Nancy Pares, RN, MSN
Metropolitan Community College
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One of the most important organ systems
Upper respiratory tract
◦ Nose, nasal cavity, pharynx, and paranasal sinuses
(see pg 573 in Adams)
◦ ‘air conditioning’ of the respiratory tract
 Warm, humidify and clean the air
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Sympathetic nervous system
◦ Constricts arterioles of the nose-widens the airway
(relief of stuffiness)
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Parasympathetic nervous system
◦ Dilates the aterioles of the nose-shrinks the airway
(causes stuffiness)
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Primary action: block the actions/attachment
of histamine at the H1 receptors
 Action: 15-60 min; lasts 4-6 hrs; works best early Causes bronchial smooth muscle relax
◦ OTC remedies for allergic rhinitis, motion sickness
and insomnia
◦ Reduces inflammation and symptoms; used to
reduce secretions and treat anaphylactic shock (IV)
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Diphenhydramine (Benedryl) prototype
Action: blocks histamine from reaching its
receptors
Uses: often combined with analgesics,
decogestants, and expectorants; treatment
of rashes, allergic reactions, Parkinson’s
disease, motion sickness and insomnia
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Fexafenadine (Allegra) prototype
Action: reduces nasal congestion, sneezing,
tearing of the eyes.
Use:same as 1st generation
Contraindication: hypersensitivity to drug;
may have synergistic sedative effects.
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First generation drugs have more significant side
effects than 2nd generation
Side/effects
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Sedation or rarely excitability
Anticholinergic effects (everything dries up)
Nursing Moms may have decreased lactation (Category C)
Respiratory secretions thicken
Young children may exhibit hypersensitivity or overdose
 CNS depression, dry mouth, fixed and dilated pupils
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Promenthazine (Phenergan): motion
sickness and n/v
Antihistamines may also be used for vertigo
and insomnia
Contraindications:
◦ Hx of heart disease, narrow angle glaucoma,
seizure disorder, CNS stimulation, renal
impairment,or prostate disease.; no use with
asthma
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See page 575
Know prototypes:
◦ Diphenhydramine (Benedryl)
◦ Fexofenadine (Allegra)
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Action:
◦ stimulate alpha 1 adrenergic receptors in
vascular smooth muscle which produces
vasoconstriction. Vasoconstriction reduces the
blood flow which slows the production of mucus
and relieves symptoms.
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Routes of administration/side effects:
◦ intranasal-few side effects
 Rebound congestion
 Use no longer than 3-5 days
 If dependence is developed, change to intranasal
glucocorticoid
◦ oral
 No rebound congestion
 Onset of action is much slower
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Sympathomimetics:
◦ Oxymetazoline (Afrin)
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Anticholinergic
◦ Ipratopium bromide (Atrovent)
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Uses: decrease blood flow of nasal surg and
common cold s/s
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Antihistamines:
◦ Auscultate breath sounds
◦ Monitor VS (including ECG w HD)
◦ Monitor thyroid labs (antihistamines may cause thyroid
storm
◦ Monitor vision changes and neuro status, especially LOC
◦ Measure I&O
◦ Monitor glucose levels
◦ Observe for anticholinergic crisis
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Decongestants:
Assess VS, especially pulse and BP
Monitor urinary output/flow
Do not use with other OTC cold preps
Immediately report palpitations, CP, dizziness,
visual changes, excessive dry mouth
◦ Use proper technique on use and care of nasal
spray dispensers.
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Antitussives (opioid and non opioid)
◦ Dampen the cough reflex
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Expectorants
◦ Reduce the thickness-increases flow
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Mucolytics
◦ Break down the chemical structure
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Codeine/hydrocodone
◦ Action:
 raise the cough threshold in CNS; usually classified as
Schedule III, IV or V
◦ S/E
 Respiratory depression
 Minimal potential for dependence
◦ Nursing Implications;
 Caution use in asthma
 Used in combination with antihistamines, decong (pg 590)
 Monitor for drowsiness; know what s/e to report
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Dextromethorphan(Benylin)
◦ Action/S/E:
 raises the cough threshold
 s/e are rare
◦ Nursing implications:
 No risk of dependence
 Contraindicated in treatment of chronic cough
(asthma, smoking, emphysema); MAOI, asthma
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Benzonatate (Tessalon)
◦ Action:
 Suppresses cough by anesthetizing stretch receptors
of lungs
◦ S/E
 uncommon, may include sedation, nausea, HA
◦ Nursing implications:
 Teach not to chew the pill-numbing effects
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Guaifenesin(Robitussin)
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Most common
Tolerated by most
Available OTC
Few adverse effects
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Acetylcysteine (Mucomyst)
◦ Action/Use:
 Breaks down mucous molecule
 Cystic fibrosis, chronic bronchitis
 Overdose of acetaminophen
◦ Route:
 Inhalation-disease processes
 IV/oral-overdose
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Critical thinking:
◦ When would an expectorant be used?
◦ When would an antitussive be used?
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Monitoring cough characteristics
Assess history of the cough
Use antitussives when cough interferes with ADL’s, rest or
sleep
Teach goals of therapy
Caution food and water immediately following taking med
Teach about environmental modifications
Do not suppress productive cough
Maintain adequate fluid intake
Teach to read label-do not take more than recommended
dose
Teach not to use prescription with OTC
Keep all meds out of reach of children-call Poison Control if
ingested---no use of Ipecac (gag reflex diminished)
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Basic Physiology of lower resp. tract
◦ Trachea, bronchus, lung
◦ See page 590 in Adams
◦ Bronchioles are elastic smooth muscle which dilate and
constrict based on metabolic needs.
 Controlled by autonomic nervous system
 Fight or flight response
 Beta 2 adrenergic receptors stimulated=bronchodilation
 Parasympathetic nervous system action
 bronchoconstriction
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Aerosol
◦ Delivers to immediate site of action=fewer systemic effects
◦ Used for bronchospasm or decrease viscosity of mucous in
bronchi
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Nebulizer
◦ Machine that vaporizes liquid via face mask or handheld
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Dry Powder Inhaler (DPI)
◦ Takes fine powder directly to bronchi
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Metered Dose Inhalers (MDI)
◦ Uses a propellant to deliver measured dose to the lungs with each
breath
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MUST USE DEVICES CORRECTLY: ONLY 10-50% OF DRUG
ACTUALLY REACHES LUNGS.
General info:
-relax bronchial smooth muscle=widening the
airway
-beta agonists alone have no anti-inflammatory
properties
-some agents activate beta 1 and beta 2 receptors
-newer agents only activate beta 2 receptors
-inhaled beta adrenergic agents have little
systemic toxicity
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Beta agonists/sympathomimetics
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Methylxanthines
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anticholinergics
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Action/Use: bronchodilatation via beta 2
receptor activation
◦ Classification by duration of action
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Ultra short (effects last 2-3 hrs)
Short (effects last 5-6 hrs)
Intermediate ( 8 hrs)
Long (12 hrs) Formoterol (Foradil)
Prototype: salmertol (Seravent)
◦ S/E
 Cardiac (tachycardia, dysrhythmias), hyperglycemia, tolerance of
med, insomnia, nervousness, tremor
◦ Nursing Interventions/contraindications:
 Monitor VS- especially BP; no MAOI’s, TAD, or antihistamines; teach
about meds (timing, use of , s/s to report)
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Action/use:
◦ Bronchodilatation; chronic persistent asthma
◦ Related to caffeine; stimulate CNS
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Route: IV or po (not inhaled)
Nursing Interventions:
◦ Assess VS-esp RR and lung sounds;monitor K+ levels,
monitor for insomnia, hyperstimulation; limit use of
caffeine and smoking; teach about meds (timing, use, as
prescribed)
◦ Prototype: theophylline (Theo-dur)
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Action/use:
◦ Blocks cholinergic receptors in bronchial smooth
muscle; chronic bronchitis, nasal congestion
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S/E/route:
◦ Irritation of upper respiratory tract, dry mouth, GI
distress, HA and anxiety; bitter taste
◦ MDI
◦ Prototype: ipratropium bromide (Atrovent)
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Nursing interventions:
◦ Wait 5 min between this med and any other, proper
technique, rinse mouth, report changes in urinary
pattern
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Action/Use:
◦ Anti inflammatory; prophylactic treatment of bronchial
asthma
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S/E/routes:
◦ Local: hoarseness; systemic: adrenal gland atrophy, peptic
ulcers, osteoporosis; growth a concern in children
◦ Oral = prednisone; IV= Solu-Medrol
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Nursing interventions:
◦ Monitor VS, Assess for s/s of infection, assess lung sounds,
oxygen sats, weight gain/loss, teach about meds.
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Assessment:
◦ Gas exchange
 Cyanosis, activity tolerance, labs, pulm tests
◦ Monitor effectiveness of therapy
 Change in cough, resp. effort, lung sounds, nature and
quality of secretions
◦ Monitor for adverse effects of drugs
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Ineffective airway clearance RT
bronchoconstricion
Impaired gas exchange RT disease process
Risk for injury RT adverse effects of drugs
Deficient knowledge RT disease process
and medication regime
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The client will:
◦ Experience effective cough and clear breath
sounds…
◦ Have 02 sats >90% ….
◦ Verbalize improvement in respiratory secretions ….
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Disease specific (amounts of 02)
Drug specific monitoring
Monitor for S/E
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Were the goals met?