1. Provide the rationale for why Ms. Bremmer is prescribed these inhalers.
2. What contraindications or precautions would eliminate the use of these drugs for Ms. Bremmer?
3. What patient variables are most important to consider for Ms. Bremmer when assessing her drug therapy?
4. What aspects of core drug knowledge (pharmacotherapeutics, pharmacokinetics, and pharmacodynamics) are especially relevant to consider because they may interact with the patient variables?
5. Which of the findings from the nursing assessment demonstrate the effectiveness of drug therapy?
6. Which of the findings from the nursing assessment demonstrate possible adverse effects from the drug therapy?
7. What nursing actions are indicated to maximize therapeutic effects?
8. What nursing actions are indicated to minimize adverse effects?
9. What teaching is required for Ms. Bremmer regarding her drug therapy? Include list of any additional data needed to determine appropriate teaching.
1. Albuterol causes increased airflow to the lungs and relaxes the bronchial muscles. Tina (TB) was found to have obstructive airway complication and hence for bronchospasm condition, this is most suitable. Flunisolide is corticosteroids class of drug and is useful in reduction of any irritation or swelling in the airway passage. Other concern such as blood pressure and body temperature is normal for TB, thus these medications are optimum for the present case.
2. Contractions as such related to any disease or disorder should be mentioned to the physician, to recommend accurate medication and avoid any adverse effect. These are:
Cardiovascular disease, high blood pressure and heart failure
Seizure or episodes related to epilepsy
Chemotherapeutic usage for Flunisolide.
3. Pregnancy is one of the concerns, where these choices of drug are not suitable. Other than, this thyroid or cardiovascular disorder may worsen the condition with the use of both Albuterol and Flunisolide usage. These can increase cardiac rhythm and are prone to cause infraction like condition.
4. Albuterol have 50 % of oral bioavailability and acts longer for 4-6 hours. It has side effect of palpitation and muscle tremors, increases BP and act for ACh release, thus should not be given with cardiovascular complications. Flunisolide has adverse drug reactions with chemotherapeutic agent and should not be prescribed for concurrent use.
5. Lungs sound have bilateral wheezes and diminished sounds at bases, which reveals obstructive airway complication and difficulty in breathing. This also confirms that the concern is related to bronchospasm, thus use of Albuterol is appropriate. Since the incidence happens in the campus on cold fall day, it might be related to season rhinitis and thus Flunisolide is used for prescription.
6. The adverse effects are with respect to inhaler used before coming to ER. These are confirmed with Pulse oximetry 92% on admission sO2 (oxygen-haemoglobin saturation, and low respiration of 26 and shallow characteristics.
7. The initial assessment is important which helps in obtaining the information related to pulse rate, body temperature, respiration rate and blood pressure. The sound assessment of lungs are critical in finding the possible explanation related to bronchospasm. These assessments are effective in minimizing any adverse drug reaction with recommendation of medication. Other than this, monitoring of patient condition is crucial after inhalation with the inhale administration.
8. Monitoring of the patient condition is crucial. Bronchospasm can induce as well as aggravate the cough. Nurses should assess whether TB have bronchial hyperreactivity, so that activation of the pulmonary receptors should not trigger any more cough and bronchoconstriction. Thus airflow, blood pressure and cardiac rate should be checked, for increasing the effectiveness of the medication.
9. Educating TB is also important for reducing the chances of reoccurrence of ill consequences and management of emergency. The approach for medication use should be taught to TB, which is very much essential, such as timing of the inhaler usage, pre-prandial or post meal usage, number of dose (two puff every 4 hours or every day for Albuterol and Flunisolide respectively). Other than this food habits and avoiding exposure to allergic agents including avoidance from dust, spicy food should be instructed. Use of woolen cloths is requisite to prevent stimulation of nociception and thermoreceptor by cold is also included in effective teaching scope.
Lilley, L. L., Collins, S. R., & Snyder, J. S. (2012). Pharmacology and the Nursing Process7: Pharmacology and the Nursing Process. Elsevier Health Sciences.