Question

Question:

1.When a client is prescribed a bronchodilator and inhaled corticosteroid, which do you recommend the client take first?

2. What general concepts should the nurse include during client education regarding respiratory inhaler medications?

3. What should the nurse evaluate to see if respiratory medication(s) are being effective?

4. When would a spacer be recommended for a client using inhalers?

5. What would you counsel a client about stopping a “controller” medication (i.e. montelukast, theophylline, or inhaled steroids)

Answer 1

1.) Bronchodilator should be used first. Bronchodilators dilate the airways and relieve the symptoms (like wheezing and shortness of breath) very fast. It produces its action within seconds of taking the dose. Corticosteroids take several hours to produce their action and they cannot penetrate smallest obstructed airways easily. So it is advisable to take brochodilators first which will open the smaller obstructed airways, wait for few minutes then take corticosteroid.

2) The general concepts include

• To practice good oral hygiene
• use proper technique of administering the dose
• To hold the breath for several seconds after releasing the medication
• Cleanse the inhaler as per instructions after every use .

3) The nurse should evaluate the techniques used by patient to administer the medication is correct. The patient is shaking the inhaler well before use. To look if there is improvement in symptoms ( e.g improved breathing, less chest tightness and no further wheezing sound).

4) When the patient is having trouble using an inhaler, spacers are recommended e.g, If patient cannot press the canister and breathe at the same time, or if patient is breathing slowly. Attaching spacer to the inhaler allows medicine to float in the spacer until the patient can breathe it in, helps medicine to reach the lungs effectively and also reduces side effects of the drug.

5) Patient should be told to not stop taking drug abruptly. The patient need to gradually reduce the dose of drug before stopping it. That is the dose should be tapered down slowly so that body can synthesize its own natural steroids gain.