Question

Concept Map: Asthma Mark Norse, a 22-year-old man who lives in a small mountain town in Colorado, is highly allergie to dust and pollen. Anxiety seems to play a role in exacerbating (triggering) his asthma attacks. Mr. Norse's wife drove him to the clinic this morning when his wheezing worsened and did not respond to be clomethosone (Vanceril) and ipratropiumbromide (Atrovent) inhalers. Upon arrival his vital signs are B/P 152/84, P 124 R 42. T. 100.4. You start Mr. Norse on O2 4L/min via nasal cannula and an IV of D/5W at a KVO rate of 40gtts/hour. His ABG's are pH 7.31, CO2 26, HCO3 26 and O2 sats at 88% 1. Identify the underlying pathophysiology of asthma. 2. Are Mr. Norse's vital signs acceptable? If not, state the abnormalities which give you concem. 3. State the difference between rescue and control medications for asthma. 4. State how bronchodilators work (Pg. 331) 5. State the difference between Beta2-adrenergic agonists and cholinergic antagonists 6. Identify the drug classifications of Vanceril and Atrovent. 7. Are Vanceril and/or Atrovent appropriate for use during an asthma attack? If not state, why. The physician orders albuterol 3mg via nebulization STST. 8. What is the rationale for this order? 9. What is the rational for starting the patient on 02 immediately? 10. What are some of the side effects of bronchodilators and one nursing intervention you can provide to minimize the effects of the drug. 11. List the specific side effects of the anticholinergies agents and signs and symptoms you would monitor to determine an adverse event. After several hours of intravenous and oral rehydration and a second Albuterol treatment, Mr. Norse's wheezing and chest tightness resolve, and he is able to expectorate his secretions. The physician discusses Mr. Norse's asthma management with him and tells the patient that his inhalers meet his needs on a day-to-day basis but fail him during an asthma attack. The physician discharges the patient with the following prescriptions: Oral steroid "burst" prednisone 40mg orally for 5 days Albuterol (Proventil) MDI and a spacer

Answer 1

1.The underlying pathophysiology of asthma in this case is

The allergic status and asthma contributes to the release of histamine >gives rise to symptoms>inflammation of the respiratory pathway>constriction of the pathway>leading to decrease oxygen supply and wheezing>impaired gaseous exchange in the lungs cause >decrease in oxygen saturation, breathing difficulties>the respiratory rate is increased to meet the demand of oxygen supply>>increased carbondioxide level>>respiratory alkalosis with decreased pH leading to metabolic acidosis

2.The patient's vital signs are not under control ,the values which concerns are

• T:100.4 (fever)
• P:124(tachycardia)
• R:42(tachypnea)
• BP:152/84 (mild elevated systolic BP)
• SPO2:88%(severe hypoxia)

3.Rescue medicine which are drugs which gives immediate relief to the symptoms in asthma eg(albuterol, salbutamol ) in the form of inhalers .As soon the medication is inhaled it dilates the constricted bronchial tubes and eases breathing

Control medications are one which are taken to control or prevent symptoms for a longer period of time .This medicines are released slowly and acts in controlling the symptoms. Eg.,Flovent,pulmicort

4.When bronchodilators are taken ,it activates the beta 2 receptor in the G protein,this leads to relaxation of the muscles which as are constricted in the respiratory pathway hence dilating the marrow pathway and enhancing breathing.