Exam 4 Nursing Processes
Topic 11
Chapter 35 - Upper Respiratory Disorders
Antihistamine: Diphenhydramine
Concept: Gas Exchange
● The lungs deliver oxygen to the pulmonary capillaries, carried by hemoglobin to body cells, and
carbon dioxide is carried away from body cells to the lungs and exhaled from the body.
Nursing Interventions
● Give the oral form of the drug with food to decrease gastric distress.
● Administer the intramuscular form in a large muscle. Avoid subcutaneous injection.
Patient Teaching
General
● Warn patients to avoid driving a motor vehicle and performing other dangerous activities if
drowsiness occurs or until stabilized on the drug.
● Advise patients to avoid alcohol and other central nervous system (CNS) depressants.
● Encourage patients to take drugs as prescribed. Notify a health care provider if confusion or
hypotension occurs.
● Teach patients on prophylaxis for motion sickness to take the drug at least 30 minutes before the
offending event, and also before meals and at bedtime during the event.
● Inform breastfeeding mothers that small amounts of drug pass into breast milk. Because children
are more susceptible to the side effects of antihistamines (e.g., unusual excitement or irritability),
breastfeeding is not recommended while using these drugs.
Side Effects
● Advise family members or parents that children are more sensitive to the effects of
antihistamines. Nightmares, nervousness, and irritability are more likely to occur in children.
● Inform older adults that they are more sensitive to the effects of antihistamines and are more
likely to experience confusion, difficult or painful urination, dizziness, drowsiness, feeling faint,
and dryness of the mouth, nose, or throat.
● Suggest using sugarless candy or gum, ice chips, or a saliva substitute for temporary relief of
mouth dryness.
Chapter 36 - Lower Respiratory Disorders
CAMS - Lower Respiratory Disorders
● Ephedra may increase the effect of the theophylline group and may cause theophylline toxicity.
● St. John’s wort may decrease montelukast concentration
Bronchodilators: Tiotropium
Concept: Oxygenation
● The addition of oxygen to the body
Nursing Interventions
● Monitor vital signs. Blood pressure and heart rate can increase greatly. Check for cardiac
dysrhythmias.
● Provide adequate hydration. Fluids help loosen secretions.
● Administer medication after meals to decrease gastrointestinal (GI) distress.
● Administer medication at regular intervals around the clock to have a sustained therapeutic level.
● Do not crush enteric-coated (EC) or sustained-released (SR) tablets or capsules.
Patient Teaching
, General
● Teach patients to monitor their pulse rate.
● Encourage patients to monitor the amount of medication remaining in the canister.
● Advise patients not to take over-the-counter (OTC) preparations without first checking with a
health care provider. Some OTC products may have an additive effect.
● Encourage patients contemplating pregnancy to seek medical advice before taking a theophylline
preparation.
● Advise patients to avoid smoking. Avoid marked sudden changes in smoking amounts, which
could affect theophylline blood levels. Smoking increases drug elimination, which may require an
increased drug dose.
● Discuss ways to alleviate anxiety, such as relaxation techniques and music.
● Advise patients having asthmatic attacks to wear an identification bracelet or MedicAlert tag.
● Inform patients that certain complementary and alternative therapies may interact with
theophylline.
● Advise patients to notify a health care provider of aggressive or altered behavior and suicidal
thoughts.
Self-Administration
● Teach patients to correctly use the inhaler or nebulizer. Caution against overuse because side
effects and tolerance may result.
● Teach patients to monitor pulse rate and report to a health care provider any irregularities in
comparison with baseline values.
Diet
● Advise patients that a high-protein, low-carbohydrate diet increases theophylline elimination.
Conversely, a low-protein, high-carbohydrate diet prolongs half-life; dosage may need
adjustment.
● Correct Use of a Metered-Dose Inhaler to Deliver Beta2 Agonist
● Insert the medication canister into the plastic mouthpiece.
● Shake the inhaler well before use.
● Remove the cap from the mouthpiece.
● Hold the mouthpiece 1 to 2 inches from the mouth or place the inhaler mouthpiece in the mouth.
A spacer may be used; discuss technique with a health care provider.
● Breathe out through the mouth, then take a slow deep breath in through the mouth; at the same
time, push the top of the medication canister once.
● Hold the breath for a few seconds; exhale slowly through pursed lips.
● Wait 2 minutes if a second dose is required, and then repeat the procedure by first shaking the
inhaler with the mouthpiece cap in place.
● Do a test spray into the air before administering the metered dose of a new inhaler or when the
inhaler has not been used recently.
Leukotriene Receptor Antagonists: Monteleukast
Concept: Oxygenation
● The addition of oxygen to the body by binding with leukotriene receptors to inhibit smooth
muscle contraction and bronchoconstriction
Nursing Interventions
● Monitor respirations for rate, depth, rhythm, and type.
● Monitor lung sounds for rhonchi, wheezing, or rales.
● Observe lips and fingernails for cyanosis.
● Monitor liver function tests; aspartate transaminase (AST) and alanine transaminase (ALT) may
be elevated with zafirlukast and montelukast.
● Provide pulmonary therapy by chest clapping and postural drainage as appropriate.
Patient Teaching
Topic 11
Chapter 35 - Upper Respiratory Disorders
Antihistamine: Diphenhydramine
Concept: Gas Exchange
● The lungs deliver oxygen to the pulmonary capillaries, carried by hemoglobin to body cells, and
carbon dioxide is carried away from body cells to the lungs and exhaled from the body.
Nursing Interventions
● Give the oral form of the drug with food to decrease gastric distress.
● Administer the intramuscular form in a large muscle. Avoid subcutaneous injection.
Patient Teaching
General
● Warn patients to avoid driving a motor vehicle and performing other dangerous activities if
drowsiness occurs or until stabilized on the drug.
● Advise patients to avoid alcohol and other central nervous system (CNS) depressants.
● Encourage patients to take drugs as prescribed. Notify a health care provider if confusion or
hypotension occurs.
● Teach patients on prophylaxis for motion sickness to take the drug at least 30 minutes before the
offending event, and also before meals and at bedtime during the event.
● Inform breastfeeding mothers that small amounts of drug pass into breast milk. Because children
are more susceptible to the side effects of antihistamines (e.g., unusual excitement or irritability),
breastfeeding is not recommended while using these drugs.
Side Effects
● Advise family members or parents that children are more sensitive to the effects of
antihistamines. Nightmares, nervousness, and irritability are more likely to occur in children.
● Inform older adults that they are more sensitive to the effects of antihistamines and are more
likely to experience confusion, difficult or painful urination, dizziness, drowsiness, feeling faint,
and dryness of the mouth, nose, or throat.
● Suggest using sugarless candy or gum, ice chips, or a saliva substitute for temporary relief of
mouth dryness.
Chapter 36 - Lower Respiratory Disorders
CAMS - Lower Respiratory Disorders
● Ephedra may increase the effect of the theophylline group and may cause theophylline toxicity.
● St. John’s wort may decrease montelukast concentration
Bronchodilators: Tiotropium
Concept: Oxygenation
● The addition of oxygen to the body
Nursing Interventions
● Monitor vital signs. Blood pressure and heart rate can increase greatly. Check for cardiac
dysrhythmias.
● Provide adequate hydration. Fluids help loosen secretions.
● Administer medication after meals to decrease gastrointestinal (GI) distress.
● Administer medication at regular intervals around the clock to have a sustained therapeutic level.
● Do not crush enteric-coated (EC) or sustained-released (SR) tablets or capsules.
Patient Teaching
, General
● Teach patients to monitor their pulse rate.
● Encourage patients to monitor the amount of medication remaining in the canister.
● Advise patients not to take over-the-counter (OTC) preparations without first checking with a
health care provider. Some OTC products may have an additive effect.
● Encourage patients contemplating pregnancy to seek medical advice before taking a theophylline
preparation.
● Advise patients to avoid smoking. Avoid marked sudden changes in smoking amounts, which
could affect theophylline blood levels. Smoking increases drug elimination, which may require an
increased drug dose.
● Discuss ways to alleviate anxiety, such as relaxation techniques and music.
● Advise patients having asthmatic attacks to wear an identification bracelet or MedicAlert tag.
● Inform patients that certain complementary and alternative therapies may interact with
theophylline.
● Advise patients to notify a health care provider of aggressive or altered behavior and suicidal
thoughts.
Self-Administration
● Teach patients to correctly use the inhaler or nebulizer. Caution against overuse because side
effects and tolerance may result.
● Teach patients to monitor pulse rate and report to a health care provider any irregularities in
comparison with baseline values.
Diet
● Advise patients that a high-protein, low-carbohydrate diet increases theophylline elimination.
Conversely, a low-protein, high-carbohydrate diet prolongs half-life; dosage may need
adjustment.
● Correct Use of a Metered-Dose Inhaler to Deliver Beta2 Agonist
● Insert the medication canister into the plastic mouthpiece.
● Shake the inhaler well before use.
● Remove the cap from the mouthpiece.
● Hold the mouthpiece 1 to 2 inches from the mouth or place the inhaler mouthpiece in the mouth.
A spacer may be used; discuss technique with a health care provider.
● Breathe out through the mouth, then take a slow deep breath in through the mouth; at the same
time, push the top of the medication canister once.
● Hold the breath for a few seconds; exhale slowly through pursed lips.
● Wait 2 minutes if a second dose is required, and then repeat the procedure by first shaking the
inhaler with the mouthpiece cap in place.
● Do a test spray into the air before administering the metered dose of a new inhaler or when the
inhaler has not been used recently.
Leukotriene Receptor Antagonists: Monteleukast
Concept: Oxygenation
● The addition of oxygen to the body by binding with leukotriene receptors to inhibit smooth
muscle contraction and bronchoconstriction
Nursing Interventions
● Monitor respirations for rate, depth, rhythm, and type.
● Monitor lung sounds for rhonchi, wheezing, or rales.
● Observe lips and fingernails for cyanosis.
● Monitor liver function tests; aspartate transaminase (AST) and alanine transaminase (ALT) may
be elevated with zafirlukast and montelukast.
● Provide pulmonary therapy by chest clapping and postural drainage as appropriate.
Patient Teaching
