A patient receiving continuous salbutamol nebulization therapy. Nurse should assess for?

AIIMS Rishikesh & Jodhpur NO - 2017

Pharmacology

Hard

Appeared in: AIIMS Rishikesh & Jodhpur NO - 2017

Explanation

Salbutamol is a selective beta-2 adrenergic agonist, a class of drugs known to affect electrolyte balance.
It stimulates the sodium-potassium (Na+/K+-ATPase) pump on cell membranes, which actively transports potassium from the blood into the body's cells.
This intracellular shift of potassium results in a lower concentration of potassium in the serum, a condition called hypokalemia.
The risk of hypokalemia is dose-dependent and is significantly higher with continuous or frequent high-dose administration, as specified in the question.
Monitoring serum potassium is essential to prevent adverse effects like muscle weakness and cardiac arrhythmias.

Option A: Salbutamol does not have a direct or clinically significant effect on serum calcium levels.
Option C: While intravenous magnesium is used to treat severe asthma exacerbations, salbutamol itself does not typically cause a significant drop in serum magnesium.
Option D: Salbutamol does not directly affect the hormones (like aldosterone or ADH) that regulate serum sodium levels.

Clinical Relevance

Nursing practice connection: Use the key finding related to Adverse effects of bronchodilator therapy to guide bedside assessment, documentation, and the next nursing action.
A primary nursing responsibility for patients on continuous salbutamol is to monitor for signs of hypokalemia, such as muscle weakness, palpitations, and ECG changes (flattened T-waves, U-waves), to prevent cardiac arrest.
This monitoring is especially critical in patients with pre-existing heart conditions or those receiving other medications that can lower potassium, such as diuretics.
What if? If the patient was also taking a potassium-wasting diuretic like furosemide, the risk of severe, life-threatening hypokalemia would be significantly increased. This would necessitate more frequent serum potassium checks and proactive potassium replacement therapy.

How to Approach the Question

First, identify the drug mentioned in the question: Salbutamol.
Next, classify the drug based on its mechanism of action. Salbutamol is a beta-2 adrenergic agonist.
Recall the common and significant side effects associated with the beta-2 agonist drug class, particularly the metabolic effects.
Remember that a key action of beta-2 stimulation is the shifting of potassium from the blood into the cells.
This physiological shift directly leads to a decrease in serum potassium levels (hypokalemia).
Based on this, conclude that the nurse must assess the patient's serum potassium level.

Concept Tested & Keywords

Concept Tested: Adverse effects of bronchodilator therapy
Stem keywords: continuous salbutamol nebulization, assess for
Lead-in keywords: assess for
Clinical cues: Continuous nebulization suggests a high-dose therapy, increasing the risk of side effects.

Q9QQA7LE6oPGKkzjDLjsA1

E6 Pharmacology Nurses Shanbhag 3e p. 364-366

E6 Pharmacology Nursing Lilley 11e Part 2 p. 169-171