A nurse has been administering mucolytic-like Hypertonic Nasal drops to an infant she has been caring for. How can she chart the effectiveness of this medication in her narrative note?
The infant tolerated the instillation of the nose drops without any shortness of breath or fever.
Saline nose drops inserted Infant cried a small amount
The infant tolerated the insertion of saline nose drops well
Saline nose drops were inserted into both nares.
Large random breath respirations 26/minute.
Correct Answer : A,C,D
"The infant's nasal congestion appeared to improve following the administration of hypertonic nasal drops. The infant tolerated the insertion of saline nose drops well, with no signs of distress or adverse reactions. The nasal passages appeared clearer after the instillation, and the infant's breathing appeared less congested. There was no significant increase in respiratory rate or other signs of respiratory distress observed. The intervention seemed to have a positive effect on the infant's nasal congestion."
This statement indicates that the mucolytic medication (hypertonic nasal drops) was administered and had a positive effect on the infant's nasal congestion. It also mentions that the infant tolerated the procedure well without any adverse reactions, such as shortness of breath or fever. The absence of distress or adverse symptoms and the observed improvement in nasal congestion indicate the effectiveness of the medication in the nurse's narrative note. The additional information about the saline nose drops and respiratory rate may not directly address the effectiveness of the mucolytic medication and can be documented separately if necessary.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
White coating in the mouth: A white coating in the mouth could be a sign of a fungal infection such as oral thrush. Fluticasone, which is a corticosteroid, can increase the risk of developing fungal infections. Therefore, the nurse should instruct the client to report any signs of oral thrush or other unusual changes in the mouth, such as white patches or discomfort, to the provider.
Prompt identification and treatment of oral thrush are necessary to prevent its progression and ensure effective management of the client's condition.
Dry oral mucous membranes: Dry oral mucous membranes are not typically associated with fluticasone/salmeterol use. However, if the client experiences persistent or severe dryness in the mouth or any other unusual oral symptoms, it should be reported to the provider. Dry mouth can sometimes occur as a side effect of medications or indicate other underlying issues that need to be addressed.
Sedation: Sedation is not a common side effect of fluticasone/salmeterol. If the client experiences excessive drowsiness or sedation that interferes with their daily activities, it may be important to report this to the provider. While sedation is not a typical adverse effect of this medication, individual responses can vary, and it is essential to ensure appropriate monitoring and management.
Increased appetite is not typically associated with fluticasone/salmeterol use. It is not a commonly reported adverse effect of the medication. However, if the client experiences significant and unexplained changes in appetite that are concerning or persistent, it may be worth mentioning to the provider during a follow-up appointment or as part of ongoing monitoring.
Correct Answer is C
Explanation
Expectorants are medications that help to loosen and thin mucus in the respiratory tract, making it easier to cough up and expel. They work by increasing the production of respiratory tract secretions, which helps to hydrate and thin the mucus, making it less sticky and easier to clear from the airways. By stimulating the production and secretion of mucus, expectorants promote coughing and facilitate the removal of excess mucus and phlegm from the respiratory system.
It's important to note that expectorants are primarily used for productive coughs (coughs that produce phlegm or mucus). If the cough is dry and non-productive, other types of cough suppressants or remedies may be more appropriate.
Regarding the other options:
Reduces inflammation: Expectorants do not have a direct effect on reducing inflammation in the respiratory tract. Anti-inflammatory medications such as glucocorticoids are typically used for reducing inflammation in conditions like asthma or chronic obstructive pulmonary disease (COPD).
Dries mucous membranes: Expectorants do not have a drying effect on mucous membranes. In fact, they work to increase the hydration and fluidity of respiratory secretions.
Suppresses the urge to cough: Expectorants do not suppress the urge to cough. They promote coughing by facilitating the clearance of mucus and phlegm from the airways. Cough suppressants, on the other hand, are medications used to relieve a dry, non-productive cough by suppressing the cough reflex.
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