Chapter 38: Upper Respiratory Disorders

Medication class of: Fluticasone (Flonase)?

Intranasal Glucocorticoid (steroid)

Primary use of Fluticasone (Flonase)?

allergic rhinitis

MOA of Fluticasone (Flonase)?

- Steroids

- Anti-inflammatory action

- May be used with H1 antihistamines

Route of Fluticasone (Flonase)?

nasal spray

Side effects of Fluticasone (Flonase)?

- continuous use can lead to nasal dryness

- systemic effects rare

Patient teaching for Fluticasone (Flonase)?

- usage should be short term ( less than 30 days is advised)

- tell pt to NOT to direct the spray at the septum

- NOT for immediate relief

* can be taken with Benadryl!!

Describe Assessment for Fluticasone (Flonase)?

- Assess nasal congestion, sneezing, allergic rhinitis symptoms

- Inspect nasal mucosa for irritation or dryness

Describe Nursing Diagnosis for Fluticasone (Flonase)?

- Ineffective airway clearance

- Impaired comfort related to allergic inflammation

Describe Nursing Planning for Fluticasone (Flonase)?

- Patient will report decreased nasal congestion by end of shift

- Patient will demonstrate correct nasal spray technique by end of day

Describe Implementation for Fluticasone (Flonase)?

- Administer as nasal spray

- May be used with antihistamines

- Monitor for nasal dryness

Describe Evaluation for Fluticasone (Flonase)?

- Improved breathing

- Decreased inflammation

- No excessive nasal irritation

Clinical Judgement for Fluticasone (Flonase)?

- If symptoms are inflammatory (allergic rhinitis) → intranasal steroid is appropriate

- If patient wants immediate relief, this is NOT the best choice (delayed onset)

Drug Class of Diphenhydramine (Benadryl)?

FIRST GENERATION antihistamine (H1 blocker)

MOA of Diphenhydramine (Benadryl)?

- constricts smooth muscles, including nose

- decreases nasal secretions

- used to treat colds and allergic rhinitis

Primary use of Diphenhydramine (Benadryl)?

Rhinitis

Routes for Diphenhydramine (Benadryl)?

Oral, IM, and/or IV

Side effects of Diphenhydramine (Benadryl)?

- drowsiness - pt safety, dry mouth, half life 2-7 hours

Contradictions for Diphenhydramine (Benadryl)?

- acute asthma attack

- liver disease

- COPD

- acute narrow angle glaucoma

- certain antidepressants ( MAOIs)

Adverse reactions of Diphenhydramine (Benadryl)?

- agranulocytosis, hemolytic anemia, thrombocytopenia

Patient teaching for Diphenhydramine (Benadryl)?

- Causes drowsiness → avoid driving or alcohol

- Use caution in older adults

- Not ideal for daytime symptom control

- may cause dry mouth, blurred vision

Describe Assessment for Diphenhydramine (Benadryl)?

- Assess allergy symptoms

- Monitor for drowsiness

- Assess urinary retention risk (older adults)

Describe Nursing Diagnosis for Diphenhydramine (Benadryl)?

- Risk for injury (sedation)

- Impaired comfort (allergic symptoms)

Describe Nursing Planning for Diphenhydramine (Benadryl)?

Patient will have reduced allergy symptoms without injury by end of shift

Describe Implementation for Diphenhydramine (Benadryl)?

- Administer orally, IM, or IV

- Monitor level of alertness

Describe Evaluation for Diphenhydramine (Benadryl)?

- Decreased nasal drainage

- Patient remains safe

Clinical Judgement for Diphenhydramine (Benadryl)?

- If patient needs daytime symptom relief → NOT ideal due to sedation

- If patient has glaucoma, BPH, or fall risk → use cautiously

Drug class of Phenylephrine (Sudafed PE)?

Systemic decongestant

MOA of Phenylephrine (Sudafed PE)?

- vasoconstriction in nose

Route of Phenylephrine (Sudafed PE)?

Oral

Side effects of Phenylephrine (Sudafed PE)?

- Jittery, restless, nervous

- can ↑ BP and ↑ glucose levels

- REBOUND NASAL CONGESTION

Describe Systemic Decongestants:

- usually last longer

- used for allergic rhinitis and congestion

- have MORE side effects

Patient teaching for Phenylephrine (Sudafed PE)?

- May increase BP and blood glucose

- avoid overuse

- report nervousness or palpations

Clinical Judgement for Phenylephrine (Sudafed PE)?

- If patient has uncontrolled HTN or diabetes → medication may be unsafe

- If patient reports jitteriness or palpitations → dose may be excessive

Describe Assessment for Phenylephrine (Sudafed PE)?

- Check BP and heart rate

- Assess for hypertension or diabetes

Diagnosis for Phenylephrine (Sudafed PE)?

- Ineffective airway clearance

- Risk for decreased cardiac output (if BP elevates)

Describe planning for Phenylephrine (Sudafed PE)?

Patient will report decreased congestion without elevated BP at end of shift.

Describe Implementation for Phenylephrine (Sudafed PE)?

- Administer orally

- Monitor BP and blood glucose

Describe evaluation for Phenylephrine (Sudafed PE)?

- Reduced congestion

- No excessive jitteriness or BP increase

Drug class of Guaifenesin?

Expectorant

Primary uses for Guaifenesin?

- productive coughs (wet)

- loosens bronchial secretions, to thin them out

- makes cough more effective

Route for Guaifenesin?

Oral

Side effects of Guaifenesin?

Nausea or Vomiting

- often combined with other meds

Patient teaching for Guaifenesin?

- Pt taking this needs to INCREASE fluid intake to 8 glasses per day

- best natural expectorant is HYDRATION!!

- take orally

MOA of Guaifenesin?

- Loosens bronchial secretions

- Makes coughs more effective

- allows Pt to cough up secretions!!

Clinical Judgement for Guaifenesin?

- If cough is dry and nonproductive → expectorant may not be helpful

- If patient is dehydrated → medication effectiveness will be reduced

Describe Assessment for Guaifenesin?

- Assess cough (productive vs nonproductive)

- Assess lung sounds

Describe Diagnosis for Guaifenesin?

Ineffective airway clearance

Describe Planning for Guaifenesin?

Patient will produce thinner secretions by end of week.

Describe Implementation for Guaifenesin?

- Administer orally

- Encourage increased fluid intake

Describe Evaluation for Guaifenesin?

- Improved ability to cough up mucus

- Clearer breath sounds

Diphenhydramine (Benadryl) is a:

cholinergic antagonist

Phenylephrine is a:

Adrenergic agonist

Fluticasone and Guaifenesin are:

Neither Adrenergic Agonist/Antagonist OR Cholinergic Agonist/Antagonist

Fluicasone =

inflammation control, NOT fast relief

Diphenhydramine =

sedating antihistamine and anticholinergic effects

Phenylephrine =

vasoconstriction → ↑ BP and glucose

Guaifenesin =

fluids = cough effectiveness