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, be-cause 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b. Request an order for an intranasal gluco-corticoid to be used while the phenyleph-rine is withdrawn.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 pheny-lephrine and begin using an intranasal an-tihistamine.
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, beginning one week before dis-continuing the decongestant, while withdrawing the decongestant, is recommended. An oral de-congestant 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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