DRUGS ACTING ON THE RESPIRATORY SYSTEM

DRUGS ACTING ON THE UPPER RESPIRATORY SYSTEM

DRUGS TO TREAT OBSTRUCTIVE PULMONARY
DISORDERS

BRONCHODILATORS
  Generic name: Salbutamol
 Brand name: Salbumin

NURSING PROCESS

ASSESSMENT

 Assess for possible contraindications or cautions: any known allergies to prevent

hypersensitivity reactions; cigarette use which affects the metabolism of the drug; peptic
ulcer, gastritis, renal or hepatic dysfunction, and coronary disease, all of which could be
exacerbated and require cautious use; and pregnancy and lactation, which are
contraindications because of the potential for adverse effects on the fetus or nursing baby.
 Perform a physical examination to establish baseline data for assessing the effectiveness of
the drug and the occurrence of any adverse effects associated with drug therapy.
 Perform a skin examination, including color and the presence of lesions, to provide a
baseline as a reference for drug effectiveness.
 Monitor blood pressure, pulse, cardiac auscultation, peripheral perfusion, and baseline
electrocardiogram to provide a baseline for effects on the cardiovascular system.
 Assess bowel sounds and do a liver evaluation and monitor liver and renal function tests to
provide a baseline for renal and hepatic function tests.
 Evaluate serum theophylline levels to provide a baseline reference and identify conditions
that may require caution in the use of xanthines.
 Evaluate urinary output and prostate palpation as appropriate to monitor anticholinergic
effects.
 Evaluate orientation, affect, and reflexes to evaluate CNS effects.

NURSING DIAGNOSIS AND CARE PLANNING

 Acute pain related to headache and GI upset.

 Disturbed sensory perception (kinesthetic, visual) related to CNS effects.
 Deficient knowledge regarding drug therapy.
 Increased cardiac output related to sympathomimetic effects.
 Disturbed thought processes related to CNS effects.
 Imbalanced nutrition: less than body requirements related to dry mouth and GI upset.

IMPLEMENTATION

 Relieve GI upset. Administer oral drug with food or milk to relieve GI irritation if GI upset is a
problem.
  Monitor drug response. Monitor patient response to the drug (e.g., relief of respiratory
difficulty, improved airflow) to determine the effectiveness of the drug dose and to adjust dose
as needed.
 Provide comfort. Provide comfort measures including rest periods, quiet environment, dietary
control of caffeine, and headache therapy as needed, to help the patient cope with the effects
of drug therapy.
 Provide follow-ups. Provide periodic follow-up, including blood tests, to monitor serum
theophylline levels.
 Individual drug response. Reassure patient that the drug of choice will vary with each
individual; these sympathomimetics are slightly different chemicals and are prepared in a
variety of delivery systems; a patient may have to try several different sympathomimetics
before the most effective one is found.
 Proper administration and dosage. Advise the patient to use the minimal amount needed for
the shortest period necessary to prevent adverse effects and accumulation of drug levels.
 Proper use of sympathomimetics. Teach the patients who use one of these drugs for
exercise-induced asthma to use it 30 to 60 minutes before exercising to ensure peak
therapeutic effects when they are needed.
 Use of adrenergic blockers. Alert the patient that long-acting adrenergic blockers are not for
use during acute attacks because they are slower acting and will not provide the necessary
rescue in a state of acute bronchospasm.
 Increase oral fluid intake. Ensure adequate hydration and provide environmental controls
such as the use of a humidifier, to make the patient more comfortable.
 Encourage voiding. Encourage the patient to void before each dose of medication to
avoid urinary retention related to drug effects.
 Small, frequent meals. Provide small, frequent meals and sugarless lozenges to relieve dry
mouth and GI upset.
 Use of inhalator. Review the use of inhalator with the patient; caution the patient not to
exceed 12 inhalations in 24 hours to prevent serious adverse effects.
 Educate the patient. Provide thorough patient teaching, including the drug name and
prescribed dosage measures to help avoid adverse effects, warning signs that may indicate
problems, and the need for periodic monitoring and evaluation, to enhance patient knowledge
about drug therapy and to promote compliance.
 Provide patient support. Offer support and encouragement to help the patient cope with the
disease and the drug regimen.

EVALUATION
 Monitor patient response to the drug (improved airflow, ease of respirations, improved
breathing).
 Monitor for adverse effects (CNS effects, increased pulse or blood pressure, GI upset, dry
skin, and mucous membranes).
 Evaluate the effectiveness of the teaching plan (patient can name drug, dosage, adverse
effects to watch for, specific measures to avoid them, and measures to take to increase the
effectiveness of the drug).
 Monitor the effectiveness of other measures to ease breathing.
 SYMPATHOMIMETICS

Generic name: Amphetamine Asparte

Brand name:

NURSING PROCESS

ASSESSMENT

 Assess for contraindications or cautions (e.g. history of allergy, pheochromocytoma, fatal

arrhythmias, etc.) to avoid adverse effects.
 Establish baseline physical assessment to monitor for any potential adverse effects.
 Assess vital signs, especially pulse and blood pressure to monitor for possible excess
stimulation of the cardiac system.
 Note respiratory rate and auscultate lungs for adventitious sounds to evaluate effects
on bronchi and respirations.
 Monitor urine output to evaluate perfusion of the kidneys and therapeutic effects.
 Monitor laboratory test results (e.g. liver and renal function tests) to determine need for
possible dose adjustment, and serum electrolyte levels to evaluate fluid loss and
appropriateness of therapy.

NURSING DIAGNOSIS AND CARE PLANNING

 Decreased cardiac output related to CV effects

 Ineffective tissue perfusion related to CV effects
IMPLEMENTATION

 Use extreme caution in calculating and preparing doses of these drugs because even small
errors could have serious effects.
 Use proper, aseptic technique when administering ophthalmic or nasal agents (alpha- and
beta- adrenergic agonists) to prevent injection and assure the therapeutic effectiveness of the
drug.
 Monitor patient response closely (vital signs, ECG, urine output) to ensure the most benefit
with the least amount of toxicity.
 Maintain phentolamine on standby in case extravasation occurs. Save the area by infiltrating
10 mL of saline containing 5-10 mg of phentolamine.
 Provide comfort measures (e.g. light control, encouragement to void, monitoring bowel
functions, support and relaxation measures) to help patient cope with the sympathomimetic
effects of the drug.
 Provide patient education about drug effects and warning signs to report.

EVALUATION

 Monitor patient response to therapy (improvement in blood pressure, ocular pressure,

bronchial airflow).
 Monitor for adverse effects (e.g. CV changes, decreased urine output, headache, GI upset).
 Evaluate patient understanding on drug therapy by asking patient to name the drug, its
indication, and adverse effects to watch for.
 Monitor patient compliance to drug therapy. 
 ANTICHOLINERGICS

Generic name:
Brand name:

NURSING PROCESS

ASSESSMENT

 Assess for contraindications or cautions (e.g., history of allergy to drug, GI obstruction,

hepatorenal dysfunction, etc.) to avoid adverse effects.
 Establish baseline physical assessment to monitor for any potential adverse effects.
 Assess neurological status (e.g., orientation, affect, reflexes) to evaluate any CNS effects.
 Assess abdomen (e.g., bowel sounds, bowel and bladder patterns, urinary output) to evaluate
for GI and GU adverse effects.
 Monitor laboratory test results to determine need for possible dose adjustments and to identify
potential toxicity.

NURSING DIAGNOSIS AND CARE PLANNING

 Acute pain related to GI, CNS, GU, and CV effects

 Decreased cardiac output related to CV effects
 Impaired urinary elimination related to effects on the bladder
 Constipation related to GI effects

IMPLEMENTATION
  Ensure proper administration of the drug to ensure effective use and decrease the risk of
adverse effects.
 Monitor patient response (e.g., blood pressure, ECG, urine output) for changes that may
indicate need to adjust dose.
 Provide comfort measures (e.g., sugarless lozenges, lighting control, small and frequent
meals) to help patient cope with drug effects.
 Provide patient education about drug effects and warning signs to report to enhance
knowledge about drug therapy and promote compliance.

EVALUATION

 Monitor patient response to therapy (improvement in condition being treated).

 Monitor for adverse effects (e.g., photophobia, heat intolerance, urinary retention).
 Evaluate patient understanding on drug therapy by asking patient to name the drug, its
indication, and adverse effects to watch for.
 Monitor patient compliance to drug therapy.
 STEROIDS

Generic name: Methyprednisolone

Brand name:

NURSING PROCESS

ASSESSMENT

 Obtain a complete health history including allergies, drug history, and possi-ble drug interactions.
 Obtain a complete physical examination, focusing on presenting symptoms.
 Determine the reason the medication is being administered.
 Obtain serum sodium and potassium levels, hematocrit and hemoglobin levels,and blood glucose
level, and blood urea nitrogen (BUN) and creatinine levels

NURSING DIAGNOSIS

 Infection, Risk for, related to immunosuppression

 Injury, Risk for, related to side effects of drug therapy
 Knowledge, Deficient, related to drug therapy
 Breast-feeding, Interrupted, related to drug therapy

NURSING INTERVENTIONS

 Monitor for infection. Protect client from potential infections. (Glucocorticoids increase susceptibility
to infections by suppressing the immune response.)
 Monitor client’s compliance with drug regimen. (Sudden discontinuation of these agents can
precipitate an adrenal crisis.)
 Monitor for symptoms of Cushing’s syndrome, such as moon face, buffalo hump, weight gain,
muscle wasting, and increased deposits of fat in the trunk. (Symptoms may indicate excessive use
of glucocorticoids.)
 Monitor blood glucose levels. (Glucocorticoids cause an increase in gluconeo-genesis and reduce
glucose utilization.)
 Monitor skin and mucous membranes for lacerations, abrasions, or break inintegrity.
(Glucocorticoids impair wound healing.)
 Monitor GI status for peptic ulcer development. (Glucocorticoids decrease gas-tric mucus
production and predispose client to peptic ulcers.
 Monitor serum electrolytes. (Glucocorticoids cause hypernatremia andhypokalemia.)
 Monitor changes in musculoskeletal system. (Glucocorticoids decrease bonedensity and strength
and cause muscle atrophy and weakness.)
 Monitor emotional stability. (Glucocorticoids may produce mood and behaviorchanges such as
depression or feeling of invulnerability.)
MAST CELL STABILIZER