Transcript NURSING 1229 * UNIT I * MEDICATION ADMINISTRATION

Kimberly Napper
Respiratory Problems
Unit IV Objective 7
C. Nursing Diagnosis
1) Gas exchange, impaired
2) Airway clearance, ineffective
3) Breathing pattern, ineffective
4) Anxiety
5) Infection, risk for
6) Fatigue
7) Knowledge deficit
Objective 5. Describe nursing responsibilities
related to treatment modalities in the care of clients
experiencing respiratory disorders across the lifespan.
5. Nursing Responsibilities Related to
Treatment Modalities
A. Drug Therapy
Unit IV Obj. 5 A. Drug Therapy
1) Classification
a.
b.
c.
d.
e.
f.
g.
h.
i.
j.
k.
Bronchial dilators
Decongestants
Antihistamines
Expectorants
Anti-tussives
Antibiotics
Anti-tuberculin
Anticoagulants
Antileukotrienes
Mast cell stabilizers
Vaccinations
1)
2)
l.
Influenza
Pneumonia
Chemotherapeutic agents
Obj. 5 A. Drug Therapy
2) Dosage, route, time
3) Action
4) Expected Therapeutic Effect
5) Contingencies
6) Expected Therapeutic Outcome
7) Common Side Effects
8) Nursing Implications
Bronchial dilators
 help open the bronchial tubes (airways) of the lungs,
allowing more air to flow through them.
 Used for
 Asthma
 Emphysema
 Bronchitis
 Examples of bronchodilators
 albuterol (Proventil, Ventolin)
 levalbuterol(Xopenex)
 ipratropium (Atrovent)
 metaproterenol (Alupent, Metaprel)
 epinephrine (Primatene)
 terbutaline (Brethine).
http://medical-dictionary.thefreedictionary.com/Bronchodilators
Bronchial dilators: Beta Agonists Lilley Table 37-3
Nonselective adrenergic drugs
Epinephrine (Adrenalin)
Nonselective beta-adrenergic drugs
Metaproterenol (Alupent)
Selective beta 2 drugs
Albuterol (Proventil, Ventolin)
Levalbuterol (Xopenex)**
Inhaled only
Less tachycardia
Salmeterol (Serevent)
long acting
Not for acute asthma attacks
Bronchial dilators
 Beta-adrenergic agonists (β-agonists)
 bind to β-receptors on cardiac and smooth muscle tissues.
 important actions in other tissues



especially bronchial smooth muscle (relaxation)
the liver (stimulate glycogenolysis)
kidneys (stimulates renin release)
What side effects would you expect?
(Pure beta-adrenergic agonists have the opposite function of beta blockers.)
http://www.cvpharmacology.com/cardiostimulatory/beta-agonist.htm
Fight or Flight
Central Nervous System
Decongestants
 Relieve swelling by narrowing the blood vessels that supply the nose.
 Caution!! (should not take decongestants unless under a physician's supervision)
 heart or blood vessel disease
 high blood pressure
 Diabetes
 enlarged prostate
 overactive thyroid
Do not use decongestant nasal sprays for more than three days.
Cough-and-cold products have not been shown
to be safe or effective in children younger than 6 yrs.
http://medical-dictionary.thefreedictionary.com/decongestants
Decongestants
 oxymetazoline (Afrin )
 pseudoephedrine (Sudafed)
 phenylephrine (Neo-Synephrine, Sudafed PE
 Caffeine can increase the side effects.
Avoid drinking large amounts of beverages
containing caffeine (coffee, tea, colas), eating large amounts of
chocolate, or taking nonprescription products that contain
caffeine
 phenylpropanolamine (PPA) (Dexatrim)
 associated with an increased risk of hemorrhagic stroke
 CAUTION!!!!!!
 Off the US market
Antihistamines
 Allergens trigger the body to releases histamines.
 Histamines attach to cells & cause them to swell & leak fluid.
 Can cause itching, sneezing, runny nose and watery eyes.
 Antihistamines prevent histamines from attaching to cells
& causing symptoms
 Two types of OTC antihistamines:
 First-generation
 Second-generation
http://familydoctor.org/familydoctor/en/drugs-procedures-devices/over-the-counter/antihistamines-understanding-your-otc-options.html
Antihistamines
Lilley Table 36-1 p. 554
 Histimine antagonists
 H1 blockers
 Anticholinergic effect
 Most obvious effects include dry mouth and dry eyes.
 Used to reduce salivary and bronchial secretions before
surgery, or to dilate the pupil.
• Cholinergic- Nerves that are stimulated by acetylcholine
• parasympathomimetic- parasympathetic nervous system
• “Rest & Digest”
First-generation Antihistamines
 Brompheniramine (Dimetapp Cold and Allergy Elixir)
 Chlorpheniramine (Chlor-Trimeton)
 Dimenhydrinate (Dramamine)
 Diphenhydramine (Benadryl)
 Doxylamine (NyQuil, Alka-Seltzer Plus Night-Time Cold Medicine)
 Work in the part of the brain that controls nausea and vomiting.
 Can help prevent motion sickness.
 One of the most common side effects is feeling sleepy.
 Sometimes used to help people who have trouble sleeping (insomnia).
Second-generation Antihistamines
 Loratadine (Alavert, Claritin)
 Cetirizine (Zyrtec)
 Much less likely to cause drowsiness!
Expectorants
 Page 559 Lilley
 Aid in expectoration of excessive mucus
 guaifenesin
 Makes it is easier to cough up the phlegm or sputum.
Expectorants are used in cough mixtures for chesty
coughs.
Anti-tussives
 Page 558 Lilley
 Reduces coughing
 May inhibit activity in cough center of CNS
 Opioid vs. nonopioid

Side effects…….
Antibiotics p.584
 Penicillins
 penicillin and amoxicillin
 Cephalosporins
 cephalexin (Keflex)
 Macrolides
 erythromycin (E-Mycin), clarithromycin (Biaxin), and
azithromycin (Zithromax)
 Fluoroquinolones
 ciprofloxacin (Cipro), levofloxacin (Levaquin), and moxifloxacin
(Avelox)
 Sulfonamides
 co-trimoxazole (Bactrim) and trimethoprim (Proloprim)
 Tetracyclines
 tetracycline (Sumycin, Panmycin) and doxycycline (Vibramycin)
Antibiotics p.584
 Aminoglycosides
 gentamicin (Garamycin) and tobramycin (Tobrex)
 Glycopeptide
 Vancomycin (Vancocin)
Antibiotics p. 604-606 Lilley
 Nursing Considerations
 Outcome criteria
 Teaching tips
 Points to Remember
Antibiotics
A client is admitted with fever, cough, & dyspnea.
Orders: CXR, sputum culture, IVPB Rocephin (ceftriaxone)
Client is a 68 year old who is allergic to penicillin and sulfa
drugs and has a history of smoking & COPD.
Any special considerations?
Which order should be carried out first?
What other medications might help this client and why?
Anti-tuberculin
Antimycobacterial drugs
P. 645 – 654 Lilley
 First line:
 Isoniazid

(INH)
 Rifampicin

(Rifadin)
 Ethambutol

(Myambutol)
 Pyrizanamide
http://www.sciencephoto.com/media/11434/enlarge
 Second line:
 Aminoglycosides

Amikacin, kanamycin.
 Fluoroquinolones

ciprofloxacin, levofloxacin,
moxifloxacin
Anti-tuberculin
 A young woman contracts tuberculosis
while living in a dorm in college.
She is being seen in the clinic and is just beginning her
medication regimen for TB.
 What should the nurse teach this young woman about
taking her medicines and any potential lifestyle
changes/special considerations?
Antileukotrienes p. 572 Lilley
 prevent the swelling and inflammation of the air passages.
 used to prevent asthma attacks, but are not useful for the
treatment of an asthma attack.
 Montelukast (Singulair)
Leukotrienes
 are inflammatory chemicals the body releases after coming in
contact with an allergen or allergy trigger.
 cause tightening of airway muscles and the production of excess
mucus and fluid.
http://www.webmd.com/allergies/leukotriene
Mast cell stabilizers p. 571 Lilley
 Stabilize cell membranes to prevent release of
inflammatory mediators like histimine
 used to prevent asthma attacks in people with bronchial
asthma.
 used to prevent bronchospasm (wheezing, chest
tightness, trouble breathing) caused by exercise,
pollutants in the air, or exposure to certain chemicals.
 Cromolyn (oral or inhaler)

Nasalcrom
 Nedocromil
Vaccines p. 706 Lilley

contain the same antigens or parts of antigens that cause
diseases, but the antigens in vaccines are either killed or
greatly weakened.
When they are injected into fatty tissue or muscle, vaccine
antigens are not strong enough to produce the symptoms
and signs of the disease but are strong enough for the
immune system to produce antibodies against them.
The memory cells that remain prevent re-infection when
they encounter that disease in the future.
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Influenza p. 713
Pneumonia p. 714
http://www.cdc.gov/vaccines/vac-gen/howvpd.htm
The End