i.      relieve non-productive coughing (forceful air expulsion) by

                                                             ii.      All but one depresses cough reflex center of MEDULLA (centrally acting)

1.      Opioid

a.       Codeine

2.      Nonopioids

a.       Dextromethorphan

b.      Dex. With benzocaine

c.       dipehndydramine

                                                            iii.      One acts peripherally by anesthesizing stretch receptors in repiratory passages

a.       benzonatate (Tessalon)

                                                               i.      CNS

1.      lightheadedness/dizziness

2.      Drowsiness/sedation

                                                             ii.      GI

1.      N/V

2.      Constipation

                                                               i.      Hypersensitivity

                                                             ii.      Codeine with a premature infant or delivery of a premature infant

                                                               i.      Those with persistent/chronic cough

                                                             ii.      Those with cough with excess secretions

                                                            iii.      Those with high fever, rash, persistent headache or N/Vbecause of aspiration

                                                           iv.      Codeine used cautiously in pregnancy (cat C-D), COPD, acute asthma, resp. disorders, acute abdominal conditions, head injury, increased intracranial pressure, convulsive disorders, hep/renal impaired, prostate hypertrophy

                                                               i.      OtherCNS depressants including alcohol may cause additive effects when taken with codeine

                                                             ii.      When dextromethorphan is given with MAOI may cuase hypotension, fever, nausea, jerking motions in leg, and coma

                                                               i.      Assessment

1.      Preadmin  - document/describe cough; what has pt done for cough; take vitals to check for infection

2.      Postadmin – watch for therapeutic effect, auscultate lung sounds and take vitals; is cough interrupting sleep and/or causing pain

1.      Optimal response

a.       Do not chew med since some may cause local anesthetic effect with possible choking

b.      Don’t use if cough is chronic, see dr, b/c can be an underlying condition that needs evaluation and treatment

2.      Support of pt needs r/t adv rxs

a.       Risk for Injury

                                                                                                                                       i.      Closely supervise pt and orient to surroundings; a night light might help

                                                                                                                                     ii.      Encourage pt to ask for help if dizzy or unsteady

                                                                                                                                    iii.      Mental impairment may result so don’t perform hazardous tasks like driving

                                                                                                                                   iv.      Codeine can cause orthostatic hypotension, another risk for falling

b.      Ineffective Airway Clearance

                                                                                                                                       i.      Antitussives can cause pooling of phlegm in lungs which can lead to pneumonia

                                                                                                                                     ii.      Encourage increase in fluids and regular changing of positions

1.      Don’t over use antitussives especially if cough produces sputum. 

2.      If cough lasts more than 10 days or accompanied by fever, chest pain, severe headache or skin rash, pt consultPCP!

3.      Read label carefully and follow directions

4.      Avoid irritants like cig. Smoke

5.      Dink lots of fluids 1500mL to 2000mL

6.      Do not chew or break open tablet

7.      If using lozenge, don’t drink fluids for 30 min after so remains effective

8.      Do no use with alcohol or otherCNS depressants like antidepressants, hypnotics, sedatives, etc.

                                                               i.      Mucolytics break down thick mucus in lower lungs. 

1.      acetylsysteine (Mucomyst) usually for cystic fibrosis

                                                             ii.      Expectorants thin and increases secretions to remove them more easily from respiratory system.

1.      guaifenesin (glyceryl guaiacolate)

2.      potassium iodide 

                                                               i.      aceteylcysteine used for (usually by nebulizer):

1.      acute bronchopul disease (pneumonia, bronchitis)

2.      trach care

3.      cystic fibrosis

4.      pulmonary complications from anesthesis

5.      atelactasis (lung collapse)

6.      APAP OVERDOSAGE

                                                             ii.      Expectorants to bring up secretions and often mixed with other types of drugs in OTC and legend meds

                                                               i.      N/V

                                                             ii.      Dizziness

                                                            iii.      Headache

                                                           iv.      Potassium iodide can cause iodism (sore moth, metallic taste, parotid swelling, etc)

                                                               i.      During pregnancy, cat B and C

                                                             ii.      With persistant cough, asthma, older adults and debilitated

a.       no significant when used as directed EXCEPT for iodine products

                                                               i.      Potassium iodide with other iodine products like lithium and antothyroid drugs may cause greater hypothyroidism

                                                             ii.      Postassium iodide with potassium-containing meds and potassium-sparing diuretics can cuase hypoklemia, cardiac arrythmias or arrest.

                                                            iii.      Potassium iodide may alter thyroid tests

                                                               i.      Assessment

1.      Pre-admin – assess respiratory status, document lung sounds, dyspnea and consistency of sputum for future comparison

2.      Post-admin – Note change is quantity and consistency of sputum.  Describe new sputum.  Asses for difficulty breathing and notifyPCP.  Assess for ability to raise sputum.

1.      Optimal response

a.       Explain treatment and demonstrate how to use nebulizer. 

b.      Acetylcysteine will stink like rotten eggs! but will dissipate quickly. 

c.       Remain with pt first few txs. 

d.      Provide tissue for excess coughing.

e.        If ordered for a trach, make sure suctioning equip is available.

2.      Support of pt r/t adv rxs

a.       Ineffective airway clearance – encourage more fluid intake up to 2L a day unless contraindicated.  Encourage deep breaths.

1.      For expectorant, direct to take as directed and to contactPCP if unusual sxs present, if drug is ineffective, etc.  If cough lasts more than 10 days or is accompanied by fever, chest pain, severe headache or rash, consultPCP.

2.      Acetylcysteine usually given at hospital, but if prescribed for home use:

a.       Respiratory therapist often gives full instructions, nurse make sure pt understands.

b.      Nurse arranges with respiratory care to arrange equiop deleivery

c.       Review regimen with pt

d.      Demonstrate procedure and evaluate return demonstration

e.       Recommend sitting or high Fowler’s position to mac lung expansion an

f.        Encourage slow, even breathing during tx and coughin as necessary

g.       Stress importance of completing full regimen

h.       Review possible adv rxs and stress need to contactPCP if problems occur

i.         Provides info regauding maintaining equip and sorage, also troubleshooting problems with equip

j.        Make sure have contact for resp therapy and equip companies