5.4 Applying the Nursing Process to Administering Respiratory Medications

Now that we have reviewed the respiratory system and common respiratory disorders, let’s apply the nursing process to the administration of respiratory medications.

Assessment

Although there are numerous details to consider when administering medications, it is always important to first think about what you are giving and why.

Respiratory medications are often given to alleviate allergies, cold symptoms, or to decrease/eliminate shortness of breath (SOB). Nurses assess the client’s respiratory status before and after administering respiratory medications. The respiratory assessment includes observing baseline respiratory effort, respiratory rate, and quality of respirations (shallow, deep); obtaining a pulse oximetry reading; and auscultating lung sounds. Other pieces of the assessment include inspecting skin color, such as observing for pallor or cyanosis; determining if a cough or sputum is present; and determining if intercostal retractions (i.e., muscles between the ribs are “sucked in” during inhalation) are present. Sputum is matter expectorated from the respiratory system that is composed of mucus but may also contain pus, blood, fibrin, or microorganisms. If sputum is present, it should be assessed for color, odor, consistency, and amount (COCA). Signs of respiratory distress (such as increased respiratory rate, decreased oxygen saturation levels, cyanosis, and intercostal retractions) require immediate notification of the health care provider and possible activation of emergency assistance.

Additional baseline information to collect prior to the administration of any respiratory medication includes previous history of allergic response or side effects/adverse effects.

Implementation of Interventions

Respiratory medications can be administered by many routes, such as nasal spray, inhalation, oral tablets or liquids, injections, or intravenously. The route helps nurses anticipate potential side effects. For example, inhalations deliver medication(s) directly to the lungs and act directly on the lung tissues, minimizing systemic side effects. On the other hand, intravenous medications are administered into the bloodstream to act quickly but can cause systemic side effects.

Some respiratory medications contain more than one drug and exist in different dosages, so the dosages of each drug must be verified when checking the rights of medication administration. For example, Advair inhalers come in various dosages and combine a long-acting bronchodilator (salmeterol) with a glucocorticoid (fluticasone).

Nurses anticipate the expected outcome of medication and any common side effects based on the medication class. For example, albuterol is a short acting Beta-2 agonist that is prescribed for bronchodilation. The nurse plans to perform a focused respiratory assessment before and after administration of albuterol to document the effectiveness of the medication, as well as to monitor for tachycardia, a common side effect.

Additionally, the nurse should also ensure the proper use of the inhalers by the client. Observe the client self-administering the medication, and further instruct the client in proper use.^[1]

Evaluation

Finally, it is important to always evaluate the client’s response to a medication. For example, for respiratory medications prescribed for a client with COPD, the nurse should assess for decreased shortness of breath. The nurse should complete a focused respiratory assessment (respirations, pulse oximetry, and lung auscultation) before and after administration of the medication and then compare the results. If the symptoms are not improving or the clinical assessment is worsening, prompt intervention is required (such as notification of the health care provider for further orders) to prevent further clinical deterioration.