What is the primary reason for instructing a patient with asthma to use an Albuterol inhaler before exposure to known triggers?

B) To dilate the airways and prevent bronchospasm

A) To prevent bacterial infections

B) To dilate the airways and prevent bronchospasm

C) To increase oxygen saturation

D) To decrease mucus production

A patient with a history of asthma presents with mild shortness of breath and wheezing. Which of the following is the most appropriate initial nursing intervention?

B) Instruct the patient to use her Albuterol inhaler as prescribed

A) Administer oxygen at 2 liters per minute via nasal cannula

B) Instruct the patient to use her Albuterol inhaler as prescribed

C) Position the patient in a supine position to promote rest

D) Initiate a nebulizer treatment with corticosteroids

What is the primary purpose of administering Albuterol to the patient in this scenario?

C) To relieve bronchoconstriction

What is the primary purpose of administering Albuterol to a patient experiencing bronchoconstriction?

D) To decrease mucus production

Which of the following assessments indicates a positive response to Albuterol treatment in a patient with asthma?

B) Slightly decreased respiratory rate

A) Increased wheezing on auscultation

B) Slightly decreased respiratory rate

What is the primary reason the nurse should monitor the patient's heart rate after administering Albuterol?

B) Albuterol may lead to tachycardia due to its stimulation of beta-adrenergic receptors.

A) Albuterol can cause bradycardia as a side effect.

B) Albuterol may lead to tachycardia due to its stimulation of beta-adrenergic receptors.

C) Albuterol is known to decrease blood pressure significantly.

D) Albuterol can cause respiratory depression.

What is the primary purpose of using a bronchodilator in a patient with asthma?

C) To relax and open the airways for easier breathing

A) To decrease inflammation in the airways

B) To improve oxygen transport in the blood

C) To relax and open the airways for easier breathing

D) To prevent infections in the respiratory tract

Which of the following actions should the nurse prioritize to ensure the patient is effectively managing her asthma at home?

B) Educate the patient on proper inhaler technique and signs of respiratory distress.

A) Instruct the patient to use her rescue inhaler every 4 hours routinely.

B) Educate the patient on proper inhaler technique and signs of respiratory distress.

C) Advise the patient to avoid all physical activities to prevent asthma exacerbation.

D) Encourage the patient to increase her prescribed bronchodilator dosage if she feels short of breath.

What action should the nurse prioritize when a patient with asthma reports occasionally forgetting to use their inhaler before physical activity?

B) Reinforce the importance of using the inhaler as prescribed

A) Encourage the patient to keep a symptom diary

B) Reinforce the importance of using the inhaler as prescribed

C) Teach the patient new breathing exercises

D) Schedule an immediate follow-up with the primary care provider

What is the primary reason for reinforcing the importance of using an inhaler before physical activity in patients with asthma?

C) To reduce the risk of exercise-induced bronchospasm.

A) To prevent dehydration during exercise.

B) To enhance lung capacity and oxygen absorption.

C) To reduce the risk of exercise-induced bronchospasm.

D) To improve overall cardiovascular endurance.

Respiratory distress - Nursing Case Study

Pathophysiology

• Primary mechanism: Impaired gas exchange - In respiratory distress, damage to the lung tissues or alveoli (tiny air sacs) leads to inadequate oxygen entering the blood and carbon dioxide being removed. This results in low oxygen levels (hypoxemia) and/or high carbon dioxide levels (hypercapnia), which are critical in maintaining normal body functions.

• Secondary mechanism: Increased work of breathing - The body compensates for impaired gas exchange by increasing respiratory effort. This involves using accessory muscles of respiration, leading to fatigue and exhaustion, especially in severe cases, as the body struggles to maintain adequate ventilation.

• Key complication: Tissue hypoxia - Due to insufficient oxygenation, organs and tissues may not receive enough oxygen to function properly, potentially leading to organ dysfunction or failure if not addressed promptly. This highlights the urgency of managing respiratory distress effectively in clinical settings.

Patient Profile

Demographics:

45-year-old female, school teacher

History:

• Key past medical history: Mild asthma, seasonal allergies

• Current medications: Albuterol inhaler as needed, loratadine 10 mg daily

• Allergies: Penicillin

Current Presentation:

• Chief complaint: Mild shortness of breath

• Key symptoms: Slight wheezing, occasional cough, no chest pain

• Vital signs: Blood pressure 120/80 mmHg, heart rate 78 bpm, respiratory rate 18 breaths per minute, temperature 98.6°F, oxygen saturation 97% on room air

Section 1

Initial assessment findings reveal that the patient's mild shortness of breath is accompanied by a slight increase in her respiratory effort. Her respiratory rate remains at 18 breaths per minute, and she continues to use accessory muscles of respiration, which is evident from the mild retractions observed around her neck and clavicle. Although her oxygen saturation is stable at 97% on room air, the nurse notes the presence of slight wheezing on auscultation, particularly during expiration. The patient denies any chest pain but mentions that her symptoms are more pronounced when exposed to strong odors or during physical activity, consistent with her asthma and allergy history.

In response to the patient's presentation, the nursing team conducts a focused respiratory assessment. Lung sounds are assessed and reveal bilateral wheezing, more prominent in the upper lobes. There is no evidence of crackles or rhonchi, and the patient’s cough is not productive. Skin color is normal, and there is no cyanosis present. The patient is alert and oriented, displaying no signs of confusion or altered mental status. Given her stable vital signs and the absence of acute distress, the primary nursing intervention centers on continued monitoring and education. The nurse reinforces the importance of using the Albuterol inhaler as needed, particularly before exposure to known triggers, and encourages the patient to maintain an upright position to facilitate easier breathing.

These findings suggest that the patient's respiratory distress is currently stable, yet it underscores the importance of ongoing monitoring to detect any potential changes in status. The nurse plans to re-evaluate the patient's respiratory status regularly and educate her on recognizing the early signs of worsening symptoms. This proactive approach ensures timely intervention and prevents progression to more severe respiratory complications. The patient is advised to follow up with her primary care provider or pulmonologist to review her asthma management plan, ensuring optimal control of her symptoms.

Section 2

The patient continues to receive nursing care with a focus on monitoring her respiratory status. During a routine assessment later in the day, the nurse notices a slight change in the patient's condition. The patient reports feeling a bit more breathless than earlier, particularly after walking to the bathroom. Her respiratory rate is now slightly increased to 20 breaths per minute, although she remains afebrile, and her heart rate is steady at 82 beats per minute. The nurse observes that the use of accessory muscles has become moderately more pronounced, and the wheezing on auscultation is now audible during both inspiration and expiration, suggesting a slight worsening of her bronchoconstriction.

In response to these findings, the nurse administers a dose of Albuterol via a metered-dose inhaler, as per the patient's asthma action plan. The patient is encouraged to take slow, deep breaths during the inhalation process. After the intervention, the nurse reassesses the patient, noting a slight improvement in her breathing effort and a reduction in the wheezing sounds upon auscultation. The patient's oxygen saturation remains stable at 98% on room air, indicating that her oxygenation is not compromised.

The nurse takes this opportunity to reinforce the importance of early intervention and consistent use of prescribed medications to prevent exacerbations. An educational session is conducted to review the patient's asthma action plan, ensuring she understands when to use her rescue inhaler and when to seek medical attention. The patient is reminded to avoid known triggers whenever possible and is encouraged to maintain regular follow-ups with her healthcare provider to optimize her asthma management. Through these interventions, the nursing team aims to stabilize the patient's condition and prevent any further complications.

Section 3

A few hours after the initial intervention with Albuterol, the nurse performs another routine assessment to evaluate the patient's response to earlier treatments and to check for any new developments in her condition. During this follow-up assessment, the nurse notes that the patient's respiratory rate has decreased slightly to 18 breaths per minute, which is within the normal range, suggesting a positive response to the bronchodilator. The wheezing on auscultation has diminished further, now only noticeable at the end of expiration, indicating an improvement in bronchoconstriction. The patient reports feeling more comfortable and less breathless, even after walking short distances.

However, while examining the patient, the nurse notices a slight increase in the patient's heart rate to 88 beats per minute, which might be attributed to the side effects of Albuterol. The patient remains afebrile, and her blood pressure is stable at 118/76 mmHg. Recognizing the potential for side effects, the nurse discusses with the patient the importance of monitoring her heart rate after using her inhaler, as well as signs and symptoms that should prompt her to seek further medical advice.

To ensure comprehensive care, the nurse schedules a meeting with the interdisciplinary team to discuss the patient's progress and to consider any necessary adjustments to her asthma management plan. The nurse also reinforces the importance of adherence to prescribed medications and highlights the need for continued monitoring of her respiratory status. This approach aims to address any underlying issues promptly and to prevent the development of new complications, ensuring that the patient's condition remains stable as she continues her recovery.

Section 4

As the nurse continues to monitor the patient, a new diagnostic result arrives. The patient's recent peak flow measurement shows a modest improvement, with a reading of 350 liters per minute, up from her baseline of 300 liters per minute. This indicates that the bronchodilator therapy is having the desired effect of easing airway obstruction. Alongside this, the patient's oxygen saturation remains steady at 96% on room air, reinforcing that her respiratory status is stabilizing. The patient expresses relief and gratitude, noting that her ability to engage in light activities without experiencing significant shortness of breath has improved.

Despite these positive indicators, the nurse remains vigilant to potential complications. During the follow-up respiratory examination, the nurse notices a slight increase in the use of accessory muscles, though the patient denies any increase in difficulty breathing. This prompts the nurse to review the patient's inhaler technique with her, ensuring she is effectively using the medication to maximize its benefits. The nurse emphasizes the importance of recognizing early signs of respiratory distress, such as increased work of breathing or prolonged wheezing, which should be promptly reported.

To facilitate ongoing improvement and prevent new complications, the nurse collaborates with the respiratory therapist to schedule a session aimed at educating the patient on effective breathing exercises and techniques to manage her asthma more independently. Additionally, a follow-up appointment with the primary care provider is arranged to reassess the patient's asthma action plan and ensure that all aspects of her care are aligned with her current health status. This proactive approach aims to empower the patient, enhance adherence to her treatment regimen, and foster a sense of confidence in managing her respiratory health moving forward.

Section 5

The next day, the nurse conducts a routine morning assessment of the patient to ensure her condition continues to improve. Upon entering the room, she notes the patient is sitting upright in bed, appearing comfortable and alert. Vital signs are taken: temperature is 98.6°F, heart rate is 82 beats per minute, respiratory rate is 18 breaths per minute, and blood pressure is 120/78 mmHg. Oxygen saturation remains steady at 96% on room air. The nurse observes that the patient is no longer using accessory muscles during breathing, which suggests that her respiratory effort has decreased since the previous day. Upon auscultation, breath sounds are clear with only minimal wheezing heard on expiration, indicating that the bronchodilator therapy continues to be effective.

The patient reports feeling "much better" and expresses confidence in her ability to manage her symptoms. She mentions having practiced the breathing exercises taught by the respiratory therapist, which she found helpful in maintaining calm and controlling her breathing. However, the patient admits that she occasionally forgets to use her inhaler before engaging in activities. The nurse takes this opportunity to reinforce the importance of adhering to the prescribed medication schedule and using the inhaler before physical activity to prevent any potential exacerbations.

The nurse reviews the patient's asthma action plan with her, ensuring she understands each step and knows how to adjust her medication in response to specific symptoms. The patient is encouraged to keep a symptom diary to track any changes or triggers that may affect her condition. As the patient prepares for her upcoming follow-up appointment with her primary care provider, the nurse reassures her that with continued adherence to her treatment plan and self-management strategies, she can maintain her current level of respiratory health and prevent future complications. This comprehensive approach aims to support the patient in achieving long-term stability and confidence in managing her asthma.