A patient will begin using ipratropium bromide (Atrovent), albuterol (Proventil), and an inhaled glucocorticoid medication (steroid) to treat chronic bronchitis.

When teaching this patient about disease and medication management, the nurse will instruct the patient to administer these medications in which order?

A. Hypotension

While diphenhydramine can cause drowsiness and may contribute to orthostatic hypotension, it is not a strict contraindication. However, caution should be exercised in patients with hypotension.

B. Allergy to penicillin

An allergy to penicillin is not directly related to the use of diphenhydramine. Allergies to specific medications, including penicillin, are important to assess but are not a primary concern when administering diphenhydramine.

C. Narrow-angle glaucoma

Diphenhydramine can cause pupil dilation and may worsen narrow-angle glaucoma, leading to increased intraocular pressure. Therefore, it is crucial to assess for a history of narrow-angle glaucoma before administering diphenhydramine. If a patient has a history of this condition, alternative medications or careful monitoring may be necessary.

D. Diabetes insipidus

Diabetes insipidus is not typically a contraindication for diphenhydramine. However, it is essential to consider the overall health status and specific needs of the patient. Diphenhydramine may have anticholinergic effects, and caution is advised in patients with certain medical conditions.

A. Cardiac Enzymes

Cardiac enzymes are markers used to assess heart health and are not directly related to myelosuppression caused by chemotherapy. Monitoring cardiac enzymes is important for assessing heart function but is not the primary concern in the context of myelosuppression.

B. Complete Blood Count with differential

This is the correct choice. The complete blood count (CBC) with differential provides information about the levels of red blood cells, white blood cells, and platelets. Since myelosuppression affects blood cell production, monitoring the CBC with differential is crucial to detect and manage any abnormalities in these cell counts.

C. Chemistry Profile

A chemistry profile typically includes measurements of electrolytes, kidney function, and other metabolic parameters. While monitoring overall health is important, the specific concern with myelosuppression and chemotherapy is related to blood cell counts. Therefore, a complete blood count (CBC) is more directly relevant in this context than a chemistry profile.

D. Liver Function Tests

Liver function tests assess the health of the liver and are not directly related to myelosuppression caused by chemotherapy. These tests are important in certain situations, but they do not provide information about blood cell counts, which are the primary concern when dealing with myelosuppression.