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Common Conditions of the Upper Respiratory System

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• Infections • Allergic rhinitis • Coughs • Common cold • Congestion

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Medication Classes of upper respiratory system

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• Antihistamines relieve allergy symptoms • Decongestants reduce nasal edema • Antitussives, mucolytics, and expectorants treat accompanying cough

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Antihistamines: Actions

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• Antihistamines block most, but not all, of the effects of histamine • First-generation antihistamines bind nonselectively to central and peripheral H1 receptors and may result in CNS stimulation or depression • Other first-generation drugs may have additional effects: Antipruritic (anti-itching) or antiemetic (antinausea) effects • Second-generation antihistamines are selective for peripheral H1 receptors and, as a group, are less sedating

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Antihistamines: Uses • The general uses of the antihistamines include:

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- Relief of the symptoms of seasonal and perennial allergies; relief of allergic and vasomotor rhinitis; relief of allergic conjunctivitis; relief of mild and uncomplicated angioneurotic edema and urticaria; relief of allergic reactions to drugs, blood, or plasma; relief of coughs caused by colds or allergy; adjunctive therapy in anaphylactic shock; treatment of parkinsonism; relief of nausea and vomiting; relief of motion sickness; sedation; adjuncts to analgesics

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Antihistamines: Adverse Reactions

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•Central nervous system reactions - Drowsiness or sedation; disturbed coordination •Anticholinergic effects (cholinergic blocking) - Dryness of mouth, nose, and throat; thickening of bronchial secretions

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Antihistamines: Contraindications and Precautions

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•Contraindicated during pregnancy and lactation - First-generation antihistamines: Patients with known hypersensitivity to the drugs, newborns, premature infants, nursing mothers, individuals undergoing monamine oxidase therapy, and in patients with angle-closure glaucoma, stenosing peptic ulcer, symptomatic prostatic hypertrophy, and bladder neck obstruction

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Antihistamines: Contraindications and Precautions (cont.)

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- Second-generation antihistamines: Patients with known hypersensitivity - Cetirizine is contraindicated in patients who are hypersensitive to hydroxyzine • Used with caution in patients with bronchial asthma, cardiovascular disease, narrow-angle glaucoma, symptomatic prostatic hypertrophy, hypertension, impaired kidney function, peptic ulcer, urinary retention, pyloroduodenal obstruction, and hyperthyroidism

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Rifampin-- Interactant drug /Effect of Interaction

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May reduce the absorption of antihistamine, fexofenadine, for example

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Monamine oxidase inhibitors-- Interactant drug /Effect of Interaction

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Monamine oxidase inhibitors --Increase in anticholinergic and sedative effects of antihistamine

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CNS depressants-- Interactant drug /Effect of Interaction

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Possible additive CNS depressant effect

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Beta blockers--Interactant drug /Effect of Interaction

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Risk for increased cardiovascular effects, with diphenhydramine, for example

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Aluminum- or magnesium-based antacids--Interactant drug /Effect of Interaction

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Decreased concentrations of antihistamine in blood, fexofenadine, for example

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Nursing Process for antihistamines: Assessment Preadministration assessment:- The assessments the nurse may perform:

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•Assess the involved areas (eyes, nose, and upper and lower respiratory tract) if the patient is receiving an antihistamine for the relief of allergy symptoms • If promethazine (Phenergan) is used with an opioid to enhance the effects and reduce the dosage of the opioid, take the patient's blood pressure, pulse, and respiratory rate before giving the drug

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Nursing Process: Assessment Ongoing assessment:

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- Observe the patient for the expected effects of the antihistamine and for adverse reactions - Antihistamine is given for a serious situation: Assess the patient at frequent intervals until the symptoms appear relieved and for about 24 hours after the incident

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Nursing Process: Planning • The expected outcomes for the patient depend on the reason for administration of the antihistamine but may include:

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- Optimal response to therapy - Supporting of patient needs related to managing adverse reactions - Understanding of and compliance with the prescribed treatment regimen

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Nursing Process: Implementation • Promoting an optimal response to antihistamine therapy:

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- Antihistamines: Given orally to prevent GI upset - *Loratadine:* Administered with or without water and placed on the tongue where it dissolves instantly - *Fexofenadine*: Not administered 2 hours after antacids - Antihistamines: Administered parentally—deep intramuscularly rather than subcutaneously

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Nursing Process: Implementation (antihistamines)

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• Monitoring and managing patient needs: - Impaired oral mucous membranes: •Dryness of the mouth, nose, and throat: Offer the patient frequent sips of water or ice chips to relieve the symptoms

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Risk of injury:

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•Assist the patient with ambulation •Place the call light within easy reach and instruct to call before attempting to get out of bed and ambulating

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Educating the patient and family:

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- Review the dosage regimen and possible adverse drug reactions with the patient

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Nursing Process: Evaluation

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• Mucous membranes are moist and intact • No injury is reported • The patient and family understand the drug regimen

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Decongestants: Actions

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- Nasal decongestants: Sympathomimetic drugs, which produce localized vasoconstriction of the small blood vessels of the nasal membranes

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Decongestants Uses:

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- Used to treat the congestion associated with the following conditions: •Common cold; hay fever; sinusitis; allergic rhinitis; congestion associated with rhinitis

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Decongestants: Adverse Reactions

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• Use of oral decongestants may result in the following adverse reactions: - Tachycardia and other cardiac arrhythmias; nervousness; restlessness; insomnia; blurred vision; nausea; vomiting

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Decongestants Contradicted:

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- In patients with known hypersensitivity and patients taking monoamine oxidase inhibitors - Sustained-released pseudoephedrine is contraindicated in children younger than 12 years of age

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Decongestants are used cautiously in patients with:

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- Thyroid disease; diabetes mellitus; cardiovascular disease; prostatic hypertrophy; coronary artery disease; peripheral vascular disease; hypertension; glaucoma - Pregnant women should consult with their primary health care provider before using these drugs

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Decongestants: Interactions

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Interactant drug Effect of interaction MAOIs Severe headache, hypertension, and possibly hypertensive crisis

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Beta-adrenergic blocking drugs

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Initial hypertension episode followed by bradycardia

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Antitussives, Expectorants, and Mucolytics: Actions and Uses

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• Expectorants increase the production of respiratory secretions, which in turn appears to decrease the viscosity of the mucus. This helps to raise secretions from the respiratory passages • Antitussives are used to relieve a nonproductive cough • Expectorants are used to help bring up respiratory secretions

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Antitussives, Expectorants, and Mucolytics: Adverse Reactions

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• Lightheadedness • Dizziness • Drowsiness or sedation

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Nursing Process: Assessment Antitussives, Expectorants, and Mucolytics • Preadministration assessment:

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- Assess the patient's blood pressure, pulse, and congestion before administering the decongestants; assess the lung sounds and bronchial secretions, and note in the patient's records; obtain the history of the use of the products

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• Antitussives, Expectorants, and Mucolytics Ongoing assessment:

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- Assess the patient's blood pressure, pulse, and congestion; question the patient about attaining therapeutic effects and presence of adverse

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Nursing Process: Diagnoses Antitussives, Expectorants, and Mucolytics

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• Risk for Injury related to drowsiness, dizziness, or sedation • Ineffective Airway Clearance related to pooling of or thick secretions • Impaired Oral Mucous Membranes related to dry mouth, nose, and throat

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Nursing Process: Planning

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• Expected outcomes for the patients include: - Optimal response to therapy - Support of patient needs related to the management of adverse reactions - Understanding of and compliance with the prescribed treatment regimen

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Nursing Process: Implementation (Antitussives, Expectorants, and Mucolytics)

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• Promoting an optimal response to therapy - Ineffective breathing pattern: •Overuse of topical form: "Rebound" nasal congestion •Patient is taught to take the drug exactly as prescribed or discontinue the drug therapy gradually

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Nursing Process: Implementation • Educating the patient and family:

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The nurse should include the following points in the teaching plan: - Use this product as directed by the primary health care provider or on the container label - Understand that overuse of topical nasal decongestants can make the symptoms worse, causing rebound congestion - If using a spray, do not allow the tip of the container to touch the nasal mucosa and do not share the container with anyone

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Nursing Process: Evaluation

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• The patient maintains effective breathing pattern • The therapeutic effect is achieved • The patient demonstrates an understanding of and compliance with the drug regimen

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Is the following statement true or false? • Cough, cold, congestion, and allergies are common problems in the upper respiratory system.

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• True • Cough, cold, congestion, and allergies are common problems in the upper respiratory system.

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Is the following statement true or false? • Expectorants or mucolytics are used to reduce inflammation.

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False • Antihistamines are used to reduce inflammation; decongestants reduce edema and swelling; antitussives are used to eliminate cough. When congestion produces secretions in either the respiratory passages or the lungs, expectorants or mucolytics are used, respectively.

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dextromethorphan

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Robitussin

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diphenhydramine

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Benadryl

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loratadine

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Claritin

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mometasone

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Nasonex

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A client is prescribed 200 mg of guaifenesin syrup. The drug is available in syrup of 200mg/5mL. The nurse administers _______.

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5mL

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Loratadine 10mg is prescribed. The drug is available in 5mg tablets. The nurse instructs the client to take _______.

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2 tablets

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Antitussives are medications that______. 1. loosen respiratory secretions 2. depress the cough center in the brain 3. increase production of mucous secretion 4. fight microbial infections of the lungs

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*2. depress the cough center in the brain*

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Which of these drugs is classified as an expectorant? 1. guaifensein 2. codeine 3. dextromethophan 4. diphenhydramine

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*1. guaifenesin*

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Which of the following is a common adverse reaction seen when administering an antihistamine? 1. sedation 2. blurred vision 3. headache 4. hypertension

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*1. sedation*

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When antihistamines are administered to clients receiving CNS depressants, the nurse monitors the client for _____. 1. an increase in anticholinergic effects 2. excessive sedation 3. seizure activity 4. loss of hearing

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*2. excessive sedation*

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A client receives a prescription for phenylephrine (Neo-Synephrine). The nurse explains that overuse of this drug may___________. 1. result in hypotensive episodes 2. decrease sinus drainage 3. cause rebound nasal congestion 4. dilate capillaries in the nasal mucosa

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*3. cause rebound nasal congestion*

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Which of the following statements is appropriate for the nurse to include in discharge instructions for a client taking an antitussive? 1. Increase the dosage if the drugs does not relieve the cough 2. Limit fluids to less than 1000 mL each day 3. Expect the cough to worsen during the first few days of treatment 4. Frequent sips of water may diminish coughing

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*4. Frequent sips of water may diminish coughing*

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The nurse is to administer a mucolytic agent. Which of the following nursing actions is appropriate to take to promote an effective airway? 1. increase fluid intake to 2000 mL per day 2. Limit fluids to 200mL per day 3. Monitor intake and output every 8 hours 4. Have the client take the mucolytic after each coughing episode

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1. increase fluid intake to 2000 mL per day

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Which of the following interactions would most likely occur when diphenhydramine is administered with a Bblocker drug such as propranolol(Inderal)? 1. increased risk for cardiovascular effects 2. increased risk for seizures 3. decreased risk for cardiovascular effects 4. decreased risk for seizures

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1. increased risk for cardiovascular effects

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Which of these drugs would most likely be used to bring up deep mucous plugs in the lungs of a client with a tracheostomy? Select all that apply. 1. acetylcysteine 2. guaifenesin 3. benzonatate 4. dextromethophan

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1. acetylcysteine

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A client with limited health literacy is prescribed an antihistamine for an upper respiratory tract allergy. You want to be sure the client does not use other cold remedies with antihistamines included. What is the best way to relay this information. Select all that apply. 1. Tell the client which drugs not to use 2. Give the client a list of medicines that include antihistamines 3. Show the client where to look on the medicine label for the ingredients 4. Make a poster for your clinic with drugs that contain antihistamines for teaching

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*2. Give the client a list of medicines that include antihistamines* *3. Show the client where to look on the medicine label for the ingredients* *4. Make a poster for your clinic with drugs that contain antihistamines for teaching*

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