Question

Respiratory Case Study 3

Instructions: Read the case study. Use the Rosdahl, Timby and drug books. For each question answered, cite the page number(s) of your reference(s). All questions apply to this case study. Your response should be brief and to the point. When asked to provide several answers, they should be listed in order of priority or significance. Do not assume information that is not provided.

M. N., a 22-year old man, is highly allergic to dust and pollen; anxiety appears to play a role in exacerbating his asthma attacks. His wife drove M. N. to the clinic when his wheezing was unresponsive to beclomethasone (Vanceril) and ipratropium bromide (Atrovent) inhalers. Upon arrival, his VS are 152/84, 124, 42, 100.4^oF. M. N. is started on 4 L O₂/nc, an IV of D5 W at KVO, and ABG’s were pH 7.31, PaCO₂ 48 mm Hg, HCO₃ 26 mEq/L, PaO₂ 55 mm Hg, SaO2 86%.

1. Explain the pathophysiology of asthma.
2. The physician orders albuterol 3 mg nebulization treatment STAT. What is the rational for this order?
3. What is the rationale for immediately starting M. N. on oxygen?
4. List 5 short-term interventions that may help relieve M. N.’s symptoms.

After several hours of IV and PO rehydration and a second albuterol treatment, M. N.’s wheezing and chest tightness resolve, and he is able to expectorate his secretions. The doctor discusses M. N.’s asthma management with him, and he tells him that his inhalers meet his needs on a day-to-day basis but fail him when he has an asthma attack. The doctor discharges M. N. with a prescription for Proventil MDI and a “spacer” and recommends that he call the pulmonary clinic for follow-up with a pulmonary specialist.

1. What issues would you address in discharge teaching with M. N.?

You ask M. N. to demonstrate the use of his MDI. He vigorously shakes the canister, holds the aerosolizer at an angle (pointing toward his cheek) in front of his mouth, and squeezes the canister as he takes a quick, deep breath.

1. Identify 4 nursing diagnoses that apply to M. N.

Answer 1

1. Asthma is a response to airway hyperresponsiveness in response to a trigger orantigen or irritant. It results from increasing airway obstruction caused bybronchospasm and bronchoconstriction, inflammation and edema of the lining of thebronchi and bronchioles and the production of thick mucus that can block the airway.Common allergies include pollen, dust, molds, spores and animal dander.Environmental irritants such as cigarette smoke, chemicals, strong fumes can cause anasthmatic response. Respiratory infection such as influenza, colds, and sinusinfections can cause asthmatic symptoms.

2. The airway system is hyperactive during an asthma attack in response to a stimuli, itcauses the antibodies attached to the mast cells within the lungs. Reexposure t o theantigens causes the antigen to attach to the antibody releasing histamine.

View full document