Respiratory administration

It is good practice to keep concentrations of airborne nickel in any chemical form as low as possible and certainly below the relevant standard. Local exhaust ventilation is the preferred method, particularly for powders, but personal respirator protection may be employed where necessary. In the United States, the Occupational Safety and Health Administration (OSHA) personal exposure limit (PEL) for all forms of nickel except nickel carbonyl is 1 mg/m. The ACGIH TLVs are respectively 1 mg/m for Ni metal, insoluble compounds, and fume and dust from nickel sulfide roasting, and 0.1 mg/m for soluble nickel compounds. The ACGIH is considering whether to lower the TLVs for all forms of nickel to 0.05 mg/m, based on nonmalignant respiratory effects in experimental animals. 

Let s eonsider lead abatement or asbestos work. These aetivities provide a good example of how hazards are minimized by eontrolling aeeess. Wlien working with either substanee, an enelosure ean be eon-strueted that keeps out unauthorized people and eontains the hazardous substanee. The only persons who should be potentially exposed are those who are trained, qualified, and medieally fit personnel who deal appropriately with the hazard. Workers in the enelosure are proteeted by PPE, respiratory proteetion, engineered ventilation systems sueh as negative air maehines, high-eflfieieney partieulate air (HEPA) vaeuums, and administrative eontrols. 

LVHV nozzles can create problems that may be sufficiently severe as to prevent their use, usually in the form of ergonomic encumbrances and excessive noise. These problems can be dealt with, to limited extents, and LVHV applications can be effective. It must also be understood that dust control by 1..VHV systems is ultimately limited. No ventilation control measure can ensure sufficient worker protection down to extraordinatily low acceptable dust levels. Worker protection must always be confirmed by industrial hygiene monitoring and evaluation, and administrative control measures such as respiratory protection may be necessary. 

Opiate overdose is a medical emergency that can result in respiratory and CNS depression. The opioid receptor antagonist naloxone immediately reverses cardiorespiratory depression. However, repeated naloxone administration is required, since the effects of naloxone last for 30 min, while opioid agonists can remain at potentially lethal blood levels for several hours. 

Administration of the aminoglycosides with the cephalosporins may increase the risks of nephrotoxicity. When the aminoglycosides are administered with loop diuretics there is an increased risk of ototoxicity (irreversible hearing loss). There is an increased risk of neuromuscular blockage (paralysis of the respiratory muscles) if the aminoglycosides are given shortly after general anesthetics (neuromuscular junction blockers). 

When an aminoglycoside is being administered, it is important to monitor the patient s respiratory rate because neuromuscular blockade has been reported with the administration of these dragp. The nurse reports any changes in the respiratory rate or rhythm to the primary health care provider because immediate treatment may be necessary. 

Monitoring and Managing Adverse Drug Reactions A variety of adverse reactions can be seen with the administration of the fluoroquinolones or aminoglycosides. The nurse observes die patient, especially during the first 48 hours of tiierapy. It is important to report the occurrence of any adverse reaction to the primary health care provider before die next dose of the drug is duei If a serious adverse reaction such as a hypersensitivity reaction, respiratory difficulty, severe diarrhea, or a decided drop in blood pressure occurs, the nurse contacts die primary health care provider immediately. 

Neuromuscular blockade or respiratory paralysis may occur after administration of the aminoglycosides Therefore, it is extremely important that any symptoms of respiratory difficulty be reported immediately. If neuromuscular blockade occurs, it may be reversed by the administration of calcium salts but mechanical ventilation may be required. 

One of the major hazards of narcotic administration is respiratory depression, widi a decrease in the respiratory rate and depth. The most common adverse reactions include light-headedness, dizziness, sedation, constipation, anorexia, nausea, vomiting, and sweating. When diese effects occur, die primary healdi care provider may lower die dose in an effort to eliminate or decrease die intensity of die adverse reaction. Otiier adverse reactions tiiat may be seen witii die administration of an agonist narcotic analgesic include ... 

It is especially important for the nurse to assess the type, location, and intensity of pain before administering the narcotic analgesic. Immediately before preparing a narcotic analgesic for administration, the nurse assesses the patient s blood pressure, pulse, and respiratory rate. 

This type of pain management is used for postoperative pain, labor pain, and cancer pain. The most serious adverse reaction associated with the administration of narcotics by the epidural route is respiratory depression. The patient may also experience sedation, confusion, nausea, pruritus, or urinary retention. Fentanyl is increasingly used as an alternative to morphine sulfate because patients experience fewer adverse reactions. 

Fhtients receiving long-term opioid therapy rarely have problems with respiratory depression. In instances where respiratory depression occurs, administration of a narcotic antagonist (see Chap. 20) may be ordered by die primary health care provider if die respiratory rate continues to fall. 

This drug is used for complete or partial reversal of narcotic depression, including respiratory depression. Narcotic depression may be due to intentional or accidental overdose (self-administration by an individual), accidental overdose by medical personnel, and drug idiosyncrasy Naloxone also may be used for diagnosis of a suspected acute opioid overdosage. 

Before the administration of naloxone, the nurse obtains the blood pressure, pulse, and respiratory rate and reviews the record for the drug suspected of causing the overdosage. If there is sufficient time, the nurse also should review the initial health history, allergy history, and current treatment modalities. 

As part of the ongoing assessment during the administration of naloxone, the nurse monitors the blood pressure, pulse, and respiratory rate at frequent intervals, usually every 5 minutes, until the patient responds. After the patient has shown response to the drug, the nurse monitors vital signs every 5 to 15 minutes. The nurse should notify tlie primary healdi care provider if any adverse drug reactions occur because additional medical treatment may be needed. The nurse monitors die respiratory rate, rhydun, and depdi pulse blood pressure and level of consciousness until the effects of die narcotics wear off. 

Because narcoticanalgesicsdepressthe CNS(see Chap. 19), the nurse should not administer a barbiturate or miscellaneous sedativesand hypnoticsapproximately 2 hoursbefore or after administration of a narcoticanalgesic or other CNS depressant. If the time interval between administration of a narcotic analgesic and a sedative or hypnotic is less than 2 hours the patient may experien ce severe respiratory depres-son, bradycardia, and unresponsiveness. 

Treatment of barbiturate toxicity is mainly supportive (ie, maintaining a patent airway, oxygen administration, monitoring vital signs and fluid balance). The patient may require treatment for shock, respiratory assistance, administration of activated charcoal, and in severe cases of toxicity, hemodialysis. 

ANALEPTICS. When a CNS stimulant is prescribed for respiratory depression, initial patient assessments will include the blood pressure, pulse, and respiratory rate. It is important to note the depth of the respirations and any pattern to the respiratory rate, such as shallow respirations or alternating deep and shallow respirations. The nurse reviews recent laboratory tests (if any), such as arterial blood gas studies. Before administering the drug, the nurse ensures that the patient has a patent airway. Oxygen is usually administered before, during, and after drug administration. 

ANALEPTICS. After administration of an analeptic, the nurse carefully monitors the patient s respiratory rate and pattern until the respirations return to normal. The nurse monitors the level of consciousness, the blood pressure and pulse rate at 5- to 15-minute intervals or as ordered by the primary health care provider. The nurse may draw blood for arterial blood gas analysis at intervals to determine the effectiveness of the analeptic, as well as the need for additional drug therapy. It is... 

Respiratory depression can be a serious event requiring administration of a respiratory stimulant. When an analeptic is administered, the nurse notes and records the rate, depth, and character of the respirations before the drug is given to provide a database for evaluation of the effectiveness of drug therapy. Oxygen is usually ordered for before and after administration of a respiratory stimulant. After administration, the nurse monitors respirations closely and records the effects of therapy. 

Although rare, benzodiazepine toxicity may occur from an overdose of the drug. Benzodiazepine toxicity causes sedation, respiratory depression, and coma. Flumazenil (Romazicon) is an antidote (antagonist) for benzodiazepine toxicity and acts to reverse die sedation, respiratory depression, and coma within 6 to 10 minutes after intravenous administration. The dosage is individualized based on the patient s response, widi most patients responding to doses of 0.6 to 1 mg. However, die drug s action is short, and additional doses may be needed. Adverse reactions of flumazenil include agitation, confusion, seizures, and in some cases, symptoms of benzodiazepine withdrawal. Adverse reactions of flumazenil related to the symptoms of benzodiazepine withdrawal are relieved by die administration of die benzodiazepine. 

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