Case Study 21 Acute Asthma Management<\/p>\n
B.T., a 31-year-old man who lives in a small mountain town in Colorado, is highly allergic to dust and pol- len and has a history of mild asthma. B.T.’s wife drove him to the emergency room when his wheezing was unresponsive to his fluticasone\/salmeterol (Advair) inhaler, he was unable to lie down, and he began to use accessory muscles to breathe. B.T. is immediately started on 4 L oxygen by nasal cannula and intrave- nous (IV) D5W at 75 mL\/hr. A set of arterial blood gases is sent to the laboratory. B.T. appears anxious and says that he is short of breath.<\/p>\n
1.\tAre B.T.’s vital signs acceptable? State your rationale.<\/p>\n
2.\tWhat is the rationale for immediately starting B.T. on O2?<\/p>\n
3.\tKeeping in mind B.T.’s health history and presenting complaint, what are the most important areas you need to evaluate during your physical assessment?<\/p>\n
4.\tInterpret B.T.’s arterial blood gas results.<\/p>\n
5.\tWhat is the rationale for the albuterol 2.5 mg plus ipratropium 250 mcg nebulizer treatment STAT (immediately)?<\/p>\n
6.\tIndicate the drug classification and expected outcome B.T. should experience with using metaproterenol sulfate (Alupent) and Fluticasone (Flovent).<\/p>\n
You assess B.T. and find that he has diminished lung sounds with inspiratory and expiratory wheezes in all lung fields with a nonproductive cough and accessory muscle use. His skin is pale, warm and dry. The electrocardiogram (ECG) shows sinus tachycardia without ectopy. He is alert and oriented\uf0b4 4 spheres. He appears anxious and is sitting upright, leaning over the bedside table, and continuing to complain of shortness of breath. When you examine B.T., you discover that he has attenuated lung sounds, wheezes on both the inhalation and exhalation side, a nonproductive cough, and auxiliary muscle use. His complexion is cool, dry, and pale. Sinus tachycardia without ectopy is visible on the electrocardiogram (ECG). He is focused and alert, 4 spheres. He is sitting up straight, leaning over the nightstand, and he is still complaining of shortness of breath. He seems nervous.<\/p>\n
7.\tWhat is your primary nursing goal at this time?<\/p>\n
8.\tDescribe six actions you must implement based on this priority.<\/p>\n
9.\tYou will need to monitor B.T. closely for the next few hours. What is the most serious complication to anticipate?<\/p>\n
10.\tIdentify four signs and symptoms of this complication you will assess for in B.T.<\/p>\n
11.\tWhen combination inhalation aerosols are prescribed without specific instructions for the sequence of administration, you need to be aware of the recommendations for safe drug administration. Describe the correct sequence for administering B.T.’s treatments.<\/p>\n
12.\tWhat are your responsibilities while administering aerosol therapy?<\/p>\n
CaSE StuDy ProGrESS<\/p>\n
After several hours of rehydration and aerosol treatments, B.T.’s wheezing and dyspnea resolve, and he is able to expectorate his secretions. The physician discusses B.T.’s asthma management with him; B.T. says he has had several asthma attacks over the last few weeks. The physician discharges B.T. with a prescrip- tion for oral steroid \u201cburst\u201d (prednisone 40 mg\/day\uf0b4 5 days), fluticasone\/salmeterol (Advair HFA 230\/21) two inhalations every morning and evening, albuterol (Proventil) metered-dose inhaler (MDI) two puffs q6h as needed using a spacer, and montelukast (Singulair) 10 mg daily each evening. He instructs B.T. to call the pulmonary clinic for follow-up with a pulmonary specialist.<\/p>\n
13.\tWhat is the rationale for B.T. being on the oral steroid burst?<\/p>\n
14.\tHow does montelukast (Singulair) differ from other asthma medications?<\/p>\n
15.\tB.T. states he had taken his Advair that morning, then again when he started to feel short of breath. He states, \u201cIt did not help,\u201d and wants to know why he has to remain on it. Is fluticasone\/salmeterol (Advair) appropriate for use during an acute asthma attack? Explain.<\/p>\n
16.\tBased on this information, what specific issue do you need to address in discharge teaching with B.T.?<\/p>\n
You ask B.T. to demonstrate the use of his MDI. He vigorously shakes the canister, holds the aerosolizer at an angle (pointing toward his cheek) in front of his mouth, and squeezes the canister as he takes a quick, deep breath.<\/p>\n
17.\tWhat common mistakes has B.T. made when using the inhaler?<\/p>\n
18.\tYou review the proper use of an MDI with B.T and possible side effects he may experience, including hoarseness, dry mouth, white spots in the oral cavity, coughing, and headaches. What actions can you teach him to prevent or diminish the incidence of these effects? Select all that apply.<\/p>\n
a.\tDecrease his fluid intake.<\/p>\n
b.\tUse a spacer on the inhaler.<\/p>\n
c.\tUse the inhaler only as prescribed.<\/p>\n
d.\tRinse out his mouth immediately after using the inhaler<\/p>\n
e.\tClean the spacer in the dishwasher on \u201chot cycle with heated dry\u201d daily.<\/p>\n
19.\tB.T.’s wife asks about the possibility of B.T. having another attack. How would you respond?<\/p>\n
20.\tB.T. states that he would like to read more about asthma on the Internet. List three credible websites to which you could direct him.<\/p>\n","protected":false},"excerpt":{"rendered":"
Case Study 21 Acute Asthma Management B.T., a 31-year-old man who lives in a small mountain town in Colorado, is highly allergic to dust and\u2026<\/p>\n","protected":false},"author":3,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[1463,7667,7669,7657,7663,7662,2751,7665,7664,1468,7666,7659,7660,7661,7658,1465],"tags":[687,116,117,121,125,8905,114,8902,8906,118,8908,8,115,62,8903,71,33,36,119,4,124,122,8904,7,77,50,105,123,8907],"class_list":["post-96415","post","type-post","status-publish","format-standard","hentry","category-best-nursing-paper-writing-service","category-buy-bsn-nursing-papers-online","category-buy-dnp-nursing-papers-online","category-healthcare-management-assignment-help-from-experts","category-help-my-assignment","category-ireland-assignment-help","category-online-healthcare-assignment-help","category-online-nursing-essay","category-online-nursing-paper-writers","category-online-nursing-papers","category-online-public-healthcare-assignment-help","category-online-tutors-helps","category-sample-assignment","category-top-essay-writing","category-urgent-assignment-helper","category-write-my-nursing-paper","tag-assignment-help-website","tag-best-essay-writing-service","tag-best-nursing-essay-writing-service","tag-best-nursing-essay-writing-services","tag-biology-essay-writing-service","tag-book-essay-title-generator","tag-healthcare-essay-writing-service","tag-help-me-write-my-essay","tag-help-write-my-essay","tag-medical-assignment-writing-services","tag-medical-essay-assignment-writi","tag-medical-essay-writing-service","tag-medical-essay-writing-service-online","tag-medical-paper-writing-service","tag-need-help-writing-an-essay","tag-nursing-answers","tag-nursing-essay-help","tag-nursing-essay-writing-examples","tag-nursing-essay-writing-services","tag-nursing-paper-writing-services-reviews","tag-nursing-writing-acers","tag-nursing-writing-helps","tag-online-essay-help-chat","tag-online-nursing-essay-writing-service","tag-pay-for-nursing-essay","tag-please-write-my-essay","tag-professional-medical-writing-services","tag-reliable-online-nursing-assignment-help","tag-write-my-essay-for-me"],"_links":{"self":[{"href":"https:\/\/www.studyproessays.com\/help\/wp-json\/wp\/v2\/posts\/96415","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=96415"}],"version-history":[{"count":0,"href":"https:\/\/www.studyproessays.com\/help\/wp-json\/wp\/v2\/posts\/96415\/revisions"}],"wp:attachment":[{"href":"https:\/\/www.studyproessays.com\/help\/wp-json\/wp\/v2\/media?parent=96415"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.studyproessays.com\/help\/wp-json\/wp\/v2\/categories?post=96415"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.studyproessays.com\/help\/wp-json\/wp\/v2\/tags?post=96415"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}