A patient with a history of asthma presents with increased shortness of breath and wheezing. Recent diagnostic results show mild lung hyperinflation and a decrease in FEV1 to 65% of the predicted value. The patient currently uses an as-needed albuterol inhaler. Which nursing intervention is most appropriate to address the patient's underlying condition?

A) Educate the patient on the importance of using a peak flow meter daily to monitor asthma control.

B) Instruct the patient to increase the frequency of albuterol use during exacerbations.

C) Advise the patient to avoid all physical activity to prevent further lung irritation.

D) Suggest the patient use over-the-counter antihistamines to manage allergic symptoms.

A patient with asthma presents with increased shortness of breath and wheezing. Recent diagnostic results show a decrease in FEV1 to 65% of the predicted value, mild hyperinflation on chest X-ray, elevated eosinophils at 8%, and an elevated serum IgE level. Which of the following nursing actions is most appropriate to address the patient's current condition?

A) Educate the patient on the use of peak flow monitoring to assess daily respiratory status.

B) Instruct the patient to increase the frequency of albuterol inhaler use to manage symptoms.

C) Recommend the initiation of an oral corticosteroid to quickly reduce airway inflammation.

D) Encourage avoidance of known allergens and review environmental control measures.

A patient with asthma has reported increased nocturnal symptoms and decreased exercise tolerance after starting a new medication regimen. During assessment, which finding would most likely indicate the need for immediate intervention?

C) Persistent wheezing with diminished breath sounds bilaterally

B) Oxygen saturation of 92% on room air

C) Persistent wheezing with diminished breath sounds bilaterally

D) Absence of accessory muscle use despite dyspnea

A patient with asthma has been experiencing increased nocturnal symptoms and a decline in exercise tolerance after a recent adjustment to their medication regimen. Vital signs show mild tachycardia and decreased oxygen saturation. Which intervention should the nurse prioritize to address the patient's current condition?

A) Administer a short-acting beta-agonist as needed for immediate relief of bronchospasm.

B) Increase the dose of the patient's inhaled corticosteroid to reduce airway inflammation.

C) Implement breathing exercises and encourage rest to conserve energy.

D) Arrange for an immediate referral to an allergist for allergen immunotherapy.

A patient with asthma is experiencing an exacerbation due to a viral infection. Based on the recent changes in the patient's management plan, which nursing intervention is most critical in preventing further respiratory compromise?

B) Educating the patient on the correct use of the rescue inhaler and recognizing signs of worsening asthma.

A) Encouraging the patient to increase fluid intake to aid in mucus clearance.

B) Educating the patient on the correct use of the rescue inhaler and recognizing signs of worsening asthma.

C) Advising the patient to rest and avoid physical exertion to conserve energy.

D) Monitoring the patient's blood glucose levels to assess the impact of systemic corticosteroids.

A patient with asthma is experiencing an exacerbation due to a viral infection and has been started on a course of oral prednisone. Which nursing intervention is most appropriate to include in the patient's care plan to address potential side effects of this medication?

A) Monitor blood glucose levels regularly

B) Encourage the patient to increase their salt intake

C) Advise the patient to decrease fluid intake

D) Suggest avoiding all physical activities during the treatment

A patient undergoing treatment for respiratory distress is experiencing mixed responses to therapy, including persistent wheezing and elevated blood glucose levels due to corticosteroid use. Which nursing intervention is the most appropriate to address the patient's current respiratory condition?

C) Administer a nebulized bronchodilator as prescribed to relieve bronchoconstriction

A) Increase the frequency of peak flow monitoring to assess respiratory status

B) Educate the patient on reducing fluid intake to decrease mucus production

C) Administer a nebulized bronchodilator as prescribed to relieve bronchoconstriction

D) Encourage bed rest to conserve energy and reduce fatigue

A patient with asthma is experiencing persistent wheezing and a mild fever after starting a new treatment regimen. Her oxygen saturation is fluctuating between 92% and 94%, and she reports increased fatigue and muscle weakness. Her current medications include an inhaled corticosteroid and systemic prednisone. What is the most appropriate nursing intervention to address the patient's current respiratory status?

B) Administer a nebulized bronchodilator as prescribed to alleviate bronchoconstriction

A) Encourage the patient to use her peak flow meter daily to monitor lung function

B) Administer a nebulized bronchodilator as prescribed to alleviate bronchoconstriction

C) Recommend increasing fluid intake to help thin mucus secretions

D) Educate the patient about the potential side effects of corticosteroids

A patient with asthma on a corticosteroid regimen reports persistent fatigue, muscle weakness, elevated blood glucose levels, and mild lower extremity edema. Which intervention should the nurse prioritize to address these complications?

B) Educate the patient about carbohydrate counting to help control blood glucose levels

A) Encourage increased fluid intake to manage edema

B) Educate the patient about carbohydrate counting to help control blood glucose levels

C) Advise the patient to engage in resistance exercises to improve muscle strength

D) Suggest increasing dietary potassium intake to counteract potential hypokalemia

A patient with chronic asthma has been experiencing improved respiratory symptoms after adding a nebulized bronchodilator but presents with new complications, including elevated blood glucose levels and edema in the lower extremities. Which nursing intervention is the priority to address these complications?

B) Educate the patient on reducing carbohydrate intake to help control blood glucose levels.

A) Advise the patient to increase fluid intake to manage edema.

B) Educate the patient on reducing carbohydrate intake to help control blood glucose levels.

C) Recommend the use of compression stockings to alleviate lower extremity edema.

D) Encourage the patient to increase physical activity to reduce fatigue and muscle weakness.

Asthma - Nursing Case Study

Pathophysiology

• Primary mechanism: Asthma is characterized by chronic inflammation of the airways, leading to hyperresponsiveness. This inflammation results in the release of inflammatory mediators like histamines and leukotrienes, causing bronchoconstriction and edema, which narrow the airways.

• Secondary mechanism: The hypersecretion of mucus further obstructs the airways. Goblet cell hyperplasia and increased mucus gland activity contribute to excessive and thick mucus production, exacerbating airflow limitation and causing difficulty in breathing.

• Key complication: If not managed, persistent airway inflammation and obstruction can lead to airway remodeling. This involves structural changes such as thickening of the airway wall and fibrosis, resulting in long-term loss of lung function and increased risk of severe asthma exacerbations.

Patient Profile

Demographics:

35-year-old female, school teacher

History:

• Key past medical history: Diagnosed with asthma 10 years ago, seasonal allergies, and a history of eczema

• Current medications: Albuterol inhaler as needed, Fluticasone nasal spray, Loratadine daily

• Allergies: Penicillin, dust mites

Current Presentation:

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

• Key symptoms: Persistent cough, chest tightness, fatigue, and difficulty performing daily activities

• Vital signs: Temperature 99.2°F, Heart rate 110 bpm, Respiratory rate 24 breaths per minute, Blood pressure 140/90 mmHg, SpO2 92% on room air

Section 1

New Diagnostic Results:

Following the initial assessment, the healthcare team decided to obtain a chest X-ray and perform pulmonary function tests to gather more information about the patient's current respiratory status. The chest X-ray revealed mild hyperinflation of the lungs, a common finding in patients with asthma, but no signs of pneumonia or other acute processes. The pulmonary function tests showed a decrease in FEV1 (Forced Expiratory Volume in one second) to 65% of the predicted value, indicating a moderate obstruction. This finding is consistent with the patient's reported symptoms of increased shortness of breath and wheezing.

Additionally, a complete blood count (CBC) was performed, revealing an elevated eosinophil count of 8%, suggesting an exacerbation of the patient's allergic asthma component. An elevated serum IgE level was also noted, further supporting the presence of an allergic response. Given the patient's history of seasonal allergies and recent exposure to known allergens, it is likely that the current asthma exacerbation is being driven by environmental triggers, potentially complicated by inadequate baseline control of asthma symptoms.

The results prompted a review of the patient's current management plan. It was determined that the patient's reliance on as-needed albuterol inhaler might not be sufficient to control the underlying inflammation. Consequently, a step-up in therapy was considered, including the initiation of a low-dose inhaled corticosteroid and long-acting beta-agonist combination to better manage the chronic inflammation and prevent further exacerbations. This adjustment aims to address both the immediate symptoms and the underlying pathophysiology to prevent future complications, such as airway remodeling and persistent airflow limitation.

Section 2

Change in Patient Status:

Following the adjustment in the patient's asthma management plan, including the introduction of a low-dose inhaled corticosteroid and long-acting beta-agonist, the patient initially reported slight improvement in symptoms, particularly during the day. However, over the next 48 hours, the patient began experiencing increased nocturnal symptoms, with frequent awakenings due to coughing and shortness of breath. The patient also reported feeling more fatigued and noticed a decline in exercise tolerance. This change in status prompted a re-evaluation of the patient's condition.

Upon re-assessment, vital signs revealed a mild tachycardia with a heart rate of 104 beats per minute and an oxygen saturation of 92% on room air, slightly lower than previous measurements. Auscultation of the lungs indicated persistent wheezing with diminished breath sounds in the lower lobes, bilaterally. There was no significant use of accessory muscles at this time, but the patient appeared mildly dyspneic at rest. Given these findings, the healthcare team suspected that the current treatment plan might not be adequately controlling the underlying inflammation and that the patient could be developing a more severe exacerbation or an additional complication, such as a viral respiratory infection.

In response to the patient's deteriorating condition, further diagnostic tests were ordered, including a repeat pulmonary function test and a sputum culture to rule out infection. Additionally, a discussion was initiated regarding the potential need for systemic corticosteroids to provide more aggressive management of the inflammatory response. The team also considered a referral to an allergist for possible allergen immunotherapy, given the significant allergic component of the patient's asthma. These steps aimed to stabilize the patient's condition and prevent further decline while addressing both the immediate symptoms and the underlying causes.

Section 3

New Diagnostic Results

The results from the repeat pulmonary function test indicated a significant decline in the patient's FEV1, which had dropped to 68% of the predicted value, down from 78% previously. This decrease suggested a worsening obstruction of the airways, consistent with an exacerbation of asthma. The patient's peak expiratory flow rate (PEFR) also showed a similar downward trend, further confirming the reduced airflow. The sputum culture revealed the presence of rhinovirus, indicating that a viral respiratory infection might be contributing to the exacerbation of symptoms. These findings highlighted that the patient's current management plan was insufficient in addressing the acute inflammation and bronchoconstriction exacerbated by the viral infection.

In light of these new diagnostic results, the healthcare team decided to initiate a course of systemic corticosteroids to rapidly reduce airway inflammation. The patient was started on oral prednisone, with instructions for a tapering dose over the following week. Additionally, the team increased the frequency of the patient's rescue inhaler use and advised the continuation of the inhaled corticosteroid and long-acting beta-agonist regimen. The team also emphasized the importance of hydration and rest to support recovery from the viral infection. A follow-up appointment was scheduled in one week to reassess the patient's lung function and overall condition.

This approach aimed to address both the immediate inflammatory response and the viral component, providing a comprehensive strategy to stabilize the patient's condition. The plan also included education on identifying early signs of worsening asthma and instructions on when to seek immediate medical attention, especially if symptoms did not improve or deteriorated further. This step was crucial to prevent further complications and ensure the patient could return to optimal health.

Section 4

Three days into the patient's new treatment regimen, her condition showed mixed responses. Upon initial assessment, the patient reported a slight improvement in her ability to breathe, but she continued to experience significant wheezing and coughing, particularly at night. Her vital signs revealed a mild fever of 37.9°C (100.2°F), a heart rate of 98 beats per minute, and a respiratory rate of 22 breaths per minute, with oxygen saturation fluctuating between 92% and 94% on room air. Auscultation of the lungs revealed diffuse bilateral wheezes and occasional crackles, suggesting ongoing bronchoconstriction and possible mucus accumulation despite the current interventions.

In addition to the respiratory symptoms, the patient began to experience new complications, including increased fatigue and muscle weakness, likely related to the systemic corticosteroid therapy. Her blood glucose levels were slightly elevated, measuring around 150 mg/dL, indicating a possible side effect of prednisone. This necessitated careful monitoring of her glucose levels and potential adjustments to her diet or medication to prevent further complications. The patient's peak expiratory flow rate remained below baseline, with readings consistently around 250 L/min, reinforcing the need for continued and enhanced therapeutic strategies.

The healthcare team recognized the need for further intervention to address these challenges. They discussed the possibility of adding a short course of a nebulized bronchodilator to provide more immediate relief from bronchoconstriction. Additionally, they considered stepping up her inhaled corticosteroid dosage temporarily to combat persistent inflammation. The team also planned to involve a dietitian to address potential dietary modifications to manage her blood glucose levels. These steps were intended to optimize the patient's recovery trajectory and prevent the development of more severe complications. A follow-up appointment was scheduled in four days to closely monitor progress and adjust treatment as necessary.

Section 5

Four days after implementing the new interventions, the patient returned for her follow-up appointment. During the initial assessment, it was noted that her respiratory symptoms had shown some improvement. The patient reported a decrease in nocturnal wheezing and coughing after the addition of the nebulized bronchodilator. Her peak expiratory flow rate had improved slightly, now averaging around 280 L/min. Vital signs included a temperature of 37.5°C (99.5°F), a heart rate of 92 beats per minute, and a respiratory rate of 20 breaths per minute, with oxygen saturation improving to 95% on room air. Auscultation still revealed bilateral wheezing, but the crackles had diminished, suggesting reduced mucus accumulation and improved bronchial dilation.

However, new complications emerged that required attention. The patient reported persistent fatigue and muscle weakness, which had not improved despite the adjustments in her corticosteroid regimen. Blood glucose levels were still elevated, with readings fluctuating between 160 mg/dL and 180 mg/dL, suggesting that the systemic effects of prednisone continued to impact her metabolism. In response, the healthcare team initiated a consultation with a dietitian to develop a tailored nutritional plan aimed at controlling her blood sugar levels through diet.

The patient also developed mild edema in her lower extremities, raising concerns about fluid retention possibly associated with corticosteroid use. The team decided to perform additional lab tests, including electrolytes and renal function tests, to rule out any renal involvement or electrolyte imbalances. These findings necessitated careful clinical reasoning to balance the management of her chronic asthma symptoms with the mitigation of side effects from her treatment regimen. The healthcare team planned to reassess her condition in another week, with the possibility of adjusting her medication dosages or introducing new therapies if necessary.