Question

A 5-year-old is being treated for an acute attack of asthma using racemic epinephrine (epinephrine hydrochloride) nebulizer stat. Which finding indicates an adverse effect of this medication? A. Excitability B. Tremors C. Heart rate 150 D. Nausea

Short answer

A. Excitability B. Tremors C. Heart rate 150 D. Nausea Answer: C. Heart rate 150

Step-by-step solution

Understand racemic epinephrine

Racemic epinephrine is a medication that is used to treat constriction of airways in patients with respiratory disorders such as asthma. It is a bronchodilator that enhances the release of norepinephrine, leading to relaxation of smooth muscles in the airways and improved airflow. While it can have some side effects, it is generally safe to use.

Analyze Option A - Excitability

Excitability can be a side effect of racemic epinephrine medication due to its effects on the release of norepinephrine, which functions as both a neurotransmitter and hormone in the body. Norepinephrine is responsible for the "fight-or-flight" response, which can lead to increased energy levels and excitability. This is an expected effect and not an adverse effect.

Analyze Option B - Tremors

Tremors are involuntary shaking/trembling of the body and can be a side effect of racemic epinephrine. This is because the medication stimulates the nervous system, which can result in increased muscle activity and lead to tremors. However, this is generally mild and short-lasting, so it is an expected effect and not an adverse effect.

Analyze Option C - Heart rate 150

An increased heart rate can occur as a result of using racemic epinephrine, as it stimulates the release of norepinephrine, which has cardiovascular effects such as increasing heart rate and blood pressure. A heart rate of 150 beats per minute is significantly elevated for a 5-year-old (normal heart rate range: 75-115 bpm). Thus, it indicates an adverse effect of the medication.

Analyze Option D - Nausea

Nausea can be a side effect of racemic epinephrine, but it is generally mild and self-limiting. It does not typically cause severe discomfort or pose a significant risk to the patient. As such, it is an expected effect and not an adverse effect.

Conclusion

Based on the analysis of each option, the finding that indicates an adverse effect of racemic epinephrine medication in the given scenario is option C - a heart rate of 150 bpm.

Key concepts

Acute Asthma Attack Treatment

Asthma is a common respiratory condition characterized by episodes of constricted airways, making breathing difficult. During an acute asthma attack, airways become severely narrowed, leading to wheezing, coughing, shortness of breath, and tightness in the chest. Quick treatment is essential to rapidly open airways and restore normal breathing.

Racemic epinephrine, often used in these situations, is delivered via a nebulizer, allowing the medication to reach the lungs directly. It acts quickly to relax the muscles around the airways. When these muscles relax, the airways widen, increasing airflow and making it easier to breathe. This is crucial, especially in pediatric cases, where airway constriction can worsen rapidly if not treated swiftly.

In treating acute asthma attacks, monitoring the patient for any changes or reactions to the medication is vital. While racemic epinephrine is effective, being aware of its potential effects helps ensure treatment safety.

Pediatric Nursing

Pediatric nursing is a specialized area of nursing dedicated to caring for infants, children, and adolescents. Nurses in this field must understand both physical and emotional aspects affecting this age group, as well as the dynamic growth and development stages they experience.

When administering treatments such as racemic epinephrine, pediatric nurses must keep in mind the unique responses of a child’s body to medications. Children metabolize drugs differently from adults, often requiring adjustments in dosage and careful observation for side effects or adverse reactions.

Pediatric nurses play a crucial role in educating parents and caregivers, helping them understand medication regimens and what symptoms to watch for after treatment. Ensuring comfort and minimizing stress during medical procedures is also a key part of pediatric nursing, as a calm environment can enhance the effectiveness of treatment and recovery.

Effective communication, empathy, and a keen observation skill set are essential for pediatric nurses to ensure the safety and well-being of young patients.

Pharmacology for Nurses

Pharmacology is the study of how medications work, how they are administered, and how they affect the body. For nurses, understanding pharmacology is crucial, as they are often the ones administering medications and monitoring patients for effects.

Nurses need to be informed about the correct doses, routes of administration, and potential side effects of drugs like racemic epinephrine. This medication, specifically, is a bronchodilator, used to open airways by relaxing smooth muscles in the lungs. Like many drugs, it operates by interacting with certain receptors in the body, leading to its therapeutic effect.

Comprehending pharmacodynamics (how drugs affect the body) and pharmacokinetics (how the body processes drugs) aids nurses in predicting potential outcomes and identifying when a medication’s effect deviates from the expected path. This knowledge is crucial for ensuring that treatments are both effective and safe.

Moreover, awareness of drug interactions is essential. Nurses must consider other medications a patient is taking, as these can influence the effects of a drug like racemic epinephrine.

Adverse Effects Identification

Identifying adverse effects is an essential part of patient care, ensuring treatments do not cause more harm than benefit. An adverse effect is a harmful or unintended reaction to a medication. When administering drugs like racemic epinephrine, nurses need to be vigilant for signs that indicate an adverse response.

For racemic epinephrine, common side effects can include excitability and tremors, generally mild and short-lived. However, an elevated heart rate, especially beyond expected levels for a child's age, can signify an adverse effect requiring immediate attention. In pediatric patients, where normal heart rates vary, a rate of 150 bpm would be considered outside the safe range and needs to be addressed promptly.

Regular monitoring and documentation of a patient's response during and after treatment helps in identifying adverse effects early. Prompt detection allows for quick intervention, such as adjusting the medication dosage or discontinuing the drug, to safeguard the patient's health.