Chapter 31: Drug Therapy for Nasal Congestion and Cough
A client reports having difficulty finding the over-the-counter (OTC) decongestant that the client used in the past. What assessment question should the nurse ask to help address the client's concern?
"Did the medication contain pseudoephedrine?"-
A 25-year-old female client presents at the clinic with bronchitis. The health care provider orders guaifenesin. Which instruction should the clinic nurse offer when teaching the client about the medication?
"Drink at least two liters of fluids each day."
The nurse is providing medication information to a parent whose 9-year-old child has been prescribed dextromethorphan in liquid form. Which statement by the parent demonstrates the information has been received correctly?
"Eating and drinking within 30 minutes of taking the medication would minimize the effect of the medication."
The client reports a mild stinging sensation after using a nasal spray decongestant. Which response by the nurse would be most appropriate?
"This sensation is common and usually disappears with continued use."
After teaching a group of parents about the use of over-the-counter cough and cold products with their children, which statement indicates the need for additional teaching?
"We can use the adult brand, but we just have to decrease the amount."
A parent asks the nurse about the use of an antitussive to treat a 7-year-old's dry cough. What principle should guide the nurse's response?
Antitussives are not recommended for use in young children.
A client asks, "What is the difference between antitussive medications and expectorants?" What information should the nurse's response be based upon?
Antitussives suppress coughing while expectorants loosen bronchial secretions.
A client comes to the clinic with what appears to be a cold. What group of upper respiratory drugs cause local vasoconstriction, which decreases blood flow and shrinks swollen membranes to improve air flow?
Decongestants
A client presents at the clinic with a dry, nonproductive cough. The client is diagnosed with bronchitis, and it is determined that they will need help thinning sputum so that the cough can become productive. What does the nurse expect will be prescribed for the client?
Guaifenesin
A client is encouraged to take guaifenesin to loosen the secretions due to a viral respiratory infection. What should the nurse suggest to the client to make the medication work more effectively?
Increase fluid intake
A female client calls the pediatrician's office for a suggestion regarding the best over-the-counter cough and cold medicine for her 6-month-old child. The pediatrician advises against the medication for what reason?
Misuse could result in overdose.-Several OTC cough and cold medicines for use in infants have been recalled voluntarily due to concerns about possible misuse that could result in overdoses.
A client with cystic fibrosis may use which type of medication to reduce the viscosity of respiratory secretions?
Mucolytic
A nurse is preparing a presentation for a local elementary school parent group about over-the-counter cold medications and their use in children. Which would be most appropriate to include?
OTC cough and cold preparations should not be used in children under the age of 4 years. Accurate dosing is essential. Following the directions is essential to prevent inadvertent overdosage. Measuring devices that come with the medication should be used to ensure accurate dosages. Parents should look for the formula for children, infants, or pediatrics.
A male client presents to the health care provider's office with reports of inability to breathe freely. When the nurse reviews his use of over-the-counter medications, it is discovered that the client routinely uses nasal spray three times a day for 1 year. The nurse knows that what may be causing this client's continuous nasal congestion?
Rebound nasal swelling
A male client is diagnosed with chronic bronchitis. What would the nurse expect to be one of his physical reports?
Retention of secretions
The nurse is preparing a teaching session for a client prescribed dextromethorphan orally. Which instruction should the nurse prioritize?
The nurse should instruct the client to swallow the whole tablet and not to chew it to ensure that the drug is absorbed properly.
A client is questioning the use of eucalyptus as a decongestant. The nurse should point out that eucalyptus is contraindicated for which clients?
The use of eucalyptus is contraindicated during pregnancy and lactation, as well as in people who are hypersensitive to eucalyptus and in children younger than 2 years. Eucalyptus is generally considered safe for postmenopausal females and men.
A male client presents to the health care provider's office for his annual visit. When questioned about over-the-counter medication use, he states that he uses echinacea to prevent colds. What statement is true about echinacea?
There is limited or no support for the use of echinacea to prevent or treat symptoms of the common cold.
The nursing instructor is discussing the use of nasal decongestants and shares what reason for their effectiveness?
They come into direct contact with nasal mucosa.-With nasal decongestants, topical preparations (i.e., nasal solutions or sprays) are often preferred for short-term use. They are rapidly effective because they come into direct contact with nasal mucosa.
Parents who treat their children's cold and flu symptoms at home, should be reminded to read the labels of medications they use. What is the most important reason for doing so?
To understand proper use, precautions, and contraindications-Anyone using an over-the-counter medication should read the label to understand ingredients, instructions for use, precautions, contraindications, and drug interactions. Because these labels are frequently confusing, users of these products should contact a healthcare provider if they're unsure whether using a product is safe.
When describing the action of decongestants, a nurse integrates knowledge of this class of drugs, identifying which mechanism?
Vasoconstriction of small blood vessels of the nasal membranes is the mechanism of action for decongestants.
The nursing instructor is discussing over-the-counter cold remedies. According to the instructor, these products typically combine
a decongestant, an analgesic, and an antihistamine.
A client has just been admitted for an overdose of pseudoephedrine. The nurse's assessment of the client should prioritize what system?
cardiovascular
The nursing instructor is teaching students about the administration of nasal sprays. According to the instructor, the correct patient position for administering the sprays is closest to
high Fowler's position.
Which nursing diagnosis would provide the clearest indication for the administration of inhaled acetylcysteine?
ineffective airway clearance-Acetylcysteine reduces the viscosity of mucous secretions with the ultimate goal of allowing the client to establish and maintain a clear airway.
The nurse is providing education to a client who has been diagnosed with a sinus infection. What would the nurse identify as a major cause of this disorder?
inflammatory processes
A 43-year-old man is taking pseudoephedrine (Sudafed) for sinusitis. He calls the clinic to report that it feels like his heart is racing and that he can "feel his heart beating fast." The nurse will instruct him to:
stop taking the medication and come to the clinic as ordered by the health care provider.
What statement best describes how the common cold is effected by and managed using medication therapy?
the tendencies to overmedicate and use antibiotics inappropriately with the common cold are widespread and pose significant risk for complications and drug resistance.-
A client is currently taking pseudoephedrine to help manage the nasal congestion resulting from seasonal allergies. When the client reports being extremely restless and having difficulty getting to sleep at night, what assessment question will the nurse ask to best provide interventions to minimize those effects?
"How much coffee, tea, and soda do you drink daily?"
A client is encouraged to take guaifenesin to loosen the secretions due to a viral respiratory infection. What should the nurse suggest to the client to make the medication work more effectively?
Increase fluid intake-Guaifenesin reduces the viscosity of tenacious secretions by irritating the gastric vagal receptors stimulating respiratory tract fluid. Thus, it increases the volume and decreases the viscosity of respiratory tract secretions. By increasing the amount of fluid ingested, the secretions will become thinner and allow an easier passage for removal.
A 29-year-old client has sinusitis and has been prescribed a topical nasal decongestant. What instructions should the nurse provide?
Increase fluids to 2 L/d.
An older adult client has reported "seeing things that aren't there" after starting to take over-the-counter dextromethorphan for a nonproductive cough associated with a cold. What assessment question will provide the most relevant information regarding the possible cause of this adverse effect?
"How much dextromethorphan have you been taking each day?"-At normal doses, dextromethorphan is known to cause nausea, drowsiness, rash, and difficulty breathing but doses exceeding recommendations can produce hallucinations and disassociation.
Which is classified as a decongestant?
Afrin is a decongestant. Xyzal is a second-generation antihistamine. Delsym is a centrally acting antitussive that contains dextromethorphan. Astelin is a second-generation antihistamine.
Acetylcysteine may be used as a mucolytic agent. What is an additional indication for the drug?
Antidote for acetaminophen poisoning
A client suffers from motion sickness. Which drug would the nurse anticipate the primary health care provider to prescribe?
Both promethazine and diphenhydramine can be used in the treatment of motion sickness.
A 45-year-old female client is being seen in the health care provider's office for a dry, hacking cough that is keeping her up at night. The provider prescribes dextromethorphan for the cough. Which statement is true about dextromethorphan?
Dextromethorphan works in the medulla to suppress the cough reflex.
A group of nursing students are reviewing information about expectorants. The students demonstrate understanding when they identify which medication as an example
Guaifenesin-Guaifenesin is an example of an expectorant. Acetylcysteine is a mucolytic. Dextromethorphan is an antitussive. Benzonatate is an antitussive.
A nurse is conducting an ongoing assessment and notes the client is experiencing difficulty bringing up mucus. Which nursing diagnosis should the nurse prioritize for this client?
Ineffective Airway Clearance
A 76-year-old man has a history of heart disease, and has been prescribed an oral decongestant. The nurse is concerned with this prescription because of the risk for which?
Oral decongestants are contraindicated or (at minimum) used with caution in clients with severe cardiovascular disease or severe hypertension because of the risks for increased heart rate, blood pressure, and myocardial contractile force.
A male client is diagnosed with chronic bronchitis. What would the nurse expect to be one of his physical reports?
Retention of secretions commonly occurs with influenza, pneumonia, upper respiratory infections, acute and chronic bronchitis, emphysema, and acute attacks of asthma.
The nurse is preparing a teaching session for a client prescribed dextromethorphan orally. Which instruction should the nurse prioritize?
Swallow the whole tablet and do not chew it.
What statement best describes how the common cold is effected by and managed using medication therapy?
The tendencies to overmedicate and use antibiotics inappropriately with the common cold are widespread and pose significant risk for complications and drug resistance.
A client reports to the nurse, "My head is stuffed up and I can't breathe through my nose." Nasal discharge is noted upon examination. The client is diagnosed with a common cold. The nurse should prepare to provide medication instructions related to what classification of medication directed at the client's nasal mucosa?
decongestant
A 43-year-old man is taking pseudoephedrine (Sudafed) for sinusitis. He calls the clinic to report that it feels like his heart is racing and that he can "feel his heart beating fast." The nurse will instruct him to:
stop taking the medication and come to the clinic as ordered by the health care provider.-Cardiovascular adverse effects such as palpitations, tachycardia, hypertension, and arrhythmias are possible with the administration of pseudoephedrine (Sudafed). If the client reports palpitations and tachycardia, the nurse should instruct him to stop the medication and come in to see his provider.