Nursing Pharmacology: Treatment for Acute Sinusitis, Asthma Exacerbation, and Stage 3 Renal Failure

This article discusses the treatment for acute sinusitis, asthma exacerbation, and stage 3 renal failure in nursing pharmacology. It covers the medications and techniques used to manage these conditions, including antibiotics, decongestants, corticosteroids, and mucolytics for sinusitis, oxygen therapy and short-acting ß2-adrenergic agonists for asthma, and ß-adrenergic blockers for hypertension in renal failure. The article also includes an exacerbation plan for asthma and the importance of environmental control.

Nursing Pharmacology
Nursing Pharmacology
Question-1
The clinical features of Mr. John suggest that he has acute sinusitis. He will be
treated for acute sinusitis and not for his cold, as cold is one of the features of acute
sinusitis. Additionally, treating acute sinusitis will cure cold and hence John will not be
treated for cold. At first, John will be treated with antibiotics to treat infection.
Decongestants will be administered to enhance drainage. Nasal corticosteroids to
reduce inflammation as well as mucolytics to increase mucous flow will be given (Lewis,
2013). Classic anti-histamines (first-generation) will be avoided as they might increase
the mucus viscosity and promote continued symptoms whereas second generation
(non- sedating) anti-histamines will be administered as they do not cause this problem.
Antibiotic therapy should be usually continued for 10 to 14 days for acute sinusitis. If
symptoms do not resolve, the antibiotic should be changed to a broader- spectrum
agent.
John will be advised to drink 6 to 8 glasses of water daily to liquefy secretions.
He should be educated about nasal cleaning techniques that involves taking hot
showers twice/day, blowing the nose, steam inhalation, bed-side humidifier or nasal
saline spray to promote secretion drainage (Gershwin, 2012). He will be educated to
avoid smoking as well as exposure to smoke as it is an irritant which could worse
symptoms. In-case of children, they should be treated by saline sinus irrigation,
nasal/systemic steroids (for allergic sinusitis) and nasal/topical decongestants (after 4-5
days of treatment to prevent re-bound vasodilatation) (Jeffe, 2012).
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Nursing Pharmacology
Question-2
2a). Zack should be administered with Oxygen through face mask or nasal cannule,
even though the oxygen saturation was maintained to 93% and should be monitored by
pulse oximetery or ABGs (if severe). At-first, short-acting ß2-adrenergic
agonists (Salbutamol) 5 puffs (0.1 mg/puff) should be administered with metered-dose
inhaler (MDI) along with a spacer once in 20 minutes to four hours, which is more
efficient as compared to a nebulizer (Lewis, 2013). Oral corticosteoirds (prednisolone) 1
- 2 mg/kg/day (max: 60 mg) or dexamethasone: 0.15–0.3 mg/kg/day (max: 10 mg) could
be administered.
2b). Zack will be taught to identify environmental triggers with preventable measures, to
avoid allergens and importance to maintain hand hygiene. He will be instructed about
the method to use MDI as well as peak-flow meter. He will be demonstrated about the
pursed-lip and diaphragmatic breathing techniques.
2c). Exacerbation plan includes GREEN- Go: which indicates that breathing is good and
hence can continue regular medication; YELLOW- Caution: that indicates mild to
moderate symptoms and hence should add reliever measures with regular medicine;
Red- Danger: severe symptoms and hence add 2- 6 puffs of quick relievers and with
very severe symptoms should call emergency (Ortiz-Alvarez, 2012).
2d). In follow-up, Zack and his care-taker will be explained about the importance of
environmental control. Medication schedules with time-frames will be given. They will be
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Nursing Pharmacology
instructed about the importance of nutrition, physical exercise, sleep and written
asthma-management plan.
Question-3
3a). ß- adrenergic blockers could be administered to the patient as it can reduce BP by
reducing rennin secretion (Lewis, 2013).
3b). Drug Lisinopril should be avoided as it can cause hyperkalemia and reduce renal
function.
3c). Stage 3 renal failure indicates that the patient has moderately decreased GFR and
hence the certain cardiac medications should be used with caution to avoid further renal
damage. Most of the drugs are excreted by the kidneys and stage-3 renal failure can
cause accumulation of toxic substances in blood and tissues (Lewis, 2013).
3d). Aspirin therapy eases inflammation in this patient as the plaque may increase the
chance of getting stroke, if it gets inflamed. Further, aspirin prevent blood clot formation.
Reference
Gershwin, M. E & Incaudo, G. (2012). Diseases of the Sinuses: A Comprehensive
Textbook of Diagnosis and treatment. Retrieved from
https://books.google.co.in/books?isbn=1461202256
Jeffe, J.S et al. (2012). Nasal saline irrigation in children: a study of compliance and
tolerance: Int J Pediatr Otorhinolaryngol. 76(3):409-13
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Lewis, S.M., Heitkemper, M. M., & Dirksen, S.R. (2013). Medical Surgical Nursing:
Assessment and Management of Clinical Problems. (9th ed.). Missouri: Mosby.
Ortiz-Alvarez, O. (2012). Managing the paediatric patient with an acute asthma
exacerbation: Paediatr Child Health. 17(5): 251–256.
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