Consider the following o You are caring for two patients in

• Consider the following: o You are caring for two patients in the hospital setting: one is an 18 year old with Step 3 asthma in for exacerbation of her disease because of an increase in pollen counts. The other is an 80 year old woman with pneumonia and a long history of smoking. She has a comorbid diagnosis of COPD/bronchitis. Medications for the 18 year old are as follows: • Albuterol MDI 2 puffs every 6 hours • Beclomethasone MDI 2 puffs every 12 hours • Prednisone 20 mg po qd • Oxygen at 2 L/min to maintain oxygen saturation > 94% For the 80 year old, medications are as follows: o Albuterol per nebulizer every 6 hours o Ipratropium per nebulizer every 6 hours o Prednisone 20 mg qd o Oxygen at 1/5 L/min only for saturations <91% or signs of distress

Discuss why the treatment is similar and different
How are you as the RN going to approach patient teaching in these scenarios?
How would adding an antihistamine to either scenario help or harm the patient?
Would an over the counter antihistamine ever be recommended to either one of these patients?

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Solution

treatment is same for both patients because in both cases asthma and pneumoniathe patients have same problem that is insufficient breathing. thatswhy both patient is given albuterol which is bronchodilator and provides sufficient oxygen. both patient is treating with prednisone which belong to steroid category and gives instant relief. since both condition requires oxygen thatswhy direct oxygen is supplying to both patients. on the other hand the difference in treatment is due to The large age difference, as the pharmacokinetics criteria changes with age factor. since the 80 year old woman has an history of COPD thats why ipratropium is given while 18 year old patient have not any COPD history. As an RN we should inform both the patients about the adverse effect of albuterol. the common side effect of albuterol is headache, nausea, vomitting, dry moth, muscle pain. some times serious side effects like wheezing, chest tightness, trouble breathig may occur. On the other hand the common side effects of ipratropium are respiratory tract infactin, urinary tract infection and exacerbation of COPD. initially it was belived that the antihistamine is not good for asthma treatment due to their sedating, anticholinergic and antiserotonergic effect. But it has been observed in the latest research that the second generation H1 antihistamine can be used in asthamatic condition safely. the antihistamine could be an added advantage in younger patient but it should be avoided in elder patient becuse she has already comorbid condition. an over the counter antihistamine can be recommended for the younger patient but not for older patient.