Question

10. The nurse is reinforcing teaching regarding nasal spray phenylephrine. Explain important points for the nurse to reinforce with the client. Ae

Answer 1

Phenylephrine nasal spray is used to relieve nasal discomfort caused by colds, allergies, and hay fever. It is also used to relieve sinus congestion and pressure.

How should this medicine be used?

Use phenylephrine nasal spray more often or for longer than the recommended period of time, your congestion may get worse or may improve but then return.

Do not use phenylephrine nasal spray for longer than 3 days. If your symptoms do not get better after 3 days of treatment, stop using phenylephrine and call your doctor.

To use the nose spray:

• Blow your nose gently. With the head upright, spray the medicine into each nostril. Sniff briskly while squeezing the bottle quickly and firmly. For best results, spray once or twice into each nostril and wait 3 to 5 minutes to allow the medicine to work. Then, blow your nose gently and thoroughly. Repeat until the complete dose is used.
• Rinse the tip of the spray bottle with hot water, taking care not to suck water into the bottle, and dry with a clean tissue. Replace the cap right after use.
• To avoid spreading the infection, do not use the container for more than one person.

To use the nose spray

• Blow your nose until your nostrils are clear.
• Wash your hands with soap and water.
• Shake the bottle gently before each use and remove the cap.
• Hold one nostril closed with your finger.
• Tilt your head slightly forward and place the tip of the bottle towards the back of your open nostril.
• Squeeze the bottle quickly and firmly 2 to 3 times while gently breathing in the medication.
• Repeat steps 4 to 6 for the other nostril.
• Wipe the tip of the bottle and replace the bottle cap.
• Blow your nose gently. With the head upright, spray the medicine into each nostril. Sniff briskly while squeezing the bottle quickly and firmly. For best results, spray once or twice into each nostril and wait 3 to 5 minutes to allow the medicine to work. Then, blow your nose gently and thoroughly. Repeat until the complete dose is used.
• Rinse the tip of the spray bottle with hot water, taking care not to suck water into the bottle, and dry with a clean tissue. Replace the cap right after use.
• To avoid spreading the infection, do not use the container for more than one person.

Before using phenylephrine nasal spray:-

1. tell your doctor and pharmacist if you are allergic to phenylephrine, any other medications, or any of the ingredients in phenylephrine nasal spray. Ask your pharmacist or check the product labeling for a list of the ingredients.
2. tell your doctor if you have or have ever had high blood pressure, diabetes, difficulty urinating due to an enlarged prostate gland, or thyroid or heart disease.
3. tell your doctor if you are pregnant, plan to become pregnant, or are breastfeeding. If you become pregnant while using phenylephrine nasal spray, call your doctor.

Phenylephrine nasal may cause side effects:-burning, stinging, sneezing, increased nasal discharge, nervousness, dizziness, difficulty falling asleep or staying asleep.

Assessment & Drug Effects:-

• Monitor pulse, BP, and central venous pressure (q2–5min) during IV administration.
• Control flow rate and dosage to prevent excessive dosage. IV overdoses can induce ventricular dysrhythmias.
• Observe for congestion or rebound miosis after topical administration to eye.

Patient Education

• Be aware that instillation of 2.5–10% strength ophthalmic solution can cause burning and stinging.
• Do not exceed recommended dosage regardless of formulation.
• Inform the physician if no relief is experienced from preparation in 5 d.
• Be aware that systemic absorption from nasal and conjunctival membranes can occur, though infrequently. Discontinue drug and report to the physician if adverse effects occur.
• Wear sunglasses in bright light because after instillation of ophthalmic drops, pupils will be large and eyes may be more sensitive to light than usual. Stop medication and notify physician if sensitivity persists beyond 12 h after drug has been discontinued.
• Be aware that some ophthalmic solutions may stain contact lenses.
• Do not breast feed while taking this drug.

Assessment Prior to administration:

1. Monitor cardiac output, central venous pressure, pulmonary artery wedge pressure, standard vital signs and urinary output.
2. Monitor vital signs and observe the nasal mucosa for changes such as excoriation or bleeding.
3. Obtain complete health history including cardiac, visual, pulmonary, GI, urinary disorders including blood studies: CBC, electrolytes, cardiac enzymes, BUN, creatinine. May include EKG, pulmonary functions, and x-rays of the chest or nasal sinuses.
4. Obtain patient’s drug history to determine possible drug interactions and allergies.

Planning: Patient Goals

The patient will:

• Demonstrate understanding of the drug's action.
• Return demonstrate proper nasal medication instillation technique.
• Demonstrate effective nasal airway clearance.
• Maintain vital signs within normal range.
• Maintain effective tissue perfusion.

Patient Education

Inform patients:

1. to immediately report shortness of breath, palpitations, dizziness, chest/arm pain or pressure or other "angina-like" symptoms.
2. to consult their health care provider before attempting to use phenylephrine to treat nasal stuffiness or eye irritation.
3. to monitor blood pressure, pulse and temperature ensuring proper use of home equipment

Instruct patient:

1. to report change in heart rate and rhythm, or chest pain.
2. to report elevated temperature, increased heart rate, and behavioral changes to the health care provider
3. to immediately report any difficulty breathing.
4. with a history of asthma to consult their health care provider before attempting to use phenylephrine to treat nasal stuffiness.
5. Instruct patients to report all drug side effects, especially headache, weakness or changes in sensorium like dizziness or altered level of consciousness.
6. to observe the nasal cavity for signs of excoriation or bleeding before instilling nasal spray or drops.
7. on the procedure for safe instillation of nasal sprays or drops.
8. to limit "over-the-counter" usage of phenylephrine; inform the patient about rebound nasal congestion.