Question

Poppy is a 9 year old female, weight 40Kg.

She presented to ED with worsening respiratory symptoms over the past few hours. Her parents state she is unable to

talk in full sentences or undertake a peak flow. In ED Poppy has been given 3 x 20 minutely nebulised Salbutamol with

6LPM of O2, IVF commenced, Stat dose of Prednisone administered, Chest X-ray shows hyperinflation of both lung

fields. She was admitted to ICU due to her deteriorating respiratory function with a diagnosis of acute exacerbation

of asthma.

EXCERPT OF RELEVANT ICU NOTES

Past History

Diagnosed with asthma age 2 (infrequent intermittent asthma).

7

Current medications: - Ventolin PRN.

IUTD (immunisations up to date)

Nursing Assessment

A. Clear, speaking in single words

B. RR 42bpm, SpO2 87% RA, 92% on 6LPM O2 + nebuliser, auscultation decreased AE bibasally, inspiratory and

expiratory wheeze

C. HR 160bpm, ST, peripherally warm

D. GCS 14/15 (E4, V4, M6)

E. Accessory muscle use, shoulder shrugging on inspiration, tracheal tug

F. IVF NaCl 53 ml/hr

G.

a. Mg- low 0.60mmol/L (0.70-1.10mmol/L) all other pathology is normal.

b. BGL 9.0mmol/L

c. Beta-agonist- Salbutamol

d. Anticholinergic - Atrovent

e. IV Hydrocortisone

f. ABG shows respiratory acidosis, (PH 7.32, PaCO2 49, PaO2 70, HCO3 27, BE -2.1, Lactate

1.4)

Plan

- Keep SpO2 92-95%%

- Beta- antagonist Salbutamol continuous via nebuliser

- Anticholinergic Ipratropium bromide (Atrovent) 500ug 4/24

- Hydrocortisone 100mg 6/24

- MgSO4 6.4mmol/20 minutes

- IVF 53ml/hr

- Repeat ABGs in 1hour

- Monitor BGL

- Peakflow /spirometry

QUESTION:

Salbutamol via nebuliser

What are the nursing considerations for this medication?

Answer 1

#. Nursing consideration for Salbutamol :-

Assessment

● Assess lung sounds, pulse, and BP before administration and during peak of medication.

Note amount, color, and character of sputum produced.

● Monitor pulmonary function tests before initiating therapy and periodically during

therapy.

● Observe for paradoxical bronchospasm (wheezing). If condition occurs,

withhold medication and notify health care professional immediately.

● Lab Test Considerations: May cause transientpin serum potassium concentrations

with nebulization or higher-than-recommended doses.

#. Patient teaching

• Take as directed, spacing remaining doses at regular intervals. Caution

• patient not to exceed recommended dose; may cause adverse effects, paradoxical bronchospasm (more likely with first dose from new canister).

● contact HCP immediately if SOB is not relieved by medication or is accompanied by diaphoresis, dizziness,

palpitations, or chest pain.

● Prime unit with 4 sprays before using and to discard canister after 200 sprays.

● Inform patient that these products contain hydrofluoralkane (HFA) and the propellant and are described as non-CFC or CFC-free (contain no chlorofluorocarbons).

● Caution patient also to avoid smoking and other respiratory irritants.

● May cause an unusual or bad taste.

● Inhaln: Instruct patient in the proper use of the metered-dose inhaler or nebulizer.

● Advise patients to use albuterol first if using other inhalation medications and allow 5 min to elapse before administering other inhalant medications unless otherwise

directed.

● Advise patient to rinse mouth with water after each inhalation dose to minimize dry mouth and clean the mouth piece with water at least once a week.

● Instruct patient to notify health care professional if there is no response

to the usual dose or if contents of one canister are used in less than 2 wk.

Asthma and treatment regimen should be re-evaluated

● Pedi: Caution adolescents and their parents about overuse of inhalers, which can

cause heart damage and life-threatening arrhythmias.