Posted: October 5th, 2022

B.T., a 31-year-old man

Case Examine 21 Acute Bronchial asthma Administration

B.T., a 31-year-old man who lives in a small mountain city in Colorado, is extremely allergic to mud and pol- len and has a historical past of delicate bronchial asthma. B.T.’s spouse 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 started to make use of accent muscle groups to breathe. B.T. is instantly began on four L oxygen by nasal cannula and intrave- nous (IV) D5W at 75 mL/hr. A set of arterial blood gases is distributed to the laboratory. B.T. seems anxious and says that he’s in need of breath.

1. Are B.T.’s very important indicators acceptable? State your rationale.

2. What’s the rationale for instantly beginning B.T. on O2?

three. Maintaining in thoughts B.T.’s well being historical past and presenting grievance, what are crucial areas you’ll want to consider throughout your bodily Assessment?

four. Interpret B.T.’s arterial blood gasoline outcomes.

5. What’s the rationale for the albuterol 2.5 mg plus ipratropium 250 mcg nebulizer remedy STAT (instantly)?

6. Point out the drug classification and anticipated end result B.T. ought to expertise with utilizing metaproterenol sulfate (Alupent) and Fluticasone (Flovent).

You assess B.T. and discover that he has diminished lung sounds with inspiratory and expiratory wheezes in all lung fields with a nonproductive cough and accent muscle use. His pores and skin is pale, heat and dry. The electrocardiogram (ECG) reveals sinus tachycardia with out ectopy. He’s alert and oriented four spheres. He seems anxious and is sitting upright, leaning over the bedside desk, and persevering with to complain of shortness of breath. Once you study B.T., you uncover that he has attenuated lung sounds, wheezes on each the inhalation and exhalation aspect, a nonproductive cough, and auxiliary muscle use. His complexion is cool, dry, and pale. Sinus tachycardia with out ectopy is seen on the electrocardiogram (ECG). He’s centered and alert, four spheres. He’s sitting up straight, leaning over the nightstand, and he’s nonetheless complaining of shortness of breath. He appears nervous.

7. What’s your main nursing aim right now?

eight. Describe six actions you need to implement primarily based on this precedence.

9. You’ll need to watch B.T. intently for the following few hours. What’s the most critical complication to anticipate?

10. Establish 4 indicators and signs of this complication you’ll assess for in B.T.

11. When mixture inhalation aerosols are prescribed with out particular directions for the sequence of administration, you want to concentrate on the suggestions for protected drug administration. Describe the right sequence for administering B.T.’s therapies.

12. What are your tasks whereas administering aerosol remedy?

CaSE StuDy ProGrESS

After a number of hours of rehydration and aerosol therapies, B.T.’s wheezing and dyspnea resolve, and he is ready to expectorate his secretions. The doctor discusses B.T.’s bronchial asthma administration with him; B.T. says he has had a number of bronchial asthma assaults over the previous couple of weeks. The doctor discharges B.T. with a prescrip- tion for oral steroid “burst” (prednisone 40 mg/day 5 days), fluticasone/salmeterol (Advair HFA 230/21) two inhalations each morning and night, albuterol (Proventil) metered-dose inhaler (MDI) two puffs q6h as wanted utilizing a spacer, and montelukast (Singulair) 10 mg each day every night. He instructs B.T. to name the pulmonary clinic for follow-up with a pulmonary specialist.

13. What’s the rationale for B.T. being on the oral steroid burst?

14. How does montelukast (Singulair) differ from different bronchial asthma drugs?

15. B.T. states he had taken his Advair that morning, then once more when he began to really feel in need of breath. He states, “It didn’t Help,” and desires to know why he has to stay on it. Is fluticasone/salmeterol (Advair) acceptable to be used throughout an acute bronchial asthma assault? Clarify.

16. Primarily based on this info, what particular difficulty do you’ll want to deal with in discharge educating with B.T.?

You ask B.T. to display using his MDI. He vigorously shakes the canister, holds the aerosolizer at an angle (pointing towards his cheek) in entrance of his mouth, and squeezes the canister as he takes a fast, deep breath.

17. What frequent errors has B.T. made when utilizing the inhaler?

18. You Assessment the right use of an MDI with B.T and attainable negative effects he could expertise, together with hoarseness, dry mouth, white spots within the oral cavity, coughing, and complications. What actions are you able to educate him to stop or diminish the incidence of those results? Choose all that apply.

a. Lower his fluid consumption.

b. Use a spacer on the inhaler.

c. Use the inhaler solely as prescribed.

d. Rinse out his mouth instantly after utilizing the inhaler

e. Clear the spacer within the dishwasher on “sizzling cycle with heated dry” each day.

19. B.T.’s spouse asks about the opportunity of B.T. having one other assault. How would you reply?

20. B.T. states that he want to learn extra about bronchial asthma on the Web. Record three credible web sites to which you would direct him.

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