A patient admitted to the hospital has been using phenylephrine nasal spray (Neo-Synephrine), 2 sprays every 4 hours, for a week
The patient complains that the medication is not working, because the nasal congestion has increased. What will the nurse do?
a. Request an order for an oral decongestant to replace the intranasal phenylephrine.
b. Request an order for an intranasal glucocorticoid to be used while the phenylephrine is withdrawn.
c. Tell the patient to increase the dose of phenylephrine to 4 sprays every 4 hours.
d. Tell the patient to stop using the phenylephrine and begin using an intranasal antihistamine.
ANS: B
This patient is experiencing rebound congestion, which develops when topical sympathomimetics are used for longer than a few days. Abrupt withdrawal can stop the cycle of rebound congestion but is uncomfortable, so using an intranasal glucocorticoid while withdrawing the decongestant is recommended. An oral decongestant is not recommended. Increasing the dose of the intranasal decongestant will only compound the problem of rebound congestion. Stopping the intranasal decongestant will only increase the congestion; using an intranasal antihistamine will not help with congestion.
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