Difficulty: Intermediate Setting: Hospital Index Words: asthma, status asthmaticus, assessment, prioritization of nursing care, education Giddens Concepts: Caregiving, Development, Gas Exchange, Patient Education HESI Concepts: Assessment, Caregiving, Developmental, Gas Exchange, Oxygenation, Patient Education<\/p>\n
Name _________________________________ Class _______________ Date<\/p>\n
_______________<\/p>\n
Scenario<\/p>\n
L.S. is a 7-year-old who has been brought to the emergency department (ED) by his mother. She<\/p>\n
immediately tells you he has a history of ED visits for his asthma. He uses an inhaler when he<\/p>\n
wheezes, but it ran out a month ago. She is a single parent and has two other children at home with<\/p>\n
a babysitter. Your assessment finds L.S. alert, oriented, and extremely anxious. His color is pale,<\/p>\n
and his nail beds are dusky and cool to the touch; other findings are heart rate 136 beats\/min, R<\/p>\n
(RR) 36 breaths\/min regular and even, oral temperature T 99.1\u00b0F (37.3\u00b0C), Spo2 89%, breath<\/p>\n
sounds decreased in lower lobes bilaterally and congested with inspiratory and expiratory wheezes,<\/p>\n
prolonged expirations, and a productive cough. As you ask L.S.\u2019s mother questions, you note that<\/p>\n
L.S.\u2019s respiratory rate is increasing; he is sitting on the side of the bed, leaning slightly forward, and<\/p>\n
having difficulty breathing. You are concerned that he is experiencing status asthmaticus.<\/p>\n
1. You check the orders and need to decide which interventions are the priority at this time. Select all<\/p>\n
that apply and explain the rationale.<\/p>\n
a. Have L.S. lie flat.<\/p>\n
b. Have L.S. perform incentive spirometry.<\/p>\n
c. Administer oxygen via face mask to keep his Spo2 above 90%.<\/p>\n
d. Administer albuterol (Proventil) and ipratropium bromide (Atrovent) via hand-held<\/p>\n
nebulizer (HHN) STAT.<\/p>\n
e. Reassess in 20 minutes, and if no improvement, administer salmeterol (Serevent<\/p>\n
Diskus) via dry-powder inhaler (DPI).<\/p>\n
f. Reassess in 20 minutes, and if no improvement, administer albuterol (Proventil)<\/p>\n
and ipratropium (Atrovent) via hand-held nebulizer again.<\/p>\n
g. Start IV normal saline (NS) at 15 mL\/hr and administer methylprednisolone 2 mg\/kg<\/p>\n
IV STAT \u00d7 1 dose.<\/p>\n
2. Explain what the nurse will assess before, during, and after the nebulizer treatment with albuterol.<\/p>\n
CASE STUDY PROGRESS<\/p>\n
You give L.S. the albuterol and Atrovent twice. His O2 saturation does not improve and remains at<\/p>\n
88% with oxygen at 6 L\/min via face mask. He says he \u201cdoes not feel any better.\u201d He is retracting<\/p>\n
and his respiration rate remains 34 breaths\/minute. You have started his IV infusion and<\/p>\n
administered the methylprednisolone. L.S.\u2019s mother is pacing and tells you she very upset and<\/p>\n
worried. You overhead page the attending ED resident to assess, and you notify the patient-family<\/p>\n
advocate. The ED resident, Dr. S., arrives within 2 minutes to assess L.S. and to speak to L.S.\u2019s<\/p>\n
mother. New orders are pending.<\/p>\n
3. Chart your actions and the patient\u2019s response using the SBAR<\/p>\n
(Situation, Background, Assessment, and Recommendation) forma<\/p>\n
CASE STUDY PROGRESS<\/p>\n
L.S. is admitted to the pediatric intensive care unit (PICU) for close monitoring. His condition<\/p>\n
improves, and 24 hours later he is transferred to the floor. Asthma teaching is ordered. You assess<\/p>\n
Ms. S.\u2019s understanding of asthma and her understanding of the disorder.<\/p>\n
4. Which statement by Ms. S. would indicate a need for further teaching? Explain your answer.<\/p>\n
a. \u201cIf he takes medications for a while, he will outgrow his asthma.\u201d<\/p>\n
b. \u201cPart of his treatment should be avoiding things that irritate his lungs.\u201d<\/p>\n
c. \u201cIf I recognize early warning signs, he might be able to take medicine and not go to<\/p>\n
the ED.\u201d<\/p>\n
d. \u201cHe should go to the doctor regularly to make sure his asthma is being treated<\/p>\n
correctly.\u201d<\/p>\n
5. You are educating L.S. and his mother on possible asthma triggers in their environment. They live<\/p>\n
in public housing in an apartment without air conditioning. Which statements indicate possible<\/p>\n
asthma triggers? Select all that apply.<\/p>\n
a. \u201cWe have a pet fish.\u201d<\/p>\n
b. \u201cL. collects stuffed animals.\u201d<\/p>\n
c. \u201cThere are hardwood floors.\u201d<\/p>\n
d. \u201cOur visitors smoke outside.\u201d<\/p>\n
e. \u201cThe building has copper pipes.\u201d<\/p>\n
f. \u201cThere are dark stains in our bathroom.\u201d<\/p>\n
g. \u201cWe had to get the housing authority to treat for bugs.\u201d<\/p>\n
h. \u201cHe coughs when we have cold nights after a warm day.\u201d<\/p>\n
6. Discuss strategies to avoid the triggers you identified in the previous question.<\/p>\n
CASE STUDY PROGRESS<\/p>\n
The following day, L.S. gets the discharge orders shown in the chart.<\/p>\n
Chart View<\/p>\n
Discharge Orders<\/p>\n
Discharge to home<\/p>\n
Follow up with primary care provider in 3 days for Assessment<\/p>\n
Albuterol (Proventil HFA) MDI: 2 puffs with spacer every 4 hours prn<\/p>\n
Prednisolone (Prelone) 1 mg\/kg PO every day for 5 days (L.S. weighs 23 kg.)<\/p>\n
Fluticasone (Flovent HFA) MDI: 1 puff with spacer twice a day<\/p>\n
Montelukast (Singulair) 5 mg every evening PO<\/p>\n
Provide peak flow meter<\/p>\n
Regular diet<\/p>\n
7. Ms. S. asks why she will use the spacer with the medicine L.S. inhales. Explain the purpose of<\/p>\n
using a spacer with the metered-dose inhaler (MDI).<\/p>\n
8. Place the steps of using the MDI with the spacer in the correct order (1 = first step, 5 = last step)<\/p>\n
a. ___ Depress the top of the inhaler to release medication, and breathe in slowly for<\/p>\n
3 to 5 seconds, holding the breath for 5 to 10 seconds at the end of inspiration.<\/p>\n
b. ___ Shake the inhaler well, 10 to 15 times, and attach to the spacer.<\/p>\n
c. ___ Wait 1 to 2 minutes between puffs if more than one puff of the quick-relief<\/p>\n
medication is ordered.<\/p>\n
d. ___ Remove and exhale slowly through the nose.<\/p>\n
e. ___ At the end of expiration, place mouthpiece into the mouth, forming an airtight<\/p>\n
seal.<\/p>\n
f. ___ Tilt the head back and exhale completely.<\/p>\n
9. During your medication teaching session with Ms. S. and L.S., you ask Ms. S. to teach back what<\/p>\n
she has learned about taking two different inhalers. Ms. S. makes this statement: \u201cSo, if he has to<\/p>\n
take both inhalers at the same time, he should take the Flovent first, then the albuterol. Right?\u201d Is<\/p>\n
this statement true or false? Explain your answer.<\/p>\n
10. Ms. S. then asks, \u201cHow long should we wait between giving the two inhalers if they are both due<\/p>\n
at the same time? Can we just give them one after the other?\u201d What is your response?<\/p>\n
11. As you continue your medication teaching, you explain the difference between long-term<\/p>\n
controllers and quick relief medications. Place a C beside the controller medication(s) and<\/p>\n
an R beside the quick relief medication(s).<\/p>\n
_____ a. Albuterol<\/p>\n
_____ b. Prelone<\/p>\n
_____ c. Flovent<\/p>\n
_____ d. Singulair<\/p>\n
12. After L.S. takes a dose of the inhaled corticosteroid Flovent, what is the most important action he<\/p>\n
should do next? Explain your answer.<\/p>\n
a. Hold his breath for 45 seconds.<\/p>\n
b. Rinse out his mouth with water.<\/p>\n
c. Repeat the dose in 5 minutes if he feels short of breath.<\/p>\n
d. Check his PFM reading for an improvement of function.<\/p>\n
13. Ms. S. comes back from the pharmacy with the Prelone and asks you to show her how much to<\/p>\n
give. Prelone is dispensed as 15 mg\/5 mL. You give her a 10-mL oral dosage syringe. How much<\/p>\n
will she draw up for this dose? (Round to tenths.)<\/p>\n
14. During the teaching session, you give L.S. a peak flow meter (PFM) and provide teaching for him<\/p>\n
and Ms. S. But L.S. looks puzzled and asks you, \u201cIs this another medicine I have to take?\u201d How<\/p>\n
would you explain the purpose of a peak flow meter to L.S.?<\/p>\n
15. L.S. tells you that he loves to play basketball and football and asks you whether he can still do<\/p>\n
these activities. How will you respond?<\/p>\n
16. Discuss the points to include in your discharge teaching regarding prevention of acute asthmatic<\/p>\n
episodes and symptom management.<\/p>\n
17. List three Internet sites to which you can refer them for further information.<\/p>\n
CASE STUDY OUTCOME<\/p>\n
L.S. is discharged to home and has a follow-up appointment scheduled in 2 weeks. His mother has<\/p>\n","protected":false},"excerpt":{"rendered":"
Difficulty: Intermediate Setting: Hospital Index Words: asthma, status asthmaticus, assessment, prioritization of nursing care, education Giddens Concepts: Caregiving, Development, Gas Exchange, Patient Education HESI Concepts:\u2026<\/p>\n","protected":false},"author":3,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[7643,7642,7645,7644],"tags":[7678,8989,8988,7387,633,8991,630,8987,8994,8467,15,8990,7656,7571,8993,66,8992],"class_list":["post-104466","post","type-post","status-publish","format-standard","hentry","category-custom-same-day-essays","category-custom-writings-writers","category-do-my-essay-mla-format","category-write-my-paper-hub-writers","tag-best-custom-paper-writing-service","tag-best-online-paper-writing-service","tag-best-paper-writing-service","tag-best-research-paper-writing-services","tag-cheap-research-paper-writing-service","tag-cheapest-paper-writing-service","tag-college-paper-writing-service","tag-free-paper-writing-service","tag-free-term-paper-writing-service","tag-paper-writing-service","tag-paper-writing-service-reddit","tag-professional-paper-writing-service","tag-someone-to-write-my-paper","tag-websites-that-write-papers-for-you","tag-what-is-the-best-paper-writing-service","tag-write-my-paper","tag-write-my-paper-for-me-free"],"_links":{"self":[{"href":"https:\/\/www.studyproessays.com\/help\/wp-json\/wp\/v2\/posts\/104466","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.studyproessays.com\/help\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.studyproessays.com\/help\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.studyproessays.com\/help\/wp-json\/wp\/v2\/users\/3"}],"replies":[{"embeddable":true,"href":"https:\/\/www.studyproessays.com\/help\/wp-json\/wp\/v2\/comments?post=104466"}],"version-history":[{"count":0,"href":"https:\/\/www.studyproessays.com\/help\/wp-json\/wp\/v2\/posts\/104466\/revisions"}],"wp:attachment":[{"href":"https:\/\/www.studyproessays.com\/help\/wp-json\/wp\/v2\/media?parent=104466"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.studyproessays.com\/help\/wp-json\/wp\/v2\/categories?post=104466"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.studyproessays.com\/help\/wp-json\/wp\/v2\/tags?post=104466"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}