Albuterol and CHF

[voraciousj]

I was doing some research the other day since I work on a tele unit that specializes in CHF (and I'm a new grad RN) and I'm getting really confused as to why you wouldn't want to give an albuterol treatment to a pt with CHF.

Could someone put it in plain English for me?

Thanks!!:heartbeat

[voraciousj]

I've seen many people more often nursing homes, give albuterol to people who were in full blown CHF. I've been an EMT for over 5 years (now an RN) I've gone to many nursing homes for difficulty breathing, and when we come in we find out that the patient has gotten 3 neb tx's and still has difficulty breathing. Just the other day a NA did the same thing, I quickly snatched the tx out of the patients hand and yelled at the NA and said did you even bother to listen to her lungs before you gave her that treatment. All she gave me was a puzzled look. I was ****** to say the least, a 'strong 40' of lasix (which in EMS is really 80 to 100mgs) and some CPAP and an inch of nitro paste cleared her right up....IMHO..dilate someone who is already filled and what do you have? just a bigger space for more water to collect...I've only seen albuterol do bad things to CHF'ers so thats why I can't stand when I see people do it...It boggles my f-ing mind....I can't see how an albuterol tx could help any patient in CHF....maybe as a LAST ditch effort??? I guess I could use some enlightening myself on this one.

Why would you yell at a NA for not assessing the pt? Isn't that the job of the RN? To assess...IMHO it is far out of the NA's scope...

[Virgo_RN, BSN, RN]

I've seen many people more often nursing homes, give albuterol to people who were in full blown CHF. I've been an EMT for over 5 years (now an RN) I've gone to many nursing homes for difficulty breathing, and when we come in we find out that the patient has gotten 3 neb tx's and still has difficulty breathing. Just the other day a NA did the same thing, I quickly snatched the tx out of the patients hand and yelled at the NA and said did you even bother to listen to her lungs before you gave her that treatment. All she gave me was a puzzled look. I was ****** to say the least, a 'strong 40' of lasix (which in EMS is really 80 to 100mgs) and some CPAP and an inch of nitro paste cleared her right up....IMHO..dilate someone who is already filled and what do you have? just a bigger space for more water to collect...I've only seen albuterol do bad things to CHF'ers so thats why I can't stand when I see people do it...It boggles my f-ing mind....I can't see how an albuterol tx could help any patient in CHF....maybe as a LAST ditch effort??? I guess I could use some enlightening myself on this one.

Okay, I'll bite. Albuterol is given as symptomatic treatment to those with dyspnea. Someone with CHF and resultant pulmonary congestion will have dyspnea. The reason it would not be appropriate for this population has nothing to do with "creating more space for fluid to collect" by dilating the bronchial tree. It is because Albuterol is a sympathomimetic, which means that it increases heart rate and blood pressure, two things that lead to pumonary congestion in CHF patients. I do not see Albuterol used in this way on the inpatient unit that I work on, however. Typically, CHF patients are treated with Lasix, Coreg, and Lisinopril. Emergent pulmonary edema might buy them some IV Lasix, nitro, and morphine. However, if the patient has COPD as well as CHF, then they may get Albuterol for bronchospasm. The Lasix, Coreg, and Lisinopril that they are recieving counteract the sympathomimetic effects of the Albuterol so that they can tolerate it without increasing their pulmonary vascular congestion. I agree with the others. Why in the world would you storm into a nursing home guns a blazin and yell at some poor NA who does not have the training to assess a patient's lung sounds and determine the correct course of action? You probably looked like a giant horse's behind to that NA, which would explain their reaction.