ASA COLLEGE

Associate in Science Degree (A.S.) in Nursing Program

NUR 120 (PHARMACOLOGY)
CRITICAL THINKING AND CASE STUDY
CHAPTER 18 – ADRENERGIC DRUGS
CASE SCENARIO:

Sixteen-year-old Maureen, who plays soccer on her high school team, has been treated for
asthma for 1 year. Her symptoms have been controlled with an inhaled steroid and occasional
use of an albuterol metered-dose inhaler. This afternoon, though, her mother brings her into the
urgent care center because Maureen has had trouble “getting her breath” after a particularly
rough game. Maureen complains of a feeling of “tightness” in her chest and wants to sit up. She
appears anxious and has a nonproductive cough. Her respiratory rate is 28 breaths/min, and her
peak expiratory flow is 70% of normal. Chest auscultation reveals a short inspiratory period with
prolonged expiratory wheezes in both lungs.

QUESTIONS:

1. The physician orders albuterol (Ventolin) to be given through a nebulizer. What should
you assess before giving this medication? During and after administration?
Answer: The nurse should auscultate the lungs to listen to the patient’s breathing
sounds as well as assess pulse, respiratory rate, blood pressure, and pule oximetry
before, during, and after drug therapy. The nurse should ask the patient and parent
about any medications the patient is on that can potentially interact with the
Ventolin. Assess the patient’s caffeine intake before giving Ventolin, because it
can cause adverse effects when taken together. After drug therapy, encourage the
patient to perform deep breaths and cough to help remove mucous.

2. Why is the albuterol given via inhalation rather than orally?

Answer: Albuterol is given via inhalation because the patient’s lungs are the
target for therapy. Albuterol relaxes and opens air passages to the lungs to make
breathing easier. The onset of action is also immediate, where as it would take 30-
60 minutes for an oral medication to start providing therapeutic effects.

3. After the nebulizer medication treatment is completed, Maureen complains of feeling

“shaky and jittery.” What do you tell her?
Answer: I would tell Maureen that the shakiness and jittery feeling is a normal
side effect to the treatment she received. She may even feel a sense of
nervousness as well. I would tell Maureen that these side effects will only last for
up to 4-6 hours and that it is nothing to worry about. I’d tell her to ring her call
light if she starts feeling her heart racing or anything out of the ordinary.

4. The physician gives Maureen a prescription for a salmeterol (Serevent) inhaler. What is
important to teach Maureen and her mother about this medication?

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 ASA COLLEGE
Associate in Science Degree (A.S.) in Nursing Program
NUR 120 (PHARMACOLOGY)
CRITICAL THINKING AND CASE STUDY
CHAPTER 18 – ADRENERGIC DRUGS
Answer: Salmeterol is used for maintenance therapy of asthma and should only
be used for that purpose. The daily dose is one puff twice a day and should not be
exceeded or given more than twice in a day.

CRITICAL THINKING AND APPLICATION:

1. The mother of 3-year-old Kyle is giving him phenylephrine (Neo-Synephrine) drops as a

nasal decongestant.
a. How does this medication help with nasal congestion?
Answer: Phenylephrine produces vasoconstriction. It shrinks blood
vessels in nasal passages, which elevates nasal congestion.

b. Kyle’s mother comes back to the clinic and complains that after 1 week, his
congestion is worse, not better. What possible explanation can the nurse offer?
Answer: Kyle’s mom might have administered the medication too often.
Overuse of nasal decongestants can cause a rebound phenomenon
which leads to greater congestion.

2. Mr. D., who has had a history of problems with a hormonal imbalance, has been admitted
for septic shock, and the physician prescribes dopamine. However, the nurse double-
checks the patient’s history before administering the drug. What condition may be a
contraindication to dopamine?
Answer: A tumor that secretes catecholamines can be a contraindication to
dopamine.

3. Mr. G. and Mr. C. are both on dopamine infusions. Mr. G.’s infusion is being
administered at a low rate, and Mr. C.’s at a high rate. Why might these infusion rates be
different?
Answer: Both patients are using dopamine for different purposes. Dopamine
infusion at a low rate is used to dilate blood vessels in the brain, heart, and
kidneys, which increases blood flow. Dopamine at a higher rate can
improve contractibility and cardiac output.

4. A patient in the intensive care unit has received too high a dose of epinephrine. The nurse
will monitor for what effects? What will the nurse expect to do for this patient?
Answer: The nurse will monitor the toxic effect of adrenergic drugs like
epinephrine. These kinds of medications have a short half-life, meaning their
effects are short lived. The nurse will monitor and treat symptoms and make sure
to support the patient’s respiratory and cardiac functions because the most life
threatening toxic effects are involving the CNS and cardiovascular systems.

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 ASA COLLEGE
Associate in Science Degree (A.S.) in Nursing Program
NUR 120 (PHARMACOLOGY)
CRITICAL THINKING AND CASE STUDY
CHAPTER 18 – ADRENERGIC DRUGS
5. Greg, a 49-year-old construction worker, is in the urgent care center for treatment of a leg
laceration. Just after a dose of intravenous penicillin is started, he begins to wheeze and
says, “Oh, I just remembered. I’m allergic to penicillin!”
a. What is happening?
Answer: The patient is having an anaphylactic reaction.
b. What will the nurse do first?
Answer: The nurse will stop the medication first and monitor his airway,
breathing, and circulation while she delegates another nurse to contact the
physician.
c. What drug will be given in this situation?
Answer: Epinephrine

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