Question

Questions 9-14

Concept Map: Asthma Mark Norse, a 22-year-old man, who lives in a small mountain town in Colorado, is highly allergic 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 (Vanceri) and ipratropium bromide (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 4 L/min via nasal cannula and an IV of D/SW at 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 concern. 3. State the difference between rescue and control medications for asthma 4. State how bronchodilators work (Pg. 331) 5. State the difference between Beta2-adrenergie agonists and cholinergic antagonists 6. Identify the drug classifications of Vanceril and Atrovent. 1. 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 physicis discharges the patient with the following prescriptions Oral steroid "burst" prednisone 40mg orally for 5 days Albuterol (Proventil) MDI and a spacer

Answer 1

9. To maintain the airway patient was started on oxygen was immediately .

10. Side effects of bronchodilators are :

insomnia, restlessness, anorexia, cardiac stimulation, hyperglycemia, tremor, vascular headache, htn, hypotension, angina.

Nursing interventions to prevent the side effects of bronchodilators are :-

- Monitor patients v/s

- administer the drug around the clock as prescribed

- Don't administer the long acting drug more than prescribed

- teach patient to maintain fluid intake of 2 - 3 liters a day

- avoid respirator irritants

- discuss with patient importance of avoiding caffeine.

11. Adverse effects and signs and symtoms of anticholinergic agents are :-

- Anticholinergic side effects (heart)

Increased heart rate

- Anticholinergic side effects (lungs)

Bronchodilation & Decreased bronchial secretions

- Anticholinergic side effects (bladder/bowels)

Urinary retention/Constipation

- Anticholinergic side effects (skin)

Decreased sweating:. hyperthermia

- Anticholinergic side effects (mouth)

Decreased salivation/Dry mouth

- Anticholinergic S.E. (eyes)

Increased pupil size-Photophobia and precipitation of glaucoma //Inhibition of accomodation-Blurred vision, esp with small print

- Anticholinergic side effects (mental)

Sedation, confusion, memory impairment

12. The rationale of the administration of medicine :-

Oral steroids for anti- inflammation

Albuterol - to dilate the bronchioles