Reference no: EM133852390

Critical Thinking exercise

1. A patient calls the clinic to ask the nurse about taking an antihistamine for a "terrible cold." She says she is so tired of sneezing and blowing her nose.

What are the priorities when the nurse assesses the patient's medical history before answering her about the use of antihistamines?

2. An older patient is discussing the use of guaifenesin with the nurse. He asks, "What else can I do to fight this terrible cold? I don't want to just take a pill." What is the nurse's best answer?

3. A patient is recovering from an emergency exploratory laparotomy. He had a cold before his surgery and is now coughing up large amounts of whitish yellow sputum. He is receiving intravenous fluids and antibiotics. He asks the nurse for something to make him stop coughing. The nurse reviews the medication sheet and sees both an expectorant and an antitussive ordered. Which medication would be the best choice at this time? Explain your answer.

1. Case study

1# A 22-year-old male college student has had allergy symptoms since moving into his dormitory. When he calls the student health centre, he is told to try an OTC topical nasal decongestant. He tries one and is excited about the relief he experiences until 2 weeks later, when his symptoms return. He calls the student health centre again, upset because his symptoms are now worse.

1. What explanation do you have for the worsening symptoms?

2. What patient education should he have received about this type of drug?

3. What other OTC drugs and nonpharmacological measures could be suggested to improve this situation?

Chapter 38: Respiratory Drugs

Critical Thinking Activities

1. A patient is taking a xanthine derivative and asks the nurse about drinking coffee with the medication. What is the nurse's best answer?

2. A patient was prescribed an oral LTRA 1 month ago. At today's follow-up appointment, he tells the nurse, "I don't think this pill works. I took it when I was short of breath, but it did not help." What is the priority when the nurse answers this patient's concerns?

3. A 13-year-old is taken to the clinic because he started to have an asthma attack while running outside in the cold air. He carries two metered-dose inhalers with him: fluticasone and salbutamol. Which inhaler is the priority at this time? Explain your answer.

2. Case study  : Chronic Obstructive Pulmonary Disease

Hazel is a 73-year-old woman who has had chronic obstructive pulmonary disease (COPD) for approximately 10 years; it was caused by exposure to workplace environmental pollutants and by cigarette smoking. She is now retired and is frequently admitted to the hospital for treatment of her condition. She quit smoking 8 years ago. She is now in the hospital for treatment of an acute exacerbation of her COPD and an URT infection. The health care provider has ordered the following: ipratropium 2 puffs q3h and salbutamol 2 puffs q3h by MDI; chest physiotherapy bid and prn; levofloxacin 500 mg IV daily; measurement of intake and output; daily weight measurement; assessment of vital signs, with breath sounds q2h and prn until stable; and salbutamol inhaler, 2 puffs q4h per respiratory therapy protocol.

1. What nursing interventions would be most appropriate for helping Hazel conserve energy while enhancing O2 and CO2 gas exchange?

2. What is the rationale for the use of salbutamol and ipratropium?

3. What is the rationale for the antibiotic? Be specific.

4. Would Hazel benefit from the use of systemic corticosteroids in the management of this exacerbation?