Albuterol Nursing Implications
Albuterol Nursing Pharmacology
Albuterol is a prescription medicine that belongs to the drug classification known as bronchodilators. It is prescribed to treat and prevent symptoms like trouble in breathing, wheezing, shortness of breath, coughing, tightness of chest caused by asthma attacks and chronic obstructive pulmonary disease (COPD) by relaxing the smooth muscles in your airway and promoting airflow to the lungs.
Albuterol powder for oral inhalation is recommended among children aged 12 years and older. In adults and children aged 2 years and older, Albuterol solution for oral inhalation is commonly prescribed. Also, albuterol inhalation aerosol is given to adults and children aged 4 years and above.
Indications of Albuterol
- Acute or severe bronchospasm. Albuterol is given to treat or prevent bronchospasm among patients suffering from reversible obstructive airway diseases such as asthma, emphysema, bronchitis, bronchiectasis, and cystic fibrosis.
- Exercise-induced bronchospasm. Albuterol is given as a quick relief treatment and prevention of asthma caused by exercise.
- Spinal cord injury (SCI). Albuterol is prescribed to treat or prevent paralysis secondary to spinal cord injury.
- Muscle paralysis. Albuterol is sometimes given to treat or improve muscle paralysis among patients with an existing medical condition that results in attacks of paralysis.
Mechanism of Action of Albuterol
- Albuterol takes action on beta-2 adrenergic receptors by relaxing the bronchial smooth muscle. These muscles surrounding the airway became narrower due to several reasons, such as mucus accumulation, or swelling of the lining of the airways. These may lead to shortness of breath, wheezing, cough, and congestion.
- Albuterol acts by dilating bronchial air passage allowing air to move in and out of the lungs.
- Albuterol acts also in cells, especially in mast cells by inhibiting the release of immediate hypersensitivity mediators from it. In most controlled clinical trials, Albuterol was shown to have more effect on the respiratory tract, through relaxation of the bronchial smooth muscles with lesser cardiovascular effects produced.
Pharmacokinetics of Albuterol
Albuterol is a beta2 receptor agonist and also some beta1 activity; It relaxes the smooth muscle in the air passage with minimal effect on heart rate.
- Absorption. Albuterol is rapidly absorbed after administration. The onset of absorption for inhalation is 25 minutes, while in nebulization it takes 30 minutes to 2 hours, and for the oral route, the onset is 2 to 3 hours. Meanwhile, for the duration, it takes 4 to 6 hours for oral formulation. The peak plasma time for inhalation solution is 2 to 5 hours and for the oral route is 2 to 2.5 hours.
- Distribution. The protein-bound is 10%
- Metabolism. Albuterol is metabolized in the liver, and may cross placenta
- Elimination. Albuterol is eliminated with a half-life of 3 to 8 hours for inhalation and 3 to 5 hours for oral administration. Albuterol is excreted through urine.
Side Effects of Albuterol
With the beneficial effects of the medicine, at some point it may also cause some unwanted effects. Although not all of these side effects may occur, it is better to inform the patient with what to expect. Listed below are the common side effects of albuterol. If any of these side effects keep on or got worse, inform the physician immediately:
- elevated blood pressure
- nervousness- in children between 2-and 6 years of age.
- insomnia- among children aged between 6-and 12 years, receiving the dose of 4-12 mg every 12 hours.
- conjunctivitis- in children aged 2-6 years
- flu syndrome
- itchiness of the eyes
- difficulty speaking
- increased sweating
- enlarged lymph nodes
- abdominal pain
- gas or belching
- increased appetite
- high blood pressure
- pain (muscle, bone, or back)
- painful urination
Serious side effects include:
- chest pain
- irregular heartbeat
- pounding heartbeats
- fast breathing
- the worsening difficulty of breathing or asthma attack
- sudden wheezing
- serious allergic reactions such as rashes, swelling of the face or tongue or throat, or lower legs.
- severe dizziness
- painful and burning sensation when urinating
- leg cramps
- numbness of legs
- tingling sensation in legs and hands
- muscle weakness
- increased or extreme thirst
- frequent urination
Adverse Reactions of Albuterol
- Immune system disorders such as hypersensitivity reactions include urticaria, angioedema, oropharyngeal edema, rashes, and an anaphylactic response.
- Respiratory disorders such as exacerbated asthma, upper respiratory infection, nasopharyngitis, paradoxical bronchospasm, and aggravated bronchospasm.
- Psychiatric concerns involve nervousness, sleepiness, insomnia, hallucination
- Cardiovascular diseases include congestive heart failure, rhythm disorder, increased blood pressure, chest pain, rapid heartbeat, prolonged QT interval, and ST-segment depression. Significant changes in systolic and diastolic blood pressure have been seen in patients after giving an adrenergic bronchodilator.
- Gastrointestinal disorders include dyspepsia, nausea, vomiting, and epigastric pain.
- Neurological/Neuromuscular disorder including seizures, tremors, and nervousness. Insomnia, hyperactivity, dizziness, epilepsy.
- Genitourinary disorders include urinary tract infection, painful urination, and nephritis.
- Metabolic disorders such as overactive thyroid, diabetes, decrease level of potassium in the blood, metabolic or lactic acidosis. Increased dosage of albuterol given intravenously has been reported to worsen preexisting diabetes and ketoacidosis. Also, albuterol can cause hypokalemia in some patients through intracellular shunting, thus having a possibility to affect cardiovascular function.
- Dermatologic issues such as pale appearance of the skin
- General manifestations such as headache, increased appetite, flatulence, dry mouth, increased sweating, conjunctivitis, chills, epistaxis, dysphonia, ocular pruritus, hypokalemia, fever, glaucoma, weakness, blurred vision, muscle cramps, hoarseness.
Overdose of albuterol can be life-threatening. Call emergency medical attention or the Poison center hotline immediately.
Overdose symptoms include:
- fast or irregular heartbeat
- excessive tiredness
- uncontrollable shakiness
- difficulty sleeping
- dry mouth
- lack of energy
Drug Reactions of Albuterol
- Other medicines for inhalation
- Other short-acting sympathomimetic bronchodilators – Be cautious to not use other short-acting bronchodilators together with albuterol inhaler.
- Adrenergic medication- To avoid causing cardiovascular harm, taking additional adrenergic while using albuterol should be avoided.
- Digoxin- Clinical test has shown that there is a decrease in serum digoxin levels after a single dose of albuterol was administered.
- Non-potassium-sparing diuretics- changes in ECG and hypokalemia are some of the effects of albuterol combined with non potassium-sparing diuretics, specifically if the prescribed dose of albuterol is exceeded. Therefore, extreme caution is advised if administered together.
- Beta-blocker– Beta-adrenergic receptor blockers interfere with the pulmonary effect of albuterol and also may cause severe bronchospasm among patients with asthma. Ideally, asthma patients are not normally prescribed beta-blockers. But in some circumstances, like prophylaxis for myocardial infarction and other conditions that have no tested alternatives, selected beta-blockers are accepted, but with extreme caution when administered.
- MAO inhibitor (MAOIs) and tricyclic antidepressant- Albuterol should be given cautiously to patients taking MAOIs and tricyclic antidepressant or even if discontinued within 2 weeks period. The reason behind this is it may increase the action of albuterol on the vascular system like high blood pressure, increase in heart rate.
- Stimulant- It is not advisable to take stimulants with albuterol because of their combined negative effects on heart rate, blood pressure.
Nursing Considerations for Albuterol
- Before taking albuterol, inform the doctor if the patient has an allergy to it or any similar drugs, or any kind of allergies. This medication may contain inactive ingredients that may result in allergic reactions. Educate the patient about the signs of hypersensitivity reactions like rashes, urticaria, and difficulty breathing.
- If the patient will use inhalation powder, ask if they have an allergy to milk protein.
- Before using albuterol, inform the doctor about the patient’s medical history, like heart problems, irregular heartbeat, chest pain, high blood pressure, seizure, thyroid problems, low level of potassium in the blood, or previous heart attack.
- If the patient is a child below 4 years old, use a face mask.
- Observe closely those patients with cardiovascular diseases as albuterol may worsen heart failure by reducing ejection fraction. Regular monitoring of vital signs is important. Monitor the blood pressure regularly and compare it with normal values. If there is a significant increase in vital signs, notify the doctor immediately.
- Monitor patient’s respiratory rate, oxygen saturation, and lungs sound before and after administering albuterol.
- Observe any changes in heart rhythm, episodes of palpitations, chest pain, shortness of breath, fatigue, and weakness.
- Check for any manifestation of fine tremors in fingers
- Take note of any signs of CNS toxicity, these include nervousness, restlessness, tremor, and hyperactivity. Severe signs may be related to the overdosage of medication.
- Check for any signs of elevated blood sugar, including increased urination, hunger, drowsiness, and fruity odor of breath. Obtain blood sugar levels regularly.
- Observe for any signs of hypokalemia, including muscle weakness, muscle aches, and leg cramps
- Observe any signs of paradoxical bronchospasms, such as wheezing, cough, difficulty breathing, chest and throat tightness, especially if the dose is higher. If this occurs, instruct the patient to withhold albuterol and inform the doctor immediately.
- Check for any signs of hypokalemia, including irregular heartbeat, muscle pain, numbness or tingling in the hands, legs, feet, trouble breathing, unusual weakness, and decreased urine output.
- Watch out for any symptoms of a serious allergic reaction, such as anaphylaxis that can be life-threatening and needs urgent medical intervention. The patient may develop skin rash, hives, itching, trouble breathing or swallowing, swelling of hands, face, or mouth while taking the medication.
- If the prescribed dose is more than one inhalation, allow at least 2 minutes of the interval between inhalations.
- Advise the patient to rinse their mouth after each use since the albuterol inhaler can cause an unusual taste.
- Assess patient adherence to the treatment. Encourage the patient to talk about if they have any concerns or questions regarding the medication. Open a line of communication with the attending doctor to notify them about any concerns.
- Inform the patient about taking albuterol can make the patient dizzy. Do not drive, use heavy machinery, or do any activity that requires alertness until the patient can do it safely.
- Remind the patient to avoid drinking alcoholic beverages when taking albuterol.
- If the patient plans to undergo any surgery, including dental procedures, inform the doctor or dentist about the medication the patient is taking. It includes prescription drugs, over-the-counter medication, vitamins and supplements, and herbal products. The doctor may need to adjust the dose of medications and monitor the patient carefully with the side effects.
- Instruct the patient not to use over-the-counter drugs without the doctor’s approval. The certain medication contains ingredients that may raise the action of albuterol.
- If the patient is pregnant or planning to get pregnant, consult first the doctor before start taking albuterol. The harmful effect of albuterol on the unborn baby is still unknown, yet having a frequent and uncontrolled asthma attack may increase the possibility of premature birth, low birth weight, or other medical problems like eclampsia. Monitor the pregnant patient carefully and evaluate their condition to maintain optimal control.
- For the breastfeeding patient, it is also important to discuss this with the doctor first. It is still unknown if albuterol is excreted in human milk. But because of the possible tumorigenicity shown for albuterol in some animal studies, it is important to discuss it first with the doctor to decide if albuterol is safe to be given or not.
- Educate the patient about the expected mild side effects, such as dizziness, drowsiness, fatigue, irregular heartbeat, sweating, anxiety, flushing, insomnia, and headache. It is supposed to be short-term and not worsening. If any of these persist in a couple of days, notify your physician immediately.
- Remind the patient to be careful not to place albuterol inhalation into the eyes.
- Keep the albuterol inhaler away from flame or sources of heat and high temperature.
- Keep the medication in a safe container, tightly closed and out of reach of children.
- For the nebulizer solution, store the vials in the refrigerator or at room temperature and away from too much heat. Do not freeze. Any open vial must be consumed immediately.
- Instruct the patient to use the nebulizer for about 5 to 15 minutes or until the medication is consumed.
- Keep the inhaler at room temperature and away from extreme heat and moisture.
- Keep the aerosol canister intact and do not puncture it. Never discard it in an incinerator or dispose of it by fire.
- For an albuterol inhaler or jet nebulizer, demonstrate to the patient the proper use of it. Allow the patient to read the instruction manual, medication guides, and patient information that come with the item. Allow the patient to show how they use the inhaler to check if they can follow the instructions properly and carefully.
- For children, discuss the proper use of inhalers together with parents or guardians so they can guide the patient when using them. Do not allow children to use the albuterol inhaler just by themselves.
- If the young patient is taking anti-inflammatory medicine for asthma, take it together and do not stop any of it without consulting the physician first.
- If the patient forgets a dose, take the missed dose immediately as the patient remembers. If the time is almost for the next dose, skip the missed dose and continue with the regular schedule. Never make the dose double to make up for the missed one.
- Advised the patient to have the prescription refilled before they run out of medication completely. They must keep albuterol on hand at all times.
- Observe if albuterol works well in treating the patient’s asthma or COPD. Consult their doctor immediately to discuss related matters.
- Remind the patient to use all medication as directed by the physician. Do not discontinue any medication schedule without consulting their physician first.
- For patients taking albuterol oral extended-release tablets, instruct them not to chew, crush or mix the medicine with food.
- Due to possible beta-agonist involvement with uterine contraction, the use of albuterol to relieve bronchospasm during labor should be limited to those women whose benefits outweigh the risk.
- When taking other inhaled medications, administer albuterol first and wait for 5 minutes to administer the other inhaled medications.
- If the patient is taking aerosol medication, instruct them to prime the inhaler before using it for the first time and if the inhaler has not been used for more than 2 weeks. Priming is by releasing 4 test sprays into the air, away from the face.
- Remind the patient to keep the mouthpiece clean all the time to avoid build-up of blockage.
- Advised the patient not to overdose on the medication. The recommended dosage for adults is only up to two inhalations with intervals of 4 to 6 hours.
- Instruct the patient to use caution when doing aerobic exercise, because of the higher risk of cardiovascular stimulation.
- Remind the patient not to decrease or over the dosage of the medication. Cardiovascular effects happen at a higher dose of excessive use of medication.
- Administer drug in pressurized forms during the second half of inspiration.
- Advise the patient to consult their doctor right away if their symptoms do not improve or get worse after starting using the medicine, and if the inhaler doesn’t seem to function as well as usual.
- Emphasize to the patient the importance of attending their doctor’s visit regularly to check their condition and progress. This allows the doctor to assess if the medication is working properly and to check if there are any adverse effects occurring.
Nursing Care Plans for Patients on Albuterol
Possible Nursing Diagnoses
- Acute Pain (Headache) related to the side effect of albuterol
- Diarrhea related to the side effect of albuterol
- Risk for Electrolyte Imbalance (Hypokalemia)
|Albuterol Nursing Interventions||Rationale|
|Assess the patient for signs and symptoms of asthma, COPD, or other respiratory conditions.||To confirm the indication for administering albuterol.|
|Check the patient’s allergy status.||Alternatives to albuterol should therefore be considered in case of allergy.|
|Assess if the patient is pregnant or lactating.||Pregnant and breastfeeding women with asthma can continue taking their albuterol daily but will be closely monitored by their physician.|
|Assess the patient’s ability to self-administer the inhaler.||To check for any potential problems with administration.|
To ensure that the right form of albuterol is given through the right route.
|Check the patient’s blood glucose and serum potassium levels. Check for current medications that include loop diuretics, MAOI, tricyclic antidepressants, beta-adrenergic drugs, and digoxin as these should be used cautiously with bronchodilators.||An increased risk of hypokalemia may occur when bronchodilators such as albuterol are administered with other medications that reduce potassium levels like diuretics. Caution is highly warranted as hypokalemia is greatly associated with dysrhythmia and heart failure.|
Nursing Planning and Intervention
|Albuterol Nursing Interventions||Rationale|
|Administer albuterol at the same time each day, ideally before meals.||Albuterol taken before meals can help the patient breathe better when eating or drinking.|
|Use spacers with albuterol inhaler and teach proper oral hygiene.||To ensure optimal absorption and therapeutic action by bronchodilators.|
To avoid oral thrush.
|Administer oral antifungal treatment if needed.||To manage oral thrush which is a common side effect of long-term albuterol use.|
|Educate the patient about the action, indication, common side effects, and adverse reactions to note when taking bronchodilators. Instruct the patient on how to self-administer bronchodilators.||To educate the patient on the crucial information of albuterol, as well as to empower him/her to safely self-administer the medication.|
|Monitor the patient’s fecal elimination.||Long-term albuterol use may cause diarrhea.|
|Advise the patient to rinse the mouth with water after using the inhaler.||To reduce the risk of developing oral thrush.|
|Towards the end of the course of bronchodilators, inform the patient if the dosage of albuterol needs to be tapered down.||Abruptly stopping albuterol may cause withdrawal symptoms such as lightheadedness and dizziness.|
|Routinely check for the serum potassium level of the patient, especially if they are on loop diuretics.||Bronchodilators such as albuterol can cause hypokalemia. The occurrence of hypokalemia is more likely if the patient is also on loop diuretic therapy.|
|Albuterol Nursing Interventions||Rationale|
|Ask the patient to repeat the information about albuterol.||To evaluate the effectiveness of health teaching on albuterol.|
|Monitor the patient’s serum electrolyte levels.||To ensure that the drug did not cause any electrolyte imbalance (particularly hypokalemia).|
|Monitor the patient’s response to albuterol.||To check if albuterol is effective or if the dose needs to be adjusted.|
|Monitor for any muscle cramps or gastrointestinal upset and treat these symptoms as they appear.||Bronchodilators such as albuterol may cause GI upset, diarrhea, and muscle cramps.|
Ackley, B. J., Ladwig, G. B., Makic, M. B., Martinez-Kratz, M. R., & Zanotti, M. (2020). Nursing diagnoses handbook: An evidence-based guide to planning care. St. Louis, MO: Elsevier. Buy on Amazon
Gulanick, M., & Myers, J. L. (2022). Nursing care plans: Diagnoses, interventions, & outcomes. St. Louis, MO: Elsevier. Buy on Amazon
Ignatavicius, D. D., Workman, M. L., Rebar, C. R., & Heimgartner, N. M. (2018). Medical-surgical nursing: Concepts for interprofessional collaborative care. St. Louis, MO: Elsevier. Buy on Amazon
Silvestri, L. A. (2020). Saunders comprehensive review for the NCLEX-RN examination. St. Louis, MO: Elsevier. Buy on Amazon
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