Question

PN 200 Fundamentals of Nursing II CASE STUDY - ASTHMA Lisa Bloom is a 30 year old secretary who presents with a six week history of a dry hacky cough after recovering from bronchitis this winter. The cough is worse at night and associated with shortness of breath. In the past she has experienced coughing spells after running a SK race. She does have hay fever that seems to be year-round and has eczema in the winter. Both of her children and her maternal grandmother have asthma. Ms. Bloom was not in acute distress. Vital signs 110/60, P. 55, R 18, peak flow was 350L/min with good effort X 3. Expected peak flow for her height and age was 512 L/min. She has no sinus tendemess, ears were negative, nasal mucosa was pale and boggy, mouth negative, lungs were clear to auscultation but forced expiration using the peak flow meter seemed to generate a cough. The abdomen soft and non-tender. Skin was dry and hands were erythematous in the web spaces but no inflammation in the anticubital, trapezius or popliteal areas. After reviewing the test results, the primary care provider instructs you to give Ms. Bloom two (2) puffs of albuterol and take postdialator readings. During a follow-up visit Ms. Bloom has mild persistent asthma because her peak flow on her albuterol and triamcinolone has increased to 450. Her cough has subsided and she can again participate in sports without problems. There is no nighttime awakening, no loss of work and no emergency room visits. She again demonstrates inhaler technique, has her peak flow record available, and knows that the Metered dose inhaler is empty when the canister floats on its side. As triggers, she has noted that wood smoke in the air causes coughing and she will pretreat with albuterol before exercising outdoors in the winter. The physician has had to order an antihistamine and nasal steroid to control the allergic rhinitis trigger. Revised 1/20

Answer 1

Asthma : Asthma is a chronic inflammatory disease of lungs which causes mucosal edema and results in air way obstruction.

ASTHMA NURSING DIAGNOSIS 2 NURSING DIAGNOSIS 1 Ineffective Breathing Pattern related to the disease condition as evidenced by forceful inspiration and shortness of breath. Ineffective airway clearance related to the increased mucus production as evidenced by the dyspnoea and cough NURSING INTERVENTIONS : NURSING INTERVENTIONS: 1. Assess the patient condition in related to the vital signs. 1. Monitor the respiratory rate of Lisa 2. Auscultate the lung sounds 2. Assess the airway pattern by auscultating the breath sounds 3. Encourage Lisa to take warm fluids 4.Assess the effectiveness of cough 3. Make the patient to lie in semi bowlers position 5. Monitor the intake out put chart 6. Assess the nature of secretions 4.Provide oxygen therapy through nasal masks according to the requirement 5.Monitor arterial blood gases. 7. Encourage deep breathing and coughing exercise. Positive out comes : Lisa will be able to breathe normally with effective airway patterns and normal vital signs noted. Positive out comes: Lisa will maintain normal respiratory depth and rates with no secretions and the periodic cough is reduced.

Negative out comes : Lisa will not be able to breathe normally, no improvement in airway pattern even after administration of oxygen. Negative outcomes: Lisa is unable to clear the nasal secretions, no effect on cough and there is no change in respiratory pattern. Evaluation: Lisa maintained an effective breathing pattern and restored to normal condition as evidenced by normal breathing pattern. Evaluation: Lisa is able to clear all the secretions, no symptoms of cough as evidenced by normal respiratory rate and depth.