Ongoing Assessment

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During the ongoing assessment, the nurse assesses the respiratory status every 4 hours and whenever the drug is administered. The nurse notes the respiratory rate, lung sounds, and use of accessory muscles in breathing. In addition, the nurse keeps a careful record of the intake and output and reports any imbalance, which may indicate a fluid overload or excessive diuresis. It is important to monitor any patient with a history of cardiovascular problems for chest pain and changes in the electrocardiogram. The primary health care provider may order periodic pulmonary function tests, particularly for patients with emphysema or bronchitis, to help monitor respiratory status.

After administration of the drug, the nurse observes the patient for the effectiveness of drug therapy. Breathing should improve, and the patient will appear less anxious. If relief does not occur, the nurse notifies the primary health care provider because a different drug or an increase in dosage may be necessary.

The nurse observes the patient for adverse drug reactions. If adverse reactions occur, the nurse withholds the next dose and contacts the primary health care provider.

Occasionally the patient may experience an acute bronchospasm either as a result of the disease, after exposure to an allergen, or as an adverse reaction to some antiasthma drugs, such as cromolyn inhalation.

An inhaled sympathomimetic, such as albuterol, may be prescribed initially. Salmeterol, a long-acting p-ago-nist, is contraindicated because of its slowed onset of action. During an acute bronchospasm, the nurse checks the blood pressure, pulse, respiratory rate, and response to the drug every 15 to 35 minutes until the patient's condition stabilizes and respiratory distress is relieved.

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