McKenna's Pharmacology for Nursing, 2e

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P A R T 1 0  Drugs acting on the respiratory system

Adverse effects Adverse effects that are associated with the use of lung surfactants include patent ductus arteriosus, brady- cardia, hypotension, intraventricular haemorrhage, pneumothorax, pulmonary air leak, hyperbilirubi- naemia and sepsis. These effects may be related to the immaturity of the neonate, the invasive procedures used or reactions to the lipoprotein. Prototype summary: Beractant Indications: Prophylactic treatment of infants at high risk for developing RDS; rescue treatment of infants who have developed RDS. Actions: Natural bovine compound of lipoproteins that reduce the surface tension and allow expansion of the alveoli; replaces the surfactant that is missing in infants with RDS. Pharmacokinetics: Route Onset Peak Intratracheal Immediate Hours T 1/2 : Unknown; metabolised by surfactant pathways. Adverse effects: Patent ductus arteriosus, intraventricular haemorrhage, hypotension, bradycardia, pneumothorax, pulmonary air leak, pulmonary haemorrhage, apnoea, sepsis, infection.

■■ Lung surfactants are naturally occurring compounds that reduce the surface tension in the alveoli, allowing them to expand. They are injected directly into the trachea of neonates who have RDS. ■■ Administration of lung surfactants requires proper placement of the endotracheal tube, suctioning of the neonate before administration (but not for 2 hours after administration unless necessary) and careful monitoring and support of the neonate to ensure lung expansion and proper oxygenation. ■ ■ Evaluate blood gases and oxygen saturation to monitor drug effectiveness. ■ ■ Assess temperature and full blood count to monitor for sepsis. Implementation with rationale ■ ■ Monitor the neonate continuously during administration and until stable to provide life support measures as needed. ■ ■ Ensure proper placement of the endotracheal tube with bilateral chest movement and lung sounds to provide adequate delivery of the drug. ■ ■ Have staff view the manufacturer’s teaching video before regular use to review the specific technical aspects of administration. administration, but do not suction for 2 hours after administration unless clinically necessary, to allow the drug time to work. ■ ■ Provide support and encouragement to parents, explaining the use of the drug in the teaching program, to help them cope with the diagnosis and treatment of their baby. ■ ■ Continue other supportive measures related to the immaturity of the neonate because this is only one aspect of medical care needed for premature infants. Evaluation ■ ■ Monitor response to the drug (improved breathing, alveolar expansion). ■ ■ Monitor for adverse effects (pneumothorax, patent ductus arteriosus, bradycardia, sepsis). ■ ■ Evaluate the effectiveness of the teaching plan, and support parents as appropriate. ■ ■ Monitor the effectiveness of other measures to support breathing and stabilise the neonate. ■ ■ Evaluate the effectiveness of other supportive measures related to the immaturity of the neonate. ■ ■ Suction the infant immediately before

Care considerations for neonates receiving lung surfactants

Assessment: History and examination

■ ■ Assess for possible contraindications or cautions : screen for time of birth and exact weight to determine appropriate doses. Because this drug is used as an emergency treatment, there are no contraindications to screen for. ■ ■ Perform a physical examination to establish baseline data for assessing the effectiveness of the drug and the occurrence of any adverse effects associated with drug therapy. ■ ■ Assess the skin temperature and colour to evaluate perfusion. ■ ■ Monitor respirations, adventitious sounds, endotracheal tube placement and patency and chest movements to evaluate the effectiveness of the drug and drug delivery. ■ ■ Evaluate blood pressure, pulse and arterial pressure to monitor the status of the neonate.

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