Question

Marge North a 55-year-old patient is highly allergic to dust and pollen; anxiety appears to play a role in exacerbating his asthma attacks. Her husband drove M.N. to the hospital when her wheezing was unresponsive to beclomethasone (Canceril) and ipratropium bromide (Atrovent) inhalers. Upons arrival, her VS are 152/84, 124, 42 100.4⁰F. M.N. is started on 4 L O₂/nc, an IV of D₅W at KVO, and ABGs were pH 7.31, PaCO₂ 48mmHg, HCO₃ 26 mEq/L, PaO₂ 55 mm Hg, SaO₂ 86%.

(Learning Objective 5)

1. Identify pathophysiologic responses during an asthma attack (1 point)
2. What is the rational for immediately starting M.N. on oxygen? (1 point)
3. Using the nursing process as a framework, discuss the care the patient will need. (Use at least two priority nursing diagnoses in your framework and please address patient teaching)
4. M.N’s husband asks about the possibility of M.N. having another attack. How would you respond? What education will you provide? (4 points)

Answer 1

Asthma

Asthma is a long term respiratory condition, in which the airway may unexpectedly and suddenly narrow, often in response to allergen, cold air, exercise and emotional stress. It is the inflammatory disease of airway that results in narrow, swollen and obstructed airway. Symptoms include shortness of breath , chest tightness, cough etc.

Pathophysiology: the causative agents of Asthma ( allergens, cold air) trigger the immune response results in the inflammation of bronchi and bronchioles. Inflammation of theses pathways of air results in increased contractabilty of smooth muscles and increased mucous production, which subsequently results in narrowing of the airways and wheezing. Inflammatory process is mediated by T.lymphocytes, macrophages, and neutrophils and chemical mediators( histamine, leukotrienes).

Oxygen therapy

Oxygen is the most commonly used drugs in hypoxia to save the life. The ABG value of MN shows that Pa CO2 is 48, ( normal range: 38- 42) Pa O2 is 55mm Hg( normal is 80- 100 mm Hg. Oxygen saturation also less than 92% strongly sugesttive of progressive hypoxia. Hypoxia is a strong indication of oxygen therapy. Otherwise hypoxia may leads to various complication.

Nursing care

Nursing Diagnosis

1. Ineffective breathing pattern related to swelling and spasms of the bronchiole tubes evidenced by dyspnea and tachypnea.

Goal: client will maintain optimal breathing pattern, as evidenced by relaxed breathing and absece of dypnea

Interventions

* Assess the vital signs, respiratory rate, depth, and rhythm and breath sounds.

* Monitor Oxygen saturation

* elevate the head of the bed

* Administer medications as prescribed

2. Ineffective airway clearance related to broncospasms and pulmonary secretions as evidenced by abnormal arterial blood gasses.

Goal: Client will maintain airway patency as evidenced by improved oxygen exchange.

Interventions

* Assess the colour changes in nail beds, lips and buccal mucosa.

* Assess the effectiveness of cough and amount, colour and viscosity of the secretions.

* Monitor ABG and oxygen saturation

* Reduce client's anxiety

* Administer medications and oxygen as prescribed.

Asthma attack

Asthmatic attack may occur again and again as the environment where the person lives remain the same. We can prevent subsequent attack by ' decreasing the risk factors such as tobacco smoking, air pollution, chemical irritants ( perfume). Encourage the client to follow the medication , prescribed. Also advice them to not to stress out and get rid of anxiety. It may trigger asthmatic symptoms.