1. After viewing the ATI video case study on Metered dose inhalers, complete the following questions using

Scenario 0900

ATI NCLEX style case scenario: metered-dose inhalers

Individual Project

Learning objectives:

• Identify the action and nursing implications essential to administer metered-dose inhalers safely.
• Discuss what nursing actions are a priority if an adverse reaction occurs.

Instructions:

• After viewing the ATI video case study on Metered dose inhalers, complete the following questions using

the ATI pharm text, Frandsen & Pennington pharm text, or Davis Drug Guide.

• Cite your information in your answers. Include a reference section in APA format. Answers should be at

least one to two paragraphs.

• Post your completed project in the Forums section of the Reggienet course.

4. The assignment is worth 12 points. Due Friday April 9th at 11:55pm.

Metered-dose inhalers:

• How will these medications help the client’s asthma/COPD? Which of the two inhalers should be

administered first? Support your answer.

Beclomethasone will decrease frequency and severity of asthma attacks by locally acting as an anti-inflammatory and immune modifier. Which will improve asthma symptoms (Vallerand & Sanoski, 2021). Albuterol will treat or prevent bronchospasms in asthma or chronic obstructive pulmonary disease (COPD) serving as a bronchodilator. This will be accomplished by binding to “beta2 -adrenergic receptors in airway smooth muscle, leading to activation of adenyl cyclase and increased levels of cyclic-3', 5'-adenosine monophosphate (cAMP)” (Vallerand & Sanoski, 2021). Which the increase in cAMP activate kinases then inhibits the phosphorylation of myosin and decrease intracellular calcium. Decreasing intracellular calcium which then relaxes smooth muscle airways. When it comes to deciding which inhaler should be administer first, that would be Albuterol. The patient has to use Albuterol first if using other inhalation medications and allow 5 min to elapse before administering other inhalant medications unless otherwise directed (Vallerand & Sanoski, 2021). The reason being that Albuterol prevents bronchospasms which open up the lungs better, making it easier for other inhalers to be absorbed better and work better (Frandsen & Pennington, 2021, p.657).Scenario 0900 The client is a 50-year-old male admitted with asthma and COPD to the medical-surgical unit. The nurse is preparing the 0900 medications. Beclomethasone and albuterol metered-dose inhalers are prescribed.

• What might be the problem? Which inhaler medication could have caused the sore mouth? Why?

The problem might be the client is not following the instructions given for medications that use an inhaler. Especially the after steps after administering the medication. After the use of an inhaler, it is advised to rinse mouth with water or mouthwash after each use to minimize fungal infections, dry mouth, and hoarseness. Including taking the inhaler apart (if it has a spacer) and cleaning it with a little bit of water (ATI) (2021). In addition, it is recommended to clean only the mouthpiece weekly with clean dry tissue or cloth, and not placing it in water (Vallerand & Sanoski, 2021). For that reason, it is the Beclomethasone medication that caused the soreness in the mouth. Since Beclomethasone has a history of causing fungus infection of the mouth or throat when after-care of the mouth or cleaning of the inhaler is not followed.

• The nurse contacts the provider with these findings. Nystatin oral liquid suspension 500,000 units/5mL

“swish and swallow” four times a day for 14 days is prescribed. Why would the provider prescribe this medication? What should be included in the teaching about this new medication?

The provider would prescribe Nystatin because it serves as an antifungal medication. Based on the information given before it would be used to treat the soreness of the mouth caused by a fungus infection after the use of Beclomethasone. Nystatin will bind to fungal cell membrane, allowing leakage of cellular components and at the getting rid of the fungus. Ultimately treating the soreness of the mouth. In the patient teaching it would be included to take medication as directed. However, if a dose is missed take as soon as remembered but not if almost time for next dose. Do not double doses. Therapy should be continued for at least 2 days after symptoms subside. Lastly, one would advise patient to report increased irritation of mucous membranes or lack of therapeutic response to health care professional (Vallerand & Sanoski, 2021).Update 0900 next day The next day the certified nursing assistant reports the client’s meal intake for breakfast is 25%. On interview by the nurse, the client reports a “hard time eating because my mouth is sore”. The nurse checks the client’s mouth and observes what is in the image to the right.

References

Assessment Technologies Institute. (2021). Metered-Dose inhaler [Video]. Video Case Studies

RN 2.0. https://atitesting.com

Frandsen, G. & Pennington, S. S. (2020). Abrams’ clinical drug therapy: Rationales for nursing practice (12 th

ed.). Philadelphia, PA: Wolters Kluwer.

Vallerand, A. H., & Sanoski, C. A. (2021). Davis drug guide for nurses. Philadelphia, PA: F.A.Davis Company.

Grading Rubric for ATI Projects

Outcome Criteria Points Used proper citation format Shared responsibility Checked spelling/grammar Included pharm texts Submitted on time APA format Indicated role of each group member if group project < 3 spelling/grammar errors Included pharm texts in references Submitted by due date

• points

Accurate and thorough responses to questions Addressed each question and supports with citation (s) Each part of question is addressed if has multiple questions One to two paragraphs written for each of the questions Each question is worth 3 points

Note: points will be deducted if criteria is not met.

Images from free stock images- Dreamstime; walgreens.com