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This chapter is from the book

This chapter is from the book

Key Concepts

This chapter includes much needed information to help the nurse apply a knowledge of respiratory disorders to the NCLEX exam. The nurse preparing for the licensure exam should review normal laboratory values, common treatment modalities and pharmacological agents used in the care of the client with respiratory disorders.

Key Terms

  • Acute respiratory failure
  • Apnea
  • Asthma
  • Bronchitis
  • Continuous positive airway pressure (CPAP)
  • Cor pulmonale
  • Cyanosis
  • Dyspnea
  • Emphysema
  • Hemoptysis
  • Hypoxemia
  • Hypoxia
  • Pleural effusion
  • Pleurisy
  • Pneumonia
  • Pulmonary embolus
  • Tachypnea

Diagnostic Tests

Many diagnostic exams are used to assess respiratory disorders. These clients would receive the usual routine exams: CBC, urinalysis, chest x-ray. The exam reviewer should be knowledgeable of the preparation and care of clients receiving pulmonary exams. While reviewing these diagnostic exams, the exam reviewer should be alert for information that would be an important part of nursing care for these clients:

  • CBC
  • Chest x-ray
  • Pulmonary function tests
  • Lung scan
  • Bronchoscopy

Pharmacological Agents Used in the Care of the Client with Disorders of the Respiratory System

An integral part of care to clients with respiratory disorders is pharmacological intervention. These medications provide an improvement or cure of the client's respiratory problems. The nursing exam reviewer needs to focus on the drugs in Table 5.1 through Table 5.4. Included in these tables is information about the most common side and adverse effects as well as pertinent nursing care associated with these medications. These medications are not inclusive of all the agents used to treat respiratory disorders; therefore, you will want to keep a current pharmacology text handy for reference.

Table 5.1. Pharmacological Agents for Respiratory Conditions




Side Effects

Nursing Care



Theo-Dur (theophylline)

Truphylline (aminophylline)

Relaxes bronchial smooth muscles

Palpitations; agitation; tachycardia; nausea; vomiting

Monitor for signs of toxicity.

Therapeutic range 10–20 mcg/mL.

Cholinergic antagonists

Atrovent (ipratropium)

Relieve bronchospasm

Headache; nausea; dry mouth

Contraindicated in clients with soybean or peanut allergies.


Epinephrine (adrenalin)

Stimulate alpha and beta receptors

Tremulousness; headache; tachycardia; vomiting

Teach client to read label of OTC meds.

Beta 2 agonists

Proventil (albuterol) Serevent (salmetrol)

Stimulate beta receptors in the lung, reduces airway resistance

Tremor; tachycardia; palpitations

Concurrent use with digoxin or beta blockers can affect drug level.



Flovent (fluticasone)

Vanceril (beclomethasone)

Azmacort (triamcinolone)

Decreases inflammation and suppresses immune response

Hyperglycemia; Cushing's syndrome; increased BP; osteoporosis; muscle wasting; gastric upset

Give with meals. Monitor for signs of infection. Taper off medication.


Decadron (dexamethasone)

Solu-Cortef (hydrocortisone)

Medrol (methylprednisolone)

Same as above

Same as above

Same as above.

Mast cell stabilizers

Intal (cromolyn)

Inhibit release of histamine

Irritation of oral or mucous membranes

Monitor for drug interactions.

Leukotriene modifiers

Singulair (montelukast)

Zyflo (zileuton)

Accolate (zafirlukast)

Block inflammatory action

Headache; infection; elevated liver enzymes

Monitor for drug interactions. Client should avoid ASA and NSAIDs.


Codeine, dextromethorphan

Suppress cough reflex by direct effect on respiratory center

Nausea; vomiting; sedation

Take only as directed.


Ammonium chloride

Guaifenesin K+ iodide

Loosen bronchial secretions

Nausea; drowsiness

Increase fluid intake.

Table 5.2. Pharmacological Agents Used in the Treatment of Community Acquired Pneumonia

Organism Responsible

Recommended Treatment


Side Effects (Adverse Effects)

Nursing Care

Streptococcus pneumoniae

Penicillin, Claforan (cefotaxime), Rocephin (ceftriaxone), Levaquin (levofloxacin)

Bacteriacidal, effective against gram positive and gram negative organisms

Nausea; diarrhea; urticaria (pseudomembranous colitis; superimposed infections)

Assess for fluid imbalances. Diarrheal stools should be checked for the presence of blood, mucus, and white blood cells, which can indicate pseudomembra-nous colitis.

Haemophilus influenza

Omnipen (ampicillin), Zithromax (azithromycin), Biaxin (clarithromycin)

Bacteriostatic, effective against gram positive and gram negative organisms

Dizziness; headache; nausea; diarrhea; abdominal pain (superimposed infections)

Assess for signs of "ampicillin rash"—dull red nonallergic maculopapular rash and pruritis. Assess for signs laryngeal edema, which indicates anaphylactic reaction.

Legionella pneumophilia

Erythrocin (erythromycin), Levaquin (levofloxacin)

Bacteriacidal, effective against gram positive and gram negative organisms

Abdominal cramps; diarrhea; nausea; (psedomembranous colitis; superimposed infections)

Assess for fluid imbalances. Diarrheal stools should be checked for the presence of blood, mucus, and white blood cells, which can indicate pseudomembranous colitis.

Mycoplasma pneumoniae

Erythrocin (erythromycin), Acromycin (tetracycline) may be used with Rifadin (rifampin)

Bacteriacidal, effective against gram negative organisms

Abdominal cramps; diarrhea; nausea; (pseudomembranous colitis; superimposed infections)

Same as above.

Viruses (influenza A&B, CMV, and coronvirus)

Symmetrel (amantadine), Virazole (ribavirin aerosol)

Antivirals inhibit viral replication

Ataxia; drowsiness; blurred vision; dry mouth

Protect from falls. Offer fluids to prevent dry mouth.

C. pneumoniae (TWAR agent)

Acromycin (tetracycline), Erythrocin (erythromycin), Levaquin (levofloxacin)

Bacteriacidal, effective against gram positive and gram negative organisms

Abdominal cramps; diarrhea; nausea; (pseudomembranous colitis; superimposed infection)

Assess for fluid imbalances. Diarrheal stools should be checked for the presence of blood, mucus, and white blood cells which, can indicate pseudomembranous colitis.

Table 5.3. Pharmacological Agents Used in the Treatment of Hospital-Acquired Pneumonia

Organism Responsible

Recommended Treatment


Side Effects (Adverse Effects)

Nursing Care

Pseudomonas aeruginosa

Amikin (amikacin), Kantrex (kanamycin), Garamycin (gentamicin), Geopen (carbenicillin)

Bacteriacidal; effective against gram-positive and gram-negative organisms

Abdominal cramps; diarrhea; nausea; (pseudomembranous colitis; superimposed infection; tinnitus; changes in urinary output)

Assess for fluid imbalances. Diarrheal stools should be checked for the presence of blood, mucus, and white blood cells; assess for signs of ototoxicity and nephrotoxicity.

Staphylococcus aureus

Unipen (nafcillin), Garamycin (gentamicin)

Same as above

Same as above

Same as above.

Klebsiella pneumoniae

Claforan (cefotaxime), Rocephin (ceftriaxone), Garamycin (gentamicin), Geopen (carbenicillin)

Same as above

Same as above

Same as above.

Pneumocystis carinii

Bactrim (trimethoprim/sulfa methoxazole), Pentam (pentamidine)

Bacteriacidal; effective against gram-positive and gram-negative organisms

Fatigue; headache; insomnia; vomiting; diarrhea; (anemia; nephrotoxicity; thrombocytopenia)

Pentamidine should be infused over 1–2 hours to decrease hypotension. Client should be observed for signs of renal impairment and hypoglycemia.

Aspergillus fumigatus

Fungizone (amphotericin B), Fungizone Nizoral (ketoconozole)

Kill or stop the growth of susceptible fungi by affecting cell membrane or interfere with protein synthesis within the cell

Headache; dizziness; nausea; diarrhea; myalgia; peripheral neuropathy (hepatoxicity; nephrotoxicity)

Drug-to-drug interactions. Use caution when administering. Check vital signs frequently.

Table 5.4. Pharmacological Agents Used in the Treatment of Tuberculosis



Side Effects

Nursing Care

Isoniazid (INH) (first-line drug)

Interferes with cell wall

Deficiency of B6; peripheral neuritis; liver dysfunction

Observe for jaundice. Frequent hearing tests.

Ethambutol HCI (myambutol) (first-line drug)

Suppresses growth of mycobacterium

Optic neuritis; decreased acuity and color vision

Frequent visual tests.

Rifampin (first-line drug)

Same as above

N & V; HA; hepatitis; red discolorations of body fluids

Teach client to avoid alcohol. Teratogenic.

Fluoroquinolones (levoflaxacin, monofloxacin, gatifloxacin)

For strains resistant to RIF, INH, and EMB

N & V; drowsiness; photosensitivity; tendonitis; and tendon rupture

Teach client to avoid prolonged sun exposure, to increase fluid intake, and to report unexplained muscle tenderness

Streptomycin (second-line drug)

Inhibits protein synthesis and suppresses growth of mycobacterium

VIII cranial nerve damage; paresthesia of face, tongue, and hands; renal damage

Ask client to sit quietly 15–30 minutes after injection.

Kanamycin (second-line drug)

Same as above

Same as above

Observe for hematuria. Frequent hearing tests.

Pyrazinamide (first-line drug)


Liver damage; gout

Teach client to increase fluid intake. Observe for jaundice.

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