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

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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