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 morning Days 36 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 Elizophyllin? Why should the nurse ask if Michael smokes?

Answer 1

1. Prednisone is a corticosteroid. Inhaled corticosteroids ( ICS) are given during asthmatic attacks because they quickly being down the inflammatory reaction in the airways. Steroids need gradual withdrawal. When a person takes them his/her HPA axis gets shut down due to negative feedback. Thus, we need to taper the dose gradually so that the HPA gets time to resume functioning normally.
2. Cromolyn sodium is a mast cell stabilizer. It needs time to act. Thus, it is not useful for acute attacks.
3. Albuterol is a bronchodilator ie it dilates the airways so it provides symptomatic relief.
4. Breathe in slowly, hold breath for ~10 seconds and then exhale.
5. Timing, intensity, factors leading to attack, etc
6. Elixophyllin belongs to a group of drugs known as methyxanthines. Its efficacy is affected if taken by someone who smokes.
7. Not exposing oneself to the triggering factor (if known), stop smoking,

• For acute attacks: short acting beta agonists, inhaled corticosteroids, ipratropium
• Preventive : long acting beta agonists, leukotriene receptor antagonist, mast cell stabilizers