Based on the initial assessment findings, what would be the most appropriate nursing intervention to help this patient optimize her asthma management?

B) Suggest the initiation of a daily maintenance inhaler

A) Recommend an increase in the use of her albuterol inhaler

B) Suggest the initiation of a daily maintenance inhaler

C) Advise discontinuation of all inhaler use

D) Encourage only using the inhaler before bedtime

Which of the following is the best initial intervention for a patient with mild intermittent asthma experiencing occasional wheezing and shortness of breath during exercise?

D) Educate the patient on proper inhaler technique and trigger avoidance

A) Increase use of albuterol inhaler

B) Initiate oral corticosteroid therapy

C) Advise the patient to avoid all physical activity

D) Educate the patient on proper inhaler technique and trigger avoidance

Based on the diagnostic results for the patient with asthma, which intervention is most appropriate to improve long-term asthma control?

B) Introduce a low-dose inhaled corticosteroid

A) Increase the dosage of the rescue inhaler

B) Introduce a low-dose inhaled corticosteroid

C) Advise the patient to avoid all physical activity

D) Begin daily use of oral corticosteroids

When assessing a patient's asthma management, which diagnostic test result indicates the need for potential adjustment of her treatment regimen?

A) Spirometry showing FEV1 at 75% of predicted value

C) Blood pressure within normal range

D) Heart rate of 72 beats per minute

A patient with asthma reports occasional episodes of mild wheezing and shortness of breath during morning jogs, particularly on high pollen days. Which of the following actions should the nurse recommend to help manage these symptoms?

C) Use the rescue inhaler before jogging and consider jogging indoors on high pollen days

A) Use the rescue inhaler only after experiencing symptoms

B) Increase the dosage of the low-dose inhaled corticosteroid without consulting a doctor

C) Use the rescue inhaler before jogging and consider jogging indoors on high pollen days

D) Discontinue all asthma medications on days when symptoms are minimal

Which strategy should the patient implement to manage her exercise-induced asthma symptoms effectively?

B) Use her rescue inhaler prior to starting her morning jogs.

A) Increase the dosage of her inhaled corticosteroid before jogging.

B) Use her rescue inhaler prior to starting her morning jogs.

C) Avoid all physical activities to prevent asthma symptoms.

D) Double the number of puffs of her rescue inhaler during symptoms.

Which medication is being added to the patient's asthma regimen to help control exercise-induced symptoms and protect against allergic triggers?

B) Leukotriene receptor antagonist

The patient has shown improvement in asthma control after starting a leukotriene receptor antagonist. Which of the following findings best indicates effective asthma management?

A) Decreased need for rescue inhaler use

D) Persistent wheezing on lung auscultation

Which of the following is a key benefit of using a leukotriene receptor antagonist in asthma management?

B) It reduces inflammation and bronchoconstriction.

A) It increases the need for rescue inhalers.

B) It reduces inflammation and bronchoconstriction.

C) It causes immediate relief of acute asthma symptoms.

D) It replaces the need for all other asthma medications.

Asthma - Nursing Case Study

Pathophysiology

• Primary mechanism: In asthma, the airways become inflamed, leading to swelling and narrowing. This inflammation is often triggered by allergens or irritants, causing the immune system to overreact and release substances that worsen the inflammation.

• Secondary mechanism: The muscles around the airways tighten or spasm, a process known as bronchoconstriction. This further narrows the airways, making it difficult for air to move in and out of the lungs, especially during an asthma attack.

• Key complication: Increased mucus production occurs, which can block the airways and exacerbate breathing difficulties. This combination of inflammation, bronchoconstriction, and mucus leads to symptoms like wheezing, coughing, and shortness of breath.

Patient Profile

Demographics:

28-year-old female, elementary school teacher

History:

• Key past medical history: Diagnosed with asthma 2 years ago, no hospitalizations or significant exacerbations

• Current medications: As-needed use of albuterol inhaler

• Allergies: Seasonal pollen

Current Presentation:

• Chief complaint: Occasional shortness of breath and wheezing

• Key symptoms: Mild wheezing, shortness of breath with exercise

• Vital signs: Blood pressure 118/76 mmHg, heart rate 72 bpm, respiratory rate 16 breaths per minute, temperature 98.6°F, oxygen saturation 98% on room air

Section 1

Initial Assessment Findings:

Upon conducting a thorough initial assessment, the patient, a 28-year-old elementary school teacher, appears well-nourished and in no acute distress. She is alert and oriented, with a calm demeanor, suggesting that her asthma is currently stable. Auscultation of the lungs reveals mild wheezing, particularly at the bases, which aligns with her description of occasional shortness of breath and exercise-induced symptoms. There are no signs of accessory muscle use, indicating that her respiratory effort is within normal limits at this time. Although her oxygen saturation is at 98% on room air, which is well within normal ranges, the presence of wheezing suggests some degree of airway obstruction.

Further assessment shows that the patient maintains a regular respiratory rate of 16 breaths per minute, with no noted retractions or nasal flaring. Her skin is warm and dry, with no cyanosis present, which further supports that her oxygenation is adequate. The patient reports that she uses her albuterol inhaler approximately once or twice a week, primarily during periods of increased physical activity or when exposed to her known allergen, seasonal pollen. She mentions that the inhaler provides quick relief, and she has not experienced any significant side effects from its use.

These findings suggest that the patient's asthma is currently well-managed with her as-needed albuterol inhaler, but there might be room for optimizing her asthma action plan to better control her symptoms and prevent future exacerbations. As a next step, it may be beneficial to explore potential adjustments to her asthma management plan, possibly including a daily maintenance medication to reduce reliance on rescue inhalers and improve her quality of life. Additionally, patient education on trigger avoidance and proper inhaler technique should be reinforced to ensure optimal control of her asthma symptoms.

Section 2

New Diagnostic Results:

Following the initial assessment, the healthcare team decided to conduct additional diagnostic tests to gain a clearer picture of the patient's asthma management needs. The patient underwent spirometry, which revealed a mild reduction in her FEV1 (Forced Expiratory Volume in one second) at 75% of the predicted value, confirming the presence of mild obstructive airway changes. This finding aligns with the intermittent wheezing noted during auscultation and suggests that while the patient's asthma is under reasonable control, there is room for improvement.

In addition to spirometry, a peak flow meter test was conducted to establish the patient's baseline peak expiratory flow rate (PEFR). The results showed a PEFR of 400 L/min, which is slightly below the expected range for her age, height, and gender. This information is valuable as it provides a benchmark for her daily monitoring, helping to identify any deviations that could indicate an impending exacerbation. The patient's allergy testing results confirmed her sensitivity to seasonal pollen, reinforcing the need for effective trigger management strategies.

Based on these diagnostic results, the healthcare team is considering the introduction of a low-dose inhaled corticosteroid to her treatment regimen to provide better long-term control and reduce her reliance on the rescue inhaler. Additionally, the patient was advised to maintain a daily asthma diary to track her symptoms, medication usage, and peak flow readings. This proactive approach will enable both the patient and her healthcare team to monitor her asthma more closely, allowing for timely interventions should her condition change.

Section 3

A few weeks after the introduction of the low-dose inhaled corticosteroid, the patient returns for a follow-up appointment. She has been diligent in maintaining her asthma diary, which reveals a consistent pattern of improved peak flow readings, averaging around 420 L/min, indicating a positive response to the medication adjustment. However, she reports occasional episodes of mild wheezing and shortness of breath during her morning jogs, which she attributes to the recent rise in pollen levels. Her diary notes a slight increase in rescue inhaler usage during these instances.

Upon reassessment, the patient's vital signs are stable with a blood pressure of 118/76 mmHg, heart rate of 76 bpm, respiratory rate of 16 breaths per minute, and oxygen saturation of 98% on room air. Auscultation of her lungs reveals clear breath sounds with no audible wheezing or crackles at rest. Given these findings, the healthcare team reinforces the importance of pre-exercise inhaler use and increased pollen avoidance strategies, such as jogging indoors on high pollen days. Additionally, the patient is educated on the potential use of a leukotriene receptor antagonist as an adjunct therapy if her exercise-induced symptoms persist.

As the patient leaves the clinic, she feels empowered by her progress and confident in managing her asthma with the support of her healthcare team. The plan is to continue monitoring her condition closely, with a follow-up appointment scheduled in three months to reassess her treatment regimen and make any necessary adjustments. This proactive management ensures that the patient remains on the path to optimal asthma control, minimizing the risk of future complications.

Section 4

Three months later, the patient returns for her scheduled follow-up appointment. She reports a continued overall improvement in her asthma control, but notes that she occasionally experiences mild shortness of breath during high-intensity exercise, particularly when she forgets to use her pre-exercise inhaler. Her asthma diary reflects sustained peak flow readings in the range of 410 to 430 L/min. However, there are a few entries indicating increased rescue inhaler usage on days when the pollen count was notably high, despite her efforts to jog indoors.

During the assessment, her vital signs remain stable: blood pressure is 116/74 mmHg, heart rate is 72 bpm, respiratory rate is 14 breaths per minute, and oxygen saturation is consistently at 99% on room air. Lung auscultation reveals clear breath sounds with no wheezing or crackles. A review of her medication adherence, confirmed by her pharmacy refill records, shows she is consistently using her low-dose inhaled corticosteroid as prescribed. Given her continued mild symptoms during exercise and increased pollen exposure, the healthcare team discusses the addition of a leukotriene receptor antagonist to her regimen, emphasizing its potential benefits in controlling exercise-induced symptoms and providing additional protection against allergic triggers.

The patient is receptive to this new addition and agrees to start the leukotriene receptor antagonist. She is encouraged to maintain her asthma diary and monitor any changes in her symptoms. A follow-up appointment is scheduled in another three months to evaluate the impact of this adjustment on her asthma control. With this proactive approach, the healthcare team aims to further optimize her asthma management, reinforcing her confidence in maintaining an active lifestyle with minimal disruptions.

Section 5

Three months later, the patient returns for her follow-up appointment after starting the leukotriene receptor antagonist. She reports a noticeable improvement in her exercise tolerance, with significantly reduced shortness of breath during high-intensity activities. She mentions that she feels more comfortable and confident engaging in her daily jogging routine, even on days when the pollen count is high. Her asthma diary reflects consistent peak flow readings between 415 and 435 L/min, with a marked decrease in the use of her rescue inhaler, even on days with elevated pollen levels.

During the assessment, her vital signs remain stable: blood pressure is 118/76 mmHg, heart rate is 70 bpm, respiratory rate is 13 breaths per minute, and oxygen saturation is 98% on room air. Lung auscultation continues to reveal clear breath sounds without wheezing or crackles. The patient expresses satisfaction with her current asthma management plan and appreciates the addition of the leukotriene receptor antagonist, which she feels has positively influenced her condition.

The healthcare team reviews her progress and reinforces the importance of continued medication adherence and environmental trigger management. They encourage her to maintain her asthma diary and to continue monitoring her symptoms closely. Given the positive response to the intervention, the team decides to maintain the current treatment regimen and schedules another follow-up in three months. This approach aims to ensure sustained asthma control and to allow for any necessary adjustments based on her ongoing needs and lifestyle.