Case Study (asthma).docx

CASE STUDY (ASTHMA) Submitted by: Tyrone Marc B. Asuncion John Clements D. Galiza Jannica Rei T. Guillermo Angelic I. Mateo Mary Ellayne A. Oducayen Group 2 BSN IV-A, Cluster 1

Submitted to: Mr. Jayflor L. Ronquillo Clinical Instructor Rona Marie T. Bergonia Student Head Nurse

March 29, 2019

CASE STUDY: ASTHMA Patient Profile E.S. is a 35 y/o mother of two school-age boys who arrives via ambulance in the emergency department (ED) with severe wheezing, dyspnea, and anxiety. She was in the ED 6 hours earlier with an asthma attack. Subjective Data Treated during previous ED visit with nebulized albuterol and responded quickly Allergic to cigarette smoke Began to experience increasing tightness in her chest and shortness of breath when she returned home following her previous ED visit Used the albuterol several times after she returned home with no relief Diagnosed with asthma 2 years ago Does not have a health care provider and is not on any medications Objective Data Physical Examination Sitting upright and using accessory muscles to breathe Talks in one-to-three-word sentences RR: 34 and shallow Audible wheezing Auscultation of lung fields reveals no air movement in lower lobes HR: 126 bpm Noted to be extremely anxious and restless Diagnostic Studies ABGs: pH 7.46, PaCO2 36 mmHg, PaO2 76 mmHg, O2 saturation 88% Chest x-ray: bilateral lung hyperinflation with lower lobe atelectasis CBC with differential and electrolytes: within normal limits An IV is started in her left forearm with normal saline infusing at 100 ml/hr Questions and Answers: 1. What other assessment information should be obtained from E.S.? The other information needed to be assessed and obtained are: Diaphoresis, increased anteroposterior thoracic diameter, hyperresonance, and visual disturbance. 2. Priority decision: What is the priority collaborative intervention for E.S.? Pulmonary Function studies including response to bronchodilator therapy. The priority intervention is administering O2 since the patient’s RR is 34. Dyspnea and using accessory muscles with an oxygen saturation of 88%. 3. What data obtained from the brief history, physical examination, and diagnostic studies indicate that E.S. is experiencing a severe or life-threatening asthma attack? “Talks in 1 to 3 word sentences”. According to Mohamedali (2018), having the inability to speak is one of the life threatening features of asthma.

4. Identify two classifications of medications the nurse should expect to be administered to this patient. What effect is expected with these medications? a. Short-acting beta2 Adrenergic Drugs: For bronchodilation Long-acting beta2 adrenergic Drugs: To manage symptoms day to day and keep airways open. b. Leukotriene Modulators: To reduce local inflammatory response in lungs and to reduce exacerbation. 5. In addition to medication administration and close monitoring of the patient, what other key role can the nurse take in helping the patient through this episode? The other key role that a nurse can be in helping the patient is being a Nurse educator. Since the patient was not on any medication and does not have a health care provider, the nurse should educate the patient about the importance of regular check-ups to avoid complications and to improve health condition. In addition, the nurse must also: a. Monitor respiration; patient’s respiratory status can continue to deteriorate; look at respiratory rate, effort, use of accessory muscle, skin color, breath sound. b. Place the patient in high fowler’s position to ease respiration c. Monitor v/s, look for changes in BP, if there is tachycardia or tachypnea. d. Give patient 3L of fluid per day to help liquify any secretions. e. Administer supplemental oxygen to help meet body’s needs. 6. What value would peak expiratory flow rate (PEFR) measures have during the care of E.S.? Yellow zone: This means “Caution” (50-80%) since the patient manifests mild symptoms such as feeling tired, shortness of breath and increased tightness of the chest. 7. Priority Decision: Based on the assessment data presented, what are the priority nursing diagnoses? What are the collaborative problems? Explain the use of a peak flow meter Encourage to do pursed-lip and diaphragmatic breathing. Instructed to do coughing and deep breathing exercises Instructed to drink water at least 3L/day Instructed to avoid known allergies/dust Encouraged adequate rest periods Teach about the importance of using mask. Instruct family to avoid burning waste.