Author Question: Over the course of treatment for chronic asthma, a client develops an allergy to the propellants in ... (Read 22 times)

Medesa · **on:** Jul 23, 2018

Over the course of treatment for chronic asthma, a client develops an allergy to the propellants in rapid-acting metered-dose inhalers (MDI). What option would the nurse expect to be used to address this problem after discharge?

1. Oral medication of the same class as the metered-dose inhaler
2. Nebulizer treatments
3. A concentrated-dose metered-dose inhaler
4. A dry powder inhaler (DPI)

Question 2

A client with limited strength in the hands is being prepared for discharge with a dry powder inhaler (DPI). The discharge nurse teaches the client that an advantage of this inhaler is that:

1. The client can activate the inhaler with less pressure than is needed for a metered-dose inhaler.
2. This inhaler has no dose limits.
3. The client can increase the effectiveness of the powder by instilling it into a small nebulizer.
4. The client can activate the inhaler simply by inhaling.

Liamb2179 · **Reply #1 on:** Jul 23, 2018

Answer to Question 1

Correct Answer: 4
Rationale 1: Oral medications would increase the systemic side effects and do not have a rapid onset for rescue.
Rationale 2: Nebulizer treatments are not portable enough for daily use, take 30 minutes to deliver the medication, and are not recommended when rapid action is required.
Rationale 3: The MDI is no longer an option because the client is experiencing difficulty with the propellants.
Rationale 4: Dry powder inhalers contain no propellants.
Global Rationale: The DPI has no propellants in the canister and is activated simply by inhalation. Oral medications would increase the systemic side effects and, like nebulizers, do not have a rapid onset for rescue. The MDI is no longer an option because the client is experiencing difficulty with the propellants.

Answer to Question 2

Correct Answer: 4
Rationale 1: No pressure is required to activate the DPI.
Rationale 2: DPIs do have dose limits.
Rationale 3: The powder cannot be removed easily and is not appropriate for nebulization.
Rationale 4: Dry powder inhalers are activated by inhaling, which is an advantage to the client with decreased upper-body strength.
Global Rationale: A dry powder inhaler (DPI) delivers the medication as a fine dry powder. Whereas the MDI is activated by pressing the canister, the DPI is automatically activated when the patient inhales through the mouthpiece. Because the timing of drug delivery and inhalation does not have to be coordinated, more medication is delivered to the lung with a DPI. DPI's require no external pressure and do have dose limits. The powder is not removed from the device prior to use.