Which principle(s) would be important to teach a patient about the use of a steroid inhaler? (SELECT ALL THAT APPLY)

A. Inspiratory stridor

Inspiratory stridor is a high-pitched, musical sound heard during inspiration and is typically caused by turbulent airflow due to partial obstruction of the upper airway. It is commonly associated with conditions such as croup, epiglottitis, or anaphylaxis. While respiratory distress may occur in a pneumothorax, inspiratory stridor specifically suggests an upper airway obstruction rather than a pneumothorax.

B. Expiratory wheeze

Expiratory wheeze is a high-pitched, musical sound heard during expiration and is typically associated with conditions such as asthma, chronic obstructive pulmonary disease (COPD), or bronchiolitis. Wheezing occurs due to narrowing of the airways, leading to turbulent airflow during expiration. While a pneumothorax can cause respiratory distress, it is not typically associated with wheezing.

C. Absence of breath sounds

The absence of breath sounds over a particular area of the chest can indicate a pneumothorax. In a pneumothorax, air accumulates in the pleural space, causing partial or complete collapse of the lung and preventing it from making contact with the chest wall. This absence of breath sounds over the affected area is a classic finding in a pneumothorax and is crucial for its detection.

D. Coarse crackles

Coarse crackles are discontinuous, bubbling or popping sounds heard during inspiration and may be indicative of conditions such as pneumonia, pulmonary edema, or bronchiectasis. These crackles are typically heard when there is fluid or mucus in the airways. While a pneumothorax can cause respiratory distress, it does not typically produce crackles on auscultation.

Correct Answers:

A. Frequent oral hygiene is necessary:Steroid inhalers can increase the risk of oral thrush and other infections, so maintaining good oral hygiene is essential to minimize this risk.

C. Rinse and spit after inhalation of the medication:Rinsing the mouth and spitting after using a steroid inhaler helps to remove residual medication and reduce the risk of developing oral thrush.

D. When taking a steroid drug as well as a bronchodilator, the bronchodilator should be administered first:Administering a bronchodilator first helps open the airways, allowing the steroid medication to reach deeper into the lungs for more effective treatment.

E. Hold your breath for 10 seconds during inhalation of the medication:Holding the breath allows for better medication absorption in the lungs.

Incorrect Answer:

B. The inhaler should be used on a PRN basis only:Steroid inhalers are typically used on a regular schedule for long-term control of asthma or other respiratory conditions, rather than on a PRN (as needed) basis. PRN use is more applicable to rescue inhalers, like short-acting bronchodilators.