Question

M.A., a 55-year-old woman, was recently diagnosed with bronchial asthma. In the past week, M.A. has had three asthmatic attacks and had to use her abuterol inhaler. M.A takes an inhaled combination glucocorticoid (fluticasone propionate 100mcg/salmeterol 50 mcg) on a daily basis.

1. Explain the purpose for inhaled glucocorticoid therapy? What are the advantages to this drug classification?
2. What patient teaching is included with glucocorticoid therapy? Can they be used to treat an asthmatic attack? Explain.
3. Why was M.A. prescribed albuterol? How does it work?
4. What are the assessment and nursing interventions for bronchodilators?
5. What is included in patient teaching for bronchodilators?
6. The provider provides montelukast to M.A’s daily regimen. Why was this medication prescribed?
7. What are the nursing interventions and patient teaching for leukotriene receptor antagonists (montelukast)? Explain your answer.

Answer 1

1.it suppress recruitment and activation of eosinophils and mast cells in airways and helps in suppression of antibody synthesis and receptor production ,inhibition of PG synthesis and up regulation of beta receptors.it is the most powrful and most effective medicine for long-term control of asthma in most people.When taken consistently,they improve lung function ,improve symptoms and reduce asthma attacks and admissions to the hospital for asthma.

2

• Advise the patient when to contact health care provider.
• perform appropriate skin care.
• Coping with stress.
• avoid infections.
• ensure proper nutrition and excercise
• maintains a written record.
• Clients should be informed that inhaled glucocorticoids must be taken daily to produce their therapeutic effect,and that these medications are not effective at terminating episodes in progress.

The primary purpose of inhaled glucocorticoid is to prevent respiratory distress.it can be used in the management of chronic asthma and to treat rhinitis.it is the most effective antiasthma available decrease inflammation and reduce pulmonary secretion .Inhaled,are drugs of choice for long-term prophylaxis of asthma.

Albuterol is useful for asthma-symptomatic relief.It relaxes smooth muscles of the bronchial tree and peripheral vasculature by stimulating adrenergic receptors of the sympathetic nervous system.it relieve bronchospasm in patients with reversible obstruction airway disease,prevention of excercise-induced bronchospasm and hyperkalemia.

Assessment

Assess BP,pulse,respirations,lung sounds and character of secretions before and during..Patients with cardiovascular history should be monitored with ECG changes and chest pain .Administer around the clock for therapeutic levels.

Patient family teaching

• Emphasize importance of taking only the prescribed dose at the prescribed intervals.
• Encourage adequate water to decrease thickness of secretions.
• Avoid OTC cough,cold and breathing preparations without consulting HCP and to limit intake of xanthine -containing foods and beverages may cause SE and arrythmiias.
• Use bronchodilators first,wait 5 min before administering other medications.

Leukotriene receptor agonists block leukotriene receptor sites so leukotrienes cant bind to receptors and cause inflammation.it is indicated for asthma prophylaxis,prevention of excecise induced asthma and allergic rhinitis.

Nursing interventions are

• Monitor response to drug.
• Monitor for adverse effects
• Evaluate teaching plan.
• Administer on empty stomach.

Patient teaching

• Advise patients to check with prescriber before taking over-the -counter or prescribed medications to determine drug interactions
• Teach patients to take medications every night on a continious schedule even if symptoms improve.