Question

PN 200 Fundamentals of Nursing II Case Study: Bronchial Asthma Michael Allen, a 55-year-old patient, was recently diagnosed with bronchial asthma. His mother and three brothers also have asthma. In the past year, Michael has had three asthma attacks that were treated with prednisone and albuterol (Proventil) inhaler. At the office visit today, prednisone is prescribed for 4 weeks, and the order is written as follows: Day 1 1 tablet by mouth four times a day Day 2 I tablet by mouth three times a day Day 3 1 tablet by mouth two times a day Day 4 1 tablet by mouth in the moming Day 5 tablet by mouth in the morning 1. Explain the use of prednisone during an asthma attack. Explain why the dosage is decreased (tapered) over a period of 5 days. 2. Can Cromolyn sodium (NasalCrom) be substituted for prednisone during an asthma attack? Explain your answer. 3. Michael is prescribed albuterol (Proventil, Ventolin). What effect does albuterol have on controlling asthma? 4. For each drug dose, Michael is to take two puffs of albuterol administered by an inhaler. What instructions should be given to the patient concerning the use of an inhaler? To minimize the frequency of Michael's asthma attacks, the health care provider prescribes theophylline (Elixophyllin) 200 mg. twice a day. The albuterol inhaler is to be taken as needed. Nursing interventions include patient history of asthma attacks and physical assessment. 5. When taking the patient's history, what should the nurse include concerning asthmatic attacks? 6. What type of drug is Elixophyllin? Why should the nurse ask if Michael smokes?

Answer 1

1. Bronchial asthma is a long-term respiratory disorder as a result of inflammation of airways that causes wheezing, breathlessness, tightness of chest, and cough.

Prednisone is used for relieving asthma symptoms. It is an anti-inflammatory drug taken orally. It is also used to treat a range of conditions apart from asthma like arthritis, allergies, skin diseases, etc. Unlike anti-inflammatory asthma inhalers (which is directly absorbed by the lungs), prednisone is absorbed by the body since it is taken orally.

Uses of prednisone during an asthma attack are:

• It helps to reduce the symptoms of asthma.
• It decreases the immune system’s response to asthma.
• It reduces inflammation and mucus secretion in the airways.
• Regular use can prevent asthma attacks
• It improves lung function.

Corticosteroids should not be stopped abruptly. The dosage should be reduced or tapered so that the body resume normal function slowly. Prednisone is a corticosteroid. It is similar to cortisol, a hormone secreted by adrenal gland. While taking prednisone, cortisol production by adrenal glands is decreased. Hence, by gradually reducing the dosage, the adrenal gland return to normal pattern of function. This the reason why the dosage is decreased (tapered) over a period of 5 days.

2. Cromolyn sodium reduces the inflammation of airways by preventing the release of certain substances that trigger the inflammation. It is effective in preventing bronchospasm due to exposure to certain allergens, pollutants, etc. It is useful in preventing asthma attacks as well.

It is not considered to be a fast acting medicine. This medication has to be used continuously. The full effect of the drug is only observed after about 4 weeks of use. Hence, symptoms may not improve immediately once it is taken. Hence, it may not work as fast as prednisone during an asthma attack. Therefore, it cannot be substituted for prednisone during an asthma attack.

3. Albuterol is also used in treating wheezing, breathlessness, tightness of chest, and cough occurring as a result of asthma. It may be used as inhalation aerosol (Proventil, Ventolin) or as powder for inhalation. It is useful in treating and preventing bronchospasm.

It is a fast acting medication that provides quick relief. It is bronchodilator that dilates bronchi and bronchioles. It reduces the resistances present in the airway and thus allows smooth passage of air in and out of lungs and relaxes muscles around breathing channels.

4. Instructions given to the patient concerning the use of inhaler:

• Albuterol inhalation must be used as prescribed by the doctor. It should not be used in excess or reduced amount.
• It should not be used for a longer period of time or for lesser period than prescribed.
• The inhaler must be kept clean. The actuator must be cleaned and the canister must be removed and cleaned once in a week.
• The right way of inhaling must be done.
• The albuterol device must be shaken before use.
• If performing any exercise, the doctor might instruct you to use 2 inhalations before 15 to 30 minutes. This should be strictly followed.
• If the inhalation medicine is not working well, it should be intimated.
• Never change the dosage or schedule without doctor’s instruction.
• The inhaler must be stored at room temperature away from sunlight, moisture, and heat or cold.