Question

Jennifer Hoffman
Scenario Details:
Patient data: Female – Age 33 years. Weight 99 pounds (45 kg). Height 61 inches (1.55 meter)
Allergies: Seasonal allergic rhinitis
Prior Medical History: History of asthma since childhood with multiple emergency visits within the past year. Medications used at home include beclomethasone dipropionate (Qvar), salmeterol xinafoate inhaled (Serevent), and albuterol sulfate (ProAir) inhaler.
Recent Medical History: Jennifer Hoffman is a 33-year-
old female brought to the Emergency Department by her
neighbor. She has a history of asthma since childhood with multiple emergency visits within the last year. She appears to be in respiratory distress, struggling to breathe. She is unable to speak other than simple one-word statements.
Primary Medical Diagnosis: Acute Severe Asthma Provider’s Orders:
Advanced Care Planning
 Goals of Care Designation – R1, Designation Definition: Patient is expected to benefit from and is accepting of any appropriate investigations/ interventions that can be offered including attempted resuscitation and ICU care.
Medication and IV’s
 IV normal saline at 150 mL/hour
 Albuterol 2.5 mg every 20 minutes × 3 doses
 Ipratropium 500 mcg QID
Respiratory Care
 O2 therapy – Titrate to Saturation – Oxygen to maintain SpO2 greater than 92%
Patient Care
 Vital signs every 30 min
 Continuous SP02 monitoring
  

Simulation Preparation Questions:

1. Knowing Jennifer’s past medical history and how she presented in the Emergency Department (her signs and symptoms) how would you prioritize your nursing assessments?

2. Identify and prioritize appropriate nursing interventions for Jennifer as she experiences an acute asthma attack.

3. Explain the significance of common lab results (RBC counts, hemoglobin...etc) and SpO2 as they relate to Jennifer’s oxygenation status and describe interventions that might occur based on these test results.

4. Discuss the indications, contraindications, and rationale for providing oxygen therapy for Jennifer.

5. Identify orders and equipment required to administer oxygen therapy to Jennifer. Research the following oxygen delivery equipment, what each are used for and in what situation each should be used.
o Nasal cannula
o Simple face mask
o Rebreather/non rebreather mask o Venturimask
o Highflowtubingequipment

6. Identify information to be reported and documented regarding the administration of oxygen therapy to Jennifer.

7. Outline the steps required to safely administer a medication via nebulizer to Jennifer, consider safety, the nursing process, and patient teaching required in this scenario.

8. Describe the comfort and safety factors to consider when caring for Jennifer holistically as she experiences a severe acute asthma attack.

9. List criteria for evaluating the effectiveness of the interventions ordered for Jennifer, such as oxygen therapy and/or inhalant medications.

Answer 1

Solution:

1.Jennifer presented in emergency department with respiratory distress, struggling to breath and unable to speak properly.

Nursing assessment:

Lung function test: this is the basic test for the assessment of asthma patients. forced expiratory volume should be noted by using spirometry. It is expressed as percentage.

Oxygen assessment test: Pulse oxymetry is used to for the measurement of oxygen saturation in asthma patients. assessment of ventilatory status of the patients can also predicted by this pulse oxymetry.

Arterial blood gas analysis: here primarly focus on partial CO2 values because this can predict the life threatening attact can occur or not. Value above 45mmHg is caution of possible attack.

Microbiological investigations should be done. Sputum is also cultured if present.

2. Nursing interventions:

Allergic to any medications is assessed.

Respiratory staus with which the patient is admited is checked.

Patients medication history and the current medication is assessed. The patient is given with antibiotics if she have respiratory infection.

The medication prescribed by the doctor should be administered to the patient.

The patient is administered with IV normal saline.

3. Significance of lab results:

Test for arterial blood gas is necessary since the partial CO2 value can predict the severity of life threatening attack.

Complete blood count test indicate the inflammation and infection of the patient.

Sputum culture: Indicate the specific bacteria present in the lungs.

AFB testing for the presence of tuberculosis or non tuberculosis bacteria presence.

Allegic sensitivity test to detect any specific allergens triggering asthma is present or not.

Asthma action plan should be taken as nursing intervention by working with doctor. If any asthma triggers present steps to be taken to avoid the triggers. Administer the antibioticts if infection is positive in lab reports. Nurses should increase or decrease the medication based on the symptoms shown by the patient. Other crucial report if finds, then inform those immediatly to the concerned doctor.

4. Indication of oxygen therapy:

Patient with diminished blood oxygen levels (Hypoxia). Patients with acute or chronic Hypoxemia. Patients having metabolic acidosis and those with low cardiac output.

Contraindication of oxygen therapy:

Patients with nasal inflammation, fatigue, air trapped oesophagus, dry mouth and rhinitis should not be give or contraindicated with oxygen therapy.

Rationale of oxygen therapy is to decrease the work of breathing in those patients having the difficulty in it. Hypoxia can be prevented thus preventing the tissue injuiry and even cell death which may cause as a result of tissue hypoxia.