At 11 p.m., a male client is admitted to the emergency department. He has a respiratory rate of 44 breaths/minute. He’s anxious, and wheezes are audible. The client is immediately given oxygen by face mask and methylprednisolone (Depo-medrol) I.V. At 11:30 p.m., the client’s arterial blood oxygen saturation is 86% and he’s still wheezing. The nurse should plan to administer:
A. alprazolam (Xanax)
B. propranolol (Inderal)
C. Morphine
D. albuterol (Proventil)
Correct Answer: D. albuterol (Proventil)
The client is hypoxemic because of bronchoconstriction as evidenced by wheezes and a subnormal arterial oxygen saturation level. The client’s greatest need is bronchodilation, which can be accomplished by administering bronchodilators. Albuterol is a beta2 adrenergic agonist, which causes dilation of the bronchioles. It’s given by nebulization or metered-dose inhalation and may be given as often as every 30 to 60 minutes until relief is accomplished.
Option A: Alprazolam is an anxiolytic and central nervous system depressant, which could suppress the client’s breathing. Alprazolam, known by various trade names, is the most commonly prescribed psychotropic medication in the United States. Alprazolam is frequently prescribed to manage panic and anxiety disorders.
Option B: Propranolol is contraindicated in a client who’s wheezing because it’s a beta2 adrenergic antagonist. Propranolol can be used to ameliorate the sympathetic response in angina, tachyarrhythmias, prevention of acute ischemic attacks, migraine prophylaxis, and restless leg syndrome. Propranolol can be used in almost all cases if the desired result is to slow contractility and decrease a patient’s heart rate.
Option C: Morphine is a respiratory center depressant and is contraindicated in this situation. Morphine can decrease the heart rate, blood pressure, and venous return. Morphine can also stimulate local histamine-mediated processes. In theory, the combination of these can reduce myocardial oxygen demand.
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