Which prescription should the practical nurse administer for a client who is experiencing an acute episode of bronchial asthma?

Learn about inhaled steroids in this nursing pharmacology guide for student nurses! Get to know its uses, side-effects, nursing considerations and more.

Inhaled steroids have been found to be a very effective treatment for bronchospasm. The drug of choice depends on the individual patient’s response; a patient may have little response to one agent and do very well on another.

Inhaled Steroids: Generic and Brand Names

Here is a list of some of the most commonly encountered inhaled steroids.

What are Inhaled Steroids?

Inhaled steroids are used to decrease the inflammatory response in the airway.

• Inhaling the steroid tends to decrease the numerous systemic effects that are associated with steroid use.
• It is usually useful to try another preparation if one is not effective within 2 to 3 weeks.

Therapeutic actions

The desired actions of inhaled steroids include:

• Decrease the inflammatory response in the airway.
• Increase airflow and facilitate respiration.
• Promotion of beta-adrenergic receptor activity, which may promote smooth muscle relaxation and inhibit bronchoconstriction.

Indication of Inhaled Steroids

Inhaled steroids are indicated for the following:

• Prevention and treatment of asthma.
• Treatment of chronic steroid-dependent bronchial asthma.
• Used as adjunctive therapy for asthma patients who do not respond to traditional bronchodilators.

Pharmacokinetics

These drugs are rapidly absorbed from the respiratory tract, but they from 2 to 3 weeks to reach effective levels.

Contraindications and Cautions

The contraindications and cautions for patients using inhaled steroids include the following:

• Emergency use. Inhaled steroids are not for emergency use and are not for use during an acute asthma attack or status asthmaticus.
• Pregnancy or lactation. They should not be used during pregnancy or lactation unless the benefit to the mother clearly outweighs any potential risk to the fetus or the nursing baby.
• Active respiratory infection. These preparations should be used with caution in any patient who has an active infection of the respiratory system because the depression of the inflammatory response could result in serious illness

Adverse effects

Adverse effects of using inhaled steroids include the following:

• CNS: Irritability, headache.
• Respiratory: Rebound congestion, epistaxis, local infection.

Nursing considerations for a patient using inhaled steroids include the following:

Nursing Assessment

History taking and physical exam of a patient using inhaled steroids include:

• Assess for possible contraindications and cautions: acute asthmatic attacks and allergy to the drugs, which are contraindications; and systemic infections, pregnancy, or lactation, which require cautious use.
• Perform a physical examination to establish baseline data for assessing the effectiveness of the drug and the occurrence of any adverse effects associated with drug therapy.
• Assess temperature to monitor for possible infections.
• Monitor blood pressure, pulse, and auscultation to evaluate cardiovascular response.
• Assess respirations and adventitious sounds to monitor drug effectiveness.
• Examine the nares to evaluate for any lesions that might lead to systemic absorption of the drug.

Nursing Diagnosis and Care Planning

Nursing diagnoses related to drug therapy might include the following:

Nursing Implementation with Rationale

Nursing interventions for patients using inhaled steroids include:

• Not for immediate relief. Do not administer inhaled steroids to treat an acute asthma attack or status asthmaticus because these drugs are not intended for the treatment of acute attack and will not provide the immediate relief needed.
• Proper tapering of steroids. Taper systemic steroids carefully during the transfer to inhaled steroids; deaths have occurred from adrenaline insufficiency with sudden withdrawal.
• Use decongestant drops. Have the patient use decongestant drops before using the inhaled steroid to facilitate penetration of the drug if nasal congestion is a problem.
• Oral care. Have the patient rinse the mouth after using the inhaler because this will help to decrease systemic absorption and decrease GI upset and nausea.
• Monitor for signs of infection. Monitor the patient for any sign of respiratory infection; continued use of steroids during acute infection can lead to serious complications related to the depression of the inflammatory and immune responses.
• Educate the client. Provide patient teaching, including the drug name and prescribed dosage, measures to help avoid adverse effects, warning signs that may indicate problems, and the need for periodic monitoring and evaluation, to enhance patient knowledge about drug therapy and to promote compliance.
• Ensure the effectiveness of the drug. Instruct the patient to continue to take the drug to reach and then maintain effective levels (drug takes 2 to 3 weeks to reach effective levels).
• Provide support. Offer support and encouragement to help the patient cope with the disease and the drug regimen.

Evaluation

Evaluation of a patient using inhaled steroids include:

• Monitor patient response to the drug (improved breathing).
• Monitor for adverse effects (nasal irritation, fever, GI upset).
• Evaluate the effectiveness of the teaching plan (patient can name drug, dosage, adverse effects to watch for, specific measures to avoid them, and measures to take to increase the effectiveness of the drug).
• Monitor the effectiveness of other measures to ease breathing.

Practice Quiz: Inhaled Steroids

Here’s a 5-item quiz for this inhaled steroids study guide. Please visit our nursing test bank page for more NCLEX practice questions.

1. A Cromolyn sodium (Intal) inhaler is prescribed to a client with asthma. A nurse provides instructions regarding the side effects of this medication. The nurse tells the client that which undesirable effect is associated with this medication?

A. Insomnia
B. ConstipationC. Wheezing

D. Hypotension