NURS 1566 Clinical Form 3: Clinical Medications Worksheets(You will need to make additional copies of these forms)

Generic NameIpratroprium BR

Trade NameAtrovent

ClassificationAnticholinergics, brohchodilators

Dose0.02% solution

RouteINH

Time/frequencyQID

Peak 1-2 hr 

Onset5-15 min 

Duration3-4 hr (up to 8 hr) 

Normal dosage range1-4 inhalations 3-4 times a day

Why is your patient getting this medicationExacerbation COPD

For IV meds, compatibility with IV drips and/or solutionsN/A

Mechanism of action and indications(Why med ordered)Mechanism of action: Inhibits cholinergic receptors in bronchial smooth muscle, resulting in decreased concentrations of cyclic guanosine monophosphate (cGMP). Decreased levels of cGMP produce local bronchodilation.Indications: Maintenance therapy of reversible airway obstruction due to COPD

Nursing Implications (what to focus on) Contraindications/warnings/interactionsHypersensitivity to ipratropium, atropine, belladonna alkaloids, bromide; Avoid use during acute bronchospasm;

Common side effectsCNS: dizziness, headache, nervousness, EENT: blurred vision, sore throat, nasal only: epistaxis, nasal dryness/irritation, Resp: bronchospasm, cough, CV: hypotension, palpitations, GI: GI irritation, nausea, Derm: rash, Misc: allergic reactions

Interactions with other patient drugs, OTC or herbal medicines (ask patient specifically)None

Lab value alterations caused by medicineNone found

Be sure to teach the patient the following about this medicationInstruct patient in proper use of nebulizer and to take medication as directed. Advise patient that rinsing mouth after using inhaler, good oral hygiene, and sugarless gum or candy may minimize dry mouth. Health care professional should be notified if stomatitis occurs or if dry mouth persists for more than 2 wk. Explain need for pulmonary function tests prior to and periodically during therapy to determine effectiveness of medication. Caution patient to avoid spraying medication in eyes; may cause blurring of vision or irritation. Advise patient to inform health care professional if cough, nervousness, headache, dizziness, nausea, or GI distress occurs.

Nursing Process- Assessment(Pre-administration assessment)Assess for allergy to atropine and belladonna alkaloids; patients with these allergies may also be sensitive to ipratropium. Assess for peanut or soy allergy. Assess respiratory status (rate, breath sounds, degree of dyspnea, pulse) before administration .

AssessmentWhy would you hold or not give this med?if severe bronchospasm is present; onset of action is too slow for patients in acute distress. If wheezing occurs, withhold medication and notify physician or other health care professional immediately.

EvaluationCheck after givingrespiratory status (rate, breath sounds, degree of dyspnea, pulse)