Question

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 len. 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 belclomethosone (Vanceril) 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 02 4L/min via nasal cannula and an IV of D/5W at a 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-adrenergic agonists and cholinergic antagonists 6. Identify the drug classifications of Vanceril and Atrovent. 7. 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 anticholinergics 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 physiciar discharges the patient with the following prescriptions: Oral steroid "burst" prednisone 40mg orally for 5 days Albuterol (Proventil) MDI and a spacer

Answer 1

1. Asthma is the type 1 hypersensitivity reaction of the immune system, which is caused by allergens like pollen and dust. It triggers lymphocytes and mast cells of the body. Eosinophils are the effector cells in this reaction, which causes inflammation of the airway and makes respiratory tract hyper-responsive.

2. No, vital signs of the man are not acceptable. They are showing signs of severe asthma. Pulse rate and respiratory rate too high. It can lead to bradycardia.

3. Rescue medications are used in acute asthma attacks as they have short-term effects. These provide quick relief from symptoms. While controller medications are used for long-term effects, to prevent asthma attacks. Controller medications are not helpful in sudden asthma attacks.