A 45-year-old female with a history of mild asthma presents with mild dyspnea and occasional wheezing. Her oxygen saturation is 94% on room air. What is the most appropriate initial nursing intervention to improve her respiratory status?

B) Encourage the patient to use her albuterol inhaler

A) Administer oxygen at 2 L/min via nasal cannula

B) Encourage the patient to use her albuterol inhaler

C) Position the patient in a supine position

D) Restrict the patient's fluid intake

A 45-year-old female with a history of mild asthma presents with mild dyspnea and occasional wheezing. Her oxygen saturation is 94% on room air, and she reports increased use of her albuterol inhaler over the past few days. Which initial nursing intervention is most appropriate to address her current symptoms?

B) Administer a prescribed bronchodilator and reassess respiratory status.

A) Encourage the patient to rest and monitor her symptoms.

B) Administer a prescribed bronchodilator and reassess respiratory status.

C) Increase the patient's oxygen delivery to 2 liters via nasal cannula.

D) Educate the patient on using a peak flow meter for daily monitoring.

What is the primary purpose of administering a bronchodilator to a patient experiencing an asthma exacerbation?

C) To dilate the bronchial muscles and improve airflow

A) To reduce inflammation in the airways

C) To dilate the bronchial muscles and improve airflow

D) To decrease mucus production

After administering a bronchodilator, which of the following findings indicates that the treatment has been effective for a patient experiencing an asthma exacerbation?

D) Oxygen saturation dropping to 90%

What is the primary purpose of administering a bronchodilator to a patient experiencing mild wheezing?

B) To improve airflow by relaxing bronchial muscles

D) To reduce oxygen saturation levels

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

B) To improve airflow and ease breathing

D) To increase oxygen saturation levels

What is the primary purpose of administering a bronchodilator to a patient experiencing respiratory distress with wheezing?

C) To relax and widen the airways

A) To increase oxygen saturation

C) To relax and widen the airways

D) To eliminate chest tightness completely

What is the most appropriate immediate action for the nurse to take after reassessing the patient and noting a modest improvement in peak flow measurement?

B) Continue monitoring the patient closely

A) Discontinue bronchodilator therapy

B) Continue monitoring the patient closely

C) Initiate supplemental oxygen therapy

D) Prepare for possible intubation

What is the primary purpose of teaching a patient with mild respiratory alkalosis to use pursed-lip breathing?

B) To promote carbon dioxide retention

A) To increase oxygen consumption

B) To promote carbon dioxide retention

D) To stimulate respiratory muscles

respiratory failure - Nursing Case Study

Pathophysiology

• Primary mechanism: Ventilation-perfusion (V/Q) mismatch - Occurs when air reaching the alveoli (ventilation) doesn't match the blood flow in the lung capillaries (perfusion). This leads to inefficient gas exchange, resulting in low oxygen levels in the blood.

• Secondary mechanism: Hypoventilation - Happens when there's inadequate movement of air in and out of the lungs, often due to weakened respiratory muscles, leading to increased carbon dioxide levels in the blood.

• Key complication: Hypoxemia - A result of both V/Q mismatch and hypoventilation, where low oxygen levels can cause organ dysfunction, impacting tissues that are highly dependent on oxygen, such as the brain and heart.

Patient Profile

Demographics:

45-year-old female, office worker

History:

• Key past medical history: Mild asthma diagnosed 5 years ago

• Current medications: Albuterol inhaler as needed

• Allergies: Penicillin

Current Presentation:

• Chief complaint: Shortness of breath

• Key symptoms: Mild dyspnea, occasional wheezing, slight fatigue

• Vital signs: Temperature 98.6°F, Heart rate 82 bpm, Respiratory rate 20 breaths/min, Blood pressure 120/80 mmHg, Oxygen saturation 94% on room air

Section 1

Initial Assessment Findings:

Upon further assessment, the patient, a 45-year-old female with a history of mild asthma, presents with mild dyspnea and occasional wheezing. She appears slightly fatigued but is in no acute distress. Her breath sounds reveal scattered wheezes, particularly on expiration, consistent with her asthma history. There is no use of accessory muscles or nasal flaring, indicating that her respiratory distress is not severe. The patient's skin is warm and well-perfused, and she is alert and oriented, responding appropriately to questions. Her oxygen saturation is slightly decreased at 94% on room air, which could be attributed to the ventilation-perfusion mismatch noted in her presentation.

The nursing assessment also includes a focused respiratory evaluation. The patient reports using her albuterol inhaler more frequently over the past few days, suggesting a possible exacerbation of her asthma symptoms. A peak flow measurement shows a slight reduction from her baseline, indicating a decrease in her ability to move air effectively. Despite these findings, her vital signs remain stable with a heart rate of 82 bpm and blood pressure of 120/80 mmHg, suggesting that her cardiovascular system is compensating adequately for her respiratory status at this time.

The initial assessment highlights the need for interventions aimed at improving ventilation and oxygenation. This will include administering bronchodilators as prescribed and providing education on asthma management and potential triggers. Monitoring of her oxygenation status and respiratory effort will be crucial in assessing the effectiveness of interventions and determining if further medical evaluation is necessary. These findings and interventions will guide the next steps in managing her respiratory condition and preventing progression to more severe respiratory failure.

Section 2

Response to Interventions:

After administering the prescribed bronchodilator treatment, the patient reports an improvement in her breathing and a noticeable decrease in wheezing. A repeat peak flow measurement shows an increase, indicating a partial restoration toward her baseline capacity. Oxygen saturation has improved slightly to 96% on room air, demonstrating enhanced oxygenation following the bronchodilator therapy. The patient expresses feeling more comfortable, with less dyspnea, and her respiratory rate remains stable at 18 breaths per minute.

The nursing team continues to monitor the patient's respiratory status closely. The patient's vital signs remain within normal limits, with a heart rate of 78 bpm and blood pressure of 118/78 mmHg. The absence of accessory muscle use and nasal flaring persists, suggesting that the intervention effectively managed the current exacerbation of her asthma symptoms. The patient is encouraged to maintain hydration and is educated on recognizing early signs of exacerbation, as well as the importance of adhering to her asthma action plan.

To further prevent future complications, the nurse provides education on identifying and avoiding potential asthma triggers, such as allergens and environmental pollutants. The patient is also reminded of the proper technique for using her inhaler to maximize its effectiveness. With these interventions and educational efforts, the patient is in a better position to manage her asthma and prevent progression to more serious respiratory issues, setting the stage for her discharge plan and follow-up care.

Section 3

Several hours later, during a routine check, the nurse notices a change in the patient's respiratory status. Although the patient continues to report feeling generally comfortable, she mentions a slight increase in chest tightness that wasn't present earlier. The nurse performs a focused respiratory assessment, noting that the patient's respiratory rate has increased to 22 breaths per minute, and mild wheezing is audible upon auscultation. Despite these changes, the patient's oxygen saturation remains stable at 96% on room air, and her vital signs are still within normal limits, with a heart rate of 82 bpm and blood pressure of 120/80 mmHg.

To address these new symptoms, the nurse reviews the patient's medication administration record and confirms that a follow-up dose of the bronchodilator is due. The bronchodilator is administered, and the nurse instructs the patient on relaxation techniques to ease her breathing. A repeat peak flow measurement is performed, showing a slight decrease from the previous reading, indicating a mild reduction in airflow. The patient is reassured that these fluctuations can occur and are being monitored closely.

The nurse also takes the opportunity to reinforce the importance of adhering to the prescribed medication schedule and using the inhaler correctly. The patient is reminded to report any further changes in symptoms immediately. With these interventions in place, the nurse plans to reassess the patient's condition in the next hour, keeping a vigilant eye on any potential escalation of symptoms and ensuring the patient remains comfortable and well-informed about her care.

Section 4

The nurse returns to reassess the patient one hour later, focusing on any changes in the respiratory status following the administration of the bronchodilator and the use of relaxation techniques. The patient's respiratory rate has slightly decreased to 20 breaths per minute, and the wheezing has diminished, although it is still present. The patient's oxygen saturation remains stable at 97% on room air, which is reassuring. The patient reports feeling a slight improvement in the chest tightness, indicating a positive response to the interventions.

As part of the ongoing assessment, the nurse decides to perform another peak flow measurement to evaluate the patient's lung function. The result shows a modest improvement compared to the earlier reading, suggesting that the bronchodilator is beginning to take effect. Given these findings, the nurse continues to monitor the patient closely for any further changes in symptoms. The patient is encouraged to continue practicing the relaxation techniques and to maintain an open line of communication about any new or worsening symptoms.

The nurse also considers potential factors that could contribute to the patient's respiratory symptoms, such as exposure to allergens or changes in environmental conditions. Education is provided on avoiding known triggers and the importance of maintaining an optimal indoor environment to support respiratory health. With these measures in place, the nurse plans to review the patient's condition with the healthcare team to ensure the care plan remains appropriate, avoiding any escalation of the current mild complications. The nurse remains attentive, ready to adjust the care plan as needed to ensure the patient's well-being and prevent further complications.

Section 5

As the nurse continues to monitor the patient, a new diagnostic result comes in from the earlier blood work. The arterial blood gas (ABG) analysis indicates mild respiratory alkalosis, with a pH of 7.45, PaCO2 of 35 mmHg, and HCO3- of 22 mEq/L. These findings suggest that while the patient's respiratory status is stable, there is a slight imbalance likely due to the hyperventilation that was present before the bronchodilator administration. The nurse interprets these results as consistent with the patient's initial presentation of respiratory distress and provides reassurance that the current interventions are appropriately addressing the condition.

In light of these findings, the nurse decides to reinforce education on breathing techniques that can help normalize the patient's breathing pattern, thereby addressing the mild alkalosis. Techniques such as pursed-lip breathing and diaphragmatic breathing are demonstrated and practiced with the patient. These methods are intended to slow down the breathing rate and improve ventilation efficiency, which can help restore the acid-base balance. The nurse emphasizes the importance of these techniques, especially if the patient begins to feel anxious or notices any changes in breathing.

The nurse plans to continue monitoring the patient's respiratory status closely, watching for any signs of improvement or deterioration. The patient's vital signs are reassessed: the heart rate remains steady at 82 beats per minute, blood pressure is stable at 118/76 mmHg, and the respiratory rate continues to hover around 20 breaths per minute. Encouraged by the modest improvements and stable vital signs, the nurse is prepared to discuss the patient's progress with the healthcare team, ensuring that the care plan remains effective and tailored to the patient's needs.