to airway management.
Differentiate rhonchi, rales, and crackles commonly heard during the respiratory assessment.
Outline
Easy Steps to ABG Analysis
Acid Base Imbalances
The 4 Abnormal Results
Rapid Interpretation Tool
Respiratory Assessment Clues You Should NEVER Miss!
Post-COVID Syndrome: Addressing Your Must-Know Questions
We are hearing different terminology but one thing is evident….up to 83% of patients are experiencing persistent symptoms after acute SARS-CoV-2 infection. Symptoms that are not explained by an alternative diagnosis.
While there remains a tremendous degree of speculation on Post-COVID Syndrome, I will provide you with the most current, scientific and peer reviewed data to assess and treat your own patients. Join me, Dr. Paul Langlois, APN, Ph.D., CCRN, CCNS, CNRN, a critical care clinical specialist, for a 90-minute presentation that will tackle what you must know today. Because of how quickly new research is being released related to Post-COVID Syndrome, there are plenty of questions that exist. Questions from patients certainly. And questions for those of us on the frontlines as well.
We will discuss actual case studies to feature evaluation of disease trajectory and rehabilitation modalities. I will share references, current guidelines and patient education tools. Let’s continue to learn from one another. To be our best. So that we can give our best to the patients we see. There is so much hope on the horizon!
Dr. Paul Langlois, APN, Ph.D., CCRN, CCNS, CNRN,
and the PESI Healthcare Team
Program Information
Objectives
Analyze co-morbid conditions of people at risk for developing Post-COVID Syndrome.
Evaluate the top four physical symptoms of Post-COVID Syndrome.
Categorize the degree of organ dysfunction of Post-COVID Syndrome, using physical and laboratory test results.
Construct a plan to minimize fatigue and poor endurance in Post-COVID Syndrome.
Outline
Stages of Recovery
Inpatient
Outpatient
Risk Factors for Post-COVID Relapse
Chronic kidney disease
COPD
Immunocompromised conditions
Obesity
Heart failure
Smoking
Type II diabetes
Liver disease
Dementia
Hypertension
Post-COVID Persistent Symptoms
Fatigue
Dyspnea
Chest discomfort
Cough
Anosmia
Hypercoagulability
Impaired memory
Post-traumatic stress disorder
Impaired memory
Poor concentration
Anxiety
Management of Post-COVID Complications
CV
Pulmonary
Neurologic and neuro-cognitive
Coagulation system
Olfactory
Functional status
Psychological
Dermatologic
Target Audience
Nurse
Physical Therapist
Physical Therapist Assistant
Occupational Therapist
Occupational Therapist Assistant
Speech-Language Pathologist
Other Healthcare Professional
Other Rehab Professional
Copyright :02/10/2021
Post-Acute Sequelae SARS-CoV-2 Infection (PASC): Evaluation and Management in Adults Post-COVID-19
Long haulers. Post-COVID symptoms. Post-Acute Sequelae SARS-CoV-2 infection (PASC).
We are hearing different terminology, but one thing is evident….at least 1 in 3 patients are experiencing persistent symptoms after acute SARS-CoV-2 infection. Symptoms that are not explained by an alternative diagnosis.
These are not people who have been seriously ill in the hospital, but patients who are often physically fit, younger people who report persistent exercise intolerance, breathlessness and cough, anxiety, palpitations, “brain-fog” and poor concentration. This false boom and bust—the illusion of recovery only to fall back into mental and physical exhaustion – is the story of those with Post-Acute Sequelae SARS-CoV-2 infection.
While most people recover quickly and completely from the COVID-19 virus, stories of persistent and troubling symptoms have now moved from anecdote to the peer reviewed journals. Join me, Dr. Paul Langlois, APN, Ph.D., CCRN, CCNS, CNRN, a critical care clinical specialist, for a 90-minute presentation that will tackle what you must know today. Patients are coming to us with their questions. Those of us on the frontlines have them as well.
We will discuss actual case studies to feature evaluation of disease trajectory and the very latest treatments. I will provide references, current guidelines and patient education tools. As a healthcare provider, you are responsible to assess and manage your patient, regardless if it is a well-established or novel condition. You need the knowledge and resources to do that.
-Dr. Paul Langlois, APN, Ph.D., CCRN, CCNS, CNRN,
and the PESI Healthcare Team
Program Information
Objectives
Distinguish the pathophysiology of COVID-19.
Differentiate between symptoms of Post-Acute Sequelae SARS-CoV-2 infection (PASC) versus other undiagnosed conditions.
Analyze the criteria for in- and out-patient management of PASC.
Distinguish the mechanisms of action of PASC medications.
Evaluate the mode of action of COVID-19 vaccine types (mRNA, viral vector, inactivated virus).