Transcript Respiratory Pharmacology

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Antitussives:
Actions
and Uses
 Some antitussives depress cough center located in
medulla and are called centrally acting drugs
 Some antitussives are peripherally acting drugs,
which act by anesthetizing stretch receptors in the
respiratory passages, thereby decreasing coughing
 Antitussives are used to relieve nonproductive cough
Antitussives: Adverse Reactions
 Central nervous system reactions:
 Sedation; dizziness; lightheadedness
 Gastrointestinal reactions:
 Nausea; vomiting; constipation
 Nonprescription cough medicines containing two
or more ingredients produce few adverse reactions
when used as directed
Antitussives: Contraindications
and Precautions
 Contraindicated in patients with known
hypersensitivity to drugs
 Opioid antitussives are contraindicated in premature
infants or during labor when delivery of premature
infant is anticipated
 Used with caution in patients:
 With persistent or chronic cough; cough
accompanied by excessive secretions; high fever;
rash; persistent headache or nausea or vomiting
Antitussives: Contraindications
and Precautions
(cont’d)
 Antitussives containing codeine are used with
caution during pregnancy and labor and in patients
with COPD; acute asthmatic attack; preexisting
respiratory disorders; acute abdominal conditions
 Opioid antitussives are used cautiously in patients
with head injury and increased intracranial pressure;
acute abdominal disorders; convulsive disorders;
hepatic or renal impairment; prostatic hypertrophy;
asthma or other respiratory conditions
Antitussives: Interactions
 Central nervous system (CNS) depressants and
alcohol may cause additive depressant effects
when administered with antitussives containing
codeine
 When dextromethorphan is administered with
monoamine oxidase inhibitors, patients may
experience hypotension, fever, nausea, jerking
motions to the leg, coma
Nursing Process: Assessment
 Preadministration assessment:
 Document type of cough and describe color and
amount of any sputum present during
preadministration assessment
 Record vital signs as some patients with
productive cough may have an infection
Nursing Process: Assessment
 Ongoing assessment:
 Observe for therapeutic effect
 Auscultate lung sounds, takes vital signs
periodically
 Describe and record in chart type of cough and
frequency of coughing
 Record whether cough interrupts sleep or causes
pain in chest or other parts of body
Nursing Process: Planning
 Expected outcome includes:
 Optimal response to therapy
 Support of patient needs related to managing
adverse drug reactions
 Understanding of and compliance with
prescribed treatment regimen
Nursing Process: Implementation
 Promoting an optimal response to therapy:
 Administer antitussives orally
 Depression of cough reflex can cause secretions
to pool in lungs
 Indiscriminate use of antitussives by general
public may prevent early diagnosis and
treatment of serious disorders, such as lung
cancer and emphysema
Nursing Process: Implementation
 Monitoring and managing patient needs:
 Risk for injury:
 Minimize risk for hospitalized patients by
carefully orienting each patients to
surroundings and closely supervising patient
 Encourage patient to ask for assistance if he or
she feels dizzy or unsteady
Nursing Process: Implementation
 Educating the patient and family:
 Discourage indiscriminate use of
nonprescription cough medicines
 Advise patient to read label carefully, follow
dosage recommendations, and consult primary
health care provider if cough persists for more
than 10 days or if fever or chest pain occurs
Nursing Process: Evaluation
 Therapeutic effect is achieved and coughing is
relieved
 Patient reports no injuries related to adverse
reactions
 Patient and family demonstrate an understanding
of drug regimen
Mucolytics and Expectorants: Actions
 Drug with mucolytic activity appears to reduce
viscosity of respiratory secretions by direct action
on mucus
 Expectorants increase production of respiratory
secretions, which in turn appears to decrease
viscosity of mucus, helps to raise secretions from
respiratory passage
Mucolytics and Expectorants: Uses
 Acute bronchopulmonary disease
 Pulmonary complications of cystic fibrosis
 Pulmonary complications associated with surgery
 Post-traumatic chest conditions
 Atelectasis due to mucus obstruction
 Acetaminophen overdosage
Mucolytics and Expectorants: Contraindications and
Precautions
 Expectorants and mucolytics are contraindicated in
patients with known hypersensitivity
 Expectorant potassium iodide is contraindicated
during pregnancy
 Expectorants are used cautiously during pregnancy
and lactation and in patients with:
 Persistent cough; severe respiratory insufficiency
or asthma; older adults or debilitated patients
Mucolytics and Expectorants: Interactions
 Patient may experience hypokalemia; cardiac
arrhythmias; or cardiac arrest when potassiumcontaining medications and potassium-sparing
diuretics are administered with iodine products
 Thyroid function tests may also be altered by
iodine
Nursing Process: Assessment
 Preadministration assessment:
 Assess respiratory status of patient before administering
drug
 Documents lung sounds, amount of dyspnea, and
consistency of sputum
 Ongoing assessment:
 Note any increase in sputum or change in consistency
 Auscultate lungs and record findings of both
assessments on patient’s chart
 Evaluate patient’s respiratory status and record these
findings on patient’s chart
Nursing Process: Planning
 Expected outcome includes:
 Optimal response to therapy
 Support of patient needs related to management
of adverse drug reactions
 Understanding of and compliance with the
prescribed treatment regimen
Nursing Process: Implementation
 Promoting an optimal response to therapy:
 Explain treatment to patient and demonstrates
how nebulizer will be used
 Remain with patient during first few treatments
 Make sure suction equipment is at bedside to be
immediately available for aspiration of
secretions
Nursing Process: Implementation
 Managing and monitoring patient needs:
 Ineffective airway clearance:
 Encourage patient to take deep, diaphragmatic
breaths
 Monitor amount and consistency of sputum
Nursing Process: Implementation
 Educating the patient and family:
 Provide full instruction to patient or family member
about use and maintenance of equipment, as well as
technique for administration of acetylcysteine
 Instruct patient to take drug as directed and contact
primary health care provider if any unusual symptoms
occur during use of drug or if drug appears to be
ineffective
Nursing Process: Evaluation
 Therapeutic effect is achieved, and secretions are
thinned and easily expectorated
 Patient has an easy, unlabored breathing pattern
 Adverse reactions are identified, reported,
successfully with nursing interventions
 patient and family demonstrate an understanding of
the drug regimen and use of equipment to administer
the drug
Antihistamine: Actions
 Antihistamines blocks most, but not all the effects of
histamine
 First-generation antihistamines bind nonselectively to central
and peripheral H1 receptors and may result in CNS
stimulation or depression
 Other first-generation drugs may have additional effectsantipruritic (anti-itching) or antiemetic (anti-nausea) effects
 Second-generation antihistamines are selective for peripheral
H1 receptors and, as a group are less sedating
Antihistamine: Uses
 The general uses of the antihistamines include:
 Relief of the symptoms of seasonal and perennial
allergies; allergic and vasomotor rhinitis; allergic
conjunctivitis; mild and uncomplicated angioneurotic
edema and urticaria; relief of allergic reactions to
drugs, blood, or plasma; relief of coughs caused by
colds or allergy; adjunctive therapy in anaphylactic
shock; treatment of parkinsonism; relief of nausea and
vomiting; relief of motion sickness; sedation; adjuncts
to analgesics
Antihistamine: Adverse Reactions
 Central nervous system reactions –
 Drowsiness or sedation; disturbed coordination
 Anticholinergic effects (cholinergic blocking) Dryness of mouth, nose, and throat; thickening of
bronchial secretion
Antihistamine:
Contraindications
and
Precautions
 Contraindicated: During pregnancy and lactation
 First-generation antihistamine: Patients with
known hypersensitivity to the drugs, newborns,
premature infants, nursing mothers, individuals
undergoing monamine oxidase therapy and in
patients with angle-closure glaugoma,
stenosing peptic ulcer, symptomatic prostatic
hypertrophy, and bladder neck obstruction
Antihistamine: Contraindications and Precautions
(cont’d)
 Second-generation antihistamines: patients with
known hypersensitivity
 Cetirizine is contraindicated in patients who are
hypersensitive to hydroxyzine
 Used with caution in patient with: bronchial asthma,
cardiovascular disease, narrow-angle glaucoma,
symptomatic prostatic hypertrophy, hypertension,
impaired kidney function, peptic ulcer, urinary
retention, pyloroduodenal obstruction, and
hyperthyroidism
Antihistamine: Interactions
Interactant drug
Effect of Interaction
Rifampin
May reduce the absorption of the
antihistamine, fexofenadine for
example
Increase in anticholinergic and
sedative effects of the antihistamine
Possible additive CNS depressant
effect
Risk for increased cardiovascular
effects, with diphenhydramine for
example
Decreased concentrations of
antihistamine in blood, fexofenadine
for example
Monamine oxidase
inhibitors
CNS depressants
Beta blockers
Aluminum- or
magnesium-based
antacids
Nursing Process: Assessment
 Preadministration assessment:
 The assessment that the nurse may perform –


Assessment of the involved areas (eyes, nose, and
upper and lower respiratory tract) if the patient is
receiving an antihistamine for the relief of allergy
symptoms
If promethazine (Phenergan) is used with an opioid to
enhance the effects and reduce the dosage of the
opioid, the nurse should take the patient’s blood
pressure, pulse, and respiratory rate before giving the
drug
Nursing Process: Assessment
 Ongoing Assessment:
 Nurse observes the patient for the expected effects
of the antihistamine and for adverse reactions
 Antihistamine is given for a serious situationnurse assesses the patient at frequent intervals
until the symptoms appear relieved and for about
24 hours after the incident
Nursing Process: Planning
 The expected outcomes for the patient depend on
the reason for administration of the antihistamine
but may include –
 Optimal response to therapy
 Supporting of patient needs related to
managing adverse reactions
 Understanding of and compliance with the
prescribed treatment regimen
Nursing Process: Implementation
 Promoting an optimal response to therapy:
 Antihistamines: Given orally to prevent GI upset
 Loratadine: Administered with or without water and placed
on the tongue where it dissolves instantly
 Fexofenadine: Not administered 2 hours after antacids
 Antihistamines: Administered parentally- deep
intramuscularly rather than subcutaneously
Nursing Process: Implementation
 Monitoring and managing patient’s needs:
 Impaired oral mucous membrane:
Dryness of the mouth, nose, and throat- offer the patient
frequent sips of water or ice chips to relieve the symptom
 Risk of injury:
 Assist the patient with ambulation
 Place the call light within easy reach and instruct to call
before attempting to get out of bed and ambulating

Nursing Process: Implementation
 Educating the patient and family:
 Nurse reviews the dosage regimen and possible
adverse drug reactions with the patient
Nursing Process: Evaluation
 Mucous membranes are moist and intact
 No injury is reported
 The patient and family understand the drug
regimen
Decongestants: Actions and Uses
 Actions:
 Nasal decongestants: Sympathomimetic drugs, which
produce localized vasoconstriction of the small blood
vessels of the nasal membranes
 Uses:
 Used to treat the congestion associated with the
following conditions:
 Common cold; hay fever; sinusitis; allergic rhinitis;
congestion associated with rhinitis
Decongestants: Adverse Reactions and Contraindications
 Use of oral decongestants may result in the following adverse
reactions:
 Tachycardia and other cardiac arrhythmias; nervousness;
restlessness; insomnia; blurred vision; nausea; vomiting
 Contradicted:
 patients with known hypersensitivity and patients taking
monoamine oxidase inhibitors
 Sustained-released pseudoephedrine is contraindicated in
children below 12 years of age
Decongestants: Precautions
 Decongestants are used cautiously in patients with:
 Thyroid disease; diabetes mellitus; cardiovascular
disease; prostatic hypertrophy; coronary artery
disease; peripheral vascular disease; hypertension;
glaucoma
 Pregnant women should consult with their
primary health care provider before using these
drugs
Decongestants: Interactions
Interactant drug
Effect of interaction
MAOIs
Severe headache,
hypertension and
possibly hypertensive
crisis
Initial hypertension
episode followed by
bradycardia
Beta-adrenergic
blocking drugs
Nursing Process: Assessment
 Preadministration assessment:
 Assess the patient’s blood pressure, pulse, and congestion
before administering the decongestants; assess the lung
sounds and bronchial secretion, note in the patient’s records;
obtain the history of the use of the products
 Ongoing Assessment:
 Assess the patient’s blood pressure, pulse, and congestion;
question the patient about attaining therapeutic effects and
presence of adverse reactions
Nursing Process: Planning
 Expected outcomes for the patients include:
 Optimal response to therapy
 Support of patient needs related to the
management of adverse reaction
 Understanding of and compliance with the
prescribed treatment regimen
Nursing Process: Implementation
 Promoting an optimal response to therapy
 Ineffective breathing pattern:
 Overuse of topical form- “rebound” nasal
congestion
 Patient is taught to take the drug exactly as
prescribed, or discontinue the drug therapy
gradually
Nursing Process: Implementation
 Educating the patient and family: The nurse should include
the following point in the teaching plan:
 Use this product as directed by the primary health care
provider or on the container label
 Understand that overuse of topical nasal decongestants can
make the symptoms worse causing rebound congestion
 If using a spray, do not allow the tip of the container to
touch the nasal mucosa and do not share the container
with anyone
Nursing Process: Evaluation
 The patient maintains effective breathing pattern
 The therapeutic effect is achieved
 The patient demonstrates an understanding of and
compliance with the drug regimen
Video: Asthma
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Sympathomimetic Bronchodilators: Actions and Uses
 Actions: Opens the bronchi and allows more air to
enter the lungs, which in turn, completely or partially
relieves respiratory distress
 Uses:
 Bronchospasm associated with acute and chronic
bronchial asthma; exercise-induced
bronchospasm; bronchitis; emphysema;
bronchiectasis; other obstructive pulmonary
diseases
Sympathomimetic Bronchodilators: Adverse Reactions,
Contraindications
 Adverse CNS effects: Tachycardia, palpitations,
and/or cardiac arrhythmias, nervousness, anxiety,
hypertension, insomnia
 Contraindicated: Patients with known
hypersensitivity to the drug, cardiac arrhythmias
associated with tachycardia, organic brain damage,
cerebral arteriosclerosis, and narrow-angle glaucoma;
salmeterol is contraindicated during acute
bronchospasm
Sympathomimetic Bronchodilators: Precautions
 Used cautiously in patients with hypertension,
cardiac dysfunction, hyperthyroidism, glaucoma,
diabetes, prostatic hypertrophy, and history of
seizures; during pregnancy and lactation
Sympathomimetic Bronchodilators:
Interactions
Interactant drug
Effects of interactions
Adrenergic drugs
Possible additive adrenergic effects
Monoamine
oxidase inhibitors
Beta blockers
Increased risk for severe headache,
hypertension and a hypertensive crisis
Inhibition of the cardiac,
bronchodilating, and vasodilating
effects of the sympathomimetic
Increased pressor response
Possible severe hypotension
Increased risk for cardiotoxicity
Methyldopa
Oxytocic drugs
Theophylline
Xanthine Derivative Bronchodilators:
Uses and Adverse Reactions
 Uses: Symptomatic relief or prevention of bronchial
asthma; reversible bronchospasm associated with chronic
bronchitis and emphysema
 Adverse reaction:
 CNS reactions: Restlessness, nervousness, tachycardia,
tremors, headache, palpitations, increased respiration
 Other: Nausea, vomiting, fever, hyperglycemia,
electrocardiographic changes
Xanthine Derivative Bronchodilators:
Contraindications and Precautions
 Contraindicated: Those with known hypersensitivity,
peptic ulcers, seizure disorders, serious uncontrolled
arrhythmias, and hyperthyroidism
 Precautions: Used cautiously in patients with cardiac
disease, hypoxemia, hypertension, congestive heart
failure, liver disease, patients over 69 years of age
 Aminophylline, dyphylline, oxtriphylline, and
theophylline are used cautiously during pregnancy and
lactation
Xanthine Derivative Bronchodilators: Interactions
 Interacts with- Barbituates, charcoal, hydantoins,
ketoconazole, rifampin, nicotine, adrenergic agents,
isoniazid, loop diuretics- decreased theophylline levels
 Interacts with- Allopurinol, beta blockers, calcium
channel blockers, cimetidine, oral contraceptives,
corticosteroids, ephedrine, influenza virus vaccine,
macrolide antibiotics, thyroid hormones, isoniazid, loop
diuretics- increased theophylline levels
Antiasthma Drugs: Corticosteroids: Actions, Uses, and
Adverse Reactions
 Actions: Given by inhalation and act to decrease the
inflammatory process in the airways of the patient with
asthma; increase the sensitivity of the B2-receptors
 Uses: Used in the management and prophylactic treatment of
the inflammation associated with chronic asthma or allergic
rhinitis
 Adverse reactions:
 Respiratory system reactions: Throat irritation, hoarseness,
cough, fungal infection of the mouth and throat
 Other: Vertigo, headache
Corticosteroids: Contraindications, Precautions, and
Interactions
 Contraindicated: In patients with hypersensitivity to the
corticosteroids, acute bronchospasm, status asthmatics,
or other acute episodes of asthma
 Precautions: used cautiously in patients with
compromised immune systems, glaucoma, kidney
disease, liver disease, convulsive disorders, and diabetes;
those taking systemic corticosteroids and during
pregnancy
 Interactions: Ketoconazole may increase plasma levels of
budesonide and fluticasone
Leukotriene Receptor Antagonists and Leukotriene
Formation Inhibitors: Actions, Uses
 Actions:
 Zileuton acts by decreasing the formation of leukotrienes
 Montelukast and zafirlukast inhibit leukotriene receptor sites
in the respiratory tract
 Uses:
 Zileuton and montelukast are used in the prophylaxis and
treatment of chronic asthma in adults and children older than
12 years; Zafirlukast is used in the prophylaxis and treatment
of chronic asthma in adults and in children older than 5 years
Leukotriene Receptor Antagonists and Leukotriene
Formation Inhibitors: Adverse Reactions
 Zafirlukast:
 CNS reactions include: Headache; dizziness
 Gastrointestinal system reaction include: Nausea;
diarrhea; abdominal pain
 Other body system reaction: myalgia; pain; fever
 Montelukast:
 CNS reactions include headache and dizziness
Leukotriene Receptor Antagonists and Leukotriene
Formation Inhibitors: Adverse Reactions
 Montelukast (cont’d):
 Gastrointestal reactions include dyspepsia and
abdominal pain
 Respiratory reactions include flulike symptoms and
cough
 Zileuton:
 Headache; GI system reactions, such as dyspepsia;
nausea; abdominal pain
Leukotriene Receptor Antagonists and Leukotriene
Formation Inhibitors: Contraindication and Precautions
 Contraindicated: In patients with known
hypersensitivity, bronchospasm in acute asthma
attacks, liver disease (Zileuton)
 Precautions: Used cautiously in pregnancy and
lactation
Leukotriene Receptor Antagonists and Leukotriene
Formation Inhibitors: Interactions
 Zafirlukast interacts with: aspirin- increased plasma levels
of zafirlukast; warfarin- increased anticoagulant effect;
theophylline, erythromycin- Decreased level of zafirlukast
 Zileuton interacts with: propranolol- increased activity of
the propranolol; theophylline- Increased serum
theophylline levels; warfarin- Increased prothrombin time
(PT)
Mast Cell Stabilizers: Actions
 Actions: Thought to stabilize the mast cell
membrane, possibly by preventing calcium ions from
entering mast cells, thus preventing the release of
inflammatory mediators
 Uses: Used in combination with other drugs in the
treatment of asthma and allergic disorders, including
allergic rhinitis (nasal solution), and to prevent
exercise-induced bronchospasm
Mast Cell Stabilizers: Adverse Reactions,
Contraindications, and Precautions
 Adverse reactions: CNS reactions: Headache, dizziness,
hypotension; Other: Nausea, fatigue; unpleasant taste
sensation in the mouth; also cause nasal or throat
irritation when given intranasally or by inhalation
 Contraindicated: Patients with known hypersensitivity to
the drug and during acute attacks of asthma
 Precautions: Used cautiously during pregnancy and
lactation, and patients with impaired renal or hepatic
function
Nursing Process: Assessment
 Preadministration assessment:
 Take the blood pressure, pulse, and respiratory rate
before initiation of therapy with a bronchodilator or
antiasthma drug
 Note any dyspnea, cough, wheezing, “noisy”
respirations, or use of accessory muscles when
breathing; also note and record the general physical
condition
 Patients with chronic asthma- question the patient
concerning allergies, frequency of attacks, severity of
attacks, factors that cause or relieve attacks, and any
antiasthma drugs used currently or taken previously
Nursing Process: Assessment
 Ongoing assessment:
 Assess the respiratory status every 4 hours (or
more often if needed) and whenever drug
administered; keep record of intake and output,
report any imbalance; after administration
observe the patient for the effectiveness of the
drug
Nursing Process: Planning
 The expected outcomes for the patient depend on
the specific reason for administering the drug but
may include:
 Optimal response to therapy
 Meeting patient’s needs related to the
management of adverse reactions
 Understanding of and compliance with the
prescribed treatment regimen
Nursing Process: Implementation
 Promoting an optimal response to therapy:
 Patients taking sympathomimetics: Take great care in
reading the primary health care provider’s order when
preparing these drugs for administration
 Epinephrine: Administer epinephrine
subcutaneously for an acute bronchospasm;
therapeutic effects- within 5 minutes after
administration, last as long as 4 hours
Nursing Process: Implementation
 Promoting an optimal response to therapy:
 Patients taking sympathomimetics: (cont’d)
 Salmeterol: Not administered more frequently
than twice daily (morning and evening)
 Formoterol fumarate (Foradil Earlier):
administered only by oral inhalation; dosage- 12
microgram for every 12 hours
Nursing Process: Implementation
 Promoting an optimal response to therapy (cont’d)
 Patients taking xanthine derivatives: For acute respiratory
symptoms, rapid theophyllinization using one of the
xanthine derivatives may be required; monitor the patient
for signs of theophylline toxicity; report any serum
theophylline levels greater than 20 mg/mL or any
symptoms associated with toxicity; when giving
theophylline or aminophylline IV monitor the patient for
hypotension, cardiac arrhythmias, and tachycardia
Nursing Process: Implementation
 Promoting an optimal response to therapy (cont’d)
 Patients taking leukotriene receptor antagonists and
leukotriene formation inhibitors: Montelukast is
administered once daily in the evening; zafirlukast is
administered twice daily 1 hour before meals or 2 hours
after meals; zileuton is administered four times daily
 Patients taking oral or inhalant corticosteroids: Administer
bronchodilator first, after several minutes administer
corticosteroid inhalant; when administering two
inhalations of the same drug, it is advisable to wait at least 1
minute between puffs
Nursing Process: Implementation
 Promoting an optimal response to therapy (cont’d)
 Patients taking mast cell stabilizers: Mast cell
stabilizers, such as cromolyn (Intal), may be
added to the patient’s existing treatment
regimen (e.g., bronchodilators); when
administered orally, cromolyn is given 1/2 hour
before meals and at bedtime
Nursing Process: Implementation
 Monitoring and managing patient needs
 Anxiety: Patients who have difficulty breathing and are
receiving a sympathomimetic drug may experience
extreme anxiety, nervousness, and restlessness, which
may be caused by their breathing difficulty or the action
of the sympathomimetic drug- reassure the patient that
the drug being administered will most likely relieve the
respiratory distress in a short time; closely monitor blood
pressure and pulse; speak and act in a calm manner not
to increase anxiety or nervousness
Nursing Process: Implementation
 Monitoring and managing patient needs (cont’d)
 Altered nutrition: Less than body requirements:
Patient with nausea should be offered frequent smaller
meals rather than three large meals; provide pleasant,
relaxed atmosphere for meals; Heartburn is minimized
if the patient remains in an upright position and sleeps
with the head of the bed elevated; have the patient
take frequent sips of water, sucks of sugarless candy, or
chew gum to alleviate unpleasant taste caused by
antiasthmatic drugs
Nursing Process: Implementation
 Monitoring and managing patient needs (cont’d)
 Impaired oral mucous membranes: Instruct the patient to
use strict oral hygiene, cleanse the inhaler as directed in the
package directions, and use the proper technique when
taking an inhalation, decrease incidence of candidiasis and
help soothe the throat
 Ineffective airway clearance: During an acute
bronchospasm- check the blood pressure, pulse,
respiratory rate, and response to the drug every 5 to15
minutes until condition stabilizes and respiratory distress
is relieved
Nursing Process: Implementation
 Educating the patient and family
 Provide a thorough explanation on the use of the aerosol
inhalator for administration of bronchodilator
 Carefully review any instruction sheets with the patient and
provide information about how the unit is assembled, used,
and cleaned
 Teach the patient how to use the peak flow meter and when
to notify the primary health care provider
Nursing Process: Evaluation
 The therapeutic effect is achieved, and breathing is easier and






more effective
Patient maintains adequate nutrition
Oral mucous membranes are intact and integrity is
maintained
Airway is maintained with effective breathing pattern
Anxiety is managed successfully
Adverse reactions are identified, reported to the primary
health care provider, and managed successfully
The patient demonstrates an understanding of the drug
regimen and use of the aerosol inhalator
 Stanley Smith is a 70-year-old African American man. He has multiple medical
conditions including hypertension, type 2 diabetes, and dyslipidemia. His
primary care provider is Dr. Jones. Mr. Smith calls Dr. Jones’s office today to
inquire what he can take for his cough. The triage nurse answers the phone call
from Mr. Smith.

 Discussion:

 1.
What information does the triage nurse need to elicit from Mr. Smith?

 2.
Mr. Smith tells the triage nurse he started taking Delsym one
teaspoonful twice a day about 10 days ago for a dry, hacking cough. His cough is
now productive; he has a temperature of 99.8F, and is having some shortness
of breath. What should the triage nurse advise Mr. Smith to do?
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 3.
Dr. Jones hands the nurse a prescription for an antibiotic and Mucinex
(guaifenesin SR) one tablet twice daily. Dr. Jones asks the nurse to go over the
prescriptions and the nonpharmacologic treatments for cough with Mr. Smith.
What instructions should the nurse give Mr. Smith with regard to his cough?
 Kimberly Jones is a 47-year-old Caucasian woman. Her current medical
conditions include hypertension and dyslipidemia. Her current medications
include metoprolol succinate (Toprol XL) 50 mg every day,
hydrochlorothiazide 25 mg every morning, and simvastatin (Zocor) 2 mg every
day. Dr. Langdon is her primary care provider. Mrs. Jones calls Dr. Langdon’s
office today to inquire what she can take for her nasal congestion. The triage
nurse takes her call and tells Mrs. Jones she will talk with Dr. Langdon and call
her back. Mrs. Jones tells the triage nurse she has not taken anything to treat
her nasal congestion. She checked her blood pressure at home today and it was
125/80 mm Hg and her pulse was 70 beats/minute. She denied any other
symptoms.
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Discussion:
1.
Was Mrs. Jones’s call warranted?
2.
What information does the triage nurse need to elicit from Mrs. Jones?
3.
Dr. Langdon recommends Mrs. Jones try an over-the-counter nasal spray
for her nasal congestion. Is this an appropriate treatment for Mrs. Jones?

 4.
What counseling should the triage nurse offer Mrs. Jones?
 Joshua Jackson is a 27-year-old Caucasian man. He was diagnosed with
asthma at the age of 8. He presents to the physician’s office
complaining of increased shortness of breath and coughing, especially
at night, despite using his albuterol (Proventil) inhaler 1 or 2
inhalations every 4 to 6 hours as needed. The physician classifies Mr.
Jackson’s asthma as step 3 persistent.

 Discussion:

 1.
What medications are recommended to treat Mr. Jackson’s
asthma?

 2.
What environmental controls can Mr. Jackson use to help control
his asthma?

 3.
Before leaving the office what should the nurse go over with Mr.
Jackson?
Respiratory Medication Equipment
 Inhalers
 Spacer
 Nebulizers
 Albuterol/Atrovent
 Oxygen Therapy
 Tubing
 Humidifier
Group Presentations