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Difficulty: Very hardPharmacological Therapies

An adult client is receiving care for an acute asthma exacerbation and has a comorbidity of essential hypertension. The medication administration record indicates a new prescription for oral propranolol 40 mg40\text{ mg} twice daily. The unit's automated medication dispenser supplies 20 mg20\text{ mg} scored tablets. The client's current assessment reveals audible expiratory wheezing, an O2O_2 saturation of 90%90\% on room air, a heart rate of 98 bpm98\text{ bpm}, and a blood pressure of 138/86 mmHg138/86\text{ mmHg}. Based on this clinical data, what is the most appropriate action for the practical nurse (PN) to take?

  1. Withhold the medication and immediately notify the registered nurse (RN) or healthcare provider.Answer
  2. B
    Administer 0.50.5 tablets of propranolol to cautiously manage the client's blood pressure.
  3. C
    Administer 22 tablets of propranolol to address the tachycardia, as the heart rate is the highest priority.
  4. D
    Administer 22 tablets of propranolol and independently perform a comprehensive respiratory assessment to monitor for bronchospasm.

Answer

The PN must withhold the propranolol and immediately report the prescription to the RN or healthcare provider due to the risk of severe bronchoconstriction.
Propranolol is a non-selective beta-blocker that inhibits both beta-1 (cardiac) and beta-2 (pulmonary) receptors. Blocking beta-2 receptors leads to bronchoconstriction. In a client already experiencing an acute asthma exacerbation with active wheezing and hypoxia, this medication can trigger a fatal respiratory crisis. The safest and most appropriate action within the PN's scope of practice is to withhold the scheduled dose and immediately notify the RN or healthcare provider to have the prescription changed.

Step-by-Step Solution

1
Analyze the client's current physiological data.
The client has an acute asthma exacerbation with active airway compromise (wheezing, SpO2 90%).
Establishing the current baseline is required before safely administering any medication.
2
Identify the pharmacological class and mechanism of the prescribed medication.
Propranolol is identified as a non-selective beta-adrenergic antagonist.
Understanding the drug class reveals its systemic effects, specifically its action on both beta-1 (cardiac) and beta-2 (pulmonary) receptors.
3
Synthesize the clinical data with the medication mechanism to determine safety.
Blocking beta-2 receptors in the lungs prevents bronchodilation and induces bronchospasm, which is strictly contraindicated in acute asthma.
Administering the medication would directly worsen the client's already compromised airway.
4
Determine the appropriate intervention within the PN scope of practice.
The PN withholds the dose and escalates the finding to the RN or provider.
The PN is responsible for recognizing critical contraindications, safeguarding the client, and communicating urgent findings to the supervising RN or prescribing provider.

Key Concept

Contraindications of non-selective beta-blockers in respiratory compromise and PN scope of practice in medication safety.
Estimated Time:1m 30s
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Topics

Pharmacological Therapies

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