Question

A client who has been using a Flovent (fluticasone) inhaler has developed a sore throat and white patches on the back of the tongue and throat. The nurse should anticipate an order for: A. Omnipen (ampicillin) B. Nystatin (mycostatin) C. Xylocaine viscous D. Benadryl (diphenhydramine)

Short answer

Answer: Nystatin (Mycostatin)

Step-by-step solution

Recognize the cause of the side effect

The client has developed a sore throat and white patches on the tongue and throat after using a Flovent inhaler. This indicates that the client is most likely experiencing an oral yeast infection (candidiasis) due to the use of the inhaler.

Eliminate unrelated answer choices

Omnipen (ampicillin) is an antibiotic and Xylocaine viscous is a local anesthetic. These medications are not used for treating oral yeast infections. Benadryl (diphenhydramine) is an antihistamine and may aid in relieving symptoms of an allergic reaction, but it does not treat a fungal infection. Therefore, options A, C, and D can be eliminated.

Choose the correct medication

Nystatin (Mycostatin) is an antifungal medication specifically used for treating oral yeast infections, such as the symptoms presented by the client. Thus, the nurse should anticipate an order for Nystatin (Mycostatin).

Conclusion

The correct answer is B. Nystatin (Mycostatin).

Key concepts

Fluticasone Side Effects

Fluticasone is a corticosteroid commonly prescribed to control and prevent symptoms of asthma and other breathing issues. While it can be highly effective, fluticasone may cause several side effects. One notable adverse effect is the increased risk of developing an oral yeast infection, also known as oral candidiasis. This occurs because fluticasone can suppress the immune system locally in the mouth, creating an environment conducive for yeast growth.

Other side effects include hoarseness, dry mouth or throat, cough, and headache. Severe side effects can involve adrenal suppression, bone loss, and eye changes like cataracts and glaucoma, especially with long-term use.

To mitigate these risks, patients using a fluticasone inhaler are often advised to rinse their mouth with water and spit it out after each use. It's important for nurses administering this medication to educate patients about potential side effects and measures to prevent them.

Oral Yeast Infection Treatment

Oral yeast infections, commonly referred to as thrush, present with symptoms such as sore throat, difficulty swallowing, and white patches on the tongue and throat. The preferred treatment for oral candidiasis includes antifungal medications such as Nystatin (Mycostatin).

Nystatin works by binding to sterols in the fungal cell membrane, altering the membrane's permeability and resulting in the leakage of the cell contents, subsequently killing the fungus. For effective management, patients are typically instructed to swish the liquid nystatin in their mouth and then swallow or spit it out, depending on the direction of healthcare providers.

It is crucial to use this medication for the full prescribed duration, even if symptoms appear to resolve sooner, to prevent the recurrence of the infection. Additionally, healthcare providers may suggest lifestyle changes, such as good oral hygiene and dietary adjustments, to support the treatment's effectiveness.

Nursing Medication Management

Nursing medication management is a critical aspect of patient care that includes ensuring the right patient receives the right medication at the right dose, via the right route, at the right time. The nursing role in medication management also involves patient education, monitoring for potential side effects, and making interventions as necessary.

For example, when managing a patient using inhaled corticosteroids like fluticasone, nurses should educate about proper inhaler use, the importance of rinsing the mouth afterward, and what side effects to watch for. Furthermore, they should be prepared to recognize adverse effects, such as the development of an oral yeast infection, and anticipate the need for appropriate treatments like Nystatin.

Effective medication management by nurses includes careful observation, timely reporting of issues or side effects, and collaboration with other healthcare team members to adjust treatment plans as needed, thereby ensuring the best outcome for the patient's health.