A patient with asthma exacerbation has a spirometry result indicating a reduced FEV1 at 65% of the predicted value, and a CBC showing mildly elevated eosinophil count. Which nursing intervention is most appropriate to address the underlying cause of the patient's symptoms?

C) Educate the patient on proper inhaler technique and allergen avoidance strategies.

A) Administer a short course of oral corticosteroids as prescribed.

B) Encourage the patient to increase fluid intake to thin mucus secretions.

C) Educate the patient on proper inhaler technique and allergen avoidance strategies.

D) Advise the patient to use a peak flow meter daily to monitor lung function.

A patient with a history of asthma presents with worsening symptoms. Diagnostic tests reveal mild hyperinflation on a chest X-ray, a reduced FEV1 at 65% of the predicted value, a decreased FEV1/FVC ratio, and a mildly elevated eosinophil count. Based on these findings, what is the most appropriate nursing intervention to include in the patient's care plan?

B) Educate the patient on allergen avoidance strategies and review inhaler technique

A) Administer a long-acting beta agonist (LABA) without an inhaled corticosteroid (ICS)

B) Educate the patient on allergen avoidance strategies and review inhaler technique

C) Recommend an increase in the frequency of short-acting beta agonist (SABA) use

D) Suggest a high-protein diet to improve respiratory muscle strength

A 35-year-old female with a history of asthma is experiencing intermittent episodes of chest tightness and increased shortness of breath on the third day of hospitalization. Her assessment shows an increased respiratory rate, decreased oxygen saturation, and diminished breath sounds. Which nursing intervention should be prioritized to address her acute respiratory symptoms?

C) Administer high-dose nebulized bronchodilator therapy as prescribed.

A) Encourage deep breathing and coughing exercises.

B) Position the patient in high Fowler's position to maximize lung expansion.

C) Administer high-dose nebulized bronchodilator therapy as prescribed.

D) Provide reassurance and monitor vital signs frequently.

A 35-year-old female with a history of asthma is experiencing worsening respiratory symptoms after initial improvement during hospitalization. Her respiratory rate is 24 breaths per minute, and her oxygen saturation is 92% on room air. Auscultation reveals diffuse wheezing and diminished breath sounds at the bases. What is the priority nursing intervention to address her current respiratory status?

A) Administer a high-dose nebulized bronchodilator as prescribed.

B) Encourage the patient to perform incentive spirometry exercises.

C) Increase the patient's oxygen flow rate to 4 L/min via nasal cannula.

D) Position the patient in a high Fowler's position to maximize lung expansion.

Following the identification of marked eosinophilia in a patient with an asthma exacerbation and the introduction of a leukotriene receptor antagonist, what is the nurse's priority action to evaluate the effectiveness of the new treatment in the next 24 hours?

B) Assess the patient's ability to complete sentences without fatigue.

A) Monitor the patient's blood pressure for potential hypotension.

B) Assess the patient's ability to complete sentences without fatigue.

C) Evaluate the patient's sputum for changes in color and consistency.

D) Check the patient's skin for signs of rash or allergic reaction.

A 45-year-old female patient with asthma is experiencing an exacerbation characterized by increased respiratory rate, fluctuating oxygen saturation, and persistent fatigue. Despite corticosteroid therapy, her CBC shows marked eosinophilia, but her sputum culture is negative for bacterial infection. Which nursing intervention is most appropriate to address the underlying cause of her symptoms?

B) Administer a leukotriene receptor antagonist as prescribed

A) Increase the oxygen flow rate to 4 liters per minute via nasal cannula

B) Administer a leukotriene receptor antagonist as prescribed

C) Encourage increased fluid intake to thin secretions

D) Administer a broad-spectrum antibiotic as a precautionary measure

A patient with persistent respiratory symptoms and new-onset gastrointestinal discomfort is being evaluated for potential adverse reactions to a leukotriene receptor antagonist and corticosteroid therapy. Which of the following nursing interventions should be prioritized to manage the patient's current clinical presentation effectively?

B) Administer the proton pump inhibitor as prescribed to protect against gastric mucosal damage.

A) Increase the dose of supplemental oxygen to improve oxygen saturation.

B) Administer the proton pump inhibitor as prescribed to protect against gastric mucosal damage.

C) Discontinue the leukotriene receptor antagonist to eliminate the potential cause of gastrointestinal symptoms.

D) Recommend reducing corticosteroid dosage to relieve gastrointestinal discomfort.

A patient with asthma has been started on a leukotriene receptor antagonist and is experiencing gastrointestinal discomfort. The healthcare team is considering different causes for her symptoms. As a nurse, what is the most appropriate initial intervention to address the patient's gastrointestinal symptoms while ensuring her respiratory condition is managed effectively?

C) Administer a proton pump inhibitor as prescribed and monitor the patient's response

A) Discontinue the leukotriene receptor antagonist immediately

B) Increase the dose of corticosteroids to reduce respiratory symptoms

C) Administer a proton pump inhibitor as prescribed and monitor the patient's response

D) Withhold all medications and consult with the healthcare provider for alternative treatments

A patient with a diagnosis of asthma is being monitored for potential drug-induced liver injury after starting a leukotriene receptor antagonist and corticosteroids. The nurse notes mildly elevated liver enzymes and a decrease in oxygen saturation to 92% on 2 liters of supplemental oxygen. Which nursing action is the most appropriate in this situation?

C) Monitor the patient’s respiratory status closely and report any changes to the healthcare provider.

A) Increase the supplemental oxygen to 4 liters to improve oxygen saturation.

B) Advise the patient to reduce physical activity to conserve energy.

C) Monitor the patient’s respiratory status closely and report any changes to the healthcare provider.

D) Discontinue the leukotriene receptor antagonist immediately and notify the healthcare provider.

A patient is receiving a reduced dosage of a leukotriene receptor antagonist and is also on a proton pump inhibitor due to elevated liver enzymes and potential gastrointestinal complications. Despite these interventions, the patient's oxygen saturation is at 92% on 2 liters of supplemental oxygen, and her peak expiratory flow rate has not improved. Which of the following nursing interventions is most appropriate to further support the patient's respiratory status?

B) Encourage the patient to perform incentive spirometry exercises regularly.

A) Increase the supplemental oxygen flow rate to 4 liters per minute.

B) Encourage the patient to perform incentive spirometry exercises regularly.

C) Discontinue the leukotriene receptor antagonist to prevent further liver damage.

D) Request an immediate consultation with a respiratory therapist for possible intubation.

asthma - Nursing Case Study

Pathophysiology

• Primary mechanism: Airway inflammation - In asthma, the airways experience chronic inflammation, leading to swelling and narrowing. This inflammation is driven by immune cells such as eosinophils and T-lymphocytes, which release cytokines that perpetuate the inflammatory response, causing symptoms like coughing and wheezing.

• Secondary mechanism: Bronchial hyperresponsiveness - The inflamed airways become overly sensitive to triggers such as allergens, cold air, or exercise. This hyperresponsiveness causes the smooth muscle surrounding the bronchi to constrict excessively, further narrowing the airways and exacerbating breathing difficulties.

• Key complication: Airway remodeling - Over time, chronic inflammation and repeated bronchoconstriction can lead to structural changes in the airways, including thickening of the airway walls and increased mucus production. This remodeling can decrease lung function and make asthma management more challenging.

Patient Profile

Demographics:

34-year-old female, school teacher

History:

• Key past medical history: Asthma diagnosed 10 years ago; occasional seasonal allergies

• Current medications: Albuterol inhaler as needed, Fluticasone propionate inhaler twice daily

• Allergies: Penicillin

Current Presentation:

• Chief complaint: Increased shortness of breath and wheezing over the past week

• Key symptoms: Persistent cough, chest tightness, difficulty breathing especially at night, occasional fatigue

• Vital signs: Blood pressure: 138/88 mmHg, Heart rate: 102 bpm, Respiratory rate: 24 breaths per minute, Temperature: 98.6°F, Oxygen saturation: 92% on room air

Section 1

New Diagnostic Results:

Following the initial assessment, a series of diagnostic tests were conducted to better understand the underlying factors contributing to the patient's worsening asthma symptoms. A chest X-ray was performed to rule out any significant pulmonary infections or other structural abnormalities. The results revealed mild hyperinflation, consistent with asthma exacerbation, but no signs of pneumonia or other acute lung issues. Additionally, spirometry was conducted to assess lung function. The results showed a reduced FEV1 (Forced Expiratory Volume in 1 second) at 65% of the predicted value, indicating a moderate obstruction. The FEV1/FVC (Forced Vital Capacity) ratio was also decreased, further confirming obstructive lung disease.

A complete blood count (CBC) was ordered to check for eosinophilia, which could indicate an allergic component exacerbating her asthma. The results showed a mildly elevated eosinophil count, suggesting that allergens might be playing a role in the patient's current symptoms. Based on these findings, the clinical team considered adjusting her asthma management plan, including a possible short course of oral corticosteroids to reduce airway inflammation and improve lung function. The importance of allergen avoidance and a review of her current inhaler technique were also emphasized, to ensure optimal delivery of medications. This detailed diagnostic evaluation set the stage for targeted interventions that could alleviate the patient's symptoms and prevent further complications.

Section 2

The patient, a 35-year-old female with a history of asthma, was admitted to the hospital following an acute exacerbation that did not respond adequately to her usual home medications. After the initial diagnostic results, the clinical team initiated a short course of oral corticosteroids and emphasized allergen avoidance. Over the next 48 hours, the patient showed some improvement in her symptoms, reporting less frequent wheezing and a reduction in nocturnal dyspnea. However, on the third day of hospitalization, the patient began experiencing intermittent episodes of chest tightness and increased shortness of breath, particularly during minimal exertion, which was not typical for her previous exacerbations.

A repeat assessment was conducted, revealing a slight increase in respiratory rate to 24 breaths per minute and an oxygen saturation drop to 92% on room air. Auscultation of the lungs revealed diffuse wheezing with diminished breath sounds at the bases, suggesting worsening airway obstruction or the development of a mucus plug. The patient's peak expiratory flow rate (PEFR) was measured at 50% of her personal best, indicating a significant decline in her respiratory function.

The clinical team recognized the potential for a new complication, possibly linked to inadequate control of underlying inflammation or new environmental triggers. They decided to initiate a high-dose nebulized bronchodilator regimen and increase the frequency of corticosteroid administration. Additionally, they ordered a repeat CBC to reassess eosinophil levels and a sputum culture to rule out any bacterial infection contributing to her deteriorating condition. These measures were aimed at addressing the acute symptoms while also identifying any new underlying issues that may be exacerbating her asthma, thus ensuring a comprehensive approach to her care.

Section 3

Following the implementation of the high-dose nebulized bronchodilator regimen and increased corticosteroid administration, the patient's condition was closely monitored to assess her response to these interventions. Over the next 12 hours, her respiratory status remained a significant concern. The patient's oxygen saturation continued to fluctuate, occasionally dropping to 90% despite supplemental oxygen at 2 liters per minute via nasal cannula. Her respiratory rate increased to 26 breaths per minute, and she reported persistent fatigue and difficulty completing sentences due to shortness of breath.

The clinical team received the results of the repeat CBC and sputum culture. The CBC revealed a marked eosinophilia, suggesting that despite corticosteroid therapy, there was ongoing eosinophilic inflammation contributing to her asthma exacerbation. The sputum culture, however, was negative for bacterial pathogens, ruling out a superimposed bacterial infection as the cause of her deteriorating condition. This information prompted the team to consider additional underlying factors, such as the possibility of aspirin-exacerbated respiratory disease (AERD) or an unidentified allergen exposure.

In light of the eosinophilia and the lack of bacterial infection, the team adjusted their management strategy. They introduced a leukotriene receptor antagonist to help control the persistent inflammatory response and advised a more comprehensive review of the patient's medication regimen and environmental exposures. Concurrently, plans were made for a referral to an allergist for further evaluation of potential hypersensitivity reactions. This multifaceted approach aimed to stabilize the patient's respiratory status while addressing the potential chronic elements contributing to her current exacerbation. The team remained vigilant for any signs of further complications, recognizing the need for ongoing assessment and adaptation of the treatment plan.

Section 4

Following the introduction of the leukotriene receptor antagonist, the clinical team closely monitored the patient's response to this new intervention. Within the next 24 hours, there was a modest improvement in her respiratory symptoms. Her respiratory rate decreased slightly to 22 breaths per minute, and she was able to speak in full sentences with less effort. However, her oxygen saturation continued to hover around 92% with 2 liters of supplemental oxygen. Her peak expiratory flow rate showed only marginal improvement compared to baseline values, indicating persistent airflow limitation.

A new complication emerged when the patient began to experience gastrointestinal discomfort, including nausea and mild abdominal pain. Concerned that these symptoms might be related to the leukotriene receptor antagonist or represent an adverse reaction to the increased corticosteroid use, the healthcare team decided to conduct a thorough review of her medication regimen. They also considered the possibility of stress-induced gastritis, given the ongoing respiratory distress and medication load.

In light of the patient's gastrointestinal symptoms and minimal respiratory improvement, the clinical team decided to consult with a gastroenterologist to evaluate the need for further diagnostic workup or potential adjustments in therapy. Meanwhile, they initiated prophylactic measures to protect the gastric mucosa, such as prescribing a proton pump inhibitor. This strategy aimed to manage the gastrointestinal side effects while continuing to address the underlying respiratory issues, ensuring a comprehensive approach to the patient's complex clinical scenario. The multidisciplinary team remained alert for any further deviations in her clinical status, ready to adapt their management approach as necessary.

Section 5

As the clinical team continued to monitor the patient, new diagnostic results emerged that required careful consideration. The gastroenterologist recommended an abdominal ultrasound and a series of blood tests to evaluate liver function, given the potential side effects of the leukotriene receptor antagonist and the corticosteroids. The ultrasound revealed no structural abnormalities in the abdominal organs, which was reassuring. However, the blood tests indicated mildly elevated liver enzymes, suggesting a possible drug-induced liver injury or stress-related hepatic response.

In light of these findings, the clinical team decided to adjust the patient's medication regimen. They reduced the dosage of the leukotriene receptor antagonist and continued the proton pump inhibitor to safeguard against any further gastrointestinal complications. Additionally, they initiated a liver-friendly diet and increased hydration to support hepatic function. Despite these adjustments, the patient's oxygen saturation remained at 92% on 2 liters of supplemental oxygen, and her peak expiratory flow rate showed no significant improvement, maintaining a focus on managing her respiratory status.

The clinical team remained vigilant, aware that the patient's situation could evolve further. They scheduled regular follow-ups with both the pulmonologist and the gastroenterologist to closely monitor her respiratory and liver function, respectively. The team also emphasized the importance of patient education, ensuring she understood her medication regimen and the signs of potential complications. This comprehensive approach aimed to stabilize her condition while anticipating and addressing any new challenges that might arise in her ongoing care journey.